Pediatric Oncology :(

what temp counts as fever

anything =/> 38.3 (101) or =/> 38 (100.4) that remains for at least 1 hour

what is a big complication of cancer and what is it

neutropenia- a decreased number of neutrophils (less than 1000 cells/mm3) which is white blood cells. A severe neutropenia is less than 500 cells/mm3. And profound count is less than 100 cells/mm3

what are pts with neutropenia at risk for and how can we protect them

they are at high risk for infection and needs to be placed on neutropenic precautions

what is neutropenic precautions and how do we implement it 

the goal is to protect the patient, so we gear up to not infect the patient

1. monitor pts temp because fever is an emergency

2. Restrict sick visitors from coming

3. not allow fresh plants/flowers from being in the hospital room

4. dedicated equipment for the patient 

Neutropenia pt teaching

1. Take temp daily and notify provider of any temp over 100 degrees - fever with neutropenia requires hospitlization

2. avoid crowds and sick people

3. don’t consume raw foods

4. avoid yard work or gardening

5. don’t change the litter box

6. wash dishes using hot water or use a dishwasher

7. wash toothbrush in the dishwasher or use bleach solution to disinfect

what’s the standard treatment for neutropenia/fever

single broad spectrum IV antibiotic (monotherapy) until neutrophil count goes up

what is nadir

it’s the lowest point in cancer, typically referring to the lowest level of WBC count after chemotherapy. The nadir period occurs 1-2 weeks after a chemotherapy cycle. At this point, pts are at the highest risk for cancer

what is most common non-CNS cancer?

neuroblastoma -  a cancer of the sympathetic nervous system that forms in neuroblasts, which are immature nerve cells most common in under kids under 5

signs and symptoms of neuroblastoma

** with this cancer, it often metastasizes (spreads) before diagnosis

1. fever

2. fatigue

3. decreased appetite and weight loss

4. limp/refusal to walk

5. blueberry muffin spots

6. hypertension

7. excessive sweating

8. orbital ecchymosis
   

how to diagnose neuroblastoma

imaging test - ultrasound, CT, MRI, and bone scan

biopsy to confirm diagnosis

what’s the treatment for neuroblastoma

1. intensive high dose chemotherapy

2. surgical removal tumor

3. radiation

4. stem cell transplant

5. antibody therapy

6. iodine 131 - MIGB therapy (high risk)

what’s the most common type of pediatric bone cancer

osteosarcoma that occurs at the end of a bone, typically in sites like the distal femur, proximal tibia, proximal humerus 

osteosarcoma risk factors

• teenagers, especially duringa growth spurt

• arfican american or hispanic descent

what are the signs and symptoms of osteosarcoma

1. pain/tenderness at affected area

2. bone pain

3. swelling

4. fractures

5. limp when walking

6. decreased range of motion

how to diagnose osteosarcoma

imaging: x-ray, MRI, CT

confirmation: biopsy

how to treat osteosarcoma

1. initial surgery - biopsy

2. adjuvant combination chemo

3. surgery - amputation, limb salvage - (surgery removing the tumor and the limb is reconstructed via internal prosthetic device), roationplasty (surgery rotating the leg 180 degrees to create a new knee joint)

what is glioblastoma

it’s tumor in the brain - cancer that attacks the glial cells in the brain and creates tumors - its agressive

what are the signs and symptoms of glioblastoma

1. headaches

2. nasuea/vomiting

3. seizures

4. depending on where the tumor is on the brain, can affect pts neurologically

how to diagnose glioblastoma

imaging: MRI

confirmation: guided brain biopsy

treatment options for gliobastoma

1. surgery

2. radiation

3. chemotherapy

4. glucocorticoids: aid in cerebral inflammation

5. antiepileptic for seizure control

what is the most common type of pediatric cancer

leukemia: the overgrowth of abnormal and immature WBC in the bone marrow which prevents the growth of RBC, platelets, and WBC

leukemia signs and symptoms

1. fatigue

2. pallor

3. anorexia

4. bruising and bleeding

5. fever

6. infection

7. bone/joint pain

8. abdominal pain

9. headache

10. vomiting

11. visual disturbances

12. tachycardia

13. anemia

if you completed a CBC on a child with leukemia, what would the labs look like

• decrease in RBC

• decrease in platelets

• increase in blasts (immature WBC)

nursing care for leukemia pts

1. neutropenic precautions

2. bleeding precations

how to diagnose leukemia

• bone biopsy

• lumbar puncture to check for spread into CNS

how to treat for leukemia

• chemotherapy

  • ALL - lower dose for longer time (2-3 years)

  • AML - higher dose for shorter time (less than a year)

• induction and maintence chemo

• car-t cell therapy

• monoclonal antibody

  • blincatumomab for b-cell for ALL

• stem cell transplant

what is the pathophysiology of acute lymphoblastic leukemia

ALL developed from WBC (lymphocytes) or from lymphoblasts (immature lymphocytes) within the bone marrow. Then, with a genetic mutation, abnormal blood cells multiply and overcrowd

what are potential risk factors for acute lymphoblastic leukemia

• down syndrome

• li-fraumeni syndrome

• neurofibromatosis

• prolonged exposure to chemicals and radiation

• family hx

• male

what’s the pathophysiology of acute myeloid leukemia (AML)

in the bone marrow, there’s a WBC called myeloblast that overcrowds

after surviving, what should pts do to take care of themselves

• follow up care for the rest of their life for risk of “late effects”

• survivor clinics to find support for transition to independence, peer support, fertility treatments.