Neoplastic Disorders

What are some warning signs when cancer affects bone marrow?

Fatigue, pallor, recurrent/severe infections, or easy bruising

What are some signs of tumor compression, infiltration, or obstruction?

Bone or abdominal pain, unusual swelling lumps or masses, or unusual discharge

Why should persistent unexplained bone pain in a child be investigated?

May indicate tumor infiltration into bone or bone marrow, such as leukemia or neuroblastoma

How should a child be positioned for a lumbar puncture and why?

Side-lying with back flexed or sitting upright and learning forward; widens space between vertebrae

What complications should be monitored after a lumbar puncture?

Headache (ICP), leakage from puncture site, bleeding, signs of infection

What is a contraindication for a lumbar puncture and why?

Increased ICP due to it causing brain tissue to shift (herniation)

What can be given prior to a lumbar puncture?

Applying local anesthetic (e.g. EMLA) to decrease pain or conscious sedation

What is the nursing management post lumbar puncture and why?

Lay child flat for 30 minutes and increase fluid intake to prevent post-procedural headaches

What is the MOA for radiation therapy?

Uses high-energy radiation to damage the DNA of cancer cells and preventing cell division

What else does radiation therapy affect other than cancer cells?

Affects normal rapidly dividing cells near area, including skin, mucosal cells, bone marrow, hair follicles, and reproductive cells

What skin changes can occur in an irradiated area?

Erythema, dryness, irritation, peeling, and increased sensitivity

What education can be given to care for irradiated skin?

Use mild soap, pat skin dry, avoid rubbing or scrubbing, and protect area from heat sun and cold exposure

What products should be avoided on irradiated skin?

Perfumes, irritating soaps, deodorants, and adhesive tapes for dressings

Why is paper tape used over standard adhesive tape for dressings during radiation therapy?

Adhesive tapes can rip and tear off patient’s extremely sensitive skin

What products can be used to moisturize the skin?

Aloe vera, vitamin E, lanolin

What sun protection should be taught for irradiated skin?

Protect area with long-sleeved clothing and use SPF 30 or higher

Why should radiation treatment markings never be scrubbed off?

They help guide accurate positioning when guiding delivery of radiation

What are side effects of chemotherapy on the bone marrow?

Myelosuppression → anemia, neutropenia, thrombocytopenia

What are side effects of chemotherapy on the digestive tract (oral mucosa)?

Mucositis, NVD, poor appetite

How should mild pain be managed during chemotherapy?

Acetaminophen w/ antiemetic, antidepressants, and glucocorticoids

How should moderate pain be managed during chemotherapy?

Weak narcotic (codeine) and nonnarcotic (acetaminophen)

How should severe pain be managed during chemotherapy?

Strong narcotic (morphine)

What is a general rule when administering pain medication for chemotherapy?

Give routinely instead of PRN and provide additional medications for breakthrough pain

What are common signs of infection to assess for in an immunocompromised child?

Fever, tenderness, cough, tachypnea, skin wounds, stomatitis, preirectal fissures

What nursing interventions help prevent infection during chemotherapy?

Handwashing, adequate nutrition, and appropriate rest/sleep periods

What should be avoided in an immunocompromised child?

Avoid rectal temps, IM injections, urinary caths, live vaccines, and exposure to crowded areas or sick individuals

What’s included in neutropenic precautions?

Private room, restrict ill visitors, avoid plants/flowers/fruits, wear a mask

What are fever signs that should be prompt a visit to the ED?

Temp spike of 101.5*F (38.6*C) or if it remains at 100.5*F (38.1*C) or higher for 4 hours or longer

What is the most common antiemetic used to treat N/V during chemotherapy?

Ondanestron PO or IV

What are other antiemetics used to treat N/V during chemotherapy?

Promethazine, metoclopramide, diphenhydramine, lorazepam

What is the nursing management for N/V during chemotherapy?

Administer antiemetics before chemo and on schedule, monitor dehydration, offer small frequent meals that child enjoys, and avoid strong odors

What is the diet management for impaired oral mucous membranes?

Avoid foods that are hard, spicy, acidic, or very hot foods

What is the diet management for stomatitis and mucositis?

What is stomatitis?

Inflammation of oral mucosa

What is mucositis?

Inflammation and damage to mucous membranes lining the mouth and other parts of GI tract

What types of foods should be recommended for children with stomatitis and mucositis?

Foods that requires little chewing (pudding, milkshakes, smoothies, bananas) or cut food into small pieces

What is advised when taking nystatin for fungal infections?

Avoid food or fluids 30 minutes after administration to allow medication to remain in contact with oral mucosa

What foods are recommended to increase fiber for constipation management?

Granola bar, cookies with raisins, popcorn, apple slices, mixed cereal

What foods are recommended for patients with diarrhea?

Offer low-residue (fiber) and low-lactose foods

What is acute lymphoblastic leukemia (ALL)?

Cancer involving uncontrolled proliferation of immature lymphoblasts in bone marrow, overcrowding other blood cells

What are signs and symptoms of ALL?

Fatigue, bone/joint pain, hepatosplenomegaly, lymphadenopathy, neuro changes

What is induction chemotherapy?

Achieving remission by rapidly reducing leukemic cells within 3-4 weeks

What types of meds are used in induction chemotherapy?

Combination therapy with vincristine, daunomycin, and steroids

What is consolidation (intensification) chemotherapy?

Strengthen remission by further reducing leukemic cell burden

What is maintenance chemotherapy?

Continue treatment to eliminate remaining leukemic cells and prevent relapse

What is acute myelogenous leukemia (AML)?

Cancer involving immature myeloid precursor cells in bone marrow, causing blasts to crowd out normal blood cells → pancytopenia

What is hyperleukocytosis?

Extremely high number of leukemic blasts (>100,000) can impair blood flow and reduce oxygen delivery to vital organs

What are possible signs of leukostasis?

Respiratory distress, headache, visual changes, vomiting, AMS

What is leukapheresis?

Procedure that rapidly removes circulating leukemic cells from blood to reduce WBC count

What unusual skin findings may occur with AML?

Leukemia cutis may appear as salmon-colored or blue-gray papular lesions

What is the treatment plan for AML?

Intensive induction chemotherapy followed by post-remission/consolidation chemotherapy; HSCT considered

What is neuroblastoma?

Malignant tumor that develops into parts of the sympathetic nervous system (e.g. adrenal gland in abdomen)

What are signs and symptoms of a neuroblastoma?

Firm irregular abdominal mass that crosses midline, periorbital ecchymosis (raccoon eyes), and elevated urine HVA and VMA

What is the treatment management for neuroblastoma?

Induction chemo, surgery, stem cell collection, radiation, Accutane

What is rhabdomyosarcoma?

Malignant soft-tissue tumor that develops into skeletal muscles and spreads through local invasion or blood/lymphatic vessels

Why are head and neck rhabdomyosarcomas concerning?

Tumor growth can compress the airway or nearby structures, causing difficulty swallowing or respiratory distress

What findings may occur with orbital rhabdomyosarcoma?

Proptosis (bulging eye)

What is a common initial manifestation of rhabdomyosarcoma?

Enlarging, firm, painless mass

What is Wilms tumor?

Malignant kidney tumor that occurs in young children, also called nephroblastoma

What are clinical manifestations of Wilms tumor?

Firm, nontender abdominal mass on one side that doesn’t cross midline, abd pain, hematuria, HTN

Why must nurse never palpate the abdomen of a child with suspected Wilms tumor?

Palpation may rupture the encapsulated tumor, causing tumor-cell spread into abdominal cavity

What is postop management for Wilms tumor?

Monitor for hemorrhaging and kidney function w/ BP I/Os, and labs

What is retinoblastoma?

Highly malignant tumor in the eye that can grow into vitreous cavity or beneath retina

What are some clinical manifestations of retinoblastoma?

Leukocoria, strabismus, hyphema (blood in chamber of eye)

What is leukocoria (cat’s eye reflex)?

Whitish or glowing appearance of pupils instead of normal red reflex

What is strabismus?

Eyes misaligned due to tumor interfering with normal vision

What is enucleation?

Surgical removal of affected eye to preserve as much useful vision as possible

What is postop care for retinoblastoma?

Prepare family for child’s appearance, change socket dressing daily by keeping it clean and dry

What are some parent education for postop retinoblastoma?

Routine eye exams, wear safety goggles during sports and avoid contact sports

Why is neuroblastoma called the silent tumor?

It rarely has noticeable symptoms until metastasis has occurred due to deep implantation inside the body

What are the common sites of rhabdomyosarcoma?

Head, neck, extremities, GU tract

What are urinary symptoms of retinoblastoma?

Urinary frequency, retention, obstruction, hematuria