Cancer/ Developmental milestones Pediatrics EXAM 2

Nephroblastoma

Malignancy that occurs in the kidney or abdomen. Usually unilateral

also called Wilms Tumor

Can be in kidney or abdomen

Brain Tumor

Can be benign or malignant but what matters most is the location

This is the common solid tumor of children

60% in infra fontanel danger area

Leukemia

Malignancy that affects the bone marrow by increasing the production of immature WBC’S with neoplastic characteristics

2 types ALL/AML ALL MOST COMMON IN BOYS

Retinoblastoma

Malignancy that arises from the retina

Can be unilateral or bilateral

Can be present at birth

Most common Intraoccqular cancer

Risk factor: Hereditary

Osteosarcoma

Malignancy that usually occurs in the long bones

Most commonly the femur bone

Can originate from any tissue that involves bone growth

Occurs in wider parts of the bone shafts

Common in adolescents (gets mistaken for sport injury)

Neuroblastoma

Silent killer

Malignancy that occurs in the adrenal gland

Can be found in the retroperitoneal area, head, neck, pelvis, or chest

Usually bilateral

A lot of neurological effects

Metastasize before diagnosis

Retinoblastoma Clinical manifestations

Leukocoria- cat eyes reflex, no red glow with photographs

Strabismus- Poor fixation of impaired eye

Pain (late finding)

Glaucoma (late finding)

Blindness (late finding)

Orbital cellulitis (late finding)

Retinoblastoma Nursing interventions

CT/MRI

RB1 gene mutation

Ophthalmologist

Anucleation

Chemo/radiation

Eye patch if no ball in place

Blood and tumor samples

Nephroblastoma Clinical manifestations

Swelling in the abdomen

Firm non tender mass that does NOT cross midline

Hypertension (release of renin)

Metabolic alterations

Anemia polycythemia/ Pallor/ Lethargy/ Anorexia

Nephroblastoma Nursing interventions

Asses but do NOT palpate the abdomen

xray/ct/mri

CBC for anemia

Monitor Blood pressure before and after surgery

Chemo therapy

Late signs: Chest pain/ dyspnea/ SOB/cough

Neuroblastoma Clinical Manifestations

Firm non tender irregular mass that DOES YES IT DOES cross the midline

Dyspnea/stridor

Urinary frequency/ urgency

Subq skin nodules

Seizures

Difficulty breathing

Neuroblstoma nursing interventions

Neuro exam

Chemistry panel

Surgery

CT/MRI

Chemo

Osteosarcoma Clinical manifestations

Bone pain

Inability to lift a heavy object/ bear weight

Constant limping

Swelling

Decrease range of motion

Swelling

Unexplained weight loss

Osteosarcoma nursing interventions

Limb salvage procedure

Surgery

Bone marrow biopsy

XRAT/CT/MRI

Chemo

Labs

Brain tumors clinical manifestations

Bulging fontanels/ increased head circumference increased ICP

Positive babinskis

Spasticity

Increased blood pressure

Decreased heart rate

Visual defects

Diabetes insidious (late sign)

Brain tumors Nursing interventions

Assess head circumference

CT/MRI

Radiation/chemo

Medication: Mannitol given for excess fluid)

Post op care

Calming environment

Leukemia clinical manifestations

Increased ICP

Unsteady gate

Increased bruising/ peticheae

Listlessness

Enlarged lymph nodes

Headache

Pallor

Leukemia late findings

Pain

Hematuria

Ulcerations in mouth

Enlarged kidneys from getting clogged

Leukemia nursing interventions

CBC showing increased WBC, decreased H&H, anemia thrombocytopenia

Bone marrow biopsy

Blood transfusion

Antibiotics

WHAT CAUSES LEUKEMIA?

Prenatal exposures to xrays

Past chemo treatments

Certain genetic conditions like Down syndrome

2 types of Leukemia

ALL: Acute Lymphoblastic Leukemia (most common in boys)

AML: Acute Myeloid Leukemia

Who’s allowed to administer Chemo therapy and where is it administered?

Chemo nurses, special certification required

Must be given in a central line( PICC, port, central)

toddlers 1-3 years old body changes

by 24 months they should be 4 times their birth weight (4-6 pounds per year)

Height (2-3 inches per year)

Head-Chest circumference is equal now

Toddler 1-3 years old Temper tantrums

Autonomy

Easily stressed/ agitated

Cry, throw themselves, hit (normal)

If they have a tantrum: stay calm, ignore them, don’t give in or reason with them

Prevent tantrums: Offer choices (2), Distraction, Triggers (close to nap time?, hangry, at the park last slide)

Toddlers 1-3 years old diaper to potty transition

Needs to be physically and mentally ready

Sphincter control voluntarily doesn’t happen until 18-24 months

Night time training takes time

Most toddlers are trained by 3 years old

Toddlers 1-3 years old On the Move Safety

Drowning

Car accidents- carseat safety

Nose dives- falls

Burns- Stove, electric outlets

Toxins out of reach

Gun safety

Suffocating- chocking, putting stuff in their mouth

Lead poisoning- Toys, Pottery, Paint, Soil

Toddlers 1-3 years old TOILET

T- two hours or more with dry diaper

O- on and off by themselves

I- interested in potty

L- likes sitting on potty (5-10min.)

E- experiences regular BM

T- tells you the need to go

Toddlers 1-3 years old Developmental Stages

Ericksons- Autonomy vs. Shame and doubt

Independent/ confident

Parallel play

Piagets: sensorimotor Birth- 2 years

Egocentric/Self absorbed

Symbolic thinking and play

Toddlers 1-3 years old Love to say NO

Negativism- opposite of what’s asked

Avoid asking questions that can have a no answer

Give options

Toddlers 1-3 years old Eating plan

Grazers

Picky eaters- no mixed or new foods

Watch out for chocking- grapes, popcorn, celery

Fun color cups and plates may help

Toddlers 1-3 years Ritualism/Rivalry/Regression

Ritualism:Things done the same way, predictable/comfortable

Rivalry: Siblings, attention diverted, jealousy, try to include them in care

Regression: Reverts back to infant skills: wanting paci, no new skills at time of birth to sibling, need to praise them

Preschooler 3-5 years old Physical changes

5 pounds a year (average 42 pounds)

Height 3 inches a year

Preschooler 3-5 years old Gross and fine motor skills

Ride tricycle

Writes names

Cutting with scisors

Buttons

Skips/jumps

Preschooler 3-5 year olds Reduced separation anxiety

Disappears at about 4-5 years old

Then they’ll just cry quietly

Preschooler 3-5 years old Ericksons and Piagets theories

Ericksons: Initiative vs. guilt, try new things, make decisions, sense of purpose

Piagets: Peoperational(2-7), still egocentric, imaginary play, magical thinking, Animism (make believe), literal thinking

Preschooler 3-5 year old scared/FEAR

Hospital/ procedures

Punishment

Preschooler 3-5 year old healthy eating

Not as picky

Decrease in ritualism

Sits for meals

Talking and eating (chocking hazard)

Preschooler 3-5 year old teeth

Baby teeth all in by 3 years old

Start loosing teeth by 5-6 years old

Preschooler 3-5 years old

Playing with others

Cooperative play

Follow rules (simple games)

Preschooler 3-5 years old child safety

Sun safety (sunscreen)

Swimming (drowning)

Strangers(anxiety)

Bikes(helmet/pads)

Burns

Carseat and Pedestrian(look both ways)

Preschool 3-5 years old Outline behaviors and expectations

Nightmares

Preschooler 3-5 year old Language explosion

Talk alot

By age 5 they use 5 word sentences

Stammering is normal

Immunizations for Preschoolers 3-5 years old

DTAP

MMR

VARICELLA

POLIO

FLU (seasonal)