peds oncology

leukemia

blood cancer that starts in bone marrow and causes rapid production of abnormal WBC

leukemia s/sx

-fatigue

-frequent infections

-easy bleeding

-bone/joint pain

-swollen lymph nodes

-weight loss

leukemia nursing interventions

-monitor hemoglobin and platelet levels

-prepare and educate the family on treatment (chemo and radiation)

-prevent infections

-manage bleeding risks and control pain

hemorrhagic cystitis

lining of the bladder becomes inflamed and bleeds d/t chemical irritation from chemotherapy

hemorrhagic cystitis s/sx

-hematuria (blood in urine)

-pain/burning when urinating

-increased frequency

-difficulty/inability to urinate (clot blocking flow)

-lower belly pain

hemorrhagic cystitis nursing interventions

-monitor for hematuria

-monitor fluid intake and ensure adequate hydration

-assess or signs of dehydration

-educate pt to void frequently (do not delay)

hemorrhagic cystitis prevention

-ensure adequate fluid intake

-encourage frequent voiding

-give chemo early in day

-give mesna (protective med given during chemo to prevent irritation)

lymphoma

blood cancer that starts in the lympthatic system

lymphoma s/sx

-swollen lymph nodes

-B symptoms (fever, night sweat, sudden weight loss)

-trouble breathing (if tumor is near windpipe)

-abdominal pain and swelling

-extreme fatigue

hodgkin lymphoma vs non-hodgkin lymphoma

hodgkin

-has abnormal cells called reed-sternberg

-more common ages 15-19

non-hodgkin

-does not have reed-sternberg cells

-develops from b cells, t cells, or natural killer cells

-grows faster and more common in younger kids

lymphoma nursing interventions

-provide explanation of invasive diagnostics (bone marrow aspiration and lymph node biopsy)

-monitor and manage chemo and radiation side effects

-prevent infection

-prevent tumor lysis syndrome

ewing sarcoma

rage aggressive cancer that forms in bone or soft tissue

-usually pelvis, long bones of LE, chest wall

ewing sarcoma s/sx

-localized pain at tumor site

-noticeable lump or mass

-reduced mobility

-higher risk of bone fractures

-fever, fatigue, poor appetite

-"mouth eating" appearance of tumor

ewing sarcoma nursing interventions

-monitor for sever neutropenia, recurrent fever, infections, and mucositis

-preserve maximum function of the affected extremity

-educate and monitor chemo/radiation symptoms

-pain management

-infection prevention

wilms tumor

most common type of kidney cancer in children

-tumor needs to stay intact -->can spill cancer cells throughout body

wilms tumor s/sx

-painless lump or mass on abdomen

-extreme swelling/enlargement of abdomen

-blood in urine

-fever

-high bp

wilms tumor nursing interventions

-monitor blood pressure

-do NOT palpate abdomen

-monitor GI activity

-post op --> monitor for infection and chemo side effects

neuroblastoma

rare cancer that develops from immature nerve cells (neuoblasts) in the tissues of sympathetic nervous system

-most common cancer in infants

neuroblastoma s/sx

*depends on tumor location*

-if near abdomen (firm, nontender mass, pain, n/v, urinary signs)

-if near thoracic (dyspnea, neck madd, stridor, dysphagia)

-if near brain/spine (neuro deficits, bladder/bowel dysfunction, seizures, paraplegia)

general:

-fever

-fatigue

-bone pain

neuroblastoma nursing interventions

-provide prep for diagnostic and operative procedures

-monitor chemo/radiation side effects

-monitor bp

-watch nerve signs (numbness, tingling, trouble moving)

-manage pain

-infection prevntion

rhabdomyosarcoma

rare soft tissue cancer that develops from primitive skeletal muscle cells

-most common soft tissue sarcoma in peds

rhabdomyosarcoma s/sx

depends on tumor location

-head/neck (bulging eye, droopy eyelid, chronic sinus issues)

-limbs (lump/swelling)

-urinary tract (hematuria and difficulty urinating)

-abdomen (pain, vomiting, constipation)

general

-firm, painless/painful lump or swelling

rhabdomyosarcoma nursing interventions

-monitoring chemo/radiation/surgery side effects

-pain management

-assess for signs of organ toxicity

retinoblastoma

rare type of eye cancer that starts in the retina

retinoblastoma s/sx

-cats eye reflex (white glow or reflection in pupil -->leukocroia)

-crossed eyes

-vision changes

-redness and pain

-bulging eye

retinoblastoma nursing interventions

-post operative care

-pain management

-monitor chemo/radiation side effects

-infection prevention

-possible need for elbow restraints on young children

-educate on prosthetic eye care

acute tumor lysis syndrome

life threatening metabolic emergency caused by rapid breakdown of cancer cells (usually seen after starting chemo)

--breakdown causes rapid release of intracellular contents

acute tumor lysis syndrome s/sx

-hyperkalemia

-hyperuricemia

-hyperphosphatemia

-hypocalcemia

-flank pain

-lethargy

-n/v

-pruritus

-tetany

-seizures

-renal complications --> hyperuricemia can lead to crystallization of uric acid which causes acute renal failure

acute tumor lysis syndrome management

-early identification

--monitor urine pH, intake and output, and give IV fluids

pharmacologic

-allopurinal (reduces uric acid)

-rasburicase (uric acid becomes more soluble)

treatment

-IV hydration

-treat metabolic abnormalities present

-exchange transfusions (to reduce metabolic consequences)

-hemodialysis in severe cases

immunosuppression

-most common complication of chemo

-results from bone marrow suppression

-creates high risk for life-threatening infections and sepsis

immunosuppression s/sx

normal asymptomatic until infection develops:

-fever

-fatigue

-body aches

-slow recovery

-neutrophil

immunosuppression management

prevention

-hand hygiene

-isolation precautions with private room

-monitor temp closely

with infection

-treat signs of infection

-obtain blood cultures immediately to begin antibiotics

-broad spectrum IV antibiotics until organism is identified

-stool, urine, and sputum cultures

-sometimes use WBC growth factors (filgrastim)

acyclovir

-antiviral med used to prevent and treat herpes virus infections in children with weakened immune systems from chemo/stem cell transplants

-used as prevention when undergoing chemo and treatment if viral infection occurs

acyclovir nursing implications

-oral: give with meals

-topical: use gloves to prevent auto inoculation

-IV: unfused LONGER than 1hr to avoid renal tubular tamage

-ensure adequate hydration

-monitor IV site closely

-monitor postural blood pressure

-commonly causes nausea, diarrhea, headaches

mesna (mesnex)

-protective medication used to prevent bleeding and inflammation in the bladder caused by chemo drugs

-binds to toxic molecules in urine to neutralize it before it damages bladder tissue

-protects urinary tract while still continuing chemo

mesna (mesnex) nursing implications

given in combination with other prevention strategies for hemorrhagic cystitis

--adequate fluid intake (>1.5 reccomended daily intake)

--frequent voiding (immedietly after feeling urge)

--giving chemo drugs in morning