Pediatric Nursing: Burns and Cancer

Number One Pediatric Cancer

Lukemia

Ondancetron Max Dose

4mg

Ondancetron Max Dose during Chemo

16mg

Wilms Tumor is a

malignant tumor of the kidney

Wilms Tumor Speed of Growth

Can double in size by 12 days

Wilms Tumor Survival Rate

90%

Manifestations of Wilms Tumor

Firm mass on one side of abdomen, HTN, hematuria

Wilms Tumor Urinalysis

May show hematuria and leukocytes

Wilms Tumor 24-Hour Urine collection will show

HVA and VMA

What does HVA and VMA distinguish

Wilms tumor

Wilms Tumor Treatment

surgery, chemo, radiation

Wilms Tumor Education

do not palpate the abdomen

Neuroblastoma

Malignant tumor located along nerve cells

Neuroblastoma age

<5 years

Neuroblastoma S/S

Abdominal mass, pain, fever, neck swelling, Vomiting, fatigue, "raccoon eyes" (orbital metastasis)

Neuroblastoma Red Flag

Spinal Cord Supression

Neuroblastoma Imaging

U/S, CT/MRI, MIBG

Acute Lymphoblastic Lukemia is

Cancer of Immature lymphocytes in the bone marrow

Immature Lymphoctes

Lymphoblasts

Acute Lymphoblastic Lukemia S/S

- Panycotopenia

- Fatigue

- pallor

- bruisiing

- fever

- joint pain

- lymphadenopathy

What cells will be present with

Acute Lymphoblastic Lukemia

Blastocytes and Lymphoblasts

With Acute Lymphoblastic Lukemia, the patient should be one

Infection Precautions

ALL Diagnosis

CBC

With ALL, the higher number of WBC,

the worse the prognosis ( higher immature wbc means more production of cancer )

ALL cure rate

70%

ALL Treatment

chemotherapy

Osteosarcoma

malignant tumor of the bone

osteosarcoma survival rate

70-75%

Osteosarcoma is typically found in

ends of long bones

Osteosarcoma creates a

osteoid

osteoid

unmineralized bone matrix

3 Classifications of osteosarcoma

- Low-grade

- Intermediate

- High Grade

In 20% cases of osteosarcoma, the cancer has spread before diagnosis.

True

Osteosarcoma Symptoms

- Bone pain

- limited mobility

- Limp

- Fever

- Night Sweats

What are the inital symptoms of osteosarcoma thought to be

Growing Pains

Osteosarcoma Treatment

surgery, chemotherapy and radiation, amputation of affected limb

Rhabdomyosarcoma

malignant cancer of the soft tissue of the skeletal muscle

Rhabdoblastoma affects what body parts

head, neck, eyes

Rhabdoblastoma manifests as

Rhabdomyoblasts, which are cancer cells that appear as harmless white masses

Rhabdomyoblasts multiply.....

quickly and aggresively, preventing healthy cells from maturing

Oncological Emergency

Tumor Lysis, Sepsis, Space Occupying Lesions, Hematologic

tumor lysis syndrome

Chemotherapy can cause massive destruction of cells leading the creation of uric acid which can be toxic to the kidneys leading to Necrosis.

Tumor Lysis Syndrome Treatment

3-4 Bolus Normal Saline

Space Occupying lesions

tumors put pressure on where the mass lies

What layer of the skin is affected in a superficial burn?

Epidermis only.

What are the characteristics of a partial-thickness burn?

Involves epidermis and dermis; red, moist, blistered, and painful.

What type of burn extends through the epidermis, dermis, and hypodermis?

Full-thickness burn.

Which burns may indicate child abuse?

Stocking or glove pattern burns, unusual shapes/patterns.

What is the first step in burn management?

Stop the burning process and assess ABCs.

How is burn severity estimated in children?

By depth, total body surface area (BSA) using Lund & Browder chart, and body part affected.

Name 3 special considerations for pediatric burns.

Eschar/constriction, facial burns (airway risk), burns >10% BSA may need enteral nutrition.

If Burns are >10% of BSA

Enteral feedings

What are first-aid steps for minor burns?

Cool water/compress (no ice), clean/dry, apply ointment, monitor for infection, give ibuprofen, soak dressings if stuck.

What to NOT put on burns

ICE

What are key nursing interventions for extensive burns?

Promote oxygenation, maintain fluid volume, prevent hypothermia, cleanse burn, prevent infection, manage pain, treat infected burns, provide rehabilitation.

How is hypothermia defined in burn patients and how is it treated?

Core temp < 95°F / 35°C; treat with passive/active rewarming, warm IV fluids, humidified oxygen, bear hugger, warm packs, and treat hypoglycemia.

Ibuprofen Dose

10mg/kg

Ibuprofen Max

600mg

Tylenol dose

15 mg/kg

Tylenol Max

75mg/kg/day