oncological disorders of pediatric

Hodgkin's disease

(a type of lymphoma) is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic characteristic of this disease.

an early sign of increased ICP

.Vomiting,

365. The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site. " 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

365. 2 Rationale: Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in consider able pain from the tumor. Options 1,3,and 4 are accurate regarding osteosarcoma. Test-Taking Strategy: Note the strategic words, need for information. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Knowledge that osteosarcoma is a malignant tumor of the bone will direct you to the correct option.

366. The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy.The nurse notes that the platelet count is 19,500 mm3 (19.5Â109/L). On the basis of this laboratory result,which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.

366. 1 Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is severely thrombocytopenic and has aplatelet count less than 20,000 mm3 (20.0Â109/L), bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures are avoided.

371. Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room . 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that any one entering the child's room wears a mask. 5. Apply firm pressure to a needle-stick area for at least 10 minutes.

371. 2, 3, 4 Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). A common complication of treatment for leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room. Applying firm pressure to a needle-stick area for at least 10 minutes is a measure to prevent bleeding.

372. The nurse is performing an assessment on a 10 year-old child suspected to haveHodgkin's disease. Which assessment findings are specifically characteristic of this disease? Select all that apply. 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area

372. 1, 5 Rationale:Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. Specific clinical manifestations associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders. Test-Taking Strategy: Note the words specifically characteristic in the question.

cerebrospinal fluid

Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately

Interventions for child at risk for bleeding and leukemia

If a child is severely thrombocytopenic and has aplatelet count less than 20,000 mm3 (20.0Â109/L), bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures are avoided.

shock

In the event of shock, the HCP is notified immediately before the nurse changes the child's position or increases intravenous fluids.

Wilms' tumor

Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells .Hematuria,fever,and hypertension are clinical manifestations associated with Wilms' tumor.

after brain tumor removeal

attention temperature because hypothalamus or brainstem inolvement during surgery.a cool blanket should be in place on the bed.

Osteogenic sarcoma

is a malignant tumor of the bone. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur.

Wilms' tumor

should not be palpated by the nurse avoid Palpating the abdomen for a mass