Pediatric content exam 5 (ch. 44 & 49) cancer and neuromuscular

preventing postoperative complications of a brain tumor

-Vitals -positioning (flat or on a side with no pillow under the head to keep midline) -regulating fluids -administering medications

assessment after surgery of a brain tumor

-Vitals are taken every 15-30 minutes until patient is stable -hyperthermia can result from surgery so temp is important -deep breathing and turning -respiratory assessments -testing reflexes -neurologic checks -observe dressings for drainage

S/S of spinal cord compression

-back pain -extremity weakness -loss of bowel and bladder function -respiratory insufficiency

Clinical manifestations of retinoblastoma

-Whitish "glow" in the pupil known as cat's eye reflex -Strabismus (crossed eyes) -Blindness (late sign)

fluid regulation after surgery of a brain tumor

-Child is allowed nothing for at least 24 hours or longer if gag or swallow reflexes are depressed -IV fluids -hypertonic solution to remove excess fluid -mouth care

Diagnostics of cerebral palsy

-Infants at risk: require careful assessment during early infancy -Neurologic examination and history -MRI is a strong predictor -Neuroimaging -Metabolic and genetic testing

A child receiving chemotherapy must be observed closely within the first hour after the infusion for signs of anaphylaxis. What emergency equipment/drug should be present in the room?

-Blood pressure monitor -Cardiac monitor -Epinephrine -Antihistamines -Aminophylline -Corticosteriods -Bag valve mask -Suction

The childhood cancer survivor

-5-year survival rate 80% -Complications common with combined treatment modalities -Late effects are of concern i. Changes related to treatment ii. Interactions between treatment modes iii. Effects may occur months to years later -Radiotherapy can decrease growth in bones or reproductive organs -Treatments may cause hormonal dysfunction -Growth and Tanner stages are important to document -Assess all body areas for abnormalities based on treatment used

Identify which of the following clinical manifestations would not be seen in a child with increasing ICP related to a brain tumor

A decreasing blood pressure

The most common type of leukemia in children is

ALL

Which laboratory result should the nurse be most concerned about if found in a 6-year old child with cancer?

Calcium level of 13 mg/dl

Many times children with Wilms tumor have a genetic anomaly present. Which is the most common anomalies?

Cryptorchidism and hypospadias

A nurse working on care planning for a child with a diagnosis of Wilms tumor. What teaching needs to occur at this point?

Do not put things on the abdomen such as toys or books which would increase pressure

What are risk factors for tumor lysis syndrome?

High WBC, large tumors, and small tumors

A 14-month old child is 24-hours from removal of a Wilms tumor. What would indicate the child had good pain control?

Increased interest in playing

A family has just received the diagnosis of leukemia for their 6-year old. Which is the best description of what occurs with leukemia in children?

Unrestricted proliferation of immature WBCs occurs

A medical diagnosis of ALL has been made for a 3-year old. Identify a common lab value seen in children with this diagnosis

WBC count of 3.5 X 10^9/L

Leukemias: acute leukemia

-A broad group of malignant disease of bone marrow and lymphatic system -Immature cells that cannot function effectively predominate -Complex disease with varying heterogeneity -Classifications are increasingly complex

Cerebral palsy (CP)

-A group of permanent disorders of the development of movement and postures, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain -Characterized by abnormal muscle tone and coordination -Incidence: 2.4 to 3.6 per 1000 live births -Most common permanent physical disability in childhood -Affected children: 15-60% also have epilepsy

Risk factors associated with cancers

-ALL: radiation, race (white), genetic conditions, birth weight more than 400 g -AML: chemotherapeutic agents and genetic conditions -Brain tumors: radiation to the head and genetic conditions -Hodgkin disease: family history of monozygotic twins, infections such as EBV -Non-hodgkin: immunodeficiency, infection such as EBV -Osteosarcoma: radiation, chemo, genetic conditions -Erwing sarcoma: race (white) -Wilms tummor: congential anomalies, race (white and black) -rhabdomyosarcoma: congenital anomalies and genetic conditions

Germ cell tumors

-Account for 14% of all tumors in children 15-19 years old -Teratoma is most common type in childhood -Most common ovarian tumors are mature cystic teratomas -Most teratomas are localized and gonadal, surgically resected without further therapy -Care management i. Teach testicular self-examination to all adolescent males ii. Teach symptoms to report iii. Teach normal findings with own anatomy

Therapeutic and care management of NHL

-Aggressive irradiation and chemotherapy -Induction, consolidation, and maintenance and some intrathecal chemotherapy -Primary focus on managing effects of chemotherapy

Erwing sarcoma

-Arise in marrow spaces -Originates in shaft of long and trunk bones i. Pelvis, femur, tibia, fibula, humorous, ulna, vertebrae, scapula, ribs, skull

Retinoblastoma: solid tumor

-Arises from retina -Single or multiple foci in one or both eyes -May be caused by genetic alterations

Diagnostic evaluation of leukemia

-Based on history, physical manifestations i. Minor infection does not disappear ii. Pale, listless, irritable, febrile, and anorexia -Peripheral blood smear i. Immature leukocytes ii. Frequently low blood cell counts -CBC with differential and blood chemistries -Bone marrow aspiration or biopsy; once confirmed, a lumbar puncture is done to evaluate central nervous system (CNS) involvement

Diagnostic evaluation of neuroblastoma

-CT scan -bone scan -MIBG scan -bone marrow biopsies -urinary catecholamines

Bone tumors

-Clinical manifestations i. Localized pain at affected site (severe/dull sometimes attributed to growing pains often relieved by a flexed position) limping, decreased physical activity, unable to hold heavy objects, palpable mass, fever, respiratory distress -Diagnosis i. Rule out trauma or infection, physical assessment to focus on status of affected area, CT or MRI, needle or surgical biopsy -Prognosis i. Most can be cured

Diagnostic evaluation of brain tumors

-Clinical signs and symptoms -MRI is gold standard -diffusion weighted imaging -spectroscopy -perfusion imaging -CT scan -lumbar puncture (contraindicated in presence of increased ICP) -biopsy

Clinical manifestations of neuroblastoma

-Depend on location and extent of the disease -Firm/nontender/irregular mass which is usually confined to one side -abdominal pain or discomfort -vomiting -respiratory compromise -urinary frequency or retention -metastases to the skin "blueberry muffin lesions"

Care management of osteosarcoma

-Depends on surgical approach (amputation vs. salvage) -Prepare family for surgical intervention and outcome -Allow child to ask questions and expect grief response; answer question but do not offer extensive information -Inform child of chemotherapy effects -Do not offer too much at a time -Phantom limb pain may develop -Start discharge planning early -Physical therapy -Assist with clothing choices

Diagnostic evaluation of retinoblastoma

-Detailed family history and s/s -Ophthalmoscopy -Ultrasound, CT, MRI -Blood and tumor samples to test for RBI gene mutations

Clinical appearance and manifestations of NHL

-Disease usually diffuse rather than nodular -Cell type undifferentiated or poorly differentiated -Dissemination occurs early and often rapidly -Mediastinal involvement and invasion of meninges -Depends on anatomic site involved -Metastasis to bone marrow or CNS may appear like leukemia -swollen lymph nodes, fever

Care management of Erwing sarcoma

-Does not necessarily lead to amputation -Prepare family for diagnostic tests including bone marrow aspiration and surgical biopsy -Wear loose fitting clothing over irritated areas -Protect irradiated area from sunlight and sudden temperature changes -Prepare child for effects of chemotherapy

Subtypes of rhabdomyosarcoma

-Embryonal: most common type; most frequently found in the head, neck, abdomen, and genitourinary tract -Alveolar: second most common type; most often seen in deep tissues of the extremities and trunk -Pleomorphic: rare in children; most often occurs in soft parts of extremities and trunk

Classification of retinoblastoma

-Group A: small (3 mm or less) intraretinal tumors away from the optic disc and foveola -Group B: all remaining tumors that are larger than 3 mm and or close to the optic disc but remain confined to the retina -Group C: discrete local disease with minimal disease under the retina or in the gelatinous material of the eye -Group D: large or poorly defined tumors with significant vitreous or subretinal seeding; retina may have become detached from back of the eye -Group E: tumor is very large, extending near the front of the eye, is bleeding or causing glaucoma; not possible to save the eye

Liver tumors

-Hepatoblastoma and hepatocellular carcinoma -Surgical resection is treatment of choice -Surgery often done after chemotherapy -Liver transplant used when resection not possible

Diagnostic evaluation of Hodgkin disease

-History and physical -CBC, uric acid, liver function, CRP or ESR, alkaline phosphatase, urinalysis -CT or MRI of neck/chest/abdomen/pelvis -Lymph node biopsy, presence of Reed-Stemberg cells

Diagnostic and management of rhabdomyosarcoma

-History and physical -PET/CT or MRI -Biopsies -Lumbar puncture -Multimodal therapy -Complete removal of primary tumor -Chemotherapy effective

Diagnostic evaluation of Wilms tumor

-History and physical for presence of anomalies (developmental delay, hypospadias, cryptorchidism) -Signs of malignancy -Ultrasound, CT, MRI, CBC, urinalysis

Lymphomas

-Hodgkin disease i. More prevalent among children 15-19 years of age -Non-Hodgkin lymphoma i. More prevalent among children less than 14 years of age

Nursing care during blood or marrow transplant

-Hospitalized for several weeks -Insertion of venous access device -Strict infection precautions (neutropenic precautions) -Most common complication is Graft versus Host Disease (GVHD) -Blood products to be irradiated to minimize additional antigens -Trying to find a match for bone marrow is important with care; biracial kids are the hardest ones to try and find a match

S/S of brain tumors are related to anatomic location and size

-Hydrocephalus -headache -vomiting -nystagmus -ataxia (impaired balance) -dysarthria (slowed speech) -diabetes insipidus -growth failure

Therapeutic management of leukemia

-IV and chemotherapy -Three phases of therapy: i. Induction 1. 4-5 weeks, beings almost immediately 2. Principal drugs are corticosteroids (dexamethasone or prednisone) ii. Intensification (consolidation) therapy to eradicate residual leukemic cells 1. Chemotherapy given periodically over 6 months iii. Maintenance therapy to preserve remission 1. Weekly or monthly CBCs 2. Treatment usually stops after 2-3 years 3. Monitor for relapse -CNS prophylactic therapy i. Used in high risk children to reduce the risk of leukemic cells taking over the CNS -Reinduction after relapse i. Each relapse means poorer prognosis ii. Testes are resistant to chemotherapy and may lead to relapse iii. Relapse in testes leads to intensive chemotherapy and irradiation -Bone marrow transplantation i. Used in both ALL and AML

Management of tumor lysis syndrome

-IV fluids -medications to reduce uric acid (Allopurinol) -serum chemistries and urine pH monitored frequently -strict intake and output recording

Staging and prognosis of Wilms tumor

-If unfavorable histology, prognosis is poor -Survival rates highest among all childhood cancers -Staging 1. Stage I: tumor is limited to one kidney and completely resected without rupture or previous biopsy 2. Stage II: tumor extends beyond kidney but is completely resected 3. Stage III: postoperative residual tumor confined to abdomen. Lymph nodes in abdomen or pelvis contain tumor cells 4. Stage IV: hematogenous metastases with disease spread to the lung, liver, bone, brain, or lymph nodes 5. Stage V: bilateral renal involvement is present at diagnosis

Therapeutic and care management of retinoblastoma

-Irradiation -Chemotherapy -Surgical implantation of iodine-125 for radiation -Photocoagulation (laser beam to destroy retinal blood vessels) -Cryotherapy (freezing of the tumor) -Prepare the family for diagnostic and therapeutic procedures and home care: possible prep for an artificial eye, facial appearance after surgery (eye patch in place) and face may be edematous or bruised, care for the surgical site/dressing -Support the family

Pathophysiologic and related clinical manifestations of ALL

-Leukemia is an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body -Liver and spleen are the most severely affected organs -Leukemia demonstrates the same neoplastic properties as solid tumors -Although leukemia is an overproduction of WBCs, often acute form causes low leukocyte count i. Greatly elevated immature cells or blasts ii. Immature cells do not attack and destroy normal blood cells -Cellular destruction takes place by infiltration and subsequent competition for metabolic elements -Weight loss, petechiae, bruising without cause, and continued complaints of bone and joint pain

Osteosarcoma

-Likely arises from bone-forming mesenchyme -Found mostly in lower extremities near growth plate; coincides with the period of rapid bone growth -Most common type of bone tumor

Therapeutic management of Erwing sarcoma

-Limb salvage or amputation depending on situation -Surgical resection when possible -Radiotherapy -Chemotherapy (vincristine, doxorubicin, ifosfamide, and etoposide)

Diagnosis and treatment of spinal cord compression

-MRI is gold standard -high dose of steroids for tumors in hard places and to reduce associated edema and or radiation if the tumor is sitting in a good area to make the cells shrink quickly

Tumor lysis syndrome

-Metabolic abnormalities that are the direct result of rapid release of intracellular contents during the lysis of malignant cells -Typically occurs in patients with acute lymphoblastic leukemia or Burkitt lymphoma

Neuroblastoma

-Most common extracranial solid tumor, most common cancer diagnosed in infancy -Originate from embryonic neural crest cells -Primary site is in abdomen

Acute lymphoblastic leukemia (ALL)

-Most common form of childhood cancer -Peak age of onset is between 2-3 years old -Risk factors: prenatal exposure to x-rays, previous treatment of chemotherapy, and genetic conditions (Down syndrome, Bloom syndrome, Fanconi anemia, Li-Fraumeni syndrome

Wilms tumor

-Most common kidney tumor of childhood -Clinical manifestations i. Painless swelling or mass in abdomen, firm/nontender/confined to one side/deep within flank area, often discovered during routine hygiene cares, hematuria, anemia (pallor, anorexia, lethargy) hypertension, dyspnea and cough if pulmonary metastasis occurs

Rhabdomyosarcoma: solid tumor

-Most common soft-tissue sarcoma in children -Most common in children 9 years and under -Arises from embryonic mesenchyme cells in muscles, tendons, bursae, and fascia (primarily in the head and neck)

Brain tumors

-Most common solid tumor in children -Specific cells may be involved -Benign or malignant -60% of the tumors are infratentorial (below the tentorium cerebelli) which they occur in the posterior part of the brain (cerebellum or brainstem) -The other tumors are supratentorial or lie within the midbrain structures

Hodgkin disease

-Neoplastic disease originating in lymph system, primarily involves lymph nodes -Often metastasizes to spleen, liver, bone marrow, lungs, and other tissues -Epstein-Barr virus is thought to have a role in the cause of this disease -Four types of Hodgkin's disease i. Lymphocytic predominance ii. Nodular sclerosis iii. Mixed cellularity iv. Lymphocytic depletion -Accurate staging is basis for treatment and prognosis -More than one staging system available

Non-Hodgkin lymphoma

-Occurs more frequently in children than Hodgkin disease -Risk factors: EBV, immunodeficiency, DNA repair syndromes, previous cancer -Prognosis improved with young age, low mediastinal involvement, low tumor burden, good response to initial therapy

S/S of Hodgkin disease

-Painless/firm/nontender/moveable nodes in the cervical or supraclavicular area -cough -abdominal discomfort -anorexia -intermittent fever -weight loss -night sweats

Which of the clinical manifestations would indicate a child is exhibiting signs of a possible brain tumor

-Parents stating their child is tripping over things more and seems to lose their balance when walking -The child exhibits a positive Babinski sign -Vomiting is present when awakening in the morning

Hyperleukocytosis

-Peripheral WBC count > 100,000/mm3 -Can lead to capillary obstruction, microinfarction, organ dysfunction, neurologic changes -Children often experience cyanosis, respiratory depression, and delirium can be a thing to see in kids with this condition -They also experience neurologic changes (altered LOC, visual disturbances, agitation, confusion, ataxia) -Management: chemotherapy, hydration, urinary alkalinization, and allopurinol

Care management of leukemia

-Prepare the family for diagnostic and therapeutic procedures i. Children need an explanation of the rationale for each procedure, what can be expected, and what they can do to help ii. Using a drawing or letting child look at a drop of blood under a microscope fosters trust between the nurse and child while assessing the child's level of understanding -Provide continued emotional support i. Parents need to know how to recognize symptoms that demand medical attention

Bone marrow dysfunction

-Proliferating cells decrease bone marrow production due to the competition for essential nutrients -Three primary consequences i. Anemia ii. Infection and neutropenia iii. Bleeding -Bones weaken and are prone to fractures -Bone pain from increased pressure -S/S: fever, pallor, fatigue, anorexia, hemorrhage, bone and joint pain

General nursing care management

-Quality patient outcomes guide care; early detection is critical to early treatment and cure -High risk for going into septic shock based on compromised immune system -Labs: CRP, CBC with differential, urine specimen/sensitivity, antibody test to see which antibiotic is best to treat infection -If a kid is undergoing radiation, be aware of mucosal ulcerations that happen in the mouth or rectal area. It makes it difficult to eat and pushing fluids is important for a cooling sensation and decreasing risk of constipation -Kids can start to develop steroid effects (moon face or cushingoid, weight issues, adrenal insufficiency, high glucose levels) make sure to have child avoid salty foods because can cause more fluid retention -Weight checks usually have to be done every morning on these kids

Management of Hodgkin disease

-Radiation -Chemotherapy (alone or with radiation) -Prognosis 1. Long-term survival is excellent 2. Aggressive therapy increases chances of complications -Care 1. Preparation for diagnostic procedures: explain why and what is going to happen 2. Side effects: lack of energy, inability to concentrate, increased susceptibility to infection 3. Family support 4. Concern for high risk of infertility

Postoperative care of Wilms tumor

-Recovery generally rapid -Typical cares following abdominal surgery -Monitor bowel function -Monitor for infection

Clinical manifestations of rhabdomyosarcoma

-Signs and symptoms related to site of tumor and compression of organs -Orbit location: ecchymosis, loss of extraocular movements -Nasopharynx location: stuffy nose, serous otitis media, pain, epistaxis, palpable neck nodes -Paranasal sinuses: nasal obstruction, discharge, sinusitis, swelling -Middle ear: chronic serous otitis media, drainage, facial nerve palsy -Retroperitoneal area (usually silent tumor): pain, abdominal mass -Perineum: visible superficial mass, bowel or bladder dysfunction

Superior vena cava syndrome

-Space-occupying lesions located in the chest, especially from Hodgkin disease and NHL may cause this syndrome leading to airway compromise and potentially respiratory failure -Second leading cause of SVCS is complications of implantable IV devices (ports or venous catheters)

Disturbance of involved organs

-Spleen, liver, and lymph glands demonstrate infiltration, enlargement, and fibrosis -Use of prophylactic CNS intrathecal therapy decreases CNS relapse -Other sites include: i. Cranial nerves ii. Spinal nerves iii. Signs and symptoms relate to the nerves involved

Staging of NHL

-Stage I: disease limited to one lymph node or one additional site (thoracic or abdomen) -Stage II: single tumor with regional lymph node involvement; two or more lymph node regions on the same side of the diaphragm -Stage III: two single tumors on opposite sides of the diaphragm -Stage IV: tumor has spread into the central nervous system or bone marrow

Ann Arbor staging of Hodgkin disease

-Stage I: lesions are limited to one lymph node area or only one additional extralymphatic site (liver, lungs, kidney, intestines) -Stage II: Two or more lymph node regions on the same side of the diaphragm or one additional extralymphatic site or organ on the same side of the diaphragm is involved -Stage III: lymph node regions on both sides of the diaphragm are involved with spread to one extralymphatic site, spleen, or both -Stage IV: diffuse spread throughout the body to one or more extralymphatic sites with or without involvement of associated lymph nodes -Improved treatment and staging has improved the survival rate

What do you always want to have in a room for a child with cancer?

-Suction materials if they vomit -bag valve mask -cardiac monitor

Therapeutic management of Wilms tumor

-Surgery and chemotherapy -May or may not have irradiation

Therapeutic management of osteosarcoma

-Surgery for biopsy and to save or amputate limb -Limb salvage includes prosthetic bone placement -Chemotherapy to decrease tumor size -Three drug treatment: cisplatin, doxorubicin, and methotrexate with citrovorum

Therapeutic and care management of neuroblastoma

-Surgery to remove as much as possible -Irradiation postoperatively -Chemotherapy (carboplatin, cyclophosphamide, doxorubicin, etoposide) with or without surgery -Immunotherapy -Retinoid therapy -Preparation for diagnostic and operative procedures -Prevention or postoperative complications -Educate family about chemotherapy and radiotherapy -Evaluate coping and provide support

Preoperative care of Wilms tumor

-Surgery usually occurs within 24-48 hours of diagnosis -Challenge to prepare family and child for surgery -Blood pressure is monitored for hypertension from excess renin production -Do not palpate tumor; careful bathing and handling of child is important -Tell parents what to expect, keep terms simple

Diagnostic evaluation of NHL

-Surgical biopsy for confirmation of disease -Bone marrow aspiration -MRI, PET scan, CT scans of the lungs and GI tract

Morphology of leukemia

-The two types of leukemia seen most often in children: Acute lymphoid leukemia (ALL) and Acute nonlymphoid (myelogenous) leukemia (ANLL or AML) -Stem cell or blast cell leukemia

What do children with cancer have higher exposure to?

-These kids are higher exposed to flu, covid, RSV, varicella, and herpes virus. Kids tend to stop going to school because too many germs in one area -Flowers can expose protozoa for these kids due to it being in the soil -Bacteria in order of least to most lethal i. Fungi: yeast infections is common ii. Pseudomonas and e-coli are gram negative iii. Staphylococcus and enterococcus are gram positive

Spinal cord compression

-Tumors press on the spinal cord -If a tumor is on the spinal cord or within the brainstem and cause compression. They spread very quickly, usually within a few days (neuroblastomas or rhabdomyosarcomas)

Pain management

-Use WHOs 3-step analgesic pain ladder -Extensive understanding of opioid and nonopioid analgesics (CBD oil and lotions, essential oils are becoming big to use with nonopioid analgesics, pet therapy is important as well for healing) -Interdisciplinary pain teams provide consultations and expertise -Doses titrated to increase analgesia and minimize side effects -NSAIDS, acetaminophen with codeine, oxycodone, and morphine are commonly used

The standard protocol for treatment of Erwing sarcoma is

-Vincristine -Doxorubicin -Radiation -Ifosfamide -Etoposide

S/S of superior vena cava syndrome

-cyanosis from the armpits and above on the body -facial edema -distended neck veins -Be aware for airway obstruction, wheezing, and dyspnea -Protect airway and reduce respiratory distress

how do you prepare family for diagnostic and operative procedures of a brain tumor?

-explain the symptoms that could be relieved and what can happen after the procedure (postsurgical headaches, vision may not be improved) -hair is shaved usually -explain size of dressing the child will have and how they will feel after the procedure

Risk factors of tumor lysis syndrome

-high WBC count -large tumor burden -cancer cell sensitivity to chemotherapy -high proliferative rate

Abnormalities that occur with tumor lysis syndrome

-hyperuricemia (crystallization of uric acid that can occur that can lead to renal failure) -hypocalcemia -hyperphosphatemia -hyperkalemia (this happens in children when the kidneys are beginning to fail)

S/S of tumor lysis syndrome

-kids will have a decrease in energy -limping -pale -lethargy -vomiting when they wake in the morning especially if they have a brain tumor because of changes in ICP -vision loss (how close are they getting to their toys?) -rapid weight loss because of the speed the abnormal cells are developing which increases metabolism -unexplained illness especially fever that lasts for days or sometimes weeks -bruising in abnormal areas, pruritus' (itchy skin) -flank pain -seizures -Adults and children; swelling that happens in the abdomen due to Wilms tumor

Causes of cerebral palsy

-prenatal brain abnormalities i. Gross abnormalities of the brain ii. Vascular occlusion iii. Laminar degeneration iv. Effects of low birth weight v. Anoxia vi. Hypoxic infarction or hemorrhage

Comfort measures after surgery from brain tumor

-providing a quiet environment -prevent any sudden movement -prevent an increase in ICP (proper positioning) -opioids for pain -ice compress to relieve facial edema

A nurse caring for a child post-op after the removal of a Wilms tumor will anticipate which of the following as orders?

Monitor the abdominal circumference

A medical provider has ordered for a CT, MRI, and PET scan for a child demonstrating clinical manifestations of a bone cancer. Which cancer is the medical provider likely trying to identify?

Osteosarcoma

A nurse is explaining the most common clinical manifestations of Erwings sarcoma to a new nurse. Which should the nurse discuss?

Pain, swelling, limping, and a fever

Risk factors for lymphoblastic leukemia in kids is

Previous radiation exposure

The nurse is caring for a child with osteosarcoma after amputation of the left lower limb. The child is continually complaining of aching and cramping in the missing limb. What is the initial nursing action?

Reassure the child that this is normal. Identify ways to help with acknowledging the leg is no longer present

Care in assessing s/s of brain tumors

Report sluggish, dilated, or unequal pupils immediately because it may indicate increased intracranial pressure or brainstem herniation

Which cancer is known to have the clinical manifestation of a whitish glow in the pupil?

Retinoblastoma

Which type of cancer is commonly seen in children 9 years and under?

Rhabdomyosarcoma

The organ most affected by leukemia is

Spleen and liver

Which of the following conditions demonstrates a child having cyanosis from the chest up?

Superior vena cava syndrome

A nurse is going to present at a conference about care for children with neuroblastomas in children younger than 3 years. What information should be included in the presentation for this age?

The most significant symptoms are headache and vomiting