Chapter 53: Nursing Care of a Family when a Child has a Malignancy

A child is receiving methotrexate as part of his chemotherapy protocol. The nurse would anticipate administering which agent to counteract the toxic effects of methotrexate?

*Leucovorin* Leucovorin is given as an antidote to methotrexate to reduce its toxic effects. Mesna is given when cyclophosphamide and ifosfamide are used to prevent hemorrhagic cystitis. Cyclosporine is an immunosuppressant used to treat graft-versus-host disease after hematopoietic stem cell transplant. Nystatin is used to treat mucositis or systemic fungal infection.

A 6-year-old child has been found to have a stage II brain tumor. The parent asks the nurse to explain what "stage II" means. Which information would the nurse provide?

*The cancer has spread in the brain itself but the chance of complete surgical removal is good.* Knowing the stage of a tumor helps the health care team design an effective treatment program, establish an accurate prognosis, and evaluate the progress or regression of the disease. In general, stage I refers to a tumor that has not extended into the surrounding tissue so can be completely removed surgically; stage II means there is some local spread but the chance for complete surgical removal is good. Stage III typically means cancer cells have spread to local lymph nodes; stage IV designates tumors that have spread systemically (metastasis).

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response?

*"I know this is scary, but leukemia has a high cure rate in children these days."* Although cancer in children is rare compared to unintentional injury or infection, it is the leading medical cause of death among persons younger than 25 years of age. Fortunately, the overall survival rate for children with cancer today has improved. The overall 5-year survival rate is 84.5%, and for acute lymphoblastic leukemia (the most common form of childhood cancer), the 5-year survival is 88.5%

The parent of a child on chemotherapy contacts the health care provider because her child was exposed to chickenpox and wants to know what to do. What is the nurse's best response?

*"Your child can be given zoster immune globulin to prevent chickenpox."* Zoster immune globulin may be administered if the child has not been immunized against varicella and is exposed to chickenpox during chemotherapy. Caution parents that live-virus vaccines should not be given during chemotherapy because if the child's immune mechanism is deficient these vaccines could cause widespread viral disease. Nonlive vaccines are also not given while receiving chemotherapy since the immune system cannot mount the response necessary to create immunity. Although diphenhydramine may help itching, there is a preventive function with zoster immune globulin.

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence?

*Acute lymphoblastic leukemia (ALL)* Acute lymphoblastic leukemia accounts for approximately 32% of all childhood cancers. Neuroblastomas account for 8%; non-Hodgkin lymphoma accounts for 6%; osteogenic sarcoma accounts for 3%.

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent?

*Body appearance changes very little.* An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis.

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority?

*Educating the child and family about the testing procedures* The priority would be educating the child and family about the testing procedures so they know what to expect and understand why the tests are being performed. Applying EMLA to the lumbar puncture site will be done prior to the procedure. The family will be educated about chemotherapy and its side effects prior to the therapy beginning, and promethazine or other antiemetics will be administered once chemotherapy has begun.

The nurse is developing a plan of care for a child who is receiving cyclophosphamide. What advice would the nurse expect to include?

*Encouraging frequent voiding during and after the infusion* Cyclophosphamide may cause hemorrhagic cystitis. Therefore, the nurse needs to provide adequate hydration and have the child void frequently during and after the infusion to decrease the risk of hemorrhagic cystitis. Fluids need to be encouraged, not withheld. Monitoring for anaphylaxis would be appropriate when asparaginase or etoposide is given. Bone pain is associated with the administration of filgrastim or sargramostim.

The nurse is planning a discussion group for parents with children who have cancer. How would the nurse describe a difference between cancer in children and adults?

*Most childhood cancers affect the tissues rather than organs.* Childhood cancers usually affect the tissues, not the organs, as in adults. Metastasis often is present when the childhood cancer is diagnosed. Childhood cancers, unlike adult cancers, are very responsive to treatment. Unfortunately, little is known about cancer prevention in children.

A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report?

*mediastinal mass* Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph) in the client with Hodgkin disease. Hepatomegaly or splenomegaly may occur when there is advanced disease. Lymphadenopathy is present in the cervical and supraclavicular nodes. These could be palpated and do not require an x-ray to diagnose. Presence of a white reflection in the pupil of the eye may indicate retinoblastoma.

A nurse is instituting neutropenic precautions for a child. What information would the nurse most likely include? Select all that apply.

Avoiding rectal exams, suppositories, and enemas Placing a mask on the child when outside the room Discouraging fresh flowers in the child's room Generally, neutropenic precautions include placing the child in a private room; avoiding rectal suppositories, enemas, and examinations; placing a mask on the child when outside the room; avoiding the intake of raw fruits and vegetables; and not permitting fresh flowers or live plants in the room.

The nurse performing a physical assessment of a client checks for signs of malignancies. Which findings may indicate a soft tissue mass? Select all that apply.

Cranium masses Swelling around eyes Drainage from ear Soft tissue masses occur most often in younger children. The most common type is rhabdomyosarcoma. This cancer affects the head, neck, arms, legs, and the genitourinary tract. Assessment for this type of cancer may include middle ear drainage, facial nerve palsy, dysphagia, painless mass in the thorax, a mass in the vagina, and hematuria. Masses on the cranium may indicate either soft tissue or bony mass. Pallor, bruising, petechiae, or mucous membrane bleeding may indicate leukemia. Night sweats may be present in Hodgkin disease.