NCLEX/HESI Pediatric Oncology Problems

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandparent of the child visits and brings a fresh bouquet of flowers picked from the garden and asks the nurse for a vase for the flowers. Which response would the nurse provide to the grandparent?

"The flowers from your garden are beautiful, but cannot be placed in the child's room at this time." * standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and need to be avoided until the white blood cell count increases.

Neuroblastoma

A tumor that originates from the embryonic neural crest cells. Firm, nontender mass is abdomen. Urinary frequency and retention. Lyphadenopathy. Bone marrow pain. Suborbital Ecchymosis/edema. Pallor, weakness, irritability. Anorexia/weight loss. Respiratory and neurological impairment. Urine analysis=vanillylmandelic acid, homovanillic acid, dopamine, and norepinephrine.

Hodgkin's disease

A type of cancer that affects the lymph tissue with the presence of Reed-Sternberg cells. -Enlarge, firm, nontender. -Nonproductive cough. -Abdominal pain. -fever. -nausea. -Weightless

A 4-year-old child is admitted to the hospital for abdominal pain. The parents report that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis?

Bone marrow biopsy showing blast cells

Late ICP signs

Bradycardia ■ Decreased motor response to command ■ Decreased sensory response to painful stimuli ■ Alterations in pupil size and reaction ■ Decerebrate (extension) or decorticate (Flexion) posturing ■ Cheyne-Stokes respirations ■ Papilledema ■ Decreased consciousness ■ Coma

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 (19.5 × 109 /L). On the basis of this laboratory result, which intervention would the nurse include in the plan of care?

Initiate bleeding precautions. *If a child has a low platelet count, usually less than 50,000 mm3 (50.0 × 109 /L), bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage.

Behavioral signs of ICP

Irritability, restlessness ■ Indifference, drowsiness ■ Decline in school performance ■ Diminished physical activity and motor performance ■ Increased sleeping ■ Inability to follow simple commands ■ Lethargy

Brain tumors

MRI determines location and extent. Surgery, radiation and chemo. Headaches upon waking. Vomiting. Ataxia. Seizures. Behavioral changes. Clumsiness/awkward gait. Diplopia. Facial weakness. Signs of ICP.

Osteosarcoma (osteogenic sarcoma)

Malignant tumor of the long bone, 13-16. Localized pain. Palpable mass. Limping. Limited ROM and strength.

A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action?

Notify the physician

The parent of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the parent tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, would plan to avoid which during the physical assessment?

Palpating the abdomen for a mass. * this tumor is an intra-abdominal and kidney tumor

Pre and post op interventions for brain tumors

Perform a neurological assessment at least every 4 hours. Institute seizure precautions. Assess weight loss and nutritional status. Shave the child's head as prescribed. Prepare the child as much as possible. Assess neurological and motor function and LOC. Closely monitor temperature-maintain a cooling blanket by the bedside. Monitor for signs of respiratory infection. Monitor for signs of meningitis (opisthotonos, Kernig's and Brudzinski's signs). Monitor for signs of increased ICP. Monitor pupil response. Monitor hemorrhage or colorless drainage. *NEVER place in Trendelenburg.

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection?

Reduce exposure to environmental organisms. Use strict aseptic technique for all procedures. Ensure that anyone entering the child's room wears a mask.

A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will conrm the diagnosis of Hodgkin's disease?

The presence of Reed-Sternberg cells in the lymph nodes

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 FURTHER instruction?

"The child does not experience pain at the primary tumor site." *Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site.

Protection from bleeding interventions

-Soft toothbrush. -No floss. -Soft foods. -Pressure to needlestick site. -Pad side rails. -Avoid blowing nose. -Avoid aspirin. -No enemas.

Leukemia symptoms

Fever Pallor Fatigue Anorexia Hemorrhage/petechiae. Bone and joint pain. Hepatosplenomegaly. Lymphadenopathy. Decreased hemoglobin and hematocrit. Cranial nerves VII-facial. ICP.

Nephroblastoma (Wilms tumor)

Genetic cancerous kidney tumor of childhood; peak 3 years. Swelling abdomen mass. urinary retention or hematuria. Pallor, Anorexia, Lethargy from anemia. Hypertension. Weight loss and fever. *DO NOT palpate the abdomen.

Initial ICP signs

Infants: ■ Tense, bulging fontanel ■ Separated cranial sutures ■ Macewen's sign (cracked-pot sound on percussion) ■ Irritability ■ High-pitched cry ■ Increased head circumference ■ Distended scalp veins ■ Poor feeding ■ Crying when disturbed ■ Setting sun sign (eyes appear downward, with the sclera seen over the iris, part of the lower pupil may be covered by the lower eyelid) Children: ■ Headache ■ Nausea ■ Forceful vomiting ■ Diplopia; blurred vision ■ Seizures

What is the major cause of death in an immunocompromised child?

Infection because children receiving chemo may not show the typical signs of infection.

The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse would plan to monitor for which early sign or symptom of increased ICP?

Vomiting *nausea, excessive vomiting, diplopia, and headaches

What is the most common side effect of chemo and radiation?

malaise

The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which action would the nurse perform immediately?

notify the surgeon. *Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid.

Leukemia

proliferating immature white blood cells (WBCs), also known as blast cells, depress the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia).