peds cancers exemplars (wk 5) pt. 2

osteosarcoma:

**malignant tumor of the bone (proliferation of osteoblasts)

when should a family of a child w cancer call the oncologist:

- FEVER!!!! (101+) - cough or rapid breathing - increased bruising, bleeding or petechiae, pallor, or increased levels of fatigue - earache, sore throat, nuchal rigidity - blisters, rashes, ulcers - red, irritated skin on child's butt - abdominal pain, difficulty or pain with eating, drinking, or swallowing - constipation or diarrhea - DO NOT GIVE ASPIRIN

options of reducing pain during tx/tests:

- Use of EMLA cream for lumbar punctures, bone marrow aspirations, intrathecal medication administration, etc. - Distraction - Mild analgesics (acetaminophen) - Heat and cold therapy - Narcotic analgesics as ordered for severe and or chronic pain

osteosarcoma most commonly affects what group

- adolescents - white males

ALL is most common in what children

- ages 2-10 - white children

complications of ALL:

- infection - hemorrhage - inadequate growth - metastasis

ALL complications:

- metastasis - impacts to neurocognitive function, cardiovascular function, and thyroid

tx of neuroblastoma: (3)

1. chemo 2. radiation 3. surgical removal of tumor

stages of leukemia tx:

1. induction: rapid induction of complete remission (3-4 wks) 2. consolidation: strengthen remission, reduce leukemic cell burden (varies) 3. maintenance: eliminate all residual leukemic cells (2-3 yrs) + CNS prophylaxis: reduces risk of CNS involvement (occurs periodically throughout all stages)

best prognosis of ALL occurs with WBC of less than what at diagnosis

50,000

ALL affects what of the body

Affects the bone marrow- normal bone marrow contents are replaced with abnormal white blood cell

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care? A. Avoiding further abdominal palpation B. Performing dressing changes to the affected area C. Administering analgesics for pain D. Preparing the child for amputation

Answer A: avoiding further abdominal assessment After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.

The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess? A. Severe bone pain B. Gait changes C. Erythema of the extremity D. Swelling of the extremity

Answer A: severe bone changes Osteosarcoma typically is characterized by dull bone pain that may be present for several months, eventually progressing to limp or gait changes. The affected limb may exhibit erythema and swelling, warmth, and tenderness.

An adolescent who had radiation for a previous malignancy has presented to the pediatric oncology clinic. Which malignancy is the nurse concerned could develop as a complication? A. brain tumor B. Hodgkin disease C. osteosarcoma D. acute myeloid leukemia

Answer C. Osteosarcoma is a malignant tumor of long bone involving rapidly growing bone tissue (mesenchymal-matrix forming cells). It occurs more commonly in boys than in girls and in children who have had radiation for other malignancies as a later life effect. The etiology of a brain tumor and AML is unknown. Hodgkin disease is thought to be related to genetic and environmental factors.

the goal of chemotherapy before surgical removal is what in osteosarcoma

Chemotherapy before to shrink the tumor and after surgery to reduce risk for metastasis

ALL cure rate:

Cure rate is 70%+

Neuroblastoma patho

Most common extracranial solid tumor and most common solid tumor in children Tumors originate from embryonic neural crest cells (neural blasts) that normally give rise to the adrenal medulla and the SNS → therefore, majority of the tumors arise from the adrenal glad or retroperitoneal sympathetic chain

what tx is required for osteosarcoma

Surgical removal is required which may or may not include amputation

neuroblastoma is usually diagnosed before what age

age of 5

peripheral blood smear is used to assess for _____

blasts

Acute Lymphoblastic Leukemia affects what group

children (1/3 of childhood cancers are leukemia)

where does osteosarcoma form?

forms in embryonic mesenchymal tissue of the bones, most commonly the long bones (humerus, tibia, and femur) - Can metastasize to the lungs and other bones

what is the goal of osteosarcoma tx?

goal is to spare the limb or use a limb-sparing surgery (remove affected bone and replace w prosthesis or cadaver bone)

where do neuroblastomas usually occur

in the abdomen but can be found in the chest or retroperitoneum

ALL classification:

is based on the type of cell involved (T cell, B cell, early pre-B cell, or pre-B cell)

LFTS, BUN, and Cr is used to identify what

most appropriate chemo option

when is neuroblastoma usually diagnosed

once metastasis has occurred

what is the most common malignant bone cancer in children

osteosarcoma

ALL has what kind of prognosis

pretty treatable and curable

in ALL, what will result in a poorer prognosis

relapse

lumbar puncture is used to assess for what cells

to assess for leukemic cells in CNS

chest x-rays are used to detect what

to assess/detect for pneumonia or masses

bone marrow aspiration is used to identify and assess...

to identify if greater than 25% lymphoblasts, also can assess for chromosomal abnormalities, can aid in classifying leukemia

neuroblastoma's prognosis is dependent on what

tumor location, stage, and age of diagnosis

ALL nursing management:

• Complication management (infection, pain, bleeding, etc.) •Blood transfusions (must be irradiated, CMV negative, and leukodepleted) in order to decrease antibodies and preventing GVHD) •Reduce pain: - Use of EMLA cream for lumbar punctures, bone marrow aspirations, intrathecal medication administration, etc. - Distraction - Mild analgesics (acetaminophen) - Heat and cold therapy - Narcotic analgesics as ordered for severe and or chronic pain •Infection prevention: neutropenic precautions, handwashing, administer vaccines but not live vaccines •Promoting nutrition: monitor height and weight weekly, nutrient rich meals, smaller more frequent meals, antiemetics if needed •Promote activity •Growth an development and psychosocial interventions

neuroblastoma health hx assessment: (what to assess for:)

•Abdomen swelling •Bowel or bladder dysfunction •S/S of metastases

ALL labs and dx:

•CBC •Peripheral blood smear •Bone marrow aspiration •Lumbar puncture •LFTs and BUN and creatinine •Chest x-ray

osteosarcoma labs and dx:

•CT or MRI to evaluate the tumor and for any metastasis •Bone scan to see if any metastasis

neuroblastoma labs and dx:

•CT or MRI: tumor size and if any metastases •Chest x-ray, bone scan to see if any metastases •Bone marrow aspiration and biopsy to see if there have been any bone metastasis

ALL pathophys:

•Cause is unknown- genetics and chromosome abnormalities may be a link 1. Abnormal lymphoblasts develop in the blood forming tissues and lack ability to fight infections 2. The lymphoblasts proliferate and replace the normal bone marrow cells 3. The proliferation impacts metabolism as they take the nutrients causing fatigue, weight loss, muscle loss, etc. 4. Bone marrow is not able to maintain normal levels of RBCs, WBCs, and platelets resulting in anemia, neutropenia, and thrombocytopenia 5. Leukemic cells can invade the bone, joint, lymph nodes, central nervous system, etc.

osteosarcoma nursing management:

•Developmentally appropriate pre op teaching for any surgery •If amputation is required, teach patient and family care of the stump and teach the patient crutch walking •Support in changes in body image - Peer support groups

ALL hx assessment:

•Fever (persistent or recurrent) •Infections •Fatigue, malaise •Pallor •Bleeding and bruising •Abdominal pain, nausea, vomiting, •Pain: headaches, bone pain •Risk factors- caucasion, down syndrome, fetal x-ray exposure, previous radiation, 2-10 yrs of age

osteosarcoma nursing assessment: (emphasis of what and inspect/palpate for what)

•Health History- emphasis on pain (dull bone pain for several months) •Physical Exam: - Inspect and palpate limb for erythema or swelling, and affected area for warmth and tenderness - Limp or gait concerns

neuroblastoma phys exam assessment:

•Neck and/or swelling of the face •Eyes for bruising and edema •Skin: pallor, bruising •Resp: work of breathing, wheezes with auscultation Palpation: cervical lymphadenopathy, abdomen for firm, nontender mass, hepatomegaly, splenomegaly

neuroblastoma nursing management:

•Post op care following surgical removal •Administer and manage side effects of chemotherapy and radiation •Emotional support and referrals

what is ALL prognosis based on:

•Prognosis is based on the WBC count at diagnosis, cytogenic factors and immunophenotype, age of diagnosis, and amount of extramedullary involvement

ALL phys exam: (observation, auscultation, palpation)

•Temperature to assess for fever •Skin: petechia, purpura, bruising, infections •Lung sounds- pneumonia •Assess for enlarged lymph nodes •Palpate liver and spleen—may be enlarged •Note any tenderness in abdomen •Pain assessment