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Who has a high likelihood of getting Leukemia?
Downs kids
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What lab will dx leukemia?
High amounts of immature WBC-Blasts
But bone marrow dysfunction showing decreased WBC, RBC, platelets
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S/S that you have leukemia....
- Bruising
- Petachiae
- Nose bleeds
- Wt. loss
- Weak
- Chills/Fever
- Bone pain
- Tachy
- UTI/URI
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DX of Leukemia
- CBC
- Bone Marrow Aspiration
- Lumbar Puncture
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S/S of Lymphomas
painless enlarged lymph node, tonsils and adenoids
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How do you treat Leukemia?
- chemotherapy
- If relapse..redo chemo then move to bone marrow transplant and stem cell transplant
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How do treat Lymphomas?
- Chemo
- Bone Marrow Transplant
- Stem Cell Transplant
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What cancer is at risk for tumor lysis?
Lymphomas
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Two types of bone tumors
Osteosarcoma and Ewings Sarcoma
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Osteosarcoma is usually found where? and is mistaken for what?
femur, tibia, humurus
growing pains....may limp
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Ewing's sarcoma is usually found where? and is mistaken for what?
femur, vertebra, pelvis, ribs
infection-pain, fever and a soft tissue mass around affected bone
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Which bone cancer is most likely to result in amputation
Osteosarcoma
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How is Osteosarcoma treated?
Chemo before and after surgery
Possible amputation
Radiation only for pain control/palliative care
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How is Ewing's Sarcoma treated
Chemotherapy before surgery to debulk the tumor and then resect the tumor
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What is Nueroblastoma?
it is a solid tumor that is typically found in the abdomen and on adrenal glands
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What can Neuroblastoma be mistaken for?
cold or flu
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S/S of Neuroblastoma
- Anemia
- Fever
- Myoclonic/Rotational eye movements
- *Mass across midline of abdomen
- Anorexia/diarrhea/constipation
- Respiratory distress
- Swallowing Difficulty
- Abnormal Gait
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2 cancers you don't want to palpate
Neuroblastoma and Wilm's Tumor (Nephroblastoma)
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How do you treat Neuroblastoma?
- Surgery
- Chemo and Radiation and Bone Marrow Transplant
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Name a Neprhroblastoma cancer
Wilm's Tumor
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What is Wilm's Tumor?
renal tumor
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S/S of Wilm's tumor
- firm abdominal mass on one side
- abdominal pain
- HTN
- Hematuria
- Anemia/Fatigue
- Fever
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How do you treat Wilm's Tumor?
- Nephrectomy
- Chemo and Radiation
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What do you monitor closely on a patient with Wilm's Tumor?
Blood pressure....increases prior to surgery and can go either way after surgery
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S/S of brain tumor
- Headache
- Vomiting in AM
- change in LOC
- Increased head circumfrence
- Change in balance
- Change in mood
- Vision changes
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Treatment for brain tumors
- surgeries
- radiation
- chemo
- supportive care
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Post op for a child after brain surgery
- raise HOB
- monitor ICP
- prevent infection
- protect airway
- watch for seizures, vomiting, facial edema
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Complications of brain tumors/surgery
- neuro deficits
- learning disabilities
- developmental delays
- paralysis
- Bell's Palsy
- Seizures
- Blindness
- Respiratory/airway compromise
- Hydrocephalus
- coma
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Normal Platelets
200,000-500,000
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ANC levels
- 1,500-2,000 low risk for infection
- 500-1,000 Moderate risk for infection
- <500 severe risk for infection
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Bleeding precautions when a kid has thrombocytopenia
- soft toothbrush
- no rectal temps
- avoid trauma, punctures and invasive procedures when possible
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What is given prophylactically with chemo?
antibiotics to prevent infection
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How do you calculate ANC?
WBC x Segs x Bands
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What does chemo wipe out?
immune system-bone marrow
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Intensification
treatment of areas not caught during induction
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Maintenance
longest phase with a goal of maintaining remission and preventing relapse
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Bone marrow-
Autologous
Allogenic
- Autologous-own marrow
- Allogenic-donated by family member or stranger
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What sort of vaccines don't you give to a person on chemo?
live virus
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Only sign of infection
fever....no immune response so wont see normal signs of infection
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If patient has a fever what will I do?
- antibiotics for T>38
- cultures-blood, urine and sputum
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What childhood illness can be deadly for a chemo patient
chicken pox
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Antibiotic that prevents opportunistic infections
Bactrim
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Central Line Care
- Need to teach patient impeccable care
- routine flushes
- dressing changes
- cap and tubing changes
- s/s of infection
- culture blood from line and site
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Early Septic Shock s/s/
- bounding pulses
- warm extremities
- flushing
- tachypnea
- tachycardia
- irritability
- restless
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Late Septic Shock s/s
- lethargy to coma
- hypotension
- widened pulse pressure
- tachycardia-bradycardia episodes
- weak pulses
- cold extremities
- increased cap. refill time
- peripheral cyanosis
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Problem with reverse isolation
cant go to play room or outside of room....get child life to help with diversional needs
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How do we care for stomatitis
- routinely check mouth for signs of infection
- mouthwash for cleaning and pain relief
- oral Nystatin for candida
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What's tumor lysis?
when the cancer cells are killed they dump their intracellular contents in to the extracellular fluids
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What are the lytes dumped in to extra cellular fluids with tumor lysis? Weird one?
- Hyperkalemia
- Hyperphosphatemia
- Hypocalcemia
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Complication from K and P being dumped during tumor lysis?
can cause acute renal failure
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Who gets tumor lysis a lot?
leukemias and non hodgkins lymphoma
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How do you treat tumor lysis syndrome?
- treat hyperkalemia
- intensive hydration
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2 meds given to a person experiencing tumor lysis syndrome to decrease urine acidity
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