1. S/S of cancer
    • Fever
    • Swollen glands
    • Frequent infection
    • Anemia
    • Bruising!
  2. Most common types of cancer
    • Leukemia
    • Lymphoma
    • Brain cancer
    • Osteocsarcoma in teens
  3. What is a neoplasm?
    A new grothw that is iether benign or malignant.
  4. Metastasis ends in
  5. solid mass, welll defined borders, usually encapsulated, grows slow, easliy removed and not recur, typically harmless but can be destructive
  6. May travel through blood or lymph nodes, invades other tissues and organs
  7. Clinical manifestations of caner
    • Pain
    • Cachexia
    • Anemia
    • Infection"
    • Bruising
    • Neurologic symptoms > ICP leads to change in LOC)
    • Palpable mass
  8. Syndrome charactereized by anorexia, weight loss, anemi, asthenia, weakness - WASTED Appearance
  9. Weight loss
    Often the first symptom that brings clients to provider for cancer
  10. Anorecia
    symptom of cancer, with food aversion
  11. Normal hgb 2 months old
  12. Normal HGB 6 - 12 years
  13. normal hgb 12-18 years old
    • 13-16 male
    • 12-16 female
  14. WBC 1 mo to 7 years
    5000-15(7 years), 17, 19,000 (1 month)
  15. Normal platelets
  16. In cancer, seen in CBC, what would you see in HGB, HCTG and platelets?
  17. Bleeding times seen in labs during cancer
  18. How to assess renal function
    Increased bun and creatinine
  19. Why do bleeding times increase?
    Destruction of platelets
  20. Diagnostics for cancer
    • BMA (bone marrow aspiration)
    • Bioplsy
    • Lumbar puncture
    • MRI, CT
    • Ultrasound
  21. Nursing interventions for biopsy
    • Assess site for bleeding
    • prevent infection
    • provide pain releif
  22. Pressure to site after bone aspiration
    5-10 minutes
  23. Assess vs freqently after
    bone marrow aspiration
  24. Assess bleeding and infection for how long after bone marrow aspiration?
    24 hours
  25. Nursing interventions for CT or MRI?
    Allergies to shellfish/dye
  26. Who should not have an MRI?
    Children with metal (remove jewelry, body piercings
  27. No metal snaps in clothing
  28. May need to sedate child for what test?
  29. Naming the tumor
  30. Describing a tumors aggressiveness
  31. spread within or beyond the tissue of origin
  32. Grade 1, most differentiated
    least malignant
  33. Grading 4
    Most malignant cells, least differentiated
  34. least differentiated grading
  35. Staging parts
  36. T of staging
    Tumor size dept and invasion
  37. N of staging
    Presense and extent of lymp node involvement
  38. M in staging
    presence or absense of distant metastisis
  39. What determines recommeded treatment?
  40. Stage 1
    less severe cancer without metastasis
  41. After surger a tumor is
    sent for study
  42. Borders after surgery
    determines if the entire tumor was removed
  43. Lymph nodes and surgery
    Removed and analyzed for metastasis
  44. Surgery is used to
    remove or reduce the size of a tumor
  45. Willms tumor is tx with
    surgery (kidney tumor)
  46. Surgery can also determine what aspects of cancer?
    size and stage
  47. How is chemo adminstered?
    Oral, IV, direct infusion into intraperitonela or intrapleural body cavaties or vascular access device
  48. Implated port or Hickman catheter (VAD)
    Used to deliver chemo and also used for TPN pain managment
  49. lenght of time of precaustions after single agent chemotherapy
    48 hours
  50. Multi agent chemo, precaustions for
    5 days
  51. Treatment regimen in cycles, rest periods allowed
  52. Threatment continued until remission or if disease progresses, a new protocol may be tried
  53. Chemo can
    • cure some cancer
    • decrease tumor size
    • used in adjunction with surgery or radiation
    • prevent or treat metastasis
  54. Plan of action for chemo based on
    • Results of stagin
    • type of cancer
    • location
    • ell type
    • degree of metast
    • agents that have greated therapuetic effect while minimizing side effects
  55. who administered chemo?
    trained and certified personnel
  56. Must wear gloves, mask and gown when preparing drug and disposal
  57. S/E of chemo
    • BM supression
    • Anemai, neutropenia (WBC), Thrombocytopenia;
    • PAIN
    • anorexia, nausea, vomit
    • weight loss
  58. More side effects of chemo
    • stomatitis
    • Alopecia
    • Imparied reproductive ability
    • Fatigue
  59. Avoid what meds during chemo
  60. Platelet level at high risk for spontaneuous bleeding
  61. S/S bleeding
    • bruiseing
    • petechia
    • purpura
  62. Neutrophil count increased risk for infection
  63. Neutrophil count severe risk for infection
  64. Administer antimocrobial, antiviral, antifungal PRN within
    30 minutes
  65. Signs of inflammation in cancer
    pain and swelling
  66. Hormone that enhances blood cell production and counteracts the myelosppresive effects of chemo
    CSF Colony Stimulating Factors
  67. CSF
    Colonly stimulating factors, helpful drug during chemo
  68. CSH
    Colony stimulating hormone
  69. Used when RBC's low due to chemo
    Epoetin alfa
  70. Give SQ or IV (CSH)
    Epoetin alfa, Neupogen
  71. Blood tiests prior to and after administration (CSG)
    Epoetin alfa
  72. Improvement in hematocrit in 7-14 days after administration (CSH)
  73. Monitor BP before and during therapy (CSH)
    Epoetin alfa
  74. CSH, monitor LOC
    Epoetin alfa
  75. Increased priduction of WBC's/neutrophils (CSH)
  76. Do not tive within 24 hours before or after chemo or their effect will be decreased (CSH)
  77. Obtain a baseliune CBC and then twice weekly (CSH)
  78. Monitor for headaches, fever, bone pain (CSH)
  79. Increases platelet count
    Hematopoietic growth factor
  80. Administer SQ (CSH)
  81. Obtain baseline CBC and platelet count; monitor platelets during tx (CSH)
  82. Side effects of:
    Edema, fever, CNS changes, daily weights and monitor for lfuid retntion (CSH)
  83. Antiemetic, adminstered BEFORE meals
  84. Non pharm for anorexia, nausea, vomit
    • Pleasant atmospheere
    • Pt select food fluids
    • smaller more frequent meals
    • nutritional supplement.s
  85. Avoid acidic foods in
  86. administer oral preperations as ordered
    stomattis, dry mouth
  87. Use gentl shamoo and brush gently
  88. no blow dryers/curling irons
  89. How long before alopecia shows up
    10 days t 2 weeks
  90. Goal of radiation
    irradiate tumor, not healthy tissue
  91. Examples of radation in children
    • rhabdomyosarcoma
    • brain tumor
    • stage III Wilms tumor
    • Hodgkin disease
  92. Avoid what after radiation?
    • soap, creams, lotions over area
    • avoid hot or water
    • wear loose clothing
    • avoid tape
    • avoid sunlight
    • medical care for blisters, weeping, red/tender skin
  93. Replacement of hematopoeitc stem cells after own bone marrow destroeyed
    hematopoetic stem cell transplattion
  94. What is treated with Hematopoietic stem cell
    Leukemia, neuroblastoma, aplastic anemia, lymphoma
  95. Autolgous
    your own
  96. isogenetic
  97. allogeneic
  98. histocompatible
    national marrow donor
  99. How long is the pretransplant phase?
    4-12 days
  100. pretransplant phase for destruction of bone marrow
    • High dose chemo
    • Total irradiation to kill cells and diseased bone marrow
    • STRICT isolation
  101. After bone marrow transplant, w/o immunity at least __ days after transplant
  102. IV transfusion with donor stem cells
    liek blood transfusion
  103. Stem cells migrate to....during transplant phase
    bone marrow
  104. If successful transplant, what happens?
    cells implant in bone and grow
  105. how long after transplant do hematopoietic cells start producing?
    2-4 weeks
  106. Post transplant, watch for
    • Pancytopenia
    • Infection, anemia, bleeding
    • May need trasnfustion of RBC and platelets
    • Aletered nutrition>TPN
    • Immosuppriive given to prevent granft versus host disease
  107. Major threat post transplant, requiring immunosupressive agents
    graft versus host disease
  108. Great source for stem cells
    Umbilical cord blood
  109. What cells are ealisy collected from umbilical cord
    Peripheral stem cells
  110. Can reproduce into RBCs WBC and platelets, and treats many dieases
    Cord blood
  111. Complementary therapies
    • Nutritional supplements
    • Herbal supplements
    • Touch therapy
    • Mind/body interventions
  112. Hematologic emergencies result from
    bone marrow suppression
  113. Have anemia and thrombocytopenia, it is a
    hematologic emergency
  114. TX for hematologic emergencies
    packed RBC for anemai, platelet tranfusion, vitamin K, and FFP for thrombocytomenai and mehorrhage
  115. redness and pus may not be apparent with
    neutropenic infections
  116. Varicella immune globulin w/in
    72 hours
  117. Do not give what vaccinations?
    OPV, MMR
  118. Nothing by rectum why?
    Risk of infection, bleeding
  119. soft music, lulabies, songs of caregiver singing for tx of
    nausea and vomiting
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