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S/S of cancer
- Fever
- Swollen glands
- Frequent infection
- Anemia
- Bruising!
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Most common types of cancer
- Leukemia
- Lymphoma
- Brain cancer
- Osteocsarcoma in teens
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What is a neoplasm?
A new grothw that is iether benign or malignant.
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solid mass, welll defined borders, usually encapsulated, grows slow, easliy removed and not recur, typically harmless but can be destructive
benign
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May travel through blood or lymph nodes, invades other tissues and organs
Malignant
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Clinical manifestations of caner
- Pain
- Cachexia
- Anemia
- Infection"
- Bruising
- Neurologic symptoms > ICP leads to change in LOC)
- Palpable mass
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Syndrome charactereized by anorexia, weight loss, anemi, asthenia, weakness - WASTED Appearance
Cachexia
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Weight loss
Often the first symptom that brings clients to provider for cancer
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Anorecia
symptom of cancer, with food aversion
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Normal hgb 2 months old
9-14
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Normal HGB 6 - 12 years
11.5-15.5
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normal hgb 12-18 years old
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WBC 1 mo to 7 years
5000-15(7 years), 17, 19,000 (1 month)
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Normal platelets
150-400k
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In cancer, seen in CBC, what would you see in HGB, HCTG and platelets?
Decreased
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Bleeding times seen in labs during cancer
Increased
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How to assess renal function
Increased bun and creatinine
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Why do bleeding times increase?
Destruction of platelets
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Diagnostics for cancer
- BMA (bone marrow aspiration)
- Bioplsy
- Lumbar puncture
- MRI, CT
- Ultrasound
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Nursing interventions for biopsy
- Assess site for bleeding
- prevent infection
- provide pain releif
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Pressure to site after bone aspiration
5-10 minutes
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Assess vs freqently after
bone marrow aspiration
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Assess bleeding and infection for how long after bone marrow aspiration?
24 hours
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Nursing interventions for CT or MRI?
Allergies to shellfish/dye
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Who should not have an MRI?
Children with metal (remove jewelry, body piercings
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No metal snaps in clothing
MRI
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May need to sedate child for what test?
MRI
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Naming the tumor
classification
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Describing a tumors aggressiveness
grading
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spread within or beyond the tissue of origin
stagin
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Grade 1, most differentiated
least malignant
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Grading 4
Most malignant cells, least differentiated
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least differentiated grading
4
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T of staging
Tumor size dept and invasion
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N of staging
Presense and extent of lymp node involvement
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M in staging
presence or absense of distant metastisis
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What determines recommeded treatment?
Staging
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Stage 1
less severe cancer without metastasis
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After surger a tumor is
sent for study
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Borders after surgery
determines if the entire tumor was removed
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Lymph nodes and surgery
Removed and analyzed for metastasis
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Surgery is used to
remove or reduce the size of a tumor
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Willms tumor is tx with
surgery (kidney tumor)
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Surgery can also determine what aspects of cancer?
size and stage
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How is chemo adminstered?
Oral, IV, direct infusion into intraperitonela or intrapleural body cavaties or vascular access device
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Implated port or Hickman catheter (VAD)
Used to deliver chemo and also used for TPN pain managment
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lenght of time of precaustions after single agent chemotherapy
48 hours
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Multi agent chemo, precaustions for
5 days
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Treatment regimen in cycles, rest periods allowed
Chemo
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Threatment continued until remission or if disease progresses, a new protocol may be tried
Chemo
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Chemo can
- cure some cancer
- decrease tumor size
- used in adjunction with surgery or radiation
- prevent or treat metastasis
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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
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who administered chemo?
trained and certified personnel
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Must wear gloves, mask and gown when preparing drug and disposal
Chemo
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S/E of chemo
- BM supression
- Anemai, neutropenia (WBC), Thrombocytopenia;
- PAIN
- anorexia, nausea, vomit
- weight loss
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More side effects of chemo
- stomatitis
- Alopecia
- Imparied reproductive ability
- Fatigue
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Avoid what meds during chemo
ASA, NSAIDS
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Platelet level at high risk for spontaneuous bleeding
20000
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Neutrophil count increased risk for infection
<2000
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Neutrophil count severe risk for infection
<500
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Administer antimocrobial, antiviral, antifungal PRN within
30 minutes
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Signs of inflammation in cancer
pain and swelling
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Hormone that enhances blood cell production and counteracts the myelosppresive effects of chemo
CSF Colony Stimulating Factors
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CSF
Colonly stimulating factors, helpful drug during chemo
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CSH
Colony stimulating hormone
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Used when RBC's low due to chemo
Epoetin alfa
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Give SQ or IV (CSH)
Epoetin alfa, Neupogen
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Blood tiests prior to and after administration (CSG)
Epoetin alfa
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Improvement in hematocrit in 7-14 days after administration (CSH)
Epoetin
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Monitor BP before and during therapy (CSH)
Epoetin alfa
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CSH, monitor LOC
Epoetin alfa
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Increased priduction of WBC's/neutrophils (CSH)
Filgastrim
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Do not tive within 24 hours before or after chemo or their effect will be decreased (CSH)
Filgastrim
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Obtain a baseliune CBC and then twice weekly (CSH)
Filgastrim
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Monitor for headaches, fever, bone pain (CSH)
Filgastrim
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Increases platelet count
Hematopoietic growth factor
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Administer SQ (CSH)
Neumega
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Obtain baseline CBC and platelet count; monitor platelets during tx (CSH)
Neumega
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Side effects of:
Edema, fever, CNS changes, daily weights and monitor for lfuid retntion (CSH)
Neumega
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Antiemetic, adminstered BEFORE meals
Zofran/Ondansetron
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Non pharm for anorexia, nausea, vomit
- Pleasant atmospheere
- Pt select food fluids
- smaller more frequent meals
- nutritional supplement.s
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Avoid acidic foods in
stomatitis
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administer oral preperations as ordered
stomattis, dry mouth
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Use gentl shamoo and brush gently
alopecia
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no blow dryers/curling irons
alopecia
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How long before alopecia shows up
10 days t 2 weeks
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Goal of radiation
irradiate tumor, not healthy tissue
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Examples of radation in children
- rhabdomyosarcoma
- brain tumor
- stage III Wilms tumor
- Hodgkin disease
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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
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Replacement of hematopoeitc stem cells after own bone marrow destroeyed
hematopoetic stem cell transplattion
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What is treated with Hematopoietic stem cell
Leukemia, neuroblastoma, aplastic anemia, lymphoma
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histocompatible
national marrow donor
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How long is the pretransplant phase?
4-12 days
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pretransplant phase for destruction of bone marrow
- High dose chemo
- Total irradiation to kill cells and diseased bone marrow
- STRICT isolation
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After bone marrow transplant, w/o immunity at least __ days after transplant
10
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IV transfusion with donor stem cells
liek blood transfusion
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Stem cells migrate to....during transplant phase
bone marrow
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If successful transplant, what happens?
cells implant in bone and grow
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how long after transplant do hematopoietic cells start producing?
2-4 weeks
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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
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Major threat post transplant, requiring immunosupressive agents
graft versus host disease
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Great source for stem cells
Umbilical cord blood
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What cells are ealisy collected from umbilical cord
Peripheral stem cells
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Can reproduce into RBCs WBC and platelets, and treats many dieases
Cord blood
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Complementary therapies
- Nutritional supplements
- Herbal supplements
- Touch therapy
- Mind/body interventions
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Hematologic emergencies result from
bone marrow suppression
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Have anemia and thrombocytopenia, it is a
hematologic emergency
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TX for hematologic emergencies
packed RBC for anemai, platelet tranfusion, vitamin K, and FFP for thrombocytomenai and mehorrhage
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redness and pus may not be apparent with
neutropenic infections
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Varicella immune globulin w/in
72 hours
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Do not give what vaccinations?
OPV, MMR
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Nothing by rectum why?
Risk of infection, bleeding
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soft music, lulabies, songs of caregiver singing for tx of
nausea and vomiting
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