NSG 441 Exam 2
General s/sx of cancer - answer Unusual mass/swelling
Unexplained paleness and loss of energy
Sudden tendency to bruise
Persistent, localized pain/limping
Prolonged unexplained fever/illness
Frequent headaches often with vomiting
Sudden eye and vision changes
Excessive rapid weight loss
Others: swollen lymph nodes, fever, abnormal CXR
Most common type of cancer in children - answer Leukemia
Leukemia - answer cancer of white blood cells
Typically dx between 2-5 yrs
2 main types → genetic testing can be used to differentiate
-Acute lymphoid leukemia (ALL)
-Acute myelogenous (non-lymphoid) leukemia (AML)
What accounts for 1/2 of all pediatric cancers? - answer Leukemia, lymphoma, and CNS tumors
(~25%)
Trisomy 21 increases risk for.... - answer Leukemia
Often seen with cardiac issues
Chemo side effects - answer Nausea, vomiting, anorexia, mucosal ulceration, neuropathy, anemia,
hemorrhagic cystitis, alopecia, dry skin, peripheral neuropathy, mood changes.
Possible cardiac toxicity
Infertility possible
Cushing syndrome from steroid meds
,Chemo side effects interventions - answer Ulcers
-Provide nutrition supplement → it may be easier to DRINK something, than eat solids foods
-Give pain relief
-Provide/ensure good oral care
Use stool softeners
Maintain proper body alignment if the child has difficulty ambulating
Radiation side effects: skin - answer Skin rxn of dry or moist desquamation followed by
hyperpigmentation, increased sensitivity to light
Encourage child to wear LOOSE-FITTING clothes over the area, to minimize any friction or skin
irritation
Wear long sleeve + long pants; stay in shade and wear sunscreen
Radiation side effects: GI - answer N/V, anorexia, mucosal ulceration, diarrhea
To help w/ N/V: give meds
ondansetron (Zofran) (serotonin receptor antagonists)
Radiation side effects: head - answer N/V, alopecia, mucositis, parotitis, sore throat, loss of taste,
Xerostomia
Radiation side effects: bone marrow - answer Myelosuppression
Bleeding and infection prevention
Radiation side effects: lab work - answer Platelets <20,000 mm3
-HIgh risk for bleeding → may cause nose, gum bleeds, internal hemorrhaging
-Hemorrhaging episodes require transfusion of platelets
Absolute Neutrophil Count (ANC) <500 mm3 → at risk for overwhelming infection!!
,-General malaise, 2nd infection, seizures
Hgb <10g/dL → may need transfusion of packed RBCs
3 major problems leukemia causes - answer Anemia d/t decreased RBCs
-Can range from mild to severe
-Fatigue, pallor, lethargy, and transient heart murmur
-Transfusions slow d/t potential heart issues
Increased infections d/t neutropenia
Increased bleeding d/t decreased plt → serious GI/brain bleed
Hodgkin's lymphoma - answer More common in teens → 15-19 yrs
Primarily involves the lymph nodes
-Metastasized mainly to spleen, liver, bone marrow, and lungs
S/sx: enlarged lymph nodes, temp > 100.4 for 3 days, night sweats, unexplained wt loss (> 10% over
last 6 month), fatigue, anorexia, cough, abd discomfort, and pruritus
Non-Hodgkin's Lymphoma - answer Common in children < 14 yrs
Diffuse not nodular → not just in the lymph nodes
-Early and rapid dissemination → metastasize quickly
~Invasion of the meninges is common → CNS s/sx can be present
Variety of manifestations d/t anatomical sites and extended involvement
Wilms tumor precuations - answer Nephroblastoma
Pre-op → no abd palpation
Contact sport precautions for children with 1 kidney
Prompt detection and tx of GU infections → protect their 1 kidney
Retinoblastoma precautions - answer Tumor that arises from the retina
Safety/injury prevention guidelines important to maintain sight in unaffected eye
-Trying to protect the unaffected/healthy eye
, -Avoid contact sports/use eye protection
Immune disorder that mimics s/sx of other GI disorders - answer Eosinophilic GI Disorder →
overproduction of eosinophils causing chronic inflammation and tissue damage.
Variety of s/s b/c it can occur anywhere in the GI tract
Reflux, vomiting, trouble swallowing, abdominal pain, malabsorption, FTT (failure to thrive)
Testing → endoscopy, biopsy
Eosinophilic GI disorder: mgt/tx - answer food elimination diets
elemental diets
-can't eat real food
-given special juice boxes
medications
-steroids, trial study meds
social and psych counseling
Where are children cared for most often at end of life? - answer Typically done at home
Collab with hospice and primary physician
Goal is to meet child's physical, psychological, and spiritual needs
Child should live life to the fullest w/o pain, having choices, and dignity
May continue after child's death to help fam adjust and cope
In the hospital if family is unable to or not comfortable caring for them at home
Principle of Double Effect - answer An action that has 1 good (intended) and 1 bad (unintended but
foreseeable) effect is permissible of the following are met
Action itself must be good/indifferent → the good consequences must be the intended action
-ex/ decreased pain with use of opioids
General s/sx of cancer - answer Unusual mass/swelling
Unexplained paleness and loss of energy
Sudden tendency to bruise
Persistent, localized pain/limping
Prolonged unexplained fever/illness
Frequent headaches often with vomiting
Sudden eye and vision changes
Excessive rapid weight loss
Others: swollen lymph nodes, fever, abnormal CXR
Most common type of cancer in children - answer Leukemia
Leukemia - answer cancer of white blood cells
Typically dx between 2-5 yrs
2 main types → genetic testing can be used to differentiate
-Acute lymphoid leukemia (ALL)
-Acute myelogenous (non-lymphoid) leukemia (AML)
What accounts for 1/2 of all pediatric cancers? - answer Leukemia, lymphoma, and CNS tumors
(~25%)
Trisomy 21 increases risk for.... - answer Leukemia
Often seen with cardiac issues
Chemo side effects - answer Nausea, vomiting, anorexia, mucosal ulceration, neuropathy, anemia,
hemorrhagic cystitis, alopecia, dry skin, peripheral neuropathy, mood changes.
Possible cardiac toxicity
Infertility possible
Cushing syndrome from steroid meds
,Chemo side effects interventions - answer Ulcers
-Provide nutrition supplement → it may be easier to DRINK something, than eat solids foods
-Give pain relief
-Provide/ensure good oral care
Use stool softeners
Maintain proper body alignment if the child has difficulty ambulating
Radiation side effects: skin - answer Skin rxn of dry or moist desquamation followed by
hyperpigmentation, increased sensitivity to light
Encourage child to wear LOOSE-FITTING clothes over the area, to minimize any friction or skin
irritation
Wear long sleeve + long pants; stay in shade and wear sunscreen
Radiation side effects: GI - answer N/V, anorexia, mucosal ulceration, diarrhea
To help w/ N/V: give meds
ondansetron (Zofran) (serotonin receptor antagonists)
Radiation side effects: head - answer N/V, alopecia, mucositis, parotitis, sore throat, loss of taste,
Xerostomia
Radiation side effects: bone marrow - answer Myelosuppression
Bleeding and infection prevention
Radiation side effects: lab work - answer Platelets <20,000 mm3
-HIgh risk for bleeding → may cause nose, gum bleeds, internal hemorrhaging
-Hemorrhaging episodes require transfusion of platelets
Absolute Neutrophil Count (ANC) <500 mm3 → at risk for overwhelming infection!!
,-General malaise, 2nd infection, seizures
Hgb <10g/dL → may need transfusion of packed RBCs
3 major problems leukemia causes - answer Anemia d/t decreased RBCs
-Can range from mild to severe
-Fatigue, pallor, lethargy, and transient heart murmur
-Transfusions slow d/t potential heart issues
Increased infections d/t neutropenia
Increased bleeding d/t decreased plt → serious GI/brain bleed
Hodgkin's lymphoma - answer More common in teens → 15-19 yrs
Primarily involves the lymph nodes
-Metastasized mainly to spleen, liver, bone marrow, and lungs
S/sx: enlarged lymph nodes, temp > 100.4 for 3 days, night sweats, unexplained wt loss (> 10% over
last 6 month), fatigue, anorexia, cough, abd discomfort, and pruritus
Non-Hodgkin's Lymphoma - answer Common in children < 14 yrs
Diffuse not nodular → not just in the lymph nodes
-Early and rapid dissemination → metastasize quickly
~Invasion of the meninges is common → CNS s/sx can be present
Variety of manifestations d/t anatomical sites and extended involvement
Wilms tumor precuations - answer Nephroblastoma
Pre-op → no abd palpation
Contact sport precautions for children with 1 kidney
Prompt detection and tx of GU infections → protect their 1 kidney
Retinoblastoma precautions - answer Tumor that arises from the retina
Safety/injury prevention guidelines important to maintain sight in unaffected eye
-Trying to protect the unaffected/healthy eye
, -Avoid contact sports/use eye protection
Immune disorder that mimics s/sx of other GI disorders - answer Eosinophilic GI Disorder →
overproduction of eosinophils causing chronic inflammation and tissue damage.
Variety of s/s b/c it can occur anywhere in the GI tract
Reflux, vomiting, trouble swallowing, abdominal pain, malabsorption, FTT (failure to thrive)
Testing → endoscopy, biopsy
Eosinophilic GI disorder: mgt/tx - answer food elimination diets
elemental diets
-can't eat real food
-given special juice boxes
medications
-steroids, trial study meds
social and psych counseling
Where are children cared for most often at end of life? - answer Typically done at home
Collab with hospice and primary physician
Goal is to meet child's physical, psychological, and spiritual needs
Child should live life to the fullest w/o pain, having choices, and dignity
May continue after child's death to help fam adjust and cope
In the hospital if family is unable to or not comfortable caring for them at home
Principle of Double Effect - answer An action that has 1 good (intended) and 1 bad (unintended but
foreseeable) effect is permissible of the following are met
Action itself must be good/indifferent → the good consequences must be the intended action
-ex/ decreased pain with use of opioids
