PEDS 4130: Peds Test 3. Study Guide.

The Child With Cancer Ch. 51 P. 1423 Wilms Tumor (Nephroblastoma) P. 1423 KNOW! - Most common renal tumor in children. 75% of cases occur in children < 5 years old. Usually affects only one kidney; can be bilateral. Cause is unknown; can be inherited genetically. Grows very quickly, doubling its size in 11 to 13 days. DD: Tumor that grows in the kidney - Bright side you can live without one kidney. Clinical Manifestations - Usually asymptomatic, firm, lobulated mass located to one side of the midline in the abdomen. Parents discover a mass during the child’s bath DD: contours of the abdomen are uneven. HTN caused by increased renin activity related to renal damage. Hematuria or abdominal pain is sometimes present. Rapid enlargement of kidney. Metastasis occurs via direct extension or bloodstream to the perirenal tissues, liver, diaphragm, lungs, abdominal muscles, and lymph nodes. DD: worry about BP and urine output. Clinical Therapy - Diagnosis is based on an ultrasound study of the abdomen or kidneys and an intravenous pyelogram. CT scanning or MRI of the lungs, liver, spleen, and brain to identify metastasis. CBC, BUN and creatinine levels, urinalysis, 24-hour urine collection, and liver function tests. Prognosis depends on staging and metastasis. Survival rate is 90%. - Surgery is performed to remove the affected kidney (nephroctomy). Chemo or radiation therapy before surgery to reduce the size of the tumor. DD: all based in staging (is it outside of the kidney, does it cross the midline?) - Long-term complications of treatment include liver damage, portal HTN, and mild cirrhosis. Radiation damage (such as thinking or weakening) of the skeleton, pelvis, and thorax. Kyphosis and scoliosis may occur from irradiation. Glomerular damage to the remaining kidney. Nursing Management Assessment and Diagnosis - Health history focuses on: Abdominal mass, abdominal pain, constipation, vomiting, anorexia, weight loss, difficulty breathing, hemihypertrophy of spine, GU problems, and family history of cancer. - Perform a thorough baseline assessment. Assess abdomen for symmetry and mass. Auscultate BBS, and palpate for lymphadenopathy. Do not palpate the abdomen or liver because of the potential for spreading the cancerous cells and possible dislodging of a piece of the tumor (Place a sign on the child’s bed and in the chart altering other nurses). DD: never put your hands on a belly suspected of having Wilms Tumor because it’s an encapsulated tumor, you don’t want to push on it and break it apart. Monitor the BP (HTN common finding). Nursing diagnoses include: o Infection, risk for, related to inadequate defenses o Urinary elimination, impaired, related to anatomic obstruction o Tissue perfusion: cardiac, risk for decreases, related to HTN caused by mechanical reduction of blood flow. o Caregiver role strain, risk for, related to child’s illness severity. o Home maintenance, impaired, related to child’s disease. Planning and Implementation - Divided into two phases: Post-renal surgery phase and the chemotherapy phase. Drawings and special teaching dolls with removable kidneys can be used to teach about surgery. - Post-renal surgery phases focuses on pain management and close monitoring of fluid levels. Frequently reposition the child and use noninvasive and pharmacologic pain interventions. Monitor fluids to prevent hypovolemia and to assess the shift of fluids out of the third space and out of the body. Assess daily weight, I&O, and urine specific gravity. Take BP frequently to watch for signs of shock and to assess the functioning of remaining kidney. - Chemotherapy phase, monitor for s/e of drugs, potential for infection from the central line site, and the function of the remaining kidney. Leukemia P. 1427 KNOW! - Most commonly diagnosed pediatric malignancies in the children under 14 years of age. Characterized by a proliferation of abnormal WBCs in the body. The most common type of childhood leukemia is ALL (acute lymphoblastic). The peak age at onset is 2 to 3 years. AML refers to all leukemias from myeloid cells. About 17% of childhood leukemias are AML (acute myelogenous). AML is most common in children younger than 2 years of age and in adolescents. Etiology and Pathophysiology - Causes are not well understood. Exposure to infectious agents can predispose children. Genetic factors are believed to play a role. Ionizing radiation exposure when in utero and chemical agents such as treatment with chemo for other cancers play some role in the development of AML. Leukemia occurs when the stem cells in the bone marrow produce immature WBCs that cannot function normally and fight infection. DD: WBCs are high but they are useless, and immature. Cells accumulate in the bone marrow and then spill out into the circulatory system where they steadily replace the normally functioning WBCs. Protective lymphocytic functions such as cellular and humoral immunity are reduced, leaving the body vulnerable to infections. The accumulation in the bone marrow replace stem cells that produce erythrocytes (RBCs) and platelets decreasing these in the circulation. The stem cells are replaced by leukemic clones resulting in anemia. Children experience abnormal bleeding (teach them about soft-bristle toothbrush), ecchymosis, or petechiae because of the reduced amount of platelets. DD: first sign is fever (cant fight infection), bruising, and bleeding. Clinical Manifestations - Children usually have fever, pallor, overt signs of bleeding, lethargy, malaise, anorexia, and large joint or bone pain. Petechiae, frank bleeding, and joint pain are cardinal signs of bone marrow failure. Enlargement of the liver and spleen (hepatosplenomegaly) and changes in the lymph nodes are common. If it has entered the CNS, the child may have signs such as headache, vomiting, papilledema, and 6th cranial nerve palsy (inability to move the eye laterally).