Peds Oncology - Define types of cancers: o o - Most common in children (under 5, down’s and males) Classified as acute and chronic Lymphoma: originates in lymphoid tissues (spleen and liver) Teens, and virally depressed immune children are more at risk Ex: Hodgkin lymphoma o Neuroblastomas: tumor forms from neural cells (adrenal involvement) o Brain tumors/spinal cord tumors: most common solid tumor o Nephroblastomas/Wilms tumors: tumors in the kidneys o Osteosarcoma: malignant tumor of the bone o Rhabdomyosarcoma: blue cell tumor found in skeletal muscle tissue o Retinoblastoma: intraocular malignant tumor Number one cause of death among cancer patients: o - Leukemias: group of malignancies in the blood forming components of the body INFECTION!!! Vaccinations for cancer children: o Live, attenuated vaccines can cause SERIOUS disease in immunocompromised children Polio Measles Rubella Mumps o Can receive inactivated vaccines o Children vaccinated 2 weeks before chemo must be considered unimmunized and can receive the live vaccine 6 months after chemo has stopped - - - Mucositis: o These can cause anorexia because they are so uncomfortable o Use a baking soda and salt mouthwash o Administer local anesthetics without alcohol o Perform mouth care routinely Controlling epistaxis: o Applying pressure to the site without disturbing clot formation is the general rule o Possible blood transfusion Controlling a neutropenic patient: o Observe for signs of sepsis o Observe for fever, could indicate infection o Always practice good hand hygiene to avoid introducing any pathogens - Diagnostics of leukemia: o Usually suspected from history, physical manifestations, and peripheral blood smear that contains immature forms of leukocytes in combination with low blood counts o Definitive diagnosis based on bone marrow aspiration or biopsy - - Bone marrow will show a monotonous infiltrate of blast cells Brain tumor manifestations: o s/s may be nonspecific or specific related to area of tumor o headache upon waking up o vomiting that is not related to feeding o bulging fontanels o increased ICP due to tumor o neuromuscular changes o bizarre behaviors Neuroblastoma manifestations: o s/s depend on the location and stage of the disease o Abdominal tumors: Firm, nontender irregular mass that crosses midline (WILMS TUMOR DOES NOT CROSS MIDLINE) o - Other s/s: Neurological impairment Respiratory obstruction from a thoracic mass Varying degrees of paralysis from compression of the spinal cord Wilm’s (nephroblastoma) tumor education and nursing actions: o o Education: Educate parents and child it is NOT their fault Keep explanations simple and repeat them often What to expect with chemo Nursing actions: Surgery will occur within 24-48 hours of admission so swift lab tests and diagnostics must be performed - Watch BP because hypertension can be a concern Post a sign that says “do not palpate abdomen” Carefully bathe as to not cause trauma to area Post-op monitor GI (bowel sounds, movements) Patho of Hodgkin Lymphoma: o Malignancy originates in the lymphoid tissue and primarily involves the lymph nodes o Metastasizes to non-nodal or extralymphatic sites, especially spleen, liver, bone marrow and lungs although it can affect all tissues Alterations in Cognitive and Neuromuscular Function - Fragile X syndrome: o o Definition: Causes varying degree of cognitive development Most common inherited cause of cognitive impairment Etiology: Abnormal gene on the lower end of the x chromosome, this is caused by a gene mutation that results in excessive repeats of nucleotide in a specific DNA segment of the X chromosome o o - - X-linked dominant Manifestations: CI of unknown cause Big ears and large forehead Enlarged testicles High palate Can be very shy or very outgoing Easily overwhelmed by sensory stimuli Aversion to being touched Poor eye contact Speech delay Autistic like s/s GOOD TO KNOW!!! No cure Require early referral to therapy Genetic counseling for parents (with hx of FXS) Down’s syndrome: o Definition: genetic disorder (trisomy 21) o GOOD TO KNOW!!! Delayed development Men will be infertile Delayed milestones Cardiac defects Feeding difficulties Sign language Screening for other health problems How to promote optimum development: o Verbal skills are often delayed sign language and picture boards o Consistent development with limit setting o Teach manners o Participate in sports, groups, activities o Appropriate behaviors and play (toys, dolls, balls) o Teach self-care skills feeding, toileting, dressing, grooming (there are numerous aids to help with this) - - Establishing discipline in children with CI: o Must begin early o Must be simple, consistently applies and appropriate for child’s mental age o Stressing moral lessons is of little value to children o Behavioral modification and use of time out is effective Cerebral palsy: o Definition: Group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in developing fetal or infant brains o o o Manifestations: Motor abnormalities Seizures Hearing or vision impairment Oral motor and speech function difficulties Spastic CP is most common type Management: MAIN GOAL: optimize abilities within confines of the dysfunction Early recognition and promotion of optimal development Establish appearance and integration of motor functions Correct defects as early and effectively as possible Provide educational opportunities adapted to the child’s needs and capabilities Mobilization devices may be needed Botox PT, OT, speech therapy Behavioral therapy Nursing actions: - Safety precautions (seizure precautions, helmets) Congenital hypothyroidism: o Frequently associated with maternal Grave’s disease that was treated with anti-thyroid drugs o Cause is unknown o Early detection is key o Manifestations: Puffy eyelids Short forehead Hyporeflexia Hypothermia o Hypotension Umbilical hernia Anemia Treatment: - Lifelong thyroid hormone replacement Congenital PKU: o Caused by: Deficiency or absence of the enzyme needed to metabolize the essential amino acid phenylamine, this results in this amnio acid to accumulate in the body and brain Manifestations: Failure to thrive Frequent vomiting Hyperactivity Unpredictable and erratic behavior Nursing care: Teach dietary restrictions Endocrine - Diabetes insipidus: o o o - Results from undersecretion of ADH or vasopressin, producing a state of uncontrolled diuresis Idiopathic Cardinal signs: Polyuria Polydipsia Irritability that is fixed with water not milk Nursing actions: Monitor I&O Monitor for dehydration Replace hormone with synthetic vasopressin injection Educate teachers on unrestricted bathroom access SIADH nursing care: o o o - Patho: Definition: Hypersecretion of ADH from pituitary hormone Frequent infections Tumors CNS disease or trauma Most common cause of hyponatremia is pediatric population seizures s/s: Nursing care: I&O Daily weight Seizure caution Education regarding fluid restrictions Addison’s disease (chronic adrenocortical insufficiency): o Rare in children o s/s: muscle weakness mental fatigue palmar creases anorexia hyperpigmentation small heart syncope attacks hypoglycemia seizures electrolyte imbalances o Treatment: - - - Cortisol side effects: o Sudden termination of the drug can cause acute adrenal crisis o Undesirable side effects: Gastric upset Increased excitability and sleeplessness Weight gain Behavioral changes Education for diabetes type 1: o Hypo and hyperglycemia o Calculating correction insulin/counting carbs o Drawing up and injecting insulin o Monitoring blood glucose o Annual appointments for prevention of diabetic complications o Prevent DKA Grave’s disease o AKA hyperthyroidism o Patho: o - Replacement of cortisol and aldosterone Caused by autoantibodies to the TSH receptor causing excess secretion of TH No cure Hyperthyroid manifestations: o High calcium levels o Emotional liability o Decelerated school performance o Tachycardia o Protruding eyeballs o Tremors o Goiter (hypertrophy of thyroid) o Fine and frail hair Common Childhood Illnesses - Headlice education and nursing care: o o - Education: Can cause a lot of embarrassment among children and cause them to be bullied Education is the most important nursing role for head lice Anyone can get it, not just children Get rid of sheets, stuffed animals, and clean area thoroughly Do not share brushes, hats, coats, and other items used near the head Nursing care: Medications (1% cream rinse (NIX) Daily removal or visible nits with comb Scabies treatment: o Definition: PARASITIC, caused by scabies mite, lesions are created as impregnated females burrow into the epidermis where she deposits her eggs and feces o - Treatment: Scabicide Permethrin 5% cream in infants older than 2 months 10% crotamiton Athlete’s foot education: o Definition: o - FUNGAL, infections in areas in between toes or on soles of feet Education: Local application of antifungals Elimination of heat, perspiration, using clean socks and well-ventilated shows Common in locker room areas Molluscum contagium education: o Definition: VIRAL, flesh-colored papules with central caseous plug that occur on trunk, face, and extremities, may be transmitted by sexual contact o - Education: Cases in well children will resolve rapidly Numerous treatments Common in school aged children Spreads by skin-to-skin contract Outbreaks must be reported Differentiate rashes by condition: o Fifths disease rash: “slapped cheek” like rash on face o Chicken pox rash: red pustule like lesions o Roseola rash infantum rash: small non raised red circles all over body, more pinkish red than measles o Measles rash: small maculopapular rash more reddish-brown than roseola - Cause: Different bacteria Treat underlying cause o Inflammation of the skin with intense redness, swelling, and firm infiltration o May progress to abscess formation Conjunctivitis: o o - Starts on the face and spreads down Cellulitis type and cause: o - Starts on the torso and spreads out Cause: Viral, bacterial, allergic, foreign body BACTERIAL IS HIGHLY CONTAGIOUS Symptoms: Bulging eyeballs Decreased eye movement Yellow gunk in eyeballs Immunization safety, precautions, contraindications: o Types: o o Live attenuated: weakened version or the virus that often requires more than one dose Varicella MMR Inactivated: virus has been killed, usually requires multiple doses Nursing interventions: Accurate documentation Encourage complete immunization Promote safety Precautions: Condition in a recipient that might increase the risk for a serious adverse reaction that might compromise the ability of the vaccine to produce immunity o Contraindication: Condition that increases the risk for a serious adverse reaction Severe febrile illness No live vaccines for immunocompromised patients Allergies to substance in vaccine
