Transcript Cancer - PBworks

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 34
Caring for the Child with Cancer
Susan Ward
Shelton Hisley
Cancer
 Cancer is a group of diseases in which there is out-ofcontrol growth and spread of abnormal cells (anaplasia).
 Anaplasic cells resist normal growth controls. This abnormal
cellular growth is also known as neoplasm and is caused by one or
a combination of three factors
 External stimuli or environment
 Viruses that alter the immune system
 Chromosomal and gene abnormalities
Tumor
 Benign
 Slow, limited, noninvasive growth (not
cancerous)
 Malignant
 Progressive virulent growth (cancerous)
Terms Associated with
the Cancer Patient
 Roadmap—protocol or treatment plan that is “mapped out” to guide staff and families
 Protocol—complete explanation of a treatment plan
 Clinical trials—medical research studies designed to answer scientific questions and
to find new ways to treat cancer
 Remission—the partial or complete disappearance of signs and symptoms of disease.
 Extravasation—leakage of potentially damaging medications into tissues
 Induction—chemotherapy given to achieve remission
 Consolidation—chemotherapy given after induction to control microscopic disease
 Maintenance—chemotherapy given on a long term basis to maintain remission
 Palliative care—treatment given to relieve rather than cure symptoms caused by
cancer.
Differences Between
Childhood and Adult Cancers
 Childhood cancers
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Arise from primitive embryonic tissue (environmental link)
Cure rate is better
Cancers affect stem cells
More aggressive and faster growing
Respond more readily to chemotherapy and radiation
Treated at major cancer centers in the United States
More resilient
Tolerate more aggressive therapy
Less other physiological problems
Common Childhood Cancers
Leukemia
 Leukemia (based on cell line affected and level
of cellular differentiation)
 Acute leukemia (progresses rapidly and affects
immature and undifferentiated cells)
 Chronic leukemia (progresses less rapidly, allowing
for the production of more mature and differentiated
cells)
 Three classifications—ALL, AML, and CML
Acute Lymphocytic Leukemia (ALL)
 Signs and symptoms
 Fever, fatigue, lethargy, anemia, pale skin, anorexia,
and bone or joint pain
 Increased WBC
 Nursing care (treatment phases)
 Remission through induction
 Consolidation
 Maintenance
Acute Myelogenous Leukemia (AML)
 Signs and symptoms
 Symptoms resembling the flu, anemia, pallor, fatigue, bone pain,
fever, headache or dizziness, petechiae, easy bruising,
nosebleeds, or bleeding gums
 Increased WBC
 Nursing care
 Administer multi-agent chemotherapy
 Discuss hematopoietic stem cell transplant
 Matched-sibling bone marrow or stem cell transplantation after
remission
Chronic Myelogenous
Leukemia (CML)
 Signs and symptoms
 Fever, fatigue, weight loss, anorexia, increased WBC,
and splenomegaly
 Nursing care
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Administer hydroxyurea (Droxia, Hydrea)
Administer interferon-α
Administer combination chemotherapy
Allogenic bone marrow or stem cell transplantation
Solid Tumors (named for the type of
cells of which they are composed)
 Type of cells
 Sarcoma (connective or supporting tissues)
 Carcinoma (glandular and epithelial cells)
 Lymphomas (lymphoid glands)
Brain Tumors
 Two types
 Supratentorial (anterior 2/3 of brain)
 Intratentorial (posterior 1/3 of brain)
 Signs and Symptoms
 Depends on the tumor location,
tumor type, and the age of the child
 Obstruction of CSF drainage leading
to ICP
 Nursing care
 Tumor is staged; surgical resection,
radiation therapy, chemotherapy, or a
combination
 Postoperative care; IV steroids and
anticonvulsants
 Conduct neurological assessment
and airway and fluid management,
prevent infection, manage pain,
ensure adequate nutrition, and
promote normal growth and
development
 Ensure good communication,
emotional support, and accurate
information
Neuroblastoma
 Signs and symptoms
 Wide variety depending on site of primary tumor
 Upon palpation, tumor crosses midline; hard painless mass in neck
or abdomen
 Nursing care
 Determined by the stage of the disease and the age of the child
 Surgery resection preformed followed by chemotherapy (radiation
or bone marrow transplant may be used)
 Conduct nursing assessment for infection and stable condition
 Alleviate pain
 Offer support, accurate information, and education
Wilm’s Tumor (Nephroblastoma)
 Signs and symptoms
 Painless abdominal mass in one or both kidneys (seldom crosses
midline)
 Nursing care
 Obtain health history and nursing assessment
 Explain laboratory and diagnostic tests
 Administer chemotherapy and give postradiation care
 Postoperative care
 Assess function of remaining kidney
 Ensure high-calorie, high-protein diet
 Give dietary supplements
Rhabdomyosarcoma
 Signs and symptoms
 Depends on location of primary tumor and metastasis (head and
neck, nasopharynx, genitourinary, extremities, skeletal or smooth
muscle, perianal regions)
 Nursing care
 Understand that treatment is based on the primary tumor and
disease stage
 Surgical resection
 Give chemotherapy and address radiation side effects
Retinoblastoma
 Signs and symptoms
 Leukocoria; strabismus; red, painful eyes (blindness is a late sign)
 Nursing care
 Preoperative—reassure parents and educate about what to expect
postoperatively
 Postoperative—teach parents about eye socket irrigation and
antibiotic ointment
 Teach parents about home care of the eye
 Offer support and encourage follow-up care
Bone Tumors
Osteosarcoma
 Signs and symptoms
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Pain and swelling
Limp
Dull aching pain
Palpation at site, tenderness, swelling, warmth, and erythema
 Nursing care
 Administer chemotherapy
 Surgery—amputation versus limb sparing
Ewing’s Sarcoma
 Two separate types of tumors
 Ewing’s sarcoma family of tumors
 Peripheral primitive neuroectodermal tumor
(PPNET)
Ewing’s Sarcoma
 Signs and symptoms
 Pain or tenderness and swelling at the site of the
tumor (chest wall tumor causes respiratory distress)
 Nursing care
 Administer multi-agent chemotherapy
 Surgical resection
 If radiation treatment is performed, address radiation
side effects.
Lymphomas
Hodgkin’s Disease (HD)
 Signs and symptoms
 Painless, firm, cervical, or supraclavicular
lymphadenopathy
 Nursing care
 Administer chemotherapy
 If radiation treatment is performed, address
radiation side effects.
Non-Hodgkin’s Lymphoma (NHL)
 Signs and symptoms
 Pain or swelling (abdomen, chest, and head/neck)
 Nursing care
 Administer aggressive multi-agent chemotherapy
 Administer intrathecal chemotherapy (for CNS
prophylaxis)
Other Cancers
Liver Cancer
 Two primary types
 Hepatoblastoma
 Hepatocellular carcinoma
 Signs and symptoms
 First sign is a mass in the abdomen (upper right side)
 Abdominal fullness, pain, vomiting, diarrhea, fever, abnormal
weight loss, jaundice, or general itching
 Nursing care
 Chemotherapy may be needed first to shrink the size of the tumor
 Surgical removal of the tumor
Nursing Care of the
Child with Cancer
Several Areas of Nursing Care
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Maintain nutrition
Prevent infection
Administer chemotherapy
Addressing radiation side effects
Understand the use of surgery and related nursing diagnosis
Control pain
Provide psychosocial support
Manage negative and long-term effects of cancer treatments
Understand psychological impact of pediatric cancer
Nutrition
 Nursing care
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Maintain good nutrition (Box 34-2)
Help parents with proper nutrition
Assess poor nutrition
Assess side effects of chemotherapy related to nutrition
Maintain immune system
Try simple care measures first (enteral feedings or TPN may be
the only option)
 Communicate to parents that their child may be able to eat
independently again
Infection
 Nursing care
 See Nursing Care Plan (Child with Acute Lymphocytic Leukemia)
 Monitor for systemic and localized signs of infection every 2–4 hours
 Take temperature every 4 hours
 Report a single temperature greater than 101.2°F (38.5°C) in a 24-hour
period or 100.4°F (38.0°C) three times in a 24-hour period
 Provide meticulous skin care and use good hand washing (instruct visitors)
 Use universal precautions and designated isolation precautions
 Monitor and report lab values
 Teach family about the principles of prophylactic antibiotics and signs and
symptoms of infection (See Family Teaching Guidelines: Signs and
Symptoms of Infection)
Chemotherapy
 Administer chemotherapy using a variety
of drugs
 See Table 34-2: Chemotherapeutic Agents
and Common Cancer Drugs
 See Table 34-3: Venous Access Devices
Radiation
 Nursing care
 Measures that address the radiation side effects
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Nausea
Alopecia
Fatigue and malaise
Low WBC
Skin desquamation
Mucous membrane inflammation and irritation
Surgery
 Nursing care
 Understand that surgery is
used as an adjunct to both
chemotherapy and radiation
 Important role in the
diagnosis of a tumor via
biopsy
 The insertion of central
venous catheters
Pain Control
 Nursing care
 Administer pain medications combined with
adequate rest and sleep, massage, heat,
distraction, and social support
 Use topical anesthetics
 Remember ethnocultural considerations
Psychological Support
 Nursing care
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Provide holistic nursing care
Encourage 24-hour stay
Involve the child-life specialist
Be present or simply listen
Provide family with community resources, reliable
Internet sources, or information about support groups
Negative Effects of Chemotherapy
 Nausea and vomiting (administer antiemetics)
 Alopecia (address body image)
 Extravasation (prevent accidental leakage of
drugs)
 Mucositis (keep oral cavity clean)
 Diarrhea (skin care, diet, and medication)
 Constipation (diet, activity, and medication)
Negative Effects of Chemotherapy
 Anemia (s/s, diet, vitamin, RBC
transfusion, administer hematopoietic
growth factors)
 Thrombocytopenia (platelet transfusion)
 Neutropenia (assess fever, blood cultures,
and administer antibiotics)
Long-Term Effects of Chemotherapy
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High-tone hearing loss
Loss of speech
Impaired depth perception
Increased response time
Lung problems (SOB)
Kidney problems (bleeding)
Musculoskeletal defects
Functional and/or mobility deficits
Hormonal abnormalities
Sterility
Growth retardation, cognitive impairment, and/or learning disabilities
Diabetes insipidus
Peripheral neuropathy
Medical Emergencies
Hemorrhagic Cystitis
 Signs and symptoms
 Bloody or painful urination
 Nursing care
 Ensure hydration
 Test urine for blood, pH, and specific gravity (see procedure 34-1)
 If urine is positive for presence of blood, notify physician
immediately
 Monitor intake and output
 Obtain daily BUN and creatinine
 Administer MESNA
Tumor Lysis Syndrome
 Signs and symptoms
 Lethargy, nausea and vomiting,
oliguria, flank pain, pruritus,
tetany, and altered level of
consciousness
 Renal failure can also occur
 Nursing care
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Keep the urine alkalinized
Maintain a low-phosphate diet
Administer allopurinol (Aloprim)
Maintain adequate hydration
Monitor electrolytes
Obtain BUN and creatinine
Understand that sometimes
dialysis or exchange transfusions
are necessary
Septic Shock
 Signs and symptoms
 Confusion; fever; tachypnea; decreased urinary output; and cold, clammy skin
 Note: Decreased blood pressure is a late sign
 Laboratory studies reveal acidosis and sometimes renal failure
 Nursing care
 A neutropenic child is given antibiotics; take vital signs every 10 to 15 minutes
during the antibiotic administration to recognize signs of septic shock
 Administer large amounts of an isotonic fluid (normal saline)
 Check peripheral pulses and capillary refill to monitor perfusion
 Perform ABCs and other emergent care measures (see Critical Nursing Action:
Nursing Care for Septic Shock)
The Psychological
Impact of Pediatric Cancer
 Signs and symptoms
 Shock, denial, confusion, fear, blame, and loss of control
 Nursing care
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Suggest support
Communicate adequate rest and nutrition for parents
Be honest
Use a multidisciplinary approach
Tailor information to developmental stage
Keep lines of communication open
Provide for spiritual care
Help child and family express feelings