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128 Cards in this Set
- Front
- Back
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When are brain cells fully matured?
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5-6 years of age (due to myelination).
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What is important re: confidentiality?
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Cannot keep life threatening issues confidential.
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Developmental Milestone at 1 year?
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1 year, 1 word
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What is important to remember about vital signs and clinical status?
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Clinical status can worsen before vital signs show it.
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Which conditions put a child at increased risk for cancer?
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Li Fraumeni Syndrome (Loss of P-53 Cancer gene inhibition. Also retinoblastoma and Down Syndrome.
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From which germ cell layer do most childhood cancers arise?
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Ectoderm or Mesoderm (Tissues deep within the body).
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What year was COG formed?
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2000-Children's Oncology Group
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APHON's Mandate
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Training Nurses
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Childhood Cancer Diagnosis
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Vague Symptoms. Could take days to weeks to get diagnosed.
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Findings r/t Alterations in Blood Cell Production
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Fever, Infection, Fatigue, Pallor
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Mediastinum Includes:
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Thymus, Thyroid, Esophagus, Lymph Nodes, Trachea, Bronchi, Heart/Pericardium, Great Vessels, Nerves.
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Mediastinal Mass/Safety
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Never Force to lie down or and never sedate unless prepared to intubate.
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Most Common Chidlhood Cancer
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ALL-Acute Lymphoblastic Leukemia
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How are Childhood Leukemias Classified?
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Onset/Course
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ALL % of Cancers
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75% of Childhood Leukemias and 25% of Childhood Cancers
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Chem Panel Changes
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K, Phos, Uric Acid, Creat, LDH all up, Ca+ is down
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What is diagnostic of leukemia?
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>25% Blasts in bone marrow
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Cytogenic Types (Fav/Unfav)
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(12:21) - Favorable
(9:22) - Unfavorable |
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ALL
WBC Count Age at Dx Response Treatment |
>=50K Unfavorable
>1<10 Favorable Rapid Early Resp.-Favorable Appropriate for Risk Factor-Fav |
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ALL Bone Marrow Rating
M1 <5% Blasts M2 5-25% M3 >25% |
M1=Remission ***
M2=Partial Response M3=Frank Leukemia *** |
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Goal of 1st Phase of Therapy
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Induction of Remission
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AML Morphology / FAB Classification
# Subtypes?? |
8 Subtypes
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AML
WBC Count Down Syndrome FAB Subtype Etiology |
>=100K Unfavorable
Present=favorable M3=Favorable Treatment related=Unfav. |
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Juvenile Myelomonocytic Leukemia (JMML) Features
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Leukocytosis (>10K)
Monocytosis (>1000/mm3) Prognosis Generally Poor Allogeneic HCT is only cure |
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Where do Lymphomas arise from?
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From Cells of Immune System (Lymphocytes)
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Peak age of Hodgkin's Lymphoma.
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Teens/Young Adulthood
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Hallmarks of Hodgkin's Disease Cytology
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Reed-Sternberg Cells
(multinucleated giant cell) (Owl's Eye appearance) (Characteristic architecture) |
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Hodkin's Clinical Presentation
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Painless Lymphadenopathy (Often firm, rubbery. 60-90% lower cervical)
Unexplained fever Drenching Night Sweats Weight loss >10% in 6 months |
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Procarbazine Teaching (Given for Hodgkin's)
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Low Tyramine Diet
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Wilm's Tumor Peak Age
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2-3 years
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Safety for Wilm's Tumor
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Do not palpate. Can be easily ruptured
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Rhabdomyosarcoma Staging
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TNM Staging
Tumor Node Metastasis |
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Treatment for Stage 2-4 Rhabdomyosarcoma
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Radiation in addition to surgery
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Osteogenic Sarcoma derived from?
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Mesenchyme (bone forming connective tissue) generally long large bones
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Peak for Osteogenic Sarcoma
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Adolescence
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Risk Factor for Osteogenic Sarcoma
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Alkylating Agent Exposure (such as Cyclophosphamide)
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Ewing's Tumors sensitive to?
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Radiation
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Ewing's most common Metasteses
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Lung
Bone Marrow Other Bones |
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Retinoblastoma 8th most common can lead to??
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Osteosarcoma
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Germ Cell Tumors Tumor Markers?
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Serum Beta-HCG
AFP |
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Langerhans Cell Histiocytosis common presentation
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Skin-scaly, erythematous, seborrhea like papules behind ears, scalp, axila
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3 Major divisions of the brain
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Forebrain
Midbrain Hind brain |
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Occipital Lobe??
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Visual
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Brainstem=
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midbrain
medulla pons |
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Infratentorium=
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Cerebellum
Pons Medulla |
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S/S increased ICP
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Initially Subtle
Decreased LOC Restlessness Irritability Bradycardia/HTN |
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Brain Tumor Grading for Benign
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Typical of Cells of Origin
Lower mitosis & necrosis Slow growing Localized May be malignant by location |
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Hallmarks of Infratentorial Tumors
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AM Vomiting
Visual Disturbances r/t Increase in ICP while sleeping |
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General Treatment for Childhood Brain Tumors
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Surgery
XRT >3yo Chemo Immune/biotherapy HCT/Stem Cell Therapy |
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Neuroblastoma arise from? Occurs in what age group?
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Neural Crest Tissue (Primitive neuroblasts of the Parasympathetic) Occurs in Infants/Toddlers
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Neuroblastoma Clinical Presentation
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- Opsoclonus/Myoclonus -(Dancing Eyes/Dancing Feet) Nystagmus and ataxia. Does not resolve - High Intellectual impairment.
- Orbital Swelling/Ecchymosis r/t bony erosion of orbit. - Blueberry muffin spots |
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Neuroblastoma - Paraspinal Mass result
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Not walking
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Neuroblastoma - Best prognosis Age
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Under 1 year
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Two congenital types of anemia
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- Diamond Blackfan-RBC Only
- Fanconi's Anemia-All 3 lines |
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ITP Treatment
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Steroids
IgG WinRhO Splenectomy (rare) |
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Hemophilia-Tingling
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Can be blood trickling under the skin
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Sickle Cell - When both parents have the trait
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1:4 chance for child to have SCD
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Evidence of engraftment after stem cell transplant
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ANC>500
Platelets>20K s/ transfusion |
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Major source of morbidity/mortality first 100 days post stem cell
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Infection
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GVHD Damages ??
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3 target organs
-skin -GI -Liver |
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GVHD Chronic complications
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Mouth ulcers
Hair loss Thickening of skin malabsorption |
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Goals of clinical trials
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- Determine effectiveness of new treatments
- Maintain Pt. Safety - Improve outcomes -increase cure, decrease tox |
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COG formed when?
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2000
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% of Peds Pt's c/ cancer on clinical trials
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75%
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Phase II Trial requirements
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Requires measurable disease response
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Phase III Trial details
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- Compares new to standard treatment
- Stratification ensures balanced representation |
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Phase IV Evaluates approved treatment for
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Impact on Quality of life. Rarely done in Peds Onc
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Nursing Role in Clinical Trials
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Provide Patient and Family Education.
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Neoadjuvant Chemo
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Used preop to decrease tumor bulk
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Cell Kill Max?
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Repeated Doses for Max Cell Kill
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Granulocyte Colony Stimulating Factor
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Stims proliferation/ differentiation of neutrophils.
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Monoclonal antibodies
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Cause cell death thru interaction c/ immune responses/recognize tumor associated antigens
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Patient's Meter Squared
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Very thin or obese base on ideal body wt. Square root of HtxWt/3600
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Dauno/Doxorubicin To know
Idarubicin |
Teach re: reddish orange discoloration of urine. Ida Also
Cumulative Max dose (550mg/m2) |
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Etoposide
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Hypotension
Liver Tox |
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Asparaginase
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Systemic Allergic Rxn (may be delayed)
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Mesna
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Rescue Drug for Ifos or Cyclafos protect bladder
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For VAD Occlusion
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TPA 1/2 to 1 mL, Leave for 60 mins, can repeat
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What does Chemo do to bone marrow
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Does not destroy existing cells, but stops making new cells.
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ANC Calc
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WBC *(Segs+Bands)
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Severe Neutropenia
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AND<500
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With Surgically implanted devices/Dental care
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Requires Cardiac prohylaxis
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Protozoa Prophylaxis
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PCP-Bactrim 6-12 mo's post-therapy
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Fever and VADs
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Alternate lumens for Abx
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Thrombocytopenia-what to avoid
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Avoid NSAIDs and ASA
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Anemia Cardiac Assessment
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May hear a gallop murmur
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Transfusion guidelines
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Irradiated leukopore filtered (irradiate kills T-cells)
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Vestibular System/NV
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Motion Sickness Incr. N/V
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Cisplatinum-
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90% of N/V
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Antiserotonins
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Revolutionized N/V Mgmt
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When supplemental feeding?
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At 5-10% Weight Loss
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C-Diff Meds
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Vanco or Flagyl
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Photo/sun sensitivity
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Methotrexate and Retinoids
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Hyperleukocytosis
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Maintain hydration for urine output 1-2 MLs/KG/Hour
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Greatest Risk Hypoerleukocytosis
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AML/ALL
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Greatest Cause of DIC
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Gram (-) Sepsis
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Spinal Cord Compression Med Mgmt
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Steroids
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Superior Vena Cava Syndrome Nursing Mgmt
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O2 and Put up head of bed
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SIADH
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Dilutional Hyponatremia
Too rapid correction can cause cerebral edema |
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Anaphylaxis risk drugs
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Aspariginase
Bleomycin Epipodophyllotoxins Carboplatins |
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Addiction
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Voluntary psychological behavioral pattern-drug seeking
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Drug tolerance
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Physiological adaptation requires larger doses
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Physical dependence
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Physiological withdrawal symptoms. Requires weaning
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Nociceptive pain
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Inflammatory response that is perceived as pain.
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Polyneuropathic pain
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Associated with many nerve centers
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Scheduled pain med dosing
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Promotes steady state blood level.
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Oral route for drugs
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Must undergo first pass effect in liver
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IV Pain Meds Best results
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Basal Rate with PRN Boluses/PCA
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Epidural requirements
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Preservative free solution
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Demerol/Mepiridine
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CNS side effects include seizures. Limit use to rigors
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Antihistamines as Adjuvant
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Not-co-analgesic. Controls side effects
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Best chance of pain control
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Multiple drugs or multiple modalities
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Which patients have more significant late effects?
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Younger patients
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Cognitive dysfunction risk
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Younger patients
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Hearing loss drugs
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Platinum
Aminoglycosides XRT |
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Rad to brain, eye, or TBI can cause which occular problem?
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Cataracts
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Cardiac effect drugs
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Anthracyclines and cyclophosphamide
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Cause of Lung fibrosis
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Bleomycin
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Drugs and hepatotoxicity
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Methotrexate
6-MP AMD |
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Thyroid problems
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Hypothyroid is most common problem
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Growth hormone replacement
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Cardiac health, controversial treatment
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Renal effects of Platinum
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Kidney failure
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Renal effects of Ifos/cyclophosph
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Bladder fibrosis, malignancy, hemorrhagic cystitis
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Long time steoir use effect on bone
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Avascular necrosis
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Late effect of Rad. to HP axis
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Fertility problems
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Core concepts of palliative care
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- Respect
- comprehensive caring - building support - addressing caregiver concerns |
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Addressing death
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Should be addressed at diagnosis with goal of cure in most cases
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Pain treatment
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Most pain undertreated
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