Cancer
Brain Tumor:
1. Patho:
a. S/S: consistent w. increased ICP
i. Depending on location additional S/S may be exhibited
1. Uncoordinated movements
2. Paralysis of one side of the body
3. Altered speech pattern
4. Altered eye movement
b. Many have long – term complications (hydrocephalus, cognitive deficits, seizure disorders)
2. Dx:
a. Complete neurological assessment
i. Lumbar puncture contraindicated bc of possible herniation of brain
b. MRI/CT
3. Tx:
a. Surgical: complete removal may not be possible
b. Chemotherapy and/or radiation
c. If hydrocephalus develops, a VP shunt may be inserted during surgery
4. Nursing considerations:
a. Preop:
i. Anxiety/fear/anger/grieving/deficit knowledge
1. Prepare parents for need to shave head & size of dressing afterwards
ii. Risk for injury
1. Age appropriate neurological assessment (Glasgow)
b. Postop:
i. Pain management, REEDA, VS, monitor GI functioning & bleeding potential
ii. Risk for injury
1. Neuro assessments (Glasgow)
a. Report s/s of increased ICP that may develop as result of bleeding into
the brain, hydrocephalus, or swelling of the brain tissue
2. Elevate HOB
a. Never place in Trendelenburg position
iii. Risk for infection/impaired skin integrity
1. Handwashing, aseptic technique
2. Monitor infection signs at surgical site, urinary, pulmonary, and lab data
iv. Risk for imbalanced fluid volume
1. I & O, weigh daily
v. Risk for delayed growth & development/risk for impaired coping
1. Specialized care: OT, PT, sensory assessments
Neuroblastoma
1. Cancer of the peripheral nervous system that originated from embryonic tissue
2. Metastasis to other organs is common
3. Dx:
, a. Difficult bc s/s similar to other diseases
b. Dx: xray, MRI, &/or CT
c. S/S range from a large abdominal mass to HTN, to marked sweating, to marked diarrhea, to
s/s of spinal cord compression
4. Tx:
a. Surgical removal
b. May be followed by chemo &/or radiation
5. Nursing considerations:
a. Preop:
i. Anxiety/fear/anger/grieving/deficient knowledge/pain
1. Give analgesics
a. Narcotics for moderate to severe
2. Non pharm pain management
ii. Risk for injury
1. Neuro assessments (Glasgow)
b. Postop:
i. Pain management, REEDA, VS, monitor GI functioning & bleeding potential
ii. Risk for injury/pain
1. Glasgow, analgesics (narcotics for moderate to severe), non pharm pain
management
iii. Risk for impaired coping.
Davis Page 426
Acute Lymphoblastic Leukemia (ALL)
1. Proliferation in the production of lymphoblasts or immature WBC in bone marrow
2. Patho:
a. Hyperproduction of immature WBC, called blast cells in bone marrow
b. Poor production of other BC & inadequate maturation of WBCs in bone marrow =
i. Reduced erythrocyte production = anemia. Characterized by fatigue & lack of energy
ii. Reduced platelet production = thrombocytopenia. Characterized by petechiae &
bruising
iii. Reduced # of mature WBC = neutropenia. Characterized by low grade fevers, recurring
infections, & lymphadenopathy
3. Dx:
a. Suspicious
i. Clinical picture
ii. Altered CBC: RBC & platelet less than normal, altered WBC count
b. Bone marrow biopsy w. DNA analysis to confirm
4. Tx:
a. Chemo
i. 3 phases
1. Induction = remission (reduce % of blast cells in blood to 5% or less)
a. Response to meds is monitored by serial bone marrow aspirations
, 2. Consolidation: maintain remission & prevent the progression of the disease to
the CNS and/or the testes in males
a. Chemo administered intrathecally (into spinal column) to prevent
migration of cells into CNS
b. Testes radiated if blast cells found
3. Maintenance: continued remission
a. Chemo administered periodically PO &/or IV over next few years
b. Periodic BC & bone marrow biopsies to monitor possible relapse
b. Bone marrow &/or cord blood transplants
i. Either autologous (own) or allogeneic (donor)
ii. Antirejection meds administered (prednisone, cyclosporine, tacrolimus)
iii. Additional meds/interventions: antibiotics, antifungals, antivirals, RBC production
stimulators (epogen) WBC production stimulators (leukine), & blood transfusions
5. Nursing considerations:
a. Anxiety/fear/pain
i. Lumbar punctures & bone marrow aspiration = frightening
b. Infection or risk for infection resulting from periods of neutropenia
i. VS (temp)
ii. Handwashing, aseptic technique
iii. Monitor for signs of infection
1. Thrush w. stomatitis (inflammation of mucous membranes in mouth)
2. Diarrhea
3. UTI
iv. Oral hygiene soft brush
v. Administer antibx, antivirals, &/or antifungals
vi. Febrile antipyretic
1. Aspirin is avoided
vii. Dead vaccines
c. Risk for altered tissue perfusion/activity intolerance/fatigue resulting from the anemia
i. Monitor: VS, signs of ineffective perfusion (fatigue, decreased activity, tachycardia,
pallor), BC
ii. Rest periods, quiet activities
d. Bleeding or risk for bleeding resulting from the thrombocytopenia
i. Assess: skin (petechiae, purpura, & bruising), stool & urine for blood
ii. Avoid contact sports
iii. Provide stool softeners
e. Risk for imbalanced nutrition: less than body requirements/risk for deficient fluid volume
resulting from complications of illness & medical therapies (poor appetite, stomatitis, N/V)
i. Administer: antiemtics, chemo at night
ii. Monitor: signs of dehydration
iii. I&O, weigh daily
iv. Nutritionists
v. Refrain from food & fluids that irritate oral mucosa (citrus juice, high salt food)
vi. High protein, high calorie supplements (milk shakes)
, f. Risk for impaired skin integrity/altered body image resulting from side effects of the illness &
of the medications
i. Assess oral mucosal for ulcerations
ii. Saline or sodium bicarbonate mouthwashes
iii. Monitor tooth eruption
iv. Change position
v. Warn loss of hair
g. Risk for injury related to side effects of medications
i. Signs of injury related to chemo meds:
1. Constipation, foot drop, cognitive dysfunction, reproductive dysfunction,
skeletal changes, altered G&D
h. Deficient knowledge
Davis page 335
Questions:
1. A 4-year-old has developed acute lymphocytic leukemia (ALL). Nursing care for the child
with ALL involves taking axillary, rather than rectal, temperatures because the child:
A) is anemic.
B) has a low white blood cell count.
C) has a low platelet count.
D) is prone to diarrhea.
Ans: C
Feedback: Children with leukemia develop lesions of the gastrointestinal tract. If touched by a
thermometer, these bleed easily; blood coagulation is poor because of a decreased platelet count.
2. Children with ALL may need periodic lumbar punctures. You would teach the mother this is
done to assess for:
A) platelets.
B) leukemic cells.
C) early meningitis.
D) early development of septicemia.
Ans: B
Feedback: Leukemic cells in cerebrospinal fluid must be identified because, if present, they
require additional therapy.
3. A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best
apply to him during therapy?
A) Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy
B) Risk for impaired mobility related to depressant effects of methotrexate
C) Excess fluid volume related to effect of methotrexate on aldosterone secretion
D) Risk for self-directed violence related to effect of methotrexate on central nervous system
Brain Tumor:
1. Patho:
a. S/S: consistent w. increased ICP
i. Depending on location additional S/S may be exhibited
1. Uncoordinated movements
2. Paralysis of one side of the body
3. Altered speech pattern
4. Altered eye movement
b. Many have long – term complications (hydrocephalus, cognitive deficits, seizure disorders)
2. Dx:
a. Complete neurological assessment
i. Lumbar puncture contraindicated bc of possible herniation of brain
b. MRI/CT
3. Tx:
a. Surgical: complete removal may not be possible
b. Chemotherapy and/or radiation
c. If hydrocephalus develops, a VP shunt may be inserted during surgery
4. Nursing considerations:
a. Preop:
i. Anxiety/fear/anger/grieving/deficit knowledge
1. Prepare parents for need to shave head & size of dressing afterwards
ii. Risk for injury
1. Age appropriate neurological assessment (Glasgow)
b. Postop:
i. Pain management, REEDA, VS, monitor GI functioning & bleeding potential
ii. Risk for injury
1. Neuro assessments (Glasgow)
a. Report s/s of increased ICP that may develop as result of bleeding into
the brain, hydrocephalus, or swelling of the brain tissue
2. Elevate HOB
a. Never place in Trendelenburg position
iii. Risk for infection/impaired skin integrity
1. Handwashing, aseptic technique
2. Monitor infection signs at surgical site, urinary, pulmonary, and lab data
iv. Risk for imbalanced fluid volume
1. I & O, weigh daily
v. Risk for delayed growth & development/risk for impaired coping
1. Specialized care: OT, PT, sensory assessments
Neuroblastoma
1. Cancer of the peripheral nervous system that originated from embryonic tissue
2. Metastasis to other organs is common
3. Dx:
, a. Difficult bc s/s similar to other diseases
b. Dx: xray, MRI, &/or CT
c. S/S range from a large abdominal mass to HTN, to marked sweating, to marked diarrhea, to
s/s of spinal cord compression
4. Tx:
a. Surgical removal
b. May be followed by chemo &/or radiation
5. Nursing considerations:
a. Preop:
i. Anxiety/fear/anger/grieving/deficient knowledge/pain
1. Give analgesics
a. Narcotics for moderate to severe
2. Non pharm pain management
ii. Risk for injury
1. Neuro assessments (Glasgow)
b. Postop:
i. Pain management, REEDA, VS, monitor GI functioning & bleeding potential
ii. Risk for injury/pain
1. Glasgow, analgesics (narcotics for moderate to severe), non pharm pain
management
iii. Risk for impaired coping.
Davis Page 426
Acute Lymphoblastic Leukemia (ALL)
1. Proliferation in the production of lymphoblasts or immature WBC in bone marrow
2. Patho:
a. Hyperproduction of immature WBC, called blast cells in bone marrow
b. Poor production of other BC & inadequate maturation of WBCs in bone marrow =
i. Reduced erythrocyte production = anemia. Characterized by fatigue & lack of energy
ii. Reduced platelet production = thrombocytopenia. Characterized by petechiae &
bruising
iii. Reduced # of mature WBC = neutropenia. Characterized by low grade fevers, recurring
infections, & lymphadenopathy
3. Dx:
a. Suspicious
i. Clinical picture
ii. Altered CBC: RBC & platelet less than normal, altered WBC count
b. Bone marrow biopsy w. DNA analysis to confirm
4. Tx:
a. Chemo
i. 3 phases
1. Induction = remission (reduce % of blast cells in blood to 5% or less)
a. Response to meds is monitored by serial bone marrow aspirations
, 2. Consolidation: maintain remission & prevent the progression of the disease to
the CNS and/or the testes in males
a. Chemo administered intrathecally (into spinal column) to prevent
migration of cells into CNS
b. Testes radiated if blast cells found
3. Maintenance: continued remission
a. Chemo administered periodically PO &/or IV over next few years
b. Periodic BC & bone marrow biopsies to monitor possible relapse
b. Bone marrow &/or cord blood transplants
i. Either autologous (own) or allogeneic (donor)
ii. Antirejection meds administered (prednisone, cyclosporine, tacrolimus)
iii. Additional meds/interventions: antibiotics, antifungals, antivirals, RBC production
stimulators (epogen) WBC production stimulators (leukine), & blood transfusions
5. Nursing considerations:
a. Anxiety/fear/pain
i. Lumbar punctures & bone marrow aspiration = frightening
b. Infection or risk for infection resulting from periods of neutropenia
i. VS (temp)
ii. Handwashing, aseptic technique
iii. Monitor for signs of infection
1. Thrush w. stomatitis (inflammation of mucous membranes in mouth)
2. Diarrhea
3. UTI
iv. Oral hygiene soft brush
v. Administer antibx, antivirals, &/or antifungals
vi. Febrile antipyretic
1. Aspirin is avoided
vii. Dead vaccines
c. Risk for altered tissue perfusion/activity intolerance/fatigue resulting from the anemia
i. Monitor: VS, signs of ineffective perfusion (fatigue, decreased activity, tachycardia,
pallor), BC
ii. Rest periods, quiet activities
d. Bleeding or risk for bleeding resulting from the thrombocytopenia
i. Assess: skin (petechiae, purpura, & bruising), stool & urine for blood
ii. Avoid contact sports
iii. Provide stool softeners
e. Risk for imbalanced nutrition: less than body requirements/risk for deficient fluid volume
resulting from complications of illness & medical therapies (poor appetite, stomatitis, N/V)
i. Administer: antiemtics, chemo at night
ii. Monitor: signs of dehydration
iii. I&O, weigh daily
iv. Nutritionists
v. Refrain from food & fluids that irritate oral mucosa (citrus juice, high salt food)
vi. High protein, high calorie supplements (milk shakes)
, f. Risk for impaired skin integrity/altered body image resulting from side effects of the illness &
of the medications
i. Assess oral mucosal for ulcerations
ii. Saline or sodium bicarbonate mouthwashes
iii. Monitor tooth eruption
iv. Change position
v. Warn loss of hair
g. Risk for injury related to side effects of medications
i. Signs of injury related to chemo meds:
1. Constipation, foot drop, cognitive dysfunction, reproductive dysfunction,
skeletal changes, altered G&D
h. Deficient knowledge
Davis page 335
Questions:
1. A 4-year-old has developed acute lymphocytic leukemia (ALL). Nursing care for the child
with ALL involves taking axillary, rather than rectal, temperatures because the child:
A) is anemic.
B) has a low white blood cell count.
C) has a low platelet count.
D) is prone to diarrhea.
Ans: C
Feedback: Children with leukemia develop lesions of the gastrointestinal tract. If touched by a
thermometer, these bleed easily; blood coagulation is poor because of a decreased platelet count.
2. Children with ALL may need periodic lumbar punctures. You would teach the mother this is
done to assess for:
A) platelets.
B) leukemic cells.
C) early meningitis.
D) early development of septicemia.
Ans: B
Feedback: Leukemic cells in cerebrospinal fluid must be identified because, if present, they
require additional therapy.
3. A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best
apply to him during therapy?
A) Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy
B) Risk for impaired mobility related to depressant effects of methotrexate
C) Excess fluid volume related to effect of methotrexate on aldosterone secretion
D) Risk for self-directed violence related to effect of methotrexate on central nervous system
