Peds Exam #5
Chapter 46: Cancer
After 6 months of age, Hgb A is the predominant type, we make it ourselves.
The fetus receives iron through the placenta from the mother
In the term infant, a period of physiologic anemia occurs between the age of 2 and 6
months
maternally derived iron stores are depleted by 4 to 6 months of age.
Sufficient iron intake is critical for the appropriate development of hemoglobin and RBCs
infant must ingest adequate quantities of iron either from breast milk or from iron-
fortified formula in early infancy and other food sources in later infancy
Adolescence is also a time of rapid growth, and intake of iron must increase.
Changes in blood cell production may result in fatigue, pallor, frequent or severe
infection, or easy bruising.
Infiltration, obstruction, or compression by a tumor may result in bone or abdominal
pain, pain in other parts of the body, swelling, or unusual discharge.
Cancer usually affects
o Tissues - kids
o Organs – adults
Cancer prevention
o Little known - kids
o 80% preventable - adults
Detection
o Usually incidental or accidental - kids
o Very early detection possible if screening recommendations followed – adults
Some of the treatments can impair the child’s growth and development.
In the child with cancer, particularly advanced disease, the decision to provide treatment
(“let’s do everything we can”) or to withhold treatment in the event of an extremely
poor prognosis is extraordinarily challenging in an ethical sense.
Educate families to start skin protection from the sun in childhood to reduce the risk of
skin cancer as an adult.
Assent American academy of peds
o Help each child to achieve a developmentally appropriate understanding of the
illness.
o Tell the child what he or she can expect regarding testing procedures and
treatments.
Treatments:
o Blood product transfusion - PRBCs: severe anemia, thalassemia, sickle cell
disease - Monitor vital signs and assess child frequently to detect adverse
reaction to blood transfusion
o If adverse reaction is suspected, immediately discontinue transfusion, run normal
saline IV, reassess the child, and notify the physician
, o Hematopoietic stem cell transplantation
Bone marrow transplant: transfer of healthy bone marrow into a child
with disease; the transplanted cells can then develop into functional cells
Stem cell transplant: Peripheral stem cells are removed from the donor
via apheresis, or stem cells are retrieved from the umbilical cord and
placenta. The stem cells are then transplanted into the recipient
Leukemia, lymphoma, other cancers, sickle cell disease, aplastic anemias,
thalassemia
Maintain medical asepsis and protective isolation to prevent infection
Provide meticulous oral care
Encourage appropriate nutrition
Administer immunosuppressive medications as ordered
o Supplemental oxygen
Hypoxia associated with sickle cell crisis or severe anemia
o Biopsy
Solid tumors
Helps with staging
o Central venous catheter
the purpose of administering medications, total parenteral medication, or
blood products
Monitor for fever – central line infection
Monitor insertion site for erythema or drainage
Can go swimming and everything at home
Medications
o Iron supplements (ferrous sulfate, ferrous fumarate)
Supplemental iron in deficient child
Iron-deficiency anemia
May color stools and urine black
Liquid can stain the teeth; mix with a small amount of juice; drinking with
straw decreases tooth staining
o Factor (VIII or IX) replacement
Replaces deficient clotting factors
Hemophilia -
Administer IV when bleeding occurs
o Chelating agents: heavy metals in the body
Remove lead from soft tissues and bone, allowing for its excretion via the
renal system
Used for blood lead levels >45 μg/dL
Ensure that lead is being removed from the child’s home
o Immunosuppressant drugs:
o Chemotherapy
Causes myelosuppression, nausea, vomiting, alopecia, mucositis
Monitor for signs of infection
, Must be certified to administer it
Kidneys take a hit
Phases of the cell cycle
Unfortunately, chemotherapeutic medications disrupt the cell cycle of not
only cancer cells but also normal rapidly dividing cells. This results in a
significant number of adverse effects.
The cells most likely to be affected by chemotherapy are those in the
bone marrow, the digestive tract (especially the mouth), the reproductive
system, and hair follicles.
Adverse effects common to chemotherapeutic drugs include
immunosuppression, infection, myelosuppression, nausea, vomiting,
constipation, oral mucositis, alopecia, and pain.
Pain is very different
Acupuncture as an adjunct therapy may help to decrease nausea,
vomiting, and aversion to chemotherapy.
o Radiation Therapy:
radiation therapy uses high-energy radiation to damage or kill cancer cells
Radiation therapy is also used to shrink a tumor prior to surgical
resection. The area to be treated is marked carefully to minimize damage
to normal cells.
Adverse effects of radiation therapy include fatigue, nausea, vomiting,
oral mucositis, myelosuppression, and alterations in skin integrity at the
site of irradiation.
Long-term complications are related to the area of the body that was
irradiated and include alterations in growth; hormone dysfunction;
, hearing and vision alterations; learning problems; cardiac dysfunction;
pulmonary fibrosis; hepatic, sexual, or renal dysfunction; osteoporosis;
and development of secondary cancer
o Hematopoietic Stem Cell Transplant
bone marrow transplantation, is a procedure in which hematopoietic
stem cells are infused intravenously into the child
The use of high-dose chemotherapy and total body irradiation kills the
tumor cells but also destroys the child’s bone marrow.
The transplanted cells migrate to the empty spaces in the child’s bone
marrow and reestablish normal hematopoiesis in the child.
it is not the first line of treatment but is used for refractory or advanced
disease
NURSING PROCESS OVERVIEW FOR THE CHILD WITH AN ALTERATION IN CELLULAR
REGULATION (HEMATOLOGIC DISORDER OR CANCER)
o Development of a plan of care will depend on which component of the blood is
altered in the hematologic disorder.
o A decrease in hemoglobin will necessitate evaluation of oxygen-carrying capacity
and effects of hypoxia on the tissues.
o A reduction in platelet production will lead the nurse to evaluate for prolonged
bleeding, hemorrhage, and shock.
o An elevation in WBCs would require an evaluation for infection.
o Assessment:
Signs of changes in the hematologic system are often insidious and
overlooked.
Skin color changes such as pallor, bruising, and flushing are often the first
signs that a problem is developing.
o Health History:
Determine the child’s sleep/wake patterns and bowel elimination
patterns, which may be affected by alterations in circulating blood volume
or changes in oxygenation
Fatigue or malaise
Pallor of the skin
Unusual bruising or petechiae (purple freckle)
Excessive bleeding or difficulty stopping bleeding
recurrent fever or frequent infections
early-morning headache with nausea or vomiting – TUMOR CONCERN
history of bone fractures unrelated to trauma
o Physical Assessment:
Note a thin or frail appearance, fatigue, or altered level of consciousness
Percuss the abdomen, noting dullness over a mass if present.
It is particularly important to determine the child’s self-esteem, level of
anxiety or stress, and coping mechanisms. Determine the spiritual status
Chapter 46: Cancer
After 6 months of age, Hgb A is the predominant type, we make it ourselves.
The fetus receives iron through the placenta from the mother
In the term infant, a period of physiologic anemia occurs between the age of 2 and 6
months
maternally derived iron stores are depleted by 4 to 6 months of age.
Sufficient iron intake is critical for the appropriate development of hemoglobin and RBCs
infant must ingest adequate quantities of iron either from breast milk or from iron-
fortified formula in early infancy and other food sources in later infancy
Adolescence is also a time of rapid growth, and intake of iron must increase.
Changes in blood cell production may result in fatigue, pallor, frequent or severe
infection, or easy bruising.
Infiltration, obstruction, or compression by a tumor may result in bone or abdominal
pain, pain in other parts of the body, swelling, or unusual discharge.
Cancer usually affects
o Tissues - kids
o Organs – adults
Cancer prevention
o Little known - kids
o 80% preventable - adults
Detection
o Usually incidental or accidental - kids
o Very early detection possible if screening recommendations followed – adults
Some of the treatments can impair the child’s growth and development.
In the child with cancer, particularly advanced disease, the decision to provide treatment
(“let’s do everything we can”) or to withhold treatment in the event of an extremely
poor prognosis is extraordinarily challenging in an ethical sense.
Educate families to start skin protection from the sun in childhood to reduce the risk of
skin cancer as an adult.
Assent American academy of peds
o Help each child to achieve a developmentally appropriate understanding of the
illness.
o Tell the child what he or she can expect regarding testing procedures and
treatments.
Treatments:
o Blood product transfusion - PRBCs: severe anemia, thalassemia, sickle cell
disease - Monitor vital signs and assess child frequently to detect adverse
reaction to blood transfusion
o If adverse reaction is suspected, immediately discontinue transfusion, run normal
saline IV, reassess the child, and notify the physician
, o Hematopoietic stem cell transplantation
Bone marrow transplant: transfer of healthy bone marrow into a child
with disease; the transplanted cells can then develop into functional cells
Stem cell transplant: Peripheral stem cells are removed from the donor
via apheresis, or stem cells are retrieved from the umbilical cord and
placenta. The stem cells are then transplanted into the recipient
Leukemia, lymphoma, other cancers, sickle cell disease, aplastic anemias,
thalassemia
Maintain medical asepsis and protective isolation to prevent infection
Provide meticulous oral care
Encourage appropriate nutrition
Administer immunosuppressive medications as ordered
o Supplemental oxygen
Hypoxia associated with sickle cell crisis or severe anemia
o Biopsy
Solid tumors
Helps with staging
o Central venous catheter
the purpose of administering medications, total parenteral medication, or
blood products
Monitor for fever – central line infection
Monitor insertion site for erythema or drainage
Can go swimming and everything at home
Medications
o Iron supplements (ferrous sulfate, ferrous fumarate)
Supplemental iron in deficient child
Iron-deficiency anemia
May color stools and urine black
Liquid can stain the teeth; mix with a small amount of juice; drinking with
straw decreases tooth staining
o Factor (VIII or IX) replacement
Replaces deficient clotting factors
Hemophilia -
Administer IV when bleeding occurs
o Chelating agents: heavy metals in the body
Remove lead from soft tissues and bone, allowing for its excretion via the
renal system
Used for blood lead levels >45 μg/dL
Ensure that lead is being removed from the child’s home
o Immunosuppressant drugs:
o Chemotherapy
Causes myelosuppression, nausea, vomiting, alopecia, mucositis
Monitor for signs of infection
, Must be certified to administer it
Kidneys take a hit
Phases of the cell cycle
Unfortunately, chemotherapeutic medications disrupt the cell cycle of not
only cancer cells but also normal rapidly dividing cells. This results in a
significant number of adverse effects.
The cells most likely to be affected by chemotherapy are those in the
bone marrow, the digestive tract (especially the mouth), the reproductive
system, and hair follicles.
Adverse effects common to chemotherapeutic drugs include
immunosuppression, infection, myelosuppression, nausea, vomiting,
constipation, oral mucositis, alopecia, and pain.
Pain is very different
Acupuncture as an adjunct therapy may help to decrease nausea,
vomiting, and aversion to chemotherapy.
o Radiation Therapy:
radiation therapy uses high-energy radiation to damage or kill cancer cells
Radiation therapy is also used to shrink a tumor prior to surgical
resection. The area to be treated is marked carefully to minimize damage
to normal cells.
Adverse effects of radiation therapy include fatigue, nausea, vomiting,
oral mucositis, myelosuppression, and alterations in skin integrity at the
site of irradiation.
Long-term complications are related to the area of the body that was
irradiated and include alterations in growth; hormone dysfunction;
, hearing and vision alterations; learning problems; cardiac dysfunction;
pulmonary fibrosis; hepatic, sexual, or renal dysfunction; osteoporosis;
and development of secondary cancer
o Hematopoietic Stem Cell Transplant
bone marrow transplantation, is a procedure in which hematopoietic
stem cells are infused intravenously into the child
The use of high-dose chemotherapy and total body irradiation kills the
tumor cells but also destroys the child’s bone marrow.
The transplanted cells migrate to the empty spaces in the child’s bone
marrow and reestablish normal hematopoiesis in the child.
it is not the first line of treatment but is used for refractory or advanced
disease
NURSING PROCESS OVERVIEW FOR THE CHILD WITH AN ALTERATION IN CELLULAR
REGULATION (HEMATOLOGIC DISORDER OR CANCER)
o Development of a plan of care will depend on which component of the blood is
altered in the hematologic disorder.
o A decrease in hemoglobin will necessitate evaluation of oxygen-carrying capacity
and effects of hypoxia on the tissues.
o A reduction in platelet production will lead the nurse to evaluate for prolonged
bleeding, hemorrhage, and shock.
o An elevation in WBCs would require an evaluation for infection.
o Assessment:
Signs of changes in the hematologic system are often insidious and
overlooked.
Skin color changes such as pallor, bruising, and flushing are often the first
signs that a problem is developing.
o Health History:
Determine the child’s sleep/wake patterns and bowel elimination
patterns, which may be affected by alterations in circulating blood volume
or changes in oxygenation
Fatigue or malaise
Pallor of the skin
Unusual bruising or petechiae (purple freckle)
Excessive bleeding or difficulty stopping bleeding
recurrent fever or frequent infections
early-morning headache with nausea or vomiting – TUMOR CONCERN
history of bone fractures unrelated to trauma
o Physical Assessment:
Note a thin or frail appearance, fatigue, or altered level of consciousness
Percuss the abdomen, noting dullness over a mass if present.
It is particularly important to determine the child’s self-esteem, level of
anxiety or stress, and coping mechanisms. Determine the spiritual status
