DOÑA REMEDIOS T.

ROMUALDEZ MEDICAL FOUNDATION

COLLEGE OF NURSING
TACLOBAN CITY
nd
2 semester S.Y. 2019-2020

WORKSHEET ON THE NURSING CARE OF CHILDREN WITH CANCER

Name: Liao, Eani Katrina Y. Section: BSN 2C Date: July 9, 2020 Time: 12:00 noon

OUTCOMES:
1. Determine the importance of Laboratory and Diagnostic Tests in Cancer among children.
2. Categorize the diagnostic examinations into Laboratory and laboratory tests.
3. Discuss the normal findings, description, purpose, Indications, procedure and nursing implications (Pretest, Client Teaching and Post-test)
GUIDE QUESTIONS:
1. What are the importance of laboratory and diagnostic tests in Cancer among children?
Tests may help diagnose cancer and measure response to treatment. Tests may help diagnose cancer recurrence and measure treatment response. Tests may help
diagnose cancer recurrence and measure response to treatment. Tests may help determine treatment options, monitor for recurrence and measure response to treatment.
2. Which from the following laboratory and diagnostic tests are utilized in Childhood cancer?

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue
for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This section describes options for diagnosing childhood cancer. Your child’s doctor may consider these factors when choosing a diagnostic test:

The type of cancer suspected:

 Your child’s signs and symptoms

 Your child’s age and general health
 The results of earlier medical tests
 Not all tests listed below will be used for every person. If possible, it is important to have tests done in a pediatric specialty center where tests can be supervised by
pediatric specialists. These are medical professionals who specialize in diagnosing and treating younger patients. In addition to a physical examination, the following tests
may be used to diagnose childhood cancer:

 Blood tests. Routine blood tests measure the number of different types of cells in a person’s blood. Levels of certain cells that are too high or too low can indicate
the presence of certain types of cancer.
 Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but except for
certain types of brain tumors, only a biopsy can make a definite diagnosis. A biopsy can be guided by imaging tests (such as a CT or MRI scan; see below) to make
the procedure accurate and precise. The type of biopsy performed depends on the location of the cancer. The sample removed during the biopsy is analyzed by a
pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.
 Bone marrow aspiration and biopsy. These 2 procedures are similar and often done at the same time to examine the bone marrow, the spongy, fatty tissue found
inside larger bones. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy
is the removal of a small amount of solid tissue using a needle.
 A pathologist then studies the samples. A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located by the hip. Doctors generally
give a type of medication called "anesthesia" beforehand to numb the area. Anesthesia is medication that blocks the awareness of pain.
 Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a needle is used to take a sample of cerebral spinal fluid (CSF) to look for cancer cells,
or tumor markers. Tumor markers are substances found in higher than normal amounts in the blood, urine, or body tissues of people with certain kinds of cancer.
CSF is the fluid that flows around the brain and the spinal cord.
 Patients are often given an anesthetic to numb the lower back before the procedure or other medications to calm or relax your child (sedation).
 Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.
 Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer then
combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size.
Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or
given as a pill or liquid to swallow. When possible, it is best to have this test done in a pediatric specialty center where it can be supervised by pediatric radiologists.
These centers are aware of the potential risks of radiation exposure from a CT scan.
 Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the
tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a
pill or liquid to swallow.
 Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you
may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a
radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy
actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
 Scans or radioisotope studies. In these procedures, a material with a small amount of radioactive substance (called a tracer) is injected into the body and then
followed with a special camera or x-ray to see where the material goes. These studies can find abnormalities in the liver, brain, bones, kidneys, and other organs.
 a. Laboratory Tests
1. Adrenocorticotropic Hormone (Plasma)
2. Alphafetoprotein(Serum)
3. Antidiuretic Hormone (Serum)
4. Bence-Jones Protein
5. Carcinoembronic Antigen (Plasma)
6. Ceruloplasmin (Serum)
7. Cold Agglutinins (Serum)
8. Copper (Serum)
9. C-Reactive Protein (Serum)
10. Cryoglobulins (Serum)
11. Cytology
12. Enzymes
a. Acid Phosphatase
b. Alkaline Phosphatase
c. Gamma-glutamyl Transpeptidase
d. Lactic Dehydrogenase (Serum)

13. Erythrocyte Sedimentation Rate

14. Haptoglobulin (Serum)
15. Immunoglobulins (Serum)
a. IgG
b. IgA
c. IgM
16. Luteinizing Hormone (Serum)
17. Melanin (Urine)
18. Parathyroid Hormone
19. Partial Thromboplastin Time (Plasma)
20. Protein Electrophoresis (Serum)
a. Albumin
b. Globulin
21. Tumor Marker Tests
 Prostate-Specific Antigen
a. CA 15-3
b. CA19-9
c. CA 27-29
d. CA 125
22. White Blood Cells (Blood)
 NORMAL NURSING
DIAGNOSTIC TEST DESCRIPTION PURPOSE INDICATION PROCEDURE
FINDINS IMPLICATIONS
16. Luteinizing  Illustration. Inside  Luteinizing  LH affects gonadal  Distinguish between 1. Your doctor should Pre-test:
Hormone (Serum) the box. hormone (LH) is function in both primary and give you exact 1. Obtain a history of the
secreted by the men and women. In secondary causes of directions to patient’s complaints,
anterior pituitary women, a surge of gonadal failure prepare for your including a list of known
gland in response to LH normally occurs  Evaluate children blood test. allergens.
stimulation by at the midpoint of with precocious 2. You may be told to 2. Obtain a history of the
gonadotropin- the menstrual cycle puberty stop taking certain patient’s endocrine and
releasing hormone, (ovulatory phase);  Evaluate male and medications that reproductive systems, as
the same this surge is female infertility, as can affect the well as results of
hypothalamic believed to be indicated by results, so be sure previously performed
releasing factor that induced by high decreased LH levels to inform your tests and procedures.
stimulates follicle- estrogen levels.  Evaluate response to doctor of all 3. For related tests, refer to
stimulating  LH causes the therapy to induce medications and the endocrine and
hormone release. ovum to be ovulation supplements you reproductive system
expelled from the  Support diagnosis of take. tables.
ovary and infertility caused by 3. If you’re a woman, 4. Obtain a list of the
stimulates anovulation, as you may need to medications the patient is
development of the evidenced by lack of stop taking birth taking, including herbs,
corpus luteum and  LH surge at the control or other nutritional supplements,
progesterone midpoint of the hormone pills for and nutraceuticals.
production. menstrual cycle up to four weeks 5. The requesting health
 As progesterone before the test. care practitioner and
levels rise, LH Your doctor will laboratory should be
production also want to know advised if the patient
decreases. In males, the date of your last regularly uses these
LH stimulates the period. products so that their
interstitial cells of 4. As with many effects can be taken into
Leydig, located in blood draws, you consideration when
the testes, to may be asked to reviewing results.
produce avoid eating or 6. There are no food, fluid,
testosterone. drinking for up to or medication restrictions
 For this reason, in eight hours leading unless by medical
reference to males, up to the test. direction.
LH is sometimes 5. If you’ve had any 7. Review the procedure
called interstitial type of test or with the patient.
cell stimulating procedure with a 8. If the test is being
radioactive performed to detect
 hormone. substance seven ovulation, inform the
 Secretion of LH is days before the LH patient that it may be
pulsatile and blood test, let your necessary to obtain a
follows a circadian doctor know. These series of samples over a
rhythm in response substances can period of several days to
to the normal interfere with the detect peak LH levels.
intermittent results of your test. 9. Inform the patient that
secretion of specimen collection takes
gonadotropin- approximately 5 to 10
releasing hormone. minutes.
Client teaching:
 Direct the patient to
breathe normally and to
avoid unnecessary
movement.
Post-test:
1. Observe venipuncture
site for bleeding or
hematoma formation.
Apply pressure bandage.
2. Evaluate test results in
relation to the patient’s
symptoms and other tests
performed. Related
laboratory tests include
adrenocorticotropichorm
one, antisperm antibody,
estradiol, follicle-
stimulating hormone,
prolactin, and
testosterone.
17. Melanin (Urine)  Urine shouldn’t  This relatively rare  To aid in the  Evaluates slight 1. Label a sterile urine Pre-test:
contain test measures urine diagnosis of increases seen in container. Correctly 1. Explain the test
melanogens or levels of melanin, malignant liver metastasis. identifies the client and procedure and the
melanin. the brown-black melanomas  Detects a late-stage the test to be purpose of the test.
pigment that covers internal melanoma. performed. 2. Assess the client’s
the skin, hair, and This test is used to 2. Obtain a freshly voided knowledge of the test.
eyes. diagnose melanoma, urine sample. Ensures 3. Adhere to standard
 An end product of a type of skin cancer accurate results. precautions.
tyrosine that produces 3. Keep specimen cool. Client teaching:
metabolism, melanin. If the High temperatures alter 1. Explain to the patient
melanin is normally cancer spreads the results. what melanin is, and tell
4. Send specimen to him the urine melanin
 produced by (especially within laboratory. test detects its presence
specialized cells the liver), the cancer in urine.
and melanocytes. may produce enough 2. Inform the patient that he
 Cutaneous of this substance that need not restrict food and
melanomas it shows up in the fluids.
malignant tumors urine. 3. Tell the patient that the
that produce test requires a random
excessive amounts urine specimen, and
of melanin develop teach him the correct
most commonly collection technique.
around the head and Post-test:
neck, but may also 1. Document urine quantity,
originate in mucous date, and exact hours of
membranes (as in collection on requisition.
the rectum), the
retinas, or the
central nervous
system, where
melanocytes
appear.
 Patients with these
tumors may excrete
melanin precursor’s
melanogens in their
urine. If the urine is
left standing,
exposure to air
converts the
melanogens to
melanin in about 24
hours.
 Tormählen’s test
uses sodium
nitroprusside
(nitrofericyanide) to
detect melanogens
or melanin in urine,
based on
 characteristic color
changes.
 More specific tests
for melanin, such as
chromatography,
isolate and measure
the pigment.
18. Parathyroid  Normal serum  Parathyroid  To aid the  Assist in the 1. Perform a venipuncture Pre-test:
Hormone PTH levels vary, hormone (PTH), differential diagnosis of and collect 3 ml of 1. Obtain a history of the
depending on the also known as diagnosis of hyperparathyroidism blood into two separate patient’s complaints,
laboratory, and parathormone, parathyroid  Assist in the 7-ml clotactivator including a list of known
must be regulates plasma disorders diagnosis of tubes. allergens.
interpreted in concentration of suspected secondary 2. Apply direct pressure 2. Obtain a history of the
association with calcium and hyperparathyroidism to the venepuncture site patient’s endocrine
serum calcium phosphorus. due to chronic renal until bleeding stops. system and results of
levels. Typical Normally, PTH failure, malignant 3. If a hematoma develops previously performed
values for intact release is regulated tumors that produce at the venepuncture tests and procedures. For
PTH range from by a negative ectopic PTH, and site, apply pressure. related tests, refer to the
10 to 50 pg/ml feedback malabsorption 4. Instruct the patient that endocrine system table.
(SI, 1.1 to 5.3 mechanism syndromes he may resume his 3. Obtain a list of the
pmol/L); involving serum  Detect incidental usual diet. medications the patient is
Nterminal calcium. Normal or damage or taking, including herbs,
fraction is 8 to 24 elevated circulating inadvertent removal nutritional supplements,
pg/ml (SI, 0.8 to calcium levels of the parathyroid and nutraceuticals. The
2.5 pmol/L); C- (especially the glands during requesting health care
terminal fraction, ionized form) thyroid or neck practitioner and
0 to 340 pg/ml inhibit PTH release; surgery laboratory should be
(SI, 0 to 35.8 decreased levels  Differentiate advised if the patient
pmol/L). stimulate PTH parathyroid and regularly uses these
release. The overall nonparathyroid products so that their
effect of PTH is to causes of effects can be taken into
raise plasma levels hypercalcemia consideration when
of calcium while  Evaluate reviewing results.
lowering autoimmune 4. The patient should fast
phosphorus levels. destruction of the for 12 hours before
parathyroid glands specimen collection.
 Evaluate parathyroid There are no fluid or
response to altered medication restrictions
 serum calcium unless by medical
levels, especially direction. Early morning
those that result specimen collection is
from malignant recommended because of
processes, leading to the diurnal variation in
decreased PTH PTH levels.
production 5. Review the procedure
 Evaluate source of with the patient.
altered calcium 6. Inform the patient that
metabolism specimen collection takes
approximately 5 to 10
minutes.
7. Prepare ice slurry in a
cup or plastic bag to have
on hand for immediate
transport of the specimen
to the laboratory.
Client teaching:
1. Explain to the patient that
the PTH test helps
evaluate parathyroid
function.
2. Instruct the patient to
observe an overnight fast
because food may affect
PTH levels and interfere
with results.
3. Tell the patient that the
test requires a blood
sample. 4. Explain who
will perform the
venipuncture and when
and where it will take
place.
4. Explain to the patient that
he may experience slight
discomfort from the
needle puncture and the
tourniquet.
Precautions:
 Handle the sample gently
to prevent hemolysis.
 Send the sample to the
laboratory immediately
so the serum can be
separated and frozen for
assay.
Post-test:
1. Observe venipuncture
site for bleeding or
hematoma formation.
Apply pressure bandage.
2. Patients with abnormal
parathyroid levels are
also likely to experience
the effects of calcium
level imbalances.
3. Instruct the patient to
report signs and
symptoms of
hypocalcemia and
hypercalcemia to the
requesting health care
practitioner.
 (For critical values, signs
and symptoms of calcium
imbalance, and
nutritional information,
see monograph titled
“Calcium.”)
4. Evaluate test results in
relation to the patient’s
symptoms and other tests
performed. Related
laboratory tests include
calcium, ionized calcium,
serum and urine
 phosphorus, and vitamin
D.
19. Partial  Normally, a fibrin  The partial  To screen for  Detect congenital 1. Perform a venipuncture Pre-test:
Thromboplastin Time clot forms 21 to thromboplastin time deficiencies of the deficiencies in and collect the sample 1. Obtain a history of the
(Plasma) 35 seconds (SI, (PTT) test is used clotting factors in clotting factors, as in a 7-ml tube with patient’s complaints,
21 to 35 s) after to evaluate all the the intrinsic seen in diseases such sodium citrate added. including a list of known
adding reagents. clotting factors of pathways as hemophilia A 2. If a hematoma develops allergens.
For a patient on the intrinsic  To monitor (factor VIII) and at the venepuncture 2. Obtain a history of the
anticoagulant pathway except response to heparin haemophilia B site, apply pressure. If patient’s hematopoietic
therapy, ask the platelets by therapy (factor IX) the hematoma is large, and hepatobiliary
physician to measuring the time  Evaluate response to monitor pulses distal to systems, history of any
specify the required for anticoagulant the venepuncture site. bleeding disorders, and
reference values formation of a therapy with heparin 3. Make sure subdermal results of previously
for the therapy fibrin clot after the or coumarin bleeding has stopped performed tests and
being delivered. addition of calcium derivatives before removing procedures, especially
and phospholipid  Identify individuals pressure. bleeding time, clotting
emulsion to a who may be prone to time, complete blood
plasma sample. An bleeding during count, PTT, platelets, and
activator, such as surgical, obstetric, prothrombin time. For
kaolin, is used to dental, or invasive related tests, refer to the
shorten clotting diagnostic hematopoietic and
time. procedures hepatobiliary system
 Identify the possible tables.
cause of abnormal 3. Obtain a list of the
bleeding, such as medications the patient is
epistaxis, hematoma, taking, including
gingival bleeding, anticoagulant therapy,
hematuria, and acetylsalicylic acid,
menorrhagia herbs, and nutraceuticals
 Monitor the known to affect
hemostatic effects of coagulation. It is
conditions such as recommended that use of
liver disease, protein these products be
deficiency, and fat discontinued 14 days
malabsorption before dental or surgical
procedures. The
requesting health care
practitioner and
laboratory should be
 advised if the patient
regularly uses these
products so that their
effects can be taken into
consideration when
reviewing results. If the
patient is receiving
anticoagulant therapy,
note the time and amount
of the last dose.
4. There are no food, fluid,
or medication restrictions
unless by medical
direction.
5. Review the procedure
with the patient.
6. Inform the patient that
specimen collection takes
approximately 5 to 10
minutes.
Client teaching:
1. Explain to the patient that
the PTT test is used to
determine if blood clots
normally.
2. Tell the patient that a
blood sample will be
taken. 3. Explain who
will perform the
venipuncture and when
and where the test will
take place.
3. Explain to the patient that
he may feel slight
discomfort from the
needle puncture and the
tourniquet.
 When appropriate, tell
 the patient receiving
heparin therapy that this
test may be repeated at
regular intervals to assess
his response to treatment.
4. Inform the patient that he
need not restrict food and
fluids.
Post-test:
1. Observe venipuncture
site for bleeding or
hematoma formation.
Apply pressure bandage.
2. Instruct the patient to
report severe bruising or
bleeding from any areas
of the skin or mucous
membranes.
3. Inform the patient with
prolonged APTT values
of the importance of
taking precautions
against bruising and
bleeding, including the
use of a soft bristle
toothbrush, use of an
electric razor, avoidance
of constipation,
avoidance of
acetylsalicylic acid and
similar products, and
avoidance of
intramuscular injections.
4. Inform the patient of the
importance of periodic
laboratory testing while
taking an anticoagulant.
5. Evaluate test results in
relation to the patient’s
 symptoms and other tests
performed. Related
laboratory tests include
antithrombin III, specific
factor assays, fibrin
breakdown products,
platelet count, protein C,
and protein S.

NORMAL NURSING
DIAGNOSTIC TEST DESCRIPTION PURPOSE INDICATION PROCEDURE
FINDINS IMPLICATIONS
    Pre-test:

   Pre-test:

   Pre-test:

    Pre-test:
 NORMAL NURSING
DIAGNOSTIC TEST DESCRIPTION PURPOSE INDICATION PROCEDURE
FINDINS IMPLICATIONS
    6. Pre-test:

    5. Pre-test:

    1. Pre-test:

    1. Pre-test:
 NORMAL NURSING
DIAGNOSTIC TEST DESCRIPTION PURPOSE INDICATION PROCEDURE
FINDINS IMPLICATIONS
    7. Pre-test:
1.
    6. Pre-test:
1.
    2. Pre-test:
1.
    2. Pre-test:
 NORMAL NURSING
DIAGNOSTIC TEST DESCRIPTION PURPOSE INDICATION PROCEDURE
FINDINS IMPLICATIONS
    8. Pre-test:
1.
    7. Pre-test:
1.
    3. Pre-test:
1.
    3. Pre-test:
1.
 NORMAL NURSING
DIAGNOSTIC TEST DESCRIPTION PURPOSE INDICATION PROCEDURE
FINDINS IMPLICATIONS
    9. Pre-test:
1.
    8. Pre-test:
1.
    4. Pre-test:
1.
    4. Pre-test:
1.
3. What are the normal findings, description, purpose, Indications, procedure and nursing implications (Pretest, Client Teaching and Post-test) for each laboratory and diagnostic test?