Chapter 53

Nursing Care of a Family When a

Child Has a Malignancy
Neoplasia #1

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Neoplasia #2

Neoplastic growth
 Causes in children versus adults
 Theories
 Genetic trigger
 Environmental irritation
 Cell mutation
 Oncogenic virus

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Neoplasia #3

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2020 National Health Goals Related to
Cancer and Children #1

Reduce the overall cancer death rate from a baseline

of 178.4 per 100,000 to 160.6 per 100,000 of the
population.
Increase the proportion of adolescents in grades 9
through 12 who follow protective measures that
may reduce the risk of skin cancer from 9.3% to
11.2%.

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2020 National Health Goals Related to
Cancer and Children #2

Reduce the rate of melanoma cancer deaths from a

baseline of 2.7 per 100,000 to a target level of 2.4
per 100,000 of the population.

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Nursing Process: Cancer

Assessment
Nursing diagnosis
Outcome identification and planning
Implementation
Outcome evaluation

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Assessing Children With Cancer #1

History
Physical and laboratory examination
o Biopsy
o Staging

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Assessing Children With Cancer #2

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Assessing the Leukemias
 Acute lymphocytic (lymphoblastic) leukemia
 Acute myeloid leukemia
o Pallor, low-grade fever, lethargy; low thrombocyte count,
petechiae, bleeding from oral mucous membranes, easy
bruising on arms and legs; abdominal pain, vomiting,
anorexia; bone and joint pain; headache or unsteady gait;
painless, generalized swelling of lymph nodes; elevated
leukocyte count; lesions on long bones; blast cells in CSF
o Bone marrow aspiration identifies type of WBC involved.

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Assessing the Lymphomas #1

Hodgkin disease
o One painless, enlarged, rubbery-feeling cervical lymph
node followed by enlargement of other nodes and liver,
spleen, bone marrow, CNS; anorexia; malaise; night
sweats; elevated sedimentation rate; anemia
o Biopsy of lymph nodes; chest, abdominal CT;
lymphangiogram

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Assessing the Lymphomas #2

Non-Hodgkin lymphoma
o Enlarged lymph glands of neck and chest; possibly of
axillary, abdominal, inguinal nodes; if mediastinal lymph
glands involved, cough or chest “tightness”; edema of
face
o Biopsy of affected lymph nodes, bone marrow

Burkitt lymphoma
o Enlarged, painless lymph node of neck or abdomen
blocking a body system; growth so rapid cell mass may
double in size in as few as 24 hours

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Assessing Neoplasms of the Brain #1

Types of brain tumors

o Cerebellar astrocytomas: slow-growing, cystic tumors that
arise from glial or support tissue surrounding neural cells
o Medulloblastomas: fast-growing tumors found most
commonly in cerebellum
o Brainstem gliomas: often cause paralysis of the fifth,
sixth, seventh, ninth, and tenth cranial nerves

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Assessing Neoplasms of the Brain #2

Symptoms of increased intracranial pressure

o Headache occurs on arising; may be intermittent
throughout day; intense on straining
o Vomiting occurs on arising; not nauseated, will eat
immediately after; morning after morning, eventually
projectile
o Diplopia, ptosis, or strabismus; papilledema
o Skull films, bone scan, ultrasound or MRI, cerebral
angiography, or a CT scan; possibly myelography; lumbar
puncture

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Assessing Bone Tumors

Osteogenic sarcoma
o Taller than average; painful, swollen site; possibly
inflamed, feels warm; report of recent trauma to site
o Elevated serum alkaline phosphatase; biopsy of site

Ewing sarcoma
o Intermittent pain at site, becomes constant and severe;
“onion-skin” reaction on X-ray
o Bone scan, bone marrow aspiration, biopsy, CT scan of
lungs, and IV pyelogram or kidney MRI

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Assessing Other Childhood Neoplasms #1

Neuroblastoma
o Palpable abdominal mass after weight loss, anorexia;
possibly excessive sweating, flushed face, hypertension;
possibly abdominal pain, constipation; possibly loss of
motor function in lower extremities
o Arteriogram; ultrasound, CT, or MRI scan of chest,
abdomen, pelvis; gallium bone scan; bone marrow
aspiration and biopsy

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Assessing Other Childhood Neoplasms #2

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Assessing Other Childhood Neoplasms #3

Nephroblastoma (Wilms tumor)

o Palpable firm, nontender abdominal mass; possibly
hematuria, low-grade fever; anemia
o CT scan or ultrasound; glomerular filtration rate or blood
urea nitrogen assays
Retinoblastoma
o Pupil appears white; strabismus
o CT scan, MRI, and ultrasound

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Nursing Diagnoses

Pain
Imbalanced nutrition
Risk for infection
Disturbed body image
Compromised family coping

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Quality & Safety Education for Nurses
(QSEN)
Patient-Centered Care
Teamwork & Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics

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Cancer Treatment #1

Radiation therapy
o Immediate side effects
o Long-term side effects
o Effects on bone
o Effects on hormones
o Effects on nervous system
o Effects on organs of chest, abdomen

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Cancer Treatment #2

Radiation therapy—(cont.)
o Before treatment
o During treatment
o After treatment

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Cancer Treatment #3

Chemotherapy
o Types
 Alkylating agents
 Antimetabolites
 Plant alkaloids
 Antitumor antibiotics

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Cancer Treatment #4

Chemotherapy—(cont.)
o Types—(cont.)
 Nitrosoureas
 Corticosteroids
 Immunotherapy

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Cancer Treatment #5

Chemotherapy—(cont.)
o Protocols
o Side effects and toxic reactions
 Alopecia
 Cushingoid appearance

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Cancer Treatment #6

Stem cell transplantation

Pain relief

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Question #1

A 2-year-old boy has a nephroblastoma (Wilms

tumor). Which would the nurse expect his parents to
report as the first symptom of this tumor?
A. Blood in urine
B. Chronic cough
C. Abdominal mass
D. Oliguria

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Answer to Question #1

C. Abdominal mass
Rationale: A Wilms tumor grows on the anterior surface of
the kidney, so it is felt as an abdominal mass.

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Question #2

A 6-year-old child receiving chemotherapy develops

stomatitis. The physician prescribes Xylocaine to be
used to decrease the discomfort associated with this.
What teaching should the nurse provide first to the
child?
A. Drink the solution with her favorite beverage.
B. Use the solution after eating.
C. Not to swallow the solution.
D. Use the solution after brushing the teeth.

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Answer to Question #2

C. Not to swallow the solution.

Rationale: Swallowing lidocaine may cause paralysis of the
gag reflex. Young children may just drink and swallow the
solution if not taught what is to be done.

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Question #3

The nurse bathes an infant receiving radiation therapy

and notices that there are ink marks at the site where
the radiation will be directed. Which nursing action is
indicated?
A. Cleanse the marks well with soap and water.
B. Remove the ink marks with acetone or alcohol.
C. Leave the ink marks alone.
D. Apply lotion to the area to keep the skin moist.

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Answer to Question #3

C. Leave the ink marks alone.

Rationale: Marks may be placed on the child’s skin to be
certain the radiation is directed at the same points with each
session. Leaving such marks in place is important. Applying
lotion is contraindicated because it could deflect the
radiation.

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