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NCM 109: MCN LEC (FINAL)

o White blood cells are part of the body’s immune
CH 53: NURSING CARE OF A FAMILY system.
o They help the body fight infection and other
WHEN A CHILD HAS A MALIGNANCY diseases.
TOPICS o Types of white blood cells are:
 WHITE BLOOD CELLS 1) Granulocytes (neutrophils, eosinophils, and
o Types of White Blood Cells basophils)
o Assessing Children with Cancer 2) Monocytes
o Physical and Laboratory 3) Lymphocytes (T cells and B cells).
Examination
1) Biopsy
2) Staging
o Overview of Cancer Treatment
Measures Used with Children
1) Radiation Therapy
2) Chemotherapy
 LEUKEMIA
o Classifications of Leukemia
o Genesis of Leukemia
o Causes
o Signs and Symptoms
o Causes
o Diagnosis
o Treatment
o Bone Marrow Transplant
o Nursing Care
1) GRANULOCYTES
 WILM’S TUMOR
A. Neutrophils.
o Staging Kidney Cancer
Help protect your body from infections by
o Causes and Risk factors
killing bacteria, fungi, and foreign debris.
o Assessment
B. Eosinophils.
o Diagnostic Evaluation
Identify and destroy parasites, and cancer
o Medical Management
cells and assist basophils with your allergic
response.
o The terms malignant and cancerous describe cells C. Basophils.
that are growing and proliferating in a disorderly, Produces an allergic response like
chaotic fashion. coughing, sneezing or a runny nose.
o In adults, cancer usually occurs in the form of a 2) MONOCYTES
solid tumor. o Defend against infection by cleaning up
o In children, the most frequent type of cancer is damaged cells.
that of immature white blood cell (WBC) o Can develop into two types of cell:
overgrowth, or leukemia (Brown & Hunger, 2013). A. Dendritic.
 Antigen-presenting cells
 Able to mark out cells that are
antigens (foreign bodies) that need
o A type of blood cell that is made in the bone to be destroyed by lymphocytes.
marrow and found in the blood and lymph tissue.
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B. Macrophages.  help to regulate other T cells
 Phagocyte cells. to prevent them targeting the
 Larger and live longer than body’s own cells.
neutrophils
 Also able to act as antigen-
presenting cells.
3) LYMPHOCYTES
o Consists of T cells, natural killer cells,
and B cells to protect against viral
infections and produce proteins to help
you fight infection (antibodies).
o Help to regulate the body’s immune
system.
o The main types of lymphocytes are:
A. B Lymphocytes (B cells)
 B lymphocytes are able to release
antibodies which are Y-shaped
proteins that bind to infected
microbes or cells of the body that
have become infected.
 Antibodies can either neutralize the
target microbe or can mark it out
for attack by T lymphocytes.
B. T lymphocytes (T cells)
 There are a number of different T
lymphocytes:
i. Helper T cells o Assessing height and weight followed by a
 release a protein called thorough physical examination of children are
cytokines which help to instrumental measures in discovering
further direct the response of malignancy.
other white blood cells. o To confirm a diagnosis, a number of further
ii. Cytotoxic T cells diagnostic procedures may be used, including X-
 also known as natural killer T ray, ultrasound, magnetic resonance imaging
cells (MRI), blood analysis, and biopsy.
 able to release molecules
which kill viruses and other
antigens. o Most children with a possible diagnosis of
iii. Memory T cells cancer will have a biopsy (the surgical removal
 will be present after the body of cells for laboratory analysis) performed to
has fought off an infection confirm the diagnosis.
and help the body to deal o Although biopsies are classified as minor
more easily with any future surgery and usually done on an ambulatory
infection of the same type. basis, do not treat lightly the meaning of them
iv. Regulatory T cells to a family.
 also known as suppressor T
cells

NCM 109: MCN LEC (FINAL)
o Bone marrow aspiration is an example of a
frequent type of biopsy used with children (see
Chapter 44).
o Tumor staging is a procedure by which a
malignant tumor’s extent and progress are
documented.
o There are various staging systems.
o The TNM system describes the tumor’s size (T),
any presence in the lymph nodes (N), and if
cancer has metastasized or spread to other
organs (M).
o A TNM system is most applicable to solid
tumors and does not apply to malignancy of the
bone marrow (leukemias).
STAGE 1  a tumor that has not extended
into the surrounding tissue
 may be completely removed
surgically
STAGE 2  there is some local spread
 but the chance for complete
surgical removal is good
STAGE 3  cancer cells have spread to local
lymph nodes
STAGE 4  tumors that have spread
systemically (metastasis).
o Therapy for a child with cancer focuses on
devising ways to kill the growth of the abnormal
cells while protecting the normal surrounding
cells.
o Treatment may include any one or a
combination of surgery, radiation,
chemotherapy, stem cell transplantation, and
immunotherapy (biologic response modifiers).
o Radiation therapy changes the DNA component
of a cell’s nucleus and prevents replication
which inhibits further cell division and growth.
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o Radiation is delivered to the tumor in three
primary ways:
1) External beam radiation
 Delivers high-energy particles
(photons, electrons, protons) from
outside the body to the tumor.
 Administered in one to two
treatments per day over several days
to a week.
2) Brachytherapy
 Delivers radiation via implants
directly to the tumor site (interstitial,
intracavitary, or on the surface).
 Radioactive material is then loaded
into the implant, typically over a 4- to
6-day period.
3) Stereotactic radiosurgery
 Delivers a single high dose of
radiation to the tumor using three-
dimensional (3-D) imaging to target
the exact tumor space (Ermoian,
Fogh, Braunstein, et al., 2016).
1. Radiation sickness (fatigue, anorexia, nausea,
vomiting) is the most frequently encountered
systemic effect.
 To counteract this, a child has often
prescribed an antiemetic before each
radiation treatment.
2. Skin reactions, such as erythema and
tenderness, are typical local effects.
 Maintaining good skin hygiene and use of
mild soaps or moisturizers (non-fragrant)
may help preserve skin integrity.
o The long-term side effects of radiation are
becoming more apparent as increasing numbers
of children who have undergone intense
radiation therapy survive years beyond the
radiation.
o Because radiation damages all cells in its path
toward the tumor to some extent, any body tissue
in the radiation field has the possibility of long-
term complications or malignant transformation.

NCM 109: MCN LEC (FINAL)
1) Asymmetric growth of bones
2) Easy fracturing
3) Scoliosis
4) Kyphosis
5) Hypoplasia (not reaching full growth potential)
are effects that can occur in bones.
o Bone tissue is most vulnerable during times of
rapid growth, such as during the first years of life
or during a prepubertal growth spurt.
o Radiation to the head and neck can result in
long-term thyroid, hypothalamic, and pituitary
gland dysfunction.
1) Growth hormone deficiency
2) Hyperprolactinemia
3) Central adrenal insufficiency
4) Gonadotropin deficiency (Rose, Horne, Howell,
et al., 2016).
o For this reason, children’s growth and endocrine
function need to be evaluated for decades after
treatment with cranial radiation to detect these
changes.
o It’s possible to treat both hypothyroidism and
hypopituitary growth failure with hormone
replacement in the coming years if these do
occur.
o Radiation to ovaries or testes can also result in
complications such as infertility or less estrogen
or testosterone production, preventing the
development of secondary sexual changes.
 For children past puberty, pretreatment
sperm or oocyte banking may be
advocated before they undergo radiation
to the testes or ovaries so they have viable
sperm or oocytes banked for use later in
life (E. K. Johnson, Finlayson, Rowell, et
al., 2017).
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o Long-term effects of radiation to the nervous
system are demyelination and necrosis of the
white matter of the brain
1) Lethargy
2) Sleepiness
3) Seizures
4) Effects on the gray matter can result in
learning disabilities.
o Careful history related to school and learning
issues is critical
o Neuropsychological testing is recommended to
identify any weakness and assist in the
development of individual education plans.
o In addition, children may experience headaches,
cataracts, salivary gland damage, and a chronic
change in or loss of taste.
o Extensive radiation to the lungs can result in a
 chronic pneumonitis
 and pulmonary fibrosis, resulting in
obstructive or restrictive chronic lung
disease.
o Heart effects may include
 left ventricular dysfunction,
 valve abnormalities,
 early coronary artery disease,
 or conduction abnormalities.
o Radiation to the GI system can result in
 chronic malabsorption from changes in
intestinal villi;
 hepatic fibrosis can result in reduced liver
function.
o Radiation to the kidney and bladder can result in
 nephritis
 and chronic cystitis.
o If the child’s head area is involved in therapy:
 permanent alopecia (hair loss),
 impaired growth of teeth,
 or reduced salivary gland function
(leading to a constantly dry mouth) may
result.

NCM 109: MCN LEC (FINAL)
o Radiation to bone marrow :
 may depress the production of both WBCs
and platelets.
o If the area to be radiated is marked on the child’s
skin, do not erase the marks.
o Expose irradiated area to air but not to direct heat
or sunlight.
o Avoid lengthy soaks in bath water or swimming
pools.
o If the head is irradiated, use mild shampoo on hair
and rinse gently with water. Air dry or pat excess
moisture gently. Avoid rough towels and hair
dryers.
o Supply a soft toothbrush to protect gums and oral
mucous membranes. Keep the mouth moist by
offering frequent sips of water—particularly if
radiation decreases salivary gland secretions.
o Encourage clothing that fits loosely over irradiated
areas.
o Because some skin preparations are drying and
some interfere with radiation, do not apply creams
or lotions to the irradiated area unless prescribed.
o To promote retention of nutrients, administer
antiemetics as prescribed.
o Encourage high-calorie meals when the child is
least likely to be nauseated. Praise the child’s
efforts to eat. Strive for peaceful and pleasant
meal and snack times.
o Provide foods identified by child as special
favorites. Serve easy-to-swallow foods at best
liked temperatures.
o Reduce amounts of fresh fruit and vegetables rich
in cellulose and eliminate apple juice from the
child’s diet because these may contribute to
diarrhea and subsequent fluid loss if the
gastrointestinal tract is in the radiation field.
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o If diarrhea occurs, administer antidiarrheal
medication as prescribed.
o Provide adequate rest periods. Schedule activities
to avoid waking the child frequently at night.
o Structure the child’s activities to be stimulating
but not physically tiring.
o Recommend mild activity that does not stress
bones that may be weakened by radiation and,
therefore, easily fractured (if applicable).
o Prepare the child for the effects of radiation
therapy, particularly hair loss (if cranial radiation),
in case they occur.
o Some comfort measures may include wearing a
wig or special cap; introducing play things, such
as dolls without hair; and most important,
stressing that people like people for themselves,
not for their appearance.
o Schedule a tour of the radiation department. If
possible, let the child play–act and become
familiar with the equipment. Provide ample time
to answer questions.
o Help the child devise “mind games” to play during
the procedure such as listing 10 friends to take
camping, 10 activities to do, or 10 favorite games
to play so the procedure is not boring but a
learning experience.
o A chemotherapeutic agent is a drug that is capable
of destroying malignant cells.
o In most instances, several chemotherapeutic
agents of differing mechanisms are used to ensure
maximal tumor cell death.
o Like radiation, chemotherapy is scheduled at
intervals that increase the ability to destroy
malignant cells throughout the cell cycle.
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NCM 109: MCN LEC (FINAL)
TYPES OF CHEMOTHERAPEUTIC AGENTS procedures (hospital specific protocols should be
CHEMOTHERAPEUTIC MECHANISM OF EXEMPLAR DRUG followed).
AGENTS ACTION o Caution parents, when administering such drugs
Alkylating agents Cell-cycle Cyclophosphamide at home, to use similar precautions.
specific; (Cytoxan)
effective
against cells in
the G1 and S o Chemotherapy is scheduled for children at set
phase growth times and days and by various predetermined
Antimetabolites Interrupts the Methotrexate routes.
cells metabolic o At first, children may remain in the hospital for a
processes;
few days of treatment; later, they may report on a
effective in S
specific day for therapy, or parents may
phase
administer the designated therapy at home.
Plant alkaloids Interferes with Vincristine
cell mitosis; o Parents must learn about the child’s treatment
effective in M protocol so that they know which drug the child
phase. will be receiving each day and on which day each
Antitumor antibiotics Impairs DNA Doxorubicin drug must be administered.
synthesis; not (Adriamycin)
cell cycle-
specific, effect
in resting and
dividing cycles 1) Malnutrition
Nitrosoureas Disrupts protein Lomustine (CCNU) 2) Nausea and vomiting
production/DNA 3) Hair loss
synthesis; 4) Mucositis (mouth irritation)
crosses the 5) Constipation
blood brain 6) Diarrhea
barrier
7) Cushingoid effects
Corticosteroids Binds to DNA to Prednisone
8) Susceptibility to infection
inhibit mitosis
o Some chemotherapy agents are referred to as
and probably
RNA synthesis vesicants and may cause extensive tissue
Immunotherapy Stimulates the Chimeric antigen sloughing and damage if infiltrated into the
body’s immune receptor T cells subcutaneous tissue.
system to (CAR-T) o Therefore, monitor IV infusions of
destroy foreign chemotherapeutic vesicants carefully, especially if
(malignant) not administered through a central line, to prevent
cells). tissue infiltration.

o Typically, any agent that needs mixing for hospital

use is prepared under a specialized hood in the
pharmacy to prevent unintentional exposure. o The procedure allows higher doses of
o When administering such agents, wear gloves and chemotherapy and radiation to be used because,
wash your hands well afterward to prevent skin in the event of severe bone marrow depression,
exposure and absorption of the drug. the child can have healthy marrow restored.
o Chemotherapy drugs should be considered
hazardous substances and have special handling

NCM 109: MCN LEC (FINAL)
o Immune cells in the transplanted marrow may
actually help to kill the remaining cancer cells in
the child’s circulation.
o Everyone coming in contact with the child must
wash their hands well, and specific infection
control precautions must be maintained.
o Transfusion of blood products may be necessary
to maintain functional blood components until
the transplanted marrow begins to function
(Carson, Stanworth, Roubinian, et al., 2016).
1) ALLOGENIC TRANSPLANT
o If stem cells are donated by someone who
is histocompatible (immune compatible)
with the child.
2) AUTOLOGOUS TRANSPLANT
o If the child’s own cord blood was
preserved and frozen since birth or
removed prior to chemotherapy.
3) A SYNGENEIC TRANSPLANT
o one between twins.
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o Blood cancer or leukemia is a cancer of the cells
in the bone marrow that form the white blood
cells (WBCs).
o They produce huge number of altered WBCs
which occupy more space and do not leave place
for the RBCs or the platelets to grow.
o Thus, WBCs function is impaired, and anemia and
bleeding tendencies developed.
o These abnormal WBCs ultimately spill into the
circulating blood from the bone marrow and later
infiltrate important organs like the liver, spleen
and even the brain.
o Leukemia is cancer that starts in the BONE
MARROW.
o Stem cells mature into different kinds of blood
cells. Each kind has a special job:
1) White blood cells
2) Red Blood Cells
3) Platelets

1. Before transplantation, the child receives a

chemotherapy agent, such as
cyclophosphamide, or total-body irradiation
to:
1) Kill as many T cells as possible
2) Suppress the child’s immune response to
the transplanted tissue
3) Create space in the bone marrow to allow
the newly transplanted cells to implant.
2. Stem cells are removed from the circulating
blood of the designated donor or from cord
blood.
3. They are then processed and transfused into
the child intravenously.
o The new stem cells enter the bone marrow
and begin to function after about 3 weeks.
o Until this time, a child is at extreme risk for
infection.

NCM 109: MCN LEC (FINAL)
1) ACUTE LEUKEMIAS
o Acute myelogenous leukemia (AML)
o Acute lymphoblastic (LYMPHOCYTIC)
leukemia (ALL)
o Characterized by the presence of
immature cells called ‘blasts’ and a
very rapid clinical course, which is fatal
unless treated.
2) CHRONIC LEUKEMIAS
o Chronic myelogenous leukemia (CML)
o Chronic lymphocytic leukemia (CLL)
o Characterized by the presence of
mature cells at least in the initial course
of the disease, and an indolent (SLOW)
course.
The process of differentiation of the stem cells
(primitive cells that develop into the mature and
normal blood cells) within the bone marrow is blocked
Accumulation of immature cells in the bone morrow.
These cells overfill the space in the morrow and do not
allow other cells like RBCs and platelets to grow
properly.
o With ALL (Acute lymphoblastic leukemia), because
the bone marrow overproduces lymphocytes and
therefore is unable to continue normal production
of other blood components, the first symptoms of
ALL in children are:
1) Decreased RBC production (anemia)
 pallor,
 low-grade fever
 lethargy
2) A low thrombocyte (platelet) count
 Petechiae
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 bleeding from oral mucous
membranes
 Easy bruising on arms and legs.
3) Spleen and liver begin to enlarge from
infiltration of abnormal cells
 Abdominal pain
 Vomiting
 Anorexia
4) As abnormal lymphocytes invade the bone
periosteum, the child experiences:
 Bone and joint pain.
5) Central nervous system (CNS)
 Headache or unsteady gait.
o On physical assessment:
 Painless, generalized swelling of
lymph nodes is revealed.
o Laboratory studies:
 Elevated leukocyte count with cells
almost stopped at the blast cell stage
 Platelet count and hematocrit value
will be low;
o Laboratory studies
 RBCs that are present are normocytic and
normochromic (of normal size and color)
but few in number.
 A lumbar puncture may show evidence of
blast cells in the cerebrospinal fluid (CSF).
 A bone marrow aspiration (performed at
the iliac crest) will be prescribed to identify
the type of WBC involved, which
documents the type of leukemia.
o ACUTE PROMYLEOCYTIC LEUKEMIA
 May present with severe bleeding
tendency especially in adults.
o ACUTE MYELOMONOCYTIC LEUKEMIA (AML)
 May present with typical features like gum
hypertrophy.
o CHRONIC MYELOGENOUS LEUKEMIA (CML)
 The onset of CML can be insidious (not
easily detected)
 Dragging pain in the abdomen
 Due to enlargement of the spleen.
 Anemia (common feature)
 Fatigue, weakness and pallor are frequent
signs

NCM 109: MCN LEC (FINAL)
 Bleeding into the skin and features of easy
bruising are also noted.
 The bleeding tendency in CML is
attributed to an abnormality in the
function of the platelets.
 Enlargement in the size of superficial
lymph nodes (most frequent).
 Later signs:
 Pallor
 Tiredness
 Weakness
 Weight Loss
o Radiation
o Chemicals
o Viruses
o Genetic and Chromosomal factors
o Diagnosis is made based on detailed history,
clinical feature together with laboratory tests.
 Complete blood counts show a typical
picture depending on the type of
leukemia.
 In AML, the ‘myeloblast’ is increased in
number.
o In ALL, the pathological cell is the ‘lymphoblast’.
o Chronic myeloid leukemia is characterized by the
presence of ‘myelocyte’
o In CLL, the dominant cell is the ‘lymphocyte.’
o Sometimes bone marrow testing is also needed for
the diagnosis.
o Newer tests like flow cytometry are available in the
advanced centers which ensure accurate
diagnosis.
FLOW CYTOMETRY
o A method of sorting and measuring types of
cells by fluorescent labeling of markers on
the surface of the cells.
o It is sometimes referred to as FACS
(Fluorescent Activated Cell Sorting) analysis.
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o General Considerations
 The objectives of the treatment are as
follows:
1) To eradicate the leukemic cells from
the blood and the bone marrow.
2) To avoid the complications due to
inadequate production of normal
blood cells.
o The age of onset of leukemias and the type of
leukemias are considered before starting the
treatment.
STAGES OF TREATMENT
1) FIRST STAGE: Remission Induction
 It aims at eradicating the disease
from the blood, bone marrow and
organs. Attainment of complete
remission entails loss of all
abnormal clinical and laboratory
findings attributable to leukemia.
2) SECOND STAGE: Maintenance Treatment
o Such remission inducing treatments
entail a high degree of morbidity but
once in remission the quality of life of
the patient certainly improves.
o Along these stages, it is important to
have a supportive treatment to avoid
complications arising from the
chemotherapy and the disease.
o Response to the treatment varies from
person to person and with the type of
the leukemia.
o Complete remissions are obtained in
more than 90% of patients with ALL.
A. Specific Therapy
 Chemotherapy is the mainstay of any
leukemia treatment, as it destroys the
leukemic cells.
 Chemotherapeutic agents include
drugs like:
 Cytosine arabinoside,
 Daunorubicin,
 Doxorubicin,
 Prednisolone,

NCM 109: MCN LEC (FINAL)
 Methotrexate etc.
B. Supportive Therapy
 Supportive therapy includes:
1. treatment of infections with
antibiotics
2. Blood transfusions to increase the
hemoglobin and platelet counts.
3. Psychological and social support
goes a long way in helping these
patients.
C. Newer Therapy
 Newer modalities of therapy include:
 Bone marrow transplantation, a
type of stem-cell therapy and
monoclonal antibody therapy.
o When special cells (called stem cells) that are
normally found in the bone marrow are taken out,
filtered, and given back either to the same person
or to another person.
1. AUTOLOGOUS BONE MARROW TRANSPLANT
o The donor is the person him/herself.
2. ALLOGENIC BONE MARROW TRANSPLANT
o The donor is another person whose tissue
has the same genetic type as the person
needing the transplant (recipient).
o Because tissue types are inherited, similar
to hair or eye color, it is more likely that the
recipient will find a suitable donor in a
brother or sister.
o This, however, happens only 25 to 30
percent of the time.
I N S O M N I A C | 10
o Nursing care is directed toward prevention and
treatment of bone marrow transplant
complications by focusing on assessment, nursing
diagnosis outcome identification, planning,
treatment and evaluation of patients requiring
inpatient care.
o Nursing care activities include:
1. Comprehensive care of all body systems
2. Assessment and treatment of comfort (pain,
nausea/vomiting, temperature imbalance)
3. Treatment of fluid and electrolyte
abnormalities
4. Administration and management of intensive
medication therapies (antibiotics, antivirals,
antifungals, growth factors, chemotherapy,
immunoglobulins ,immunosuppressants,
biological response modifiers and blood
products)
5. Early intervention and treatment of common
complications/side effects of transplant
including mucositis, bowel changes,
myelosuppression, graft versus host disease,
hemorrhagic cystitis, veno- occlusive disease,
tumor lysis syndrome and sepsis.
6. Nurses also provide ongoing education for the
patient and their family and caretakers.
 I N S O M N I A C | 11
NCM 109: MCN LEC (FINAL)

o Wilms tumor is the most common form of

childhood kidney cancer.
o The exact cause of this tumor in most children is
unknown.
o A missing iris of the eye (aniridia) is a birth defect
that is sometimes associated with Wilms tumor.
o Other birth defects linked to this type of kidney
cancer include:
 Urinary tract problems and
 Enlargement of one side of the body
o Wilms tumor is a type of kidney cancer that occurs (hemihypertrophy)
in children. o It is more common among some siblings and
o Malignant tumor twins, which suggests a possible genetic cause.
o It accounts for 6% of all childhood cancers. o The disease occurs in about 1 out of 200,000 to
o It generally grows to a large size before it is 250,000 children.
diagnosed, usually before the child reaches age 5. o It usually strikes when a child is about 3 years old.
o The tumor expands the renal parenchyma, and the o It rarely develops after age 8.
capsule of the kidney becomes stretched over the
surface of the tumor
o Staging is from I (limited to kidney) to IV 1. A firm, non-tender mass in the upper quadrant
(matastasis) and stage V, which indicates bilateral of the abdomen is usually the presenting sign.
involvement (rare).  It may be on either side.
o The tumor may metastasize to the lymph nodes, 2. Abdominal pain which is related to rapid
lungs, liver, and brain. growth of the tumor.
3. As the tumor enlarges, pressure may cause:
STAGING KIDNEY CANCER
 Constipation
STAGE 1  Confined to the kidney and
 Vomiting
measures < 7 cm
 Abdominal distress
STAGE 2  Cancer is > 7 cm,
 Anorexia
 may have spread to the renal
 weight loss
vein or the outer tissue of the
 Dyspnea
kidney,
 no spread to lymphnodes
STAGE 3  Has spread to nearby
lymphnodes, or has spread to
o Abdominal ultrasound detects the tumor and
adrenal glands
assesses the status of the opposite kidney.
STAGE 4  Has spread beyond the kidney,
o Chest X-ray and CT scan may be done to identify
adrenal gland, lymphnodes,
matastasis.
distant parts of the body
o MRI or CT scan of the abdomen may be done to
 Metastatic kidney cancer
evaluate local spread to lymph nodes.
o Urine specimens show hematuria; no increase in
vanillylmandelic acid (a metabolite of adrenaline)

NCM 109: MCN LEC (FINAL)
and homovanillic acid levels as occurs with
neuroblastoma.
o Complete blood count, blood chemistries,
especially serum electrolytes, uric acid, renal
function tests, and liver functions tests(SGPT-
serum glutamicpyruvic transaminase), are done
for baseline measurement and to detect
metastasis.
o If your child is diagnosed with this condition, avoid
pushing on the child's abdominal area, and use
care during bathing and handling to avoid injury to
the tumor site.
o The first step in treatment is to stage the tumor.
 Staging helps doctors determine how far
the cancer has spread and to plan for the
best treatment.
o Surgery to remove the tumor is scheduled as soon
as possible.
 Surrounding tissues and organs may also
need to be removed if the tumor has
spread.
o Radiation therapy and chemotherapy will often be
started after surgery, depending on the stage of
the tumor.
o Knowledge deficit of the disorder and therapy
1) Observe the surgical incision for erythema,
drainage or separation. Report any of these
changes.
2) Monitor for elevated temperature or sign of
infection post-operatively.
3) Monitor I.V. fluid therapy and intake and output
carefully, including nasogastric (NG) drainage.
4) Encourage the parents to ask questions and to
understand fully the risk and benefits of
surgery.
5) Prepare the child for surgery, explain the
procedures at the appropriate developmental
level.
I N S O M N I A C | 12
6) Continue supporting the parents during the
postoperative period.
7) Insert NG tube as ordered. Many children
require gastric suction postoperatively to
prevent distension or vomiting.
8) When bowel sounds have returned, begin
administering small amounts of clear fluids.
9) Administer pain control medications as
ordered in the immediate postoperative
period.
10) Allow the child to participate in the selection of
foods.
11) As the child recovers, encourage child to eat
progressively larger meals.
12) If unable to eat because of radiation and
chemotherapy provide I.V. fluids,
hyperalimentation, or tube feedings as
indicated.
13) Prepare child and family for fatigue during
recovery from surgery and with radiation
treatments. Plan frequently rest periods
between daily activities.
14) Prepare the child and parents for loss of hair
associated with chemotherapy and encourage
use of hat as desired. Reassure the hair will
grow back.