How to handle Pediatric

Oncology Patients?
Role of Pediatric Oncology
Nurses
CREDIT TO:
Dr. Larissa de Leon
Pediatric Oncologist
December 6, 2019
 Objectives
• To present the roles of Pediatric Oncology Nurses in
• 1. Managing Side Effects
• Myelosuppression and Infection
• Bleeding and Anemia
• Nausea and Vomiting
• Mucositis
• Procedure Related Pain
• 2. Facilitating Psychosocial Support
• To present comments on issues important by families and patients
 Pediatric Oncology Nurses

• Essential contributors to the

successful diagnosis, treatment
and cure of children with cancer
• Member of the multidisciplinary
team
• Coordinator of patient care,
facilitating communication
among team members
Direct Patient
Care Nursing
Roles
• Competently manage symptoms
of common side effects of
treatment
• Provide education and emotional
support to families with a child
newly diagnosed with cancer
• A child advocate, ensuring proper
preparation prior to invasive
procedures and treatment
Managing Side Effects
 Myelosuppression and Infection
• Most infections in the
neutropenic child
• Caused by Endogenous flora
( Staphylococcus,
Escherichia coli,
Streptococcus)
• Adequate protection from
infection is the best defense
• Hand washing before and after
contact with patient
• single most important
method of preventing
nosocomial infection
 Myelosuppression
and Infection
• Nursing care of the child with febrile neutropenia is directed toward
monitoring for signs of septic shock
• Monitor Vital Signs frequently to identify fluctuations in HR RR BP
and temp
• Hypotension is usually a late sign of shock
• Delayed CRT and tachycardia are early signs of impending shock
• Strict intake and output must be measured to monitor renal
function

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 Myelosuppression and Infection
• Level of consciousness
• Temperature measurement by rectal
route and use of suppositories and
enemas must be avoided
• Mouth care and peri -anal hygiene

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 Myelosuppression and Infection
• Prevention of infection
• Adequate Nutrition
• Prophylaxis for Pneumocystis jirovecii (cause life threatening Pneumonia)
• Cotrimoxazole PO BID MWF
• Reverse Isolation
• Avoid crowded places
 Bleeding and Anemia
• Avoid Ibuprofen and Aspirin
• Use soft toothbrush for dental care
• Not eat or chew sharp foods to prevent gingival
bleeding
• Adolescent female pts may be given oral OCPs to
suppress menses

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 Bleeding and Anemia
• Nursing intervention
• In thrombocytopenic patient
• Prevent injury
• Inspection of body fluids for evidence of blood
• Monitor vital signs and peripheral perfusion for evidence of blood loss
• Platelet transfusion
• In anemic patient
• PRBC transfusion when hgb is less than 7 g/dL

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 Nausea and Vomiting
• Many cancer agents are emetogenic
• nausea and vomiting can severely alter fluid balance in the pediatric patient
• Some patients receiving cisplatin and carboplatin experience nausea
and vomiting several days after the drugs are given
• Strict I and O (dehydration or overhydration)
• Anti emetic therapy (ondansetron)
 Nausea and Vomiting
• Patient assessment prior to chemotherapy can provide insight into
strategies that can decrease nausea and vomiting
• Nurses can educate the patient and family regarding these
nonpharmacologic methods
 Strategies for
Nausea & Vomiting

• Eat foods served cold or at room temperature

• Drink sips of clear liquids
• Eat light meals throughout the day
• Avoid foods that are very sweet, spicy , hot or strong-flavored
 Strategies for
Nausea & Vomiting

 Maintain good oral hygiene

 Avoid eating/drinking for 1-2 hrs prior to and after chemotherapy
 Use distraction such as music, tv, games and reading
 Listen to relaxation tapes
 Strategies for
Nausea & Vomiting
• Advice for parents
• Do not push the child to eat
• Try to get foods they ask for
• Explain reasons behind the need for good nutrition
• Offer food 6 times a day: 3 meals and 3 snacks
• “Power pack” the food – add extra margarine, cheese, gravy or sauce to food.
Offer high fat version of food
 Mucositis
• Gastro intestinal damage from
chemotherapy or radiation therapy
can cause ulcerations in the mucosal
surface of the alimentary canal

• Anorexia commonly occurs, because

eating and drinking cause extreme
pain

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 Mucositis
• Meticulous oral hygiene assists in preventing or lessening the
deleterious effects of mucositis
• In infants and small children
• Gingival care includes wrapping a gauze pad around a finger, soaking the
gauze pad in saline solution and swabbing the patient’s gums, palate and
buccal mucosa
• Done after eating or drinking or as often as every 2 hours
 Mucositis
• Older children can cleanse their own teeth and gums with a soft nylon
toothbrush and use a saline-based oral solution to rinse the mouth
• Toothbrushes may become colonized with bacteria
• Replaced with every cycle of chemotherapy or after each febrile illness
 Mucositis
Guidelines for Oral Care
• Rinses
• Antiseptics
• Topical anesthetics
• Coating agents
 Procedure Related Pain
• Invasive procedures are the most
painful and traumatic events
experienced by children receiving
treatment for cancer
• Although procedure-related pain
represents an acute, brief
experience, it is accompanied by
fear and anxiety
• Bone marrow aspirations and
lumbar punctures are perceived as
extremely painful by children with
cancer
 Procedure Related Pain
• Previous studies have shown that children do not adapt to the
discomfort associated with invasive procedures, and they experience
greater levels of anxiety with repeated painful experiences
• Children often experience symptoms such as depression, insomnia,
and anorexia before the clinic or hospital visit when such procedures
are scheduled
 Procedure Related Pain
• Preparation before the procedure includes providing children with
sensory and procedural information in an age-appropriate manner
and providing training in coping skills
• Teaching parents and children cognitive behavioral interventions (i.e.,
distraction, relaxation, guided imagery) for support during invasive
procedures continue to be effective in decreasing pain and distress
 Procedure Related Pain
Developmental approach to manage procedure related pain
1. The child and parents should be prepared
2. Pleasant environment should be created in the treatment room
3. Special attention to the treatment of pain and anxiety for the initial
procedure should be given to reduce the development of subsequent
anxiety symptoms
 Procedure Related Pain
4. Local anesthetics should be used
5. Staff responsible for procedures should be knowledgeable about behavioral
and pharmacological treatment of acute pain and anxiety
6. Appropriate monitoring and resuscitative equipment must be readily
available
 Procedure Related Pain
• Pharmacologic management
• Analgesics and sedative agents
• Benzodiazepines
• General anesthesia (propofol)
• Topical anesthetics
• EMLA cream
 Procedure Related Pain
• Parental participation is helpful to the child, particularly for toddlers
and preschool children, in whom separation issues are paramount
• During minor procedures, such as venipuncture or IV access, the
parent can hold and hug the child while assisting in isolating and
restraining a limb or body part
• During more extensive procedures (e.g., bone marrow aspiration,
lumbar puncture) the parent can be positioned close to the child,
within the child's view, to talk with and soothe the child
 Pain Management

• Procedure Related Pain

• Non Pharmacologic management
• Tactile Stimulation
• Relaxation techniques
• Distraction
Facilitating Psychosocial Support
 Facilitating Psychosocial Support
• A child’s family is the primary source of strength throughout the
cancer experience
• The nurse must understand family systems and the role of each
member plays in the family
• Diagnosis, treatment, discontinuation of therapy, relapse and
terminal illness are crisis points for families who have a child with
cancer
 Facilitating Psychosocial Support
• At diagnosis – family members commonly feel anxiety, fear, anger and
depression
• Nurses provide support by helping family members work together
• During Treatment period, nurses are resources of the family.
• Nurses teach the family members about the disease and treatment
• Provide support during stressful situations
• Prevent parental overprotection and isolation of the child
 Facilitating Psychosocial Support
• Cessation of therapy
• Nurses must encourage the child and parents to verbalize the fears
• Relapse of disease
• Nurses must be excellent listeners and must create a caring atmosphere
• Terminal illness
• Nurses help the family accept the terminal status of their child’s disease ,
encouraging expression of emotions and guilt feelings, and planning for the
future
Facilitating
Psychosocial
Support
Children and their families
find comfort in the actions
of pediatric oncology
nurses