NURSING CARE OF A

FAMILY WHEN A CHILD HAS

A MALIGNANCY
NEOPLASIA
 NEOPLASIA

• Neoplastic growth
• Causes in children versus adults
• Theories
• Genetic trigger
• Environmental irritation
• Cell mutation
• Oncogenic virus
NEOPLASIA
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%.
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.
NURSING PROCESS: CANCER

• Assessment
• Nursing diagnosis
• Outcome identification and planning
• Implementation
• Outcome evaluation
 ASSESSING CHILDREN WITH CANCER
❖History
Weight loss, loss of appetite, easy bruising, swelling of any body part ,
headache, eye deviation
Family history of cancer
Swollen lymph nodes- Hodgkin
Nausea and Vomiting- brain tumor
Ecchymotic marks- leukemia
Pain and swelling in the large joints- osteosarcoma, ewing sarcoma
Eye deviations- brain tumor, retinoblastoma
Palpable mass in the abdomen- neuroblastoma, wilms tumor
❖Physical and laboratory examination
 Biopsy
 Surgical removal of tissue or cells for
laboratory evaluation and analysis
 Benign or malignant neoplasm
Staging
• Stage 1- a tumor that has not extended to the
surrounding tissue and maybe completely
remove surgically
• Stage II- there is some local spread, but the
chance of surgical removal is good
• Stage III- cancer cells have spread to local
lymph nodes
• Stage IV- tumor spread
systematically(metastasis)
ASSESSING CHILDREN WITH CANCER
• Leukemia
• Distorted and
uncontrolled
proliferation of
WBC’s leukocytes
and is the most
frequently
occurring type of
cancer in children.
ASSESSING THE LEUKEMIAS

• Acute lymphocytic (lymphoblastic)

leukemia(75%)
• Involves immature
lymphocytes(lymphoblast)
• Pallor, low grade fever, lethargy
• Acute myeloid leukemia (20%)
• Involves the over proliferation of granulocytes
(neutrophils, basophils, and eosinophils)
• 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
• Bone marrow aspiration identifies type of WBC
involved.
 ASSESSING THE LYMPHOMAS
 Hodgkin disease

 Lymphocytes proliferate in the lymph glands.

 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
 Biopsy of lymph nodes; chest, abdominal CT;
lymphangiogram
ASSESSING THE LYMPHOMAS
• Non-Hodgkin lymphoma

• Malignant disorders of the lymphocytes (either

B or Tcells) and occur in a number of forms
• 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
• Biopsy of affected lymph nodes, bone marrow
• Burkitt lymphoma
• Non Hodgkin lymphoma specifically
involving the B-lymphocyte cells
• 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
ASSESSING NEOPLASMS OF THE BRAIN

❖Types of brain tumors

• Cerebellar astrocytomas: slow-growing, cystic
tumors that arise from glial or support tissue
surrounding neural cells
• Medulloblastomas: fast-growing tumors found most
commonly in cerebellum
• Brainstem gliomas: often cause paralysis of the fifth,
sixth, seventh, ninth, and tenth cranial nerves
 ASSESSING NEOPLASMS OF THE BRAIN
• Symptoms of increased intracranial pressure
• Headache occurs on arising; may be intermittent
throughout day; intense on straining
• Vomiting occurs on arising; not nauseated, will eat
immediately after; morning after morning, eventually
projectile
• Diplopia, ptosis, or strabismus; papilledema
• Skull films, bone scan, ultrasound or MRI, cerebral
angiography, or a CT scan; possibly myelography;
lumbar puncture
ASSESSING BONE TUMORS
• Osteogenic sarcoma
• Malignant tumor of long bone
involving rapidly growing
bone tissue.
• Taller than average; painful,
swollen site; possibly
inflamed, feels warm; report
of recent trauma to site
• biopsy of site
• Ewing sarcoma
• Malignant connective tissue
tumor
• Intermittent pain at site,
becomes constant and severe;
“onion-skin” reaction on X-
ray
• Bone scan, bone marrow
aspiration, biopsy, CT scan of
lungs, and IV pyelogram or
kidney MRI
ASSESSING OTHER CHILDHOOD
NEOPLASMS

 Neuroblastoma
 Tumors that arise from the neuroectodermal cells of
the SNS, cells are highly undifferentiated and
invasive, and occur most frequently in the abdomen

 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
DIAGNOSTIC

• Arteriogram
• ultrasound, CT, or MRI scan of
chest, abdomen, pelvis;
• gallium bone scan; bone marrow
aspiration and biopsy
RHABDOMYO
SARCOMA

TUMOR OF
THE
STRIATED
MUSCLE
ASSESSING OTHER CHILDHOOD
NEOPLASMS

• Nephroblastoma (Wilms tumor)

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

• Pain
• Imbalanced nutrition
• Risk for infection
• Disturbed body image
• Compromised family coping
CANCER TREATMENT

• Radiation therapy
• Utilizes radiation to destroy cancer cells and reduce the size of
tumors by causing damage to DNA
• Immediate side effects
• Fatigue, anorexia, nausea and vomiting
• Long-term side effects
• Long term complication or malignant
transformation
• Effects on bone
• Asymmetric growth of bones, easy fracturing, scoliosis,
kyphosis and hypoplasia(not reaching full growth
potential)
• Effects on hormones
• Radiation in the head and neck can result to long-term
thyroid, hypothalamic, and pituitary gland dysfunction,
resulting in growth hormone deficiency,
hyperprolactinemia, central adrenal insufficiency, or
gonadotropin deficiency
• Effects on the nervous system
• Demyelination and necrosis of white matter of the brain,
which results in symptoms of lethargy, sleepiness, and
possibly seizures and effects on gray matter, which result
in learning disabilities and cognitive challenges.
• Effects on organs of the chest, abdomen
• Extensive radiation to the lungs can result in chronic
pneumonitis and pulmonary fibrosis, resulting in
obstructive or restrictive chronic lung disease.
CANCER TREATMENT

• Radiation therapy
• Before treatment
• Radiation therapy as usually
marked on the child’s skin in
indelible ink or tattoo
• Do not apply lotion or cream
• During treatment
• Lie still
• No sensation from radiation
• Infants or young children are sedated
or given general anesthesia

• After treatment
• Reassessment, CBC,
• Evaluation for NV, poor oral intake and
hydration
CANCER TREATMENT

• Chemotherapy
• Types
• Alkylating agents-prevents cell division
• Antimetabolites- prevent replication
• Plant alkaloids- prevent DNA replication
• Antitumor antibiotics- disrupt protein synthesis
 CANCER
TREATMENT

• Chemotherapy
• Types
• Nitrosoureas- DNA damage
• Corticosteroids- anti-swelling
• Immunotherapy- boost immune system
CANCER TREATMENT

• Chemotherapy
• Protocols
• Side effects and toxic
reactions
• Alopecia
• Cushingoid
appearance
CANCER
TREATMENT

• Stem cell
transplantation

• Pain relief