The Child with Cancer Case Study # 1 Questions Related to this Case Study What is this childs probable

le diagnosis? The most fre uent presenting signs and symptoms of this diagnosis result from what? The organs of which system are most se!erely affected in patients with this diagnosis?

Questions " continued #nore$ia% fatigue and weight loss in a patient with this diagnosis are the result of&? 'ollys (gb and (ct suggest what? What tests will be done to confirm the diagnosis? 'ollys neutrophil count of )1* is indicati!e of++? #+ ,eutropenia -+ 'egoblastic anemia C+ .ranulocytopenia /+ 0eu1ocytosis White -lood Cell Count and /ifferential Total W-Cs $ 12223mm456l7 ,ewborn8 9:;2 Child <) years8 =+):1> Child ?) yrs3#dult @:12 /ifferential * #bsolute 5per mm47 ,eutrophils @@:>2 )@22:A222 0ymphocytes )2:B2 1222:B222 'onocytes ):A 122:>22 Cosinophils 1:B @2:@22 -asophils 2+@:1+2 )@:122 Critical Dalues W-Cs <)@22 or ? ;2%2223 mm4 Leukocytosis " W-C E 12%2223mm4 " Fsually indicates infection% inflammation% tissue necrosis or leu1emic neoplasia Leukopenia W-C < B%2223mm4 : occurs in many forms of bone marrow failure

#bsolute ,eutrophil Count 5#,C7 Gage 1B>; in Te$tboo1 /etermine the total percentage of ,eutrophils " HGolysI or HSegsI and H-andsI 'ultiply White -lood Cell 5W-C7 Count by * of ,eutrophils C$ample W-C J )222 ,eutrophils J 12* ,onsegemented ,eutrophils 5-ands7 J >* Step Kne 12* L >* J 1>* Step Two 2+1> $ )222 J ;B2 'ollys8 W-C J =@22 ,eutrophil Count J )1* #,C J 2+)1 $ =@22 J 1;=@ #,C < @223mm4patient is at ris1 for8 K!erwhelming infection 5Sepsis7 .eneral 'alaise /ehydration SeiMures " Noung infants and children On!asion of organisms producing secondary infections 'ollys platelet count of ;2%222 is responsible for which of the following? #+ Gallor -+ Getechiae C+ -ruises /+ Point Gain 'ollys serum Fric #cid of = mg indicates what? #+ Ommature cells in the urine -+ # normal le!el C+ #bnormal renal function /+ Cell -rea1down : What precautions should be considered to reduce 'ollys susceptibility to infection? #+ Grotecti!e Osolation -+ 0ong:term prophylactic antibiotic therapy C+ 'aintained 'yelosuppression /+ #de uate ,utrition The treatment of 'ollys disease in!ol!es the combined use of chemotherapy and irradiation+ What side effects can 'olly e$perience from these forms of therapy? #+ #lopecia -+ /iarrhea C+ /ry S1in /+ Flceration of 'ucosa Why is the aim of treatment for 'olly directed toward pre!enting a relapse? /escribe the following components of the treatment regime for #00 Remission Onduction Ontensification3Consolidation C,S Grophylactic Therapy 'aintenance What is complete remission determined by? #bsence of clinical signs or symptoms

 < @* -last cells in the bone marrow The following drugs are most commonly gi!en during the Onduction Ghase of the #00 treatment+ Qnow these drugs and their most common side effects Dincristine Corticosteroids " Grednisone or /e$amethasone 0:asparginase /o$orubicin may or may not be used Gediatric Kncological Cmergencies What life:threatening condition may de!elop in 'olly prior to the initiation of therapy or right after the initial treatment begins? Tumor 0ysis Syndrome What are the hallmar1 metabolic abnormalities of Tumor 0ysis Syndrome? (yperuricemia% (ypocalcemia% (yperphosphatmeia% (yper1alemia and Fremia The crystalliMation of uric acid in the renal tubules can lead to acute renal failure and death Treatment of #cute Tumor 0ysis Syndrome Carly identification of patients at ris1 Serum Chemistries and Frine p( fre uently Strict O R K #ggressi!e OD fluids 'edications li1e #llopurinol to decrease uric acid production and promote e$cretion of by:products of purine metabolism+ Dincristine and Grednisone will be continued during the maintenance phase of therapy+ The following drugs are also gi!en+ Qnow why the drugs are used and the most common side effects /aily Kral =:'ercaptopurine 'ethotre$ate #llopurinol -actrim Care Glan for the Child with Cancer pgs 1B>2:1B>) ,ursing /iagnoses (igh Ris1 for8 Onfection related to depressed body defenses Projected Outcome Child will not come in contact with infected persons /oes not e$hibit signs of infection OnSury 5(emorrhage and (emorrhagic Cystitis7 related to interference in cell proliferation Projected Outcome Child C$hibits no e!idence of bleeding Will !oid without discomfort+ ,o hematuria will be present (igh Ris1 for8 Onfection related to depressed body defenses Projected Outcome Child will not come in contact with infected persons

 /oes not e$hibit signs of infection OnSury 5(emorrhage and (emorrhagic Cystitis7 related to interference in cell proliferation Projected Outcome Child C$hibits no e!idence of bleeding Will !oid without discomfort+ ,o hematuria will be present #ltered ,utrition8 0ess than body re uirements related to loss of appetite Projected Outcome " Child will recei!e ade uate nutrition Ompaired s1in integrity related to administration of chemotherapeutic agents% radiotherapy and immobility Projected Outcomes8 S1in remains clean and intact Child and family will comply with suggestions Ompaired physical mobility related to neuromuscular impairment 5neuropathy7 Projected Outcome " Child ambulates without incident or difficulty -ody Omage disturbance related to loss of hair% moon face% debilitation Projected Outcomes " Child will e$hibit positi!e coping s1ills Gain related to diagnosis% treatment% physiological effects of neoplasia Projected Outcome " Child will e$perience no pain or reduction of of pain to le!el acceptable to child Tear related to diagnostic tests% procedures and treatments Projected Outcome " Child will ha!e reduced fear r3t diagnostic procedures and treatment Onterrupted family processes related to ha!ing a child with a life:threatening disease GroSected Kutcome " Child and family will demonstrate understanding of the disease and treatment Wilms Tumor 5,ephroblastoma7 /efinition " 'alignant neoplasms of the 1idney that most often affects young children Gea1 age of incidence is ; U years A+131 million caucasian children < 1@ years of age C!idence of genetic inheritance " Os inheritable in 1@:)2* of cases #utosomal dominant 5 'ode of inheritance in < )*7 with !ariable penetrance and e$pressi!ity+ Oncrease incidence between siblings and identical twins #lso #ssociated with other Congenital #nomalies #niridia (emihypertrophy and genitourinary anomalies Clinical 'anifestations Gainless swelling or mass within abdomen (ematuria #nemia (ypertension " Why??? Weight 0oss and Te!er 'etastasis to lungs: /yspnea% Cough% SK- and Gain in the Chest /iagnostic #ssessment V:ray " #bdominal Fltrasound 'RO " CT Scan

 -one 'arrow #spirate (ematological studies Frinanalysis Tumor Classification3Staging Classification " Refers to biological characteristics of the tumor Staging refers to e$tent of disease at time of diagnosis Therapeutic 'anagement Surgery " Gre and Gost:op Chemotherapy Radiation Greoperati!e Care for a Child /iagnosed with a Wilms Tumor Glace Sign o!er bed " ,K ,KT G#0G#TC #-/K'C, Signs and Symptoms of tumor rupture? Gain " #cute and localiMed in abdomen (emorrhage Cardiac Oncreased (R Widening Gulse Gressure Gallor #bdomen #cute localiMation of pain /istention .uarding Tummy area Signs and Symptoms of Tumor Rupture " cont++ (emorrhage ,eurological Changes in le!el of consciousness Orritability Restlessness /isorientation Ta1e care in bathing and handling of child Kbtain necessary blood wor1 'onitor -G Fse appropriate siMed cuff 'onitor Frine Kutput /aily Weight #ssess Child for (T, -ounding pulses Oncreasing irritability and headaches Changes in beha!ior Tlushing Gostoperati!e Care of the Child after a Resection a Wilms Tumor What type of postoperati!e care is necessary? Same as any child after abdominal surgery 'aintain OD #cc ORK Gossible ,. " for what purpose? Gain 'anagement Tre uent e!aluation of DS especially -G Gulmonary hygiene Grepare for administration of chemotherapy and radiation therapy

0ong Term: Child only has one 1idney " Should a!oid contact sports Gre!ent FTOs especially in little girls Ksteosarcoma#Q# Ksteogenic Sarcoma /efinition " Ksseous bone tumor that arises in the mesenchyme+ Os the most common malignant bone tumor seen in childhood Seen primarily in times of bone growth spurts and in areas that demonstrate rapid growth " 'ost common site is metaphysis " @2* occur in femur 'etastases most commonly occurs in the lungs but often to other bones+ 0ymphatic system and li!er may also be in!ol!ed Oncidence Gea1 incidence between 12:)@ years:of: age% Gea1 ages 1@:19 years:of:age Se$es e ually affected until puberty% then males increase in incidence o!er females )81 /iagnostic #ssessment (istory and physical e$am V:ray -iopsy Therapeutic 'anagement #mputation 0imb Sal!age Chemotherapy Ghantom 0imb Gain ,ursing Care Glan for the Child with a -one Tumor #nticipatory grie!ing related to prospect of loss of limb Ompaired physical mobility related to amputation /isturbed body image related to loss of limb Onterrupted family processes related to ha!ing a child with a lifelong disability and traumatic therapy Cured !s Truly Cured Cured Cessation of Therapy Continuous freedom from clinical and lab e!idence of cancer 'inimal or no ris1 of relapse Truly Cured Tree of disease /e!elopmentally commiserate with Well adSusted despite ha!ing had cancer