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PEDIATRIC ONCOLOGY

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PEDIATRIC ONCOLOGY Leslie Meador, RN, BSN, CPON Children s Mercy Hospital * Review function of RBC, WBC, & Platelets. Discuss implications of each cytopenia. – PowerPoint PPT presentation

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Title: PEDIATRIC ONCOLOGY


1
PEDIATRIC ONCOLOGY
  • Leslie Meador, RN, BSN, CPON
  • Childrens Mercy Hospital

2
What is cancer?
  • Normal cells grow and divide, then eventually
    die.
  • Cancer occurs when the body is unable to regulate
    cell growth, leading to an overgrowth of abnormal
    cells.

3
Cell development
4
Benign v. Malignant
  • Benign overgrowth of cells that are NOT
    cancerous
  • Malignant overgrowth of cells that ARE cancerous

5
What is cancer?
  • Cell development
  • Healthy growth Unhealthy growth
  • Normal cells Tumor cells
  • Benign Malignant

6
Pediatric Oncology Facts
  • In the U.S., cancer remains responsible for more
    deaths in ages one year through adolescence than
    any other disease more deaths than asthma,
    diabetes, cystic fibrosis and AIDS combined.
  • Each year in the U.S., approximately 12,500
    children and adolescents are diagnosed with
    cancer. Thats the equivalent of two average size
    classrooms diagnosed each school day.

7
Pediatric Oncology Facts
  • In the early 1950s, less than 10 percent of
    childhood cancer patients could be cured.
  • Today, nearly 80 of children diagnosed with
    cancer become long-term survivors and the
    majority of them are considered cured.

8
Pediatric Oncology Facts
  • Most common childhood cancers
  • -leukemia (blood)
  • -brain and nervous system
  • -the lymphatic system (lymphoma)
  • -kidneys (Wilms tumor)
  • -bones (osteosarcoma Ewings
    sarcoma)
  • -muscles (rhabdomyosarcoma)

9
Pediatric v. Adult
Characteristic Pediatric Adult
Frequency Rare lt1 of all cancers Common gt99 of all cancers
Primary sites Involves TISSUE Involves ORGANS
Pathogenesis Genetic alterations Environment lifestyle
10
Pediatric v. Adult
Characteristic Pediatric Adult
Screening/ Early detection Small percentage screening tests are generally not applicable Many can be detected by adhering to screening guidelines
Manifestations at diagnosis Metastatic disease 80 Local or regional disease
Treatment Follows protocols as standard Doesnt always follow a protocol
Prognosis 70-90 cure (depending on tumor stage) lt60 cure (depending on tumor stage)
11
Means of diagnosis
  • Well child check-ups (physical assessment
    review of symptoms)
  • Blood tests
  • Radiology exams (x-rays, CT, MRI)
  • Pathology (biopsy of mass)
  • Diagnostic procedures
  • -Bone marrow aspirate
  • -Bone marrow biopsy
  • -Lumbar puncture

12
Methods for treatment
  • Depends of type and stage of malignancy
  • Includes the following
  • -Chemotherapy
  • -Radiation
  • -Surgical resection
  • -Stem cell transplantation

13
Chemotherapy
  • Chemotherapy can be delivered by the bloodstream
    to reach cancer cells all over the body, or it
    can be administered directly to specific cancer
    sites.
  • Chemotherapy can be given through various
    methods
  • -intravenously (IV)
  • -intrathecally (IT)
  • -intramuscularly (IM)
  • -subcutaneously (SQ)
  • -orally (PO).

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17
Chemotherapy
  • Works by interfering with the ability of cancer
    cells to divide and reproduce themselves.
  • Attacks all rapidly dividing cells.

18
Rapidly dividing cells
  • Hair
  • Skin
  • Nails
  • Blood cells
  • -Red blood cells
  • -White blood cells
  • -Platelets

19
Three blood lines
  • Red blood cells
  • -carry oxygen to surrounding tissues
  • White blood cells
  • -fight off infection
  • Platelets
  • -help to prevent excessive bleeding assists in
    clot formation

20
Complications of chemotherapy
  • Low Red Blood Cells ? Anemia
  • Low Platelets ? Thrombocytopenia
  • Low White Blood Cells ? Neutropenia
  • INFECTION
  • Hair loss
  • Mouth sores (mucositis)
  • Nausea, vomiting diarrhea
  • Organ toxicities

21
Radiation
  • Managed by a radiation oncologist
  • The radiation oncology team will precisely
    measure and mark the radiation field." This
    field is established to deliver the maximum
    radiation to the tumor with the least impact
    possible on the surrounding tissues.
  • Frequency duration depends on diagnosis stage.

22
Complications of radiation
  • Nausea and vomiting
  • Low blood counts
  • Infection
  • Mouth sores
  • Skin changes (may look and feel like a sunburn)
  • After radiation to the head and spine, other side
    effects may occur months to years later,
    including
  • Problems with growth
  • Hormone production
  • Learning problems

23
Surgery
  • Can be done initially if tumor is isolated (most
    common in benign tumors or in brain kidney
    tumors).
  • Usually done following a few rounds of chemo.
    This allows the tumor to shrink, which should
    allow the surgery to be less invasive.

24
Complications of Surgery
  • Infection
  • Rupture of tumor increases risk of later
    metastasis
  • Delay in other treatments due to time required to
    heal from surgery.

25
Stem Cell Transplant
  • Purpose
  • 1. Remove any remaining diseased cells
  • 2. Clear bone marrow space through
    ablative therapy (consisting of chemotherapy
    or chemotherapyradiation).
  • 3. Replace bone marrow space with healthy
    stem cells.

26
Complications of Stem Cell Transplant
  • Organ toxicity
  • Organ failure
  • INFECTION
  • Engraftment Failure
  • Graft v. Host Disease
  • Death

27
  • WHAT DOES CANCER LOOK LIKE?

28
Normal WBC on smear
G
A
E
D
B
H
F
C
  • Banded Neutrophil B. Lymphocyte
  • Monocyte D. Segmented Neutrophil
  • Eosinophil F. Basophil
  • G. Platelet H Red blood cell

29
Acute Lymphocytic Leukemia on smear
30
Osteosarcoma
Humerus
Distal Femur
31
Osteosarcoma
32
Brain tumor
33
Brain tumor
34
Photo video
  • http//www.onetruemedia.com/otm_site/view_shared?p
    70c54d2a5c5870016c90d7skin_id701large

35
WHY this profession?
  • LOVE KIDS!!!!!!
  • Hem/Onc - Increased acuity than med/surg units ?
    mentally challenging each day pathophysiology is
    complex in this population
  • Opportunity to INVEST in PEOPLE
  • Develop long-term relations with patients
  • See effects of my efforts over time
  • End of life care
  • Working 3 days/week Full time!!!

36
What is my day like?
  • 12 hour shifts 7 7
  • Nurse patient ratio 13 max
  • Manage care for each assigned patient, which may
    include, but not limited to medication
    administration, IVF, chemo (monitoring/managing
    side effects), blood products, procedures
    (including sedation) for BMA LP, bone marrow
    transplant infusions, monoclonal antibodies, ng
    placement/feeds, IV access, obtaining
    monitoring labs, coordinating with other
    disciplines (PT/OT, speech therapy, radiology,
    OR) being PROACTIVE in patient care, focusing
    on management while preventing further
    issues/complications.

37
And the numbers are
  • Starting salary 21.49/hr (CMH in top 5 salary
    for RNs in KC area)
  • Shift differentials 10 evening (3-1130pm), 15
    nights (7p-7a), 10 weekend
  • Specialty differentials 10 critical care, 5
    OR, SDS, PACU, 1.00/hr for approved specialty
    certifications
  • Up to 3000/year educational assistance

38
Why Childrens Mercy Hospitals and Clinics?
  • Only pediatric hospital between St. Louis
    Denver
  • Competitive salary benefits
  • MAGNET Designation reflects nursing
    satisfaction
  • gt50 medical/surgical sections to practice in
  • CMH is expanding throughout KC area to include
    Urgent Care South in the Northland, along with
    clinics in Eastern and Western KC
  • Other professions APN, PT/OT, Speech Therapy,
    Musical Therapy, Child Life Specialist, RT,
    physicians, PA, EMT and more!

39
References
  • Hooke, M., Kline, N., ONeill, J., Norville, R.,
    Wilson, K. (2004). (Essentials of Pediatric
    Oncology A Core Curriculum ( 2nd ed.) (pp
    2-12,57). Glenview, IL Association of Pediatric
    Oncology Nurses
  • http//www.cancer.org
  • http//www.childsdoc.org/fall2000/braintumors.asp
  • http//www.curesearch.org/
  • ghr.nlm.nih.gov/.../ basics/MitosisMeiosis.jpg
  • http//www.med.harvard.edu/JPNM/TF96_97/Nov4/Write
    Up.html
  • http//www-medlib.med.utah.edu/WebPath/HEMEHTML/HE
    MEIDX.html
  • http//www-medlib.med.utah.edu/WebPath/BONEHTML/BO
    NE001.html
  • http//faculty.mercer.edu/summervill_j/iv.htm
  • Sciencephotolibrary

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