•
**NEED antibiotics STAT**
•
**Try to pull out bacteria you can – draw first and send for culture, then start antibiotics, give Tylenol LAST
•
Absolute Neutrophil Count
o
(% Neutrophils + % Bands) (WBC x 10) = ANC
o
Normal ANC >1000
o
If less than 500
•
Cannot give chemo
•
Have patient wear mask
•
Cannot go to school
o
**Slide 46 pic**
•
WBC of 9.2, 22% Neuts, and 4% bands
•
(22+4) (9.2 x 10) = 2,392
•
Side Effects: Acute Tumor Lysis Syndrome
o
Life threatening
o
S/sx: anorexia, vomiting, weakness, lethargy
o
**Usually with ALL and (something) Lymphoma
o
4 metabolic abnormalities – all released at the same time & hard for kidneys to handle
•
Hyperphosphatemia
•
Hypocalcemia – binds with extra phosphate so Ca+ gets depleted = will see:
•
Positive Trousseaus' sign
•
Positive Chvostek sign
•
Treat with calcium gluconate IV – must give SLOW
•
Hyperuricemia – tumors release nucleaic acids which break down and body makes uric acid
•
Crystalizes in kidneys = acute kidney failure
•
Hyperkalemia
•
Dysrhythmias
•
**Needs cardio/respiratory monitoring**
o
Metabolites are released too quickly for kidney to excrete them
o
Prevention of Tumor Lysis
•
IV hydration
•
Urinary alkalinization
•
Monitor urine pH
•
Hypouricemic agents
•
Allopurinol: decreases formation of uric acid
•
Monitor I & Os
•
Monitor Serum Electrolytes
•
Treatment: Supportive Care
•
Steroids
o
Relieve sickness associated with chemotherapy
o
Increase appetite
o
Immunosuppressant
o
Reduce inflammation
o
Increase erythropoiesis
o
Increase neuts
o
Decrease lymphs
•
Radiation – DON’T do on kids less than 3 because of developmental mess-ups
o
Side Effects
•
Skin
•
Alopecia
•
Dry or moist skin
•
GI
o
N/V/D
o
Anorexia
o
Mucosal ulceration
•
GU
o
Cystitis
•
Hematologic
o
Myelosupporession
•
Types
•
X-rays, gamma rays and charged particles
•
Systemic radiation vs. directed radiation
•
Damages cell DNA and cells cannot divide
•
Bone Marrow Transplant
o
Kill original bone marrow = TONS OF CHEMO to wipe out
o
Transplant with donor marrow = given to receiver via IV
o
At risk for GVHD – graft vs host disease
•
Body reacting to host marrow = HEMMORRAGE EVERYWHERE, Clots everywhere
•
**TONS OF PAIN** - usually do not survive
o
At risk for infection
o
May change blood type
•
Nursing Interventions
o
Pain Management – Opioids scheduled & sometimes OVER dose range
o
Pharmacological management – monitor ALL side effects
o
Decrease anxiety – Ativan sometimes
o
IV hydration
o
Nutrition
o
Developmental care – usually delayed after chemo
o
Family care & Child Life support
o
**Immunizations have to start from ground zero**
•
Leukemia
o
Group of malignant diseases of the bone marrow and lymphatic system
o
ALL: most common form of childhood cancer
•
Boys>girls
•
Caucasians>African Americans
•
Peak age 2-5 years
•
90% survival rates
o
AML (Acute myelocytic leukemia)
•
15-20% of leukemia
•
Boys=girls
•
Higher rates during first year of life
•
65% survival rate
o
Leukemia
•
Unrestricted proliferation of immature WBC (could be super low or super high)
•
Not a “tumor”
•
SUPER THICK BLOOD
•
