Environmental carcinogens o Drug exposure as risk for cancer Patterns of onset

Environmental carcinogens o drug exposure as risk for

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Environmental carcinogens o Drug exposure as risk for cancer Patterns of onset o Infancy/early childhood Neuroblastoma Retinoblastoma Wilm’s tumor ALL – Acute Lymphocytic Leukemia o Adolescence Lymphomas Osteosarcoma Melanomas o **Slide 36 Pic** Adolescents – more likely to get different TYPES of cancer **Don’t need to memorize certain numbers** **Know which kids are more likely to get what* o **Slide 37 Pic** S/S diff types of cancer Infections – fevers DO NOT go away with Tylenol Pediatric (0 – 19 yrs) Diagnoses of Cancer 1975 – 2010 o ALL o Brian/CNS tumors Pediatric (0 – 19 yrs) Mortality Rate 1975 – 2010 o Decreased throughout the years for all cancers o CNS still highest cause for mortality General diagnostic tests o CBC Look at WBC, RBCs, Hgb, Hct, Platelets = all low (pantycopenia) o BMP o Absolute Neutrophil Count (ANC) o Lumbar Puncture – make sure no CNS involvement Relieve ICP pressure – if big tumor = can cause hernia of brain tissue **MUST DO CT SCAN BEFORE LUMBAR PUNCTURE** o CT – tumor in brain = larger ICP o MRI o Ultrasound o Biopsy o Bone Marrow Aspiration Bone Marrow Aspiration o **Pic on slide 41** o To rule out Leukemia = MUST DO BOTH SIDES o Ilieac spine o Pathologists reads IN room General treatment modalities o Surgery – take out tumor if can Encapsulated tumor = better prognosis o Chemotherapy o Steroids o Radiation o Bone marrow transplantation Chemotherapy o Primary form of treatment o Interferes with cells ability to grow and reproduce Chemo kills rapidly growing cells **NOT cell specific** o Used alone or in combination with other treatments o Routes of chemotherapy IV Push – MUST BE ON THE DOT IVPB Intrathecal – into CSF IM – sometimes dose is too much for one muscle – 2 nurses give 2 shots at once PO – comfort in hospice situation or after treated aggressively o Side Effects of Chemo Extravasation – necrotic tissue Vinchristine – need to give in a central line
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**Always check for blood return BEFORE, DURING, and AFTER Alopecia GI Problems – Biggest issues Nausea/ Vomiting (48 hours) – can be up to a week after Nutrition Offer small meals & give them what they want Give child choice – whatever they want = give it Constipation/diarrhea (constipation = miralax) Diarrhea = SKIN CARE Mucosal ulceration = magic mouth wash Chew on ice chips while getting chemo = causes vasoconstriction in mouth **Watch for ulcerations on anal area too** GU Problems Hemorrhagic cystitis Bleeding and clots in bladder Mesna = protects bladder **TONS of IV fluid = 200% maintenance Will always be peeing – look for color (blood) & weigh o Side Effects of Chemo Myelosuppression Usually within 7-10 days after drug given Nadir: lowest blood count Anemia Epoetin Alfa (SQ or IV) Transfusion if Hgb <7 Neutropenic Fever – if have a fever = COME IN NOW Emergency!
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  • Spring '17
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