Neurological Disorders in the Pediatric Patient Presented by Marlene Meador RN, MSN, CNE.
PEDIATRIC ONCOLOGY Leslie Meador, RN, BSN, CPON Staff RN III Children’s Mercy Hospital.
-
Upload
brook-strickland -
Category
Documents
-
view
219 -
download
1
Transcript of PEDIATRIC ONCOLOGY Leslie Meador, RN, BSN, CPON Staff RN III Children’s Mercy Hospital.
PEDIATRIC PEDIATRIC ONCOLOGYONCOLOGYPEDIATRIC PEDIATRIC ONCOLOGYONCOLOGY
Leslie Meador, RN, BSN, CPONLeslie Meador, RN, BSN, CPONStaff RN IIIStaff RN III
Children’s Mercy HospitalChildren’s Mercy Hospital
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.
Cell development
What is cancer?Cell development
Healthy growth Unhealthy growth
Normal cells Tumor cells
Benign Malignant
Benign v. Malignant• Benign: overgrowth of cells that
are NOT cancerous• Malignant: overgrowth of cells that
ARE cancerous
Pediatric Oncology Facts
• In the U.S., cancer remains responsible for more deaths from 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. That’s the equivalent of two average size classrooms diagnosed each school day.
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.
Pediatric Oncology Facts
• Most common childhood cancers:-leukemia (blood) -brain and nervous system-the lymphatic system (lymphoma)
-kidneys (Wilm’s tumor) -bones (osteosarcoma & Ewing’s
sarcoma)-muscles (rhabdomyosarcoma)
Pediatric v. AdultCharacteristic Pediatric Adult
Frequency Rare: <1% of all cancers
Common: >99% of all cancers
Primary sites Involves TISSUE
Involves ORGANS
Pathogenesis Genetic alterations
Environment & lifestyle
Pediatric v. AdultCharacteristic 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
Doesn’t always follow a protocol
Prognosis
70-90% cure (depending on tumor & stage)
<60% cure (depending on tumor & stage)
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
Bone Marrow Aspiration
Methods for treatment• Depends of type and stage of
malignancy• Includes the following:
-Chemotherapy -Radiation
-Surgical resection-Stem cell transplantation
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).
Chemotherapy• Works by interfering with the
ability of cancer cells to divide and reproduce themselves.
• Attacks all rapidly dividing cells.
Rapidly dividing cells:• Hair• Skin• Nails• Blood cells
-Red blood cells-White blood cells-Platelets
Three blood lines• Red blood cells:
-carry oxygen to surrounding tissues
• White blood cells:White blood cells:-fight off infection-fight off infection
• Platelets:Platelets:-help to prevent excessive -help to prevent excessive
bleeding; assists in clot formationbleeding; assists in clot formation
Complications of chemotherapy
• Anemia (low RBC)• Thrombocytopenia (low platelet)• Neutropenia (low WBC)• INFECTION• Hair loss• Mouth sores (mucositis)• Nausea, vomiting & diarrhea• Organ toxicities
WHAT DOES CANCER LOOK
LIKE?
Normal WBC on smear
A
B
C
D
E
F
G
H
A. Banded Neutrophil B. Lymphocyte
C. Monocyte D. Segmented Neutrophil
E. Eosinophil F. Basophil
G. Platelet H: Red blood cell
Acute Lymphocytic Leukemia on smear
Osteosarcoma
Distal Femur Humerus
Osteosarcoma
Brain tumor
Brain tumor
The Faces of Childhood Cancer
• The Faces of Childhood Cancer
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!!!
What is my day like?• 12 hour shifts; 7am – 7pm• Nurse: patient ratio = 1:3 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.
And the numbers are …• Starting salary: $21.49/hr (CMH in top
5% salary for RN’s in KC area)• Shift differentials: 10% evening (3-
11:30pm), 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
References• Hooke, M., Kline, N., O’Neill, 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/
References cont.• ghr.nlm.nih.gov/.../ basics/MitosisMeiosis.jpg• http://www.med.harvard.edu/JPNM/TF96_97/N
ov4/WriteUp.html• http://www-medlib.med.utah.edu/WebPath/HE
MEHTML/HEMEIDX.html• http://www-medlib.med.utah.edu/WebPath/BO
NEHTML/BONE001.html