PEDS Final-oncology

Tumor lysis syndrome occurs when a large number of tumor cells are destroyed and released into the bloodstream at a faster rate than the body can eliminate them. This can lead to the release of various substances, such as potassium, phosphate, and uric acid, which can overwhelm the body's normal elimination mechanisms. This can result in electrolyte imbalances, kidney dysfunction, and other complications.

Weight gain is not a typical finding in Acute Lymphoblastic Leukemia (A.L.L). A.L.L is a type of cancer that affects the white blood cells, leading to symptoms such as nose bleeds, unexplained fevers, and lethargy. Weight loss or failure to thrive is more commonly associated with A.L.L due to the effects of the disease on the body. Therefore, weight gain would be inconsistent with A.L.L.

The correct answer is Blast. Blast cells are immature cells that are found in the bone marrow and can develop into various types of blood cells. In the case of malignancy, these blast cells can multiply uncontrollably and replace the normal functioning cells in the marrow, leading to conditions such as leukemia. Adenomatous and squamous cells are not typically associated with the bone marrow, and the esophagus is not directly related to the question.

The correct answer suggests that the child is being screened for Acute Lymphoblastic Leukemia (A.L.L.) because their symptoms of hip, shoulder, and abdominal pain could potentially be caused by marrow expansion and an enlarged liver, which are commonly associated with A.L.L. This explanation helps the parent understand the reason behind the screening and provides insight into the potential causes of the child's pain.

The correct answer is Prednisone. Prednisone is a corticosteroid medication commonly used in the treatment of Acute Lymphoblastic Leukemia (A.L.L.). One of the side effects of prednisone is fluid retention, which can lead to a puffy face. Additionally, long-term use of prednisone can affect growth and development, causing a child to fall below the normal growth charts. Therefore, the nurse should suspect that prednisone is contributing to the child's puffy face and below-average growth.

Renomegaly, which refers to the enlargement of the kidneys, is not associated with Acute Lymphocytic Leukemia (ALL). ALL is a type of cancer that affects the white blood cells, specifically the lymphocytes. It commonly leads to symptoms such as hepatomegaly (enlargement of the liver), splenomegaly (enlargement of the spleen), and lymphadenopathy (enlarged lymph nodes). However, it does not cause renomegaly.

Allopurinol is used to inhibit the production of uric acid. Uric acid is a waste product that is produced when the body breaks down purines, which are found in certain foods and drinks. High levels of uric acid can lead to conditions such as gout, kidney stones, and uric acid nephropathy. Allopurinol works by blocking the enzyme xanthine oxidase, which is involved in the production of uric acid. By inhibiting this enzyme, allopurinol helps to reduce the levels of uric acid in the body and prevent the formation of uric acid crystals.

Providing the toddler with analgesic medication is the most effective intervention for managing the pain experienced by a toddler with terminal cancer. Analgesic medication helps to alleviate pain and improve the toddler's comfort. This intervention directly addresses the primary concern of the toddler's pain, providing relief and promoting a better quality of life. Distracting the toddler with his favorite toy may provide temporary relief, but it does not address the underlying cause of the pain. Frequently changing the toddler's position or giving him food or fluids that he requests may not have a significant impact on pain management.

For a child with Acute Lymphoblastic Leukemia (A.L.L.), the priority nursing diagnosis would be "Risk for infection." A.L.L. is a type of cancer that affects the white blood cells, which weakens the immune system and makes the child more susceptible to infections. Therefore, the nurse should prioritize assessing and managing the child's risk for infection to prevent complications and ensure their safety and well-being.

The nurse's first concern should be increased intracranial pressure. Papilledema, infrequent seizures, and preretinal hemorrhages are all signs of increased intracranial pressure, which can be a life-threatening condition. It is important for the nurse to address this concern promptly to prevent further complications and provide appropriate interventions to manage the elevated pressure in the brain. Anemia, neutropenia, and thrombocytopenia may be present in a patient with A.L.L., but they are not the immediate priority in this case.

The peak onset for Acute Lymphocytic Leukemia is typically between 3-5 years of age. This means that the highest number of cases of this type of leukemia occur in children within this age range. It is important to note that while this is the peak onset, Acute Lymphocytic Leukemia can still occur in individuals of other age groups as well.

A bone marrow aspiration is a procedure used to diagnose and monitor certain blood disorders and cancers. If the results of a bone marrow aspiration are positive, meaning abnormal cells or cancerous cells are found, it indicates the possibility of systemic involvement. Since the question specifically asks about checking for central nervous system (CNS) involvement, a lumbar puncture would be the most appropriate exam. A lumbar puncture involves collecting cerebrospinal fluid (CSF) from the spinal canal, which can be analyzed for the presence of abnormal cells or other indicators of CNS involvement.

Ewing's sarcoma is a highly aggressive form of cancer that commonly affects children and young adults. It is known to be more invasive than Osteosarcoma, which is another type of bone cancer. Additionally, the treatment for Ewing's sarcoma often involves total body radiation, which typically lasts for a period of 6-8 weeks. Therefore, the statement that Ewing's sarcoma is more invasive than Osteosarcoma and requires 6-8 weeks of total body radiation is true.

A.L.L. (Acute Lymphoblastic Leukemia) is a type of cancer that affects the white blood cells. In this condition, the bone marrow produces too many immature lymphocytes called blast cells. A positive result for A.L.L. would typically show a high percentage of blast cells in the blood or bone marrow. Therefore, a lower percentage of blast cells, such as 15%, would not be considered a positive result for A.L.L.

Osteogenic sarcoma is a type of bone cancer that commonly affects teenagers and young adults. It can cause a change in gait, which refers to the way a person walks, due to pain and discomfort in the affected bone. Intermittent joint pain is also a common symptom of osteogenic sarcoma, as the cancer can spread to nearby joints. Pathological starburst fractures, which are fractures that radiate out from a central point, can occur as a result of the weakening of the bone by the tumor. Therefore, osteogenic sarcoma is the most likely condition to cause these symptoms.

Alkaline phosphate is an enzyme found in the liver, bones, and other tissues. An elevated level of alkaline phosphate in the blood can indicate bone or liver disease. In the case of a school-age child with suspected osteosarcoma, which is a type of bone cancer, an elevated level of alkaline phosphate may be observed. This is because osteosarcoma can cause the destruction of bone tissue, leading to the release of alkaline phosphate into the bloodstream. Therefore, an elevated lab value of alkaline phosphate would be expected in a child with suspected osteosarcoma.

Urticaria is a type of allergic reaction that presents as raised, itchy, and red welts on the skin. It can be a sign of an allergic reaction to the chemotherapy medication, which could potentially be life-threatening. Therefore, the nurse should report the presence of urticaria to the primary care provider immediately so that appropriate interventions can be taken to address the allergic reaction and ensure the child's safety.

Methotrexate is a medication that is commonly used to protect the central nervous system (CNS) during chemotherapy. It is a type of chemotherapy drug known as an antimetabolite, which means it interferes with the growth and division of cancer cells. Methotrexate is able to cross the blood-brain barrier, allowing it to reach the CNS and target cancer cells that may have spread to the brain or spinal cord. By protecting the CNS, methotrexate helps prevent the spread of cancer to these vital areas and reduces the risk of neurological complications.

Bone marrow aspiration is a procedure in which a small sample of bone marrow is taken for diagnostic purposes. The iliac spine, also known as the iliac crest, is a common site for bone marrow aspiration. It is easily accessible and provides a good representation of the bone marrow. The lumbar spine and femur are not typically used for bone marrow aspiration. The zygomatic bone, also known as the cheekbone, is not related to bone marrow aspiration.

Treating headache with Ibuprofen is not an appropriate intervention for A.L.L. because A.L.L. (Acute Lymphoblastic Leukemia) is a type of cancer that affects the white blood cells. Headache is not a common symptom of A.L.L., and treating it with Ibuprofen would not address the underlying cause. Instead, the focus should be on assessing for petechiae (small red or purple spots on the skin), applying pressure to wounds to control bleeding, and testing for guiac (a test for blood in the stool). These interventions are more relevant to the management of A.L.L.

When administering a whole blood transfusion to a pediatric oncology patient receiving radiation therapy, the nurse should consider the risk for fluid overload. This is because the patient may already have compromised fluid balance due to their underlying condition and radiation therapy. Administering a large volume of whole blood could potentially lead to fluid overload, which can cause complications such as pulmonary edema or heart failure. Therefore, it is important for the nurse to closely monitor the patient's fluid status and assess for any signs of fluid overload during and after the transfusion.

The correct answer is Apple. Pediatric oncology patients often have a weakened immune system due to their illness and treatment, making them more susceptible to infections. Apples are a common source of bacteria and should be avoided to reduce the risk of foodborne illnesses.

The correct answer is Tdap. The Tdap vaccine is recommended for adolescents and adults to protect against tetanus, diphtheria, and pertussis (whooping cough). Since the 6-year-old female is undergoing cancer treatment, her immune system may be compromised, making her more susceptible to infections. The Tdap vaccine can help prevent these serious bacterial and viral infections, which could be especially harmful to her in her current condition. The other options (LAIV, MMR, VAR) may not be suitable for her due to her weakened immune system.

The correct answer for post-op nursing considerations for Osteosarcoma limb removal would include a tourniquet at the patient bedside. This is because a tourniquet may be needed in case of excessive bleeding or to control bleeding during the surgery. It is a device that applies pressure to the limb to restrict blood flow, allowing the surgeon to work more effectively and minimize blood loss. Having a tourniquet readily available at the patient's bedside ensures that it can be quickly applied if necessary, ensuring the patient's safety and preventing complications.

Ewing's sarcoma is a common bone tumor that infiltrates the soft tissue around the bone. It is a type of cancer that primarily affects children and young adults. Ewing's sarcoma is characterized by the abnormal growth of cells in the bones or soft tissues, leading to the formation of tumors. These tumors often infiltrate the surrounding soft tissue, causing pain, swelling, and limited mobility. Early diagnosis and treatment are crucial for managing Ewing's sarcoma and improving patient outcomes.

After a limb is removed, a pillow should be used to elevate the stump for the first 24 hours. Elevating the stump helps to reduce swelling and promote blood circulation in the area. This can aid in minimizing pain and discomfort, as well as prevent complications such as fluid accumulation. After the initial 24 hours, other measures may be taken to promote healing and prevent complications, but elevating the stump with a pillow is particularly important in the immediate aftermath of the limb removal.

Mesna is a medication that is used to bind to and detoxify toxic metabolites, particularly those produced by certain chemotherapy drugs. One of the side effects of these drugs is hemorrhagic cystitis, which is inflammation and bleeding in the bladder. Mesna helps to prevent this side effect by binding to the toxic metabolites and reducing their harmful effects on the bladder. Allopurinol is a medication used to treat gout, Methotrexate is a chemotherapy drug, and Plantinol is not a medication.

The nurse can administer Bleomycin for the patient's bacterial infection because it is an antibiotic that is commonly used to treat various types of infections, including bacterial infections. It is not contraindicated in patients who have not had a cardiac workup or PET scan. Actinomycin, on the other hand, is an antineoplastic medication that is used to treat certain types of cancer and not indicated for bacterial infections.

The lab finding of 4.4 Calcium is not consistent with A.L.L (Acute Lymphoblastic Leukemia). In A.L.L, the calcium levels are typically normal or low due to the increased uptake of calcium by leukemic cells. Therefore, a calcium level of 4.4 is not consistent with the expected findings in A.L.L.

If a child has an infection that has been active for 16 days, it is recommended to test them for Acute Lymphoblastic Leukemia (A.L.L.). A.L.L. is a type of cancer that affects the white blood cells, and it can present with symptoms similar to an infection. Testing for A.L.L. is important to ensure early detection and appropriate treatment for the child.

The nurse should also check for hyperglycemia. The patient's puffy face and below 5% on the growth charts may indicate Cushing's syndrome, which can be caused by long-term steroid use in the treatment of A.L.L. Steroids can also cause hyperglycemia, so it is important for the nurse to assess the patient's blood glucose levels to determine if hyperglycemia is present.

The management of TLS (Tumor Lysis Syndrome) involves various strategies to prevent and treat electrolyte imbalances caused by rapid cell breakdown during cancer treatment. This typically includes aggressive fluid resuscitation to maintain hydration, osmotic diuretics like Mannitol to enhance urine production and remove excess substances, and other interventions to manage electrolyte imbalances. Lasix, also known as furosemide, is a loop diuretic commonly used to treat conditions like edema and hypertension, but it is not typically used in the management of TLS.

The patient/family teaching for a patient undergoing surgical interventions for Osteosarcoma should include the following: exercise to strengthen upper arms, preparing for extensive physical therapy, discussing the importance for the patient to grieve the loss of the limb, and introducing the patient to support groups. These interventions are important for the patient's physical recovery, emotional well-being, and adjustment to the changes in their body and lifestyle. Focusing on what the patient cannot do may have a negative impact on their mental health and overall recovery, so it should not be included in the teaching.

Patient education regarding radiation should include information about the potential side effects that may occur after 7-10 days, such as fatigue, skin changes, and gastrointestinal symptoms. Dysphagia, which refers to difficulty swallowing, is another important side effect that patients should be aware of. Alopecia, or hair loss, can also occur as a result of radiation therapy. Myleosuppression, which is a decrease in the production of blood cells, and pneumonitis, which is inflammation of the lungs, are both potential complications of radiation therapy that patients should be educated about.

When educating a patient on the side effects of Vincristine, the nurse should mention the possibility of peripheral neuropathy, severe constipation, bowel innervation, and nausea and vomiting. Vincristine is known to cause peripheral neuropathy, which is damage to the peripheral nerves that can result in symptoms such as tingling, numbness, and weakness in the extremities. Severe constipation is another potential side effect of Vincristine, as it can slow down the movement of the bowels. Bowel innervation refers to the regulation of bowel movements, and Vincristine can disrupt this process. Lastly, nausea and vomiting are common side effects of Vincristine treatment.

When performing mouth care on a Chemo patient, the nurse should not use Listerine, toothbrush, or dental floss. Listerine contains alcohol which can irritate and dry out the mucous membranes in the mouth. A toothbrush and dental floss can cause trauma to the gums and increase the risk of bleeding and infection. It is important to use gentle methods of mouth care such as a soft toothbrush, saline solution, or a mouthwash specifically designed for chemotherapy patients.