Care of Mother and Child at Risk or with

Problems (Acute and Chronic)

LESSON TITLE: NURSING CARE OF A FAMILY WHEN A CHILD Materials:

HAS A MALIGNANCY Part 2
Pen, paper, index card, book, and class List
Learning Targets:
At the end of the module, students will be able to:
1. Define the common types of cellular aberrations that occur References:
in children.
2. Integrate the knowledge of the cellular aberrations in Pilliteri, Adele and Silbert-Flagg, JoAnne
children and describe these malignancies that occur in (2018) Maternal and Child Health Nursing, 8th
these classifications of children in formulating nursing care Edition. USA: Lippincott Williams and Wilkins
plan in giving quality maternal and child health nursing care

A. LESSON PREVIEW/REVIEW

To the students: Review of past lessons regarding disorders affecting oxygenation.

B. MAIN LESSON
The instructor should discuss the following topics. Instruct students to take down notes.

Please refer to Chapter 53: Nursing Care of a Family When a Child Has a Malignancy-Neoplasms of the Brain p. 1517
and Bone Tumors p.1521

NEOPLASMS OF THE BRAIN

 the second most common form of cancer and the most common solid tumor in children.
 Tumors tend to occur between 1 and 10 years of age, with 5 years being the peak age of incidence
TYPES OF BRAIN TUMORS 2. MEDULLOBLASTOMAS
1. ASTROCYTOMAS  are fast-growing tumors found most commonly in
 Are slow-growing, cystic tumors that arise from the cerebellum.
the glial or support tissue surrounding neural cells.  The peak age of incidence is 5 to 10 years.
 They account for about one fourth of all brain  Usually found at the midline, they cause fourth-
tumors in children. ventricle compression and disturbances in the
 The peak age of incidence is 5 to 8 years. flow of CSF.
 Brainstem gliomas often cause paralysis of the
5th, 6th, 7th, 9th, and 10th cranial nerves.
 They may produce symptoms of ataxia,
nystagmus, and changes in respiratory and pulse
findings because of pressure on these centers
ASSESSMENT
 develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head
circumference, or papilledema.
 Lethargy, projectile vomiting, and coma are late signs.
 Diplopia or ptosis because of cranial nerve involvement or strabismus because of suppression of vision in one
eye may begin to be noticeable as the tumor continues to grow
 nystagmus (constant horizontal movement of the eye) or visual field defects.
 As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and
seizures may occur.
 Neurologic examination
 a bone scan
 ultrasound or MRI
 cerebral angiography, or a CT scan will be performed as needed.
 Myelography may be done to identify tumors that could have spread into the spinal column.
 Lumbar puncture must be done cautiously because the release of CSF can cause the brainstem (under
pressure from the tumor) to herniate into the spinal cord, interfering with respiratory and cardiac function.
THERAPEUTIC MANAGEMENT  Statements such as “Child says he sees two forks

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 Care of Mother and Child at Risk or with
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Radiation therapy is carefully staged because, if when I show him one” or “Child is unable to see
tumor tissue is not rapidly proliferating, cells are objects held out on her left side” are much more
not easily destroyed. Chemotherapy is also limited meaningful to a neurologic exam than “Child has
because many chemotherapeutic agents do not difficulty seeing.”
readily cross the blood–brain barrier.  Completely describe any seizure activity observed
 Typical drugs used are carboplatin or a as well, particularly the beginning movements of
combination of thioguanine, procarbazine, the seizure, because these can help localize the
lomustine, and vincristine. Administration of drugs point of maximum brain pressure.
directly into the ventricular system via a reservoir  Be certain side rails are in place for protection in
(Ommaya) may increase drug effectiveness. case a seizure should occur while the child is in
 Note and document episodes of irritability, bed.
drowsiness, speech difficulty, and eye
involvement.
BONE TUMORS
 Tumors derived from connective tissue, such as bone and cartilage, muscle, blood vessels, or lymphoid tissue,
are termed sarcomas.
 They are the second most frequently occurring neoplasms in adolescents (only lymphomas occur more
frequently).
 Bone tumors may arise during adolescence because rapid bone growth is occurring at this time.
 Because girls have a puberty growth spurt a year or two earlier than boys, bone tumors tend to occur slightly
earlier in girls than in boys (13 compared with 14 or 15 years of age).
 The two most frequently occurring types are osteogenic sarcoma and Ewing sarcoma.
OSTEOGENIC SARCOMA  Caution children not to bear weight on an affected
 a malignant tumor of long bone involving rapidly leg while waiting for tests or surgery because if
growing bone tissue (mesenchymal matrix forming the bone has become weakened by the growing
cells). tumor, weight bearing could result in a fracture at
 It occurs more commonly in boys than in girls and the tumor site.
in children who have had radiation for other
malignancies as a later life effect. THERAPEUTIC MANAGEMENT
 The most common sites of occurrence are the  Chemotherapy is prescribed to shrink the tumor
distal femur, the proximal tibia, and the proximal before surgery.
humerus, and the tumor is often associated with  If parents are concerned with this delay, explain
locoregional pain and swelling. that, with a bone tumor, this is a helpful
 Children with a specific genetic syndrome have a intervention because it will make removal of the
higher incidence than usual of developing an tumor more successful.
osteosarcoma, so a hereditary predisposition may  A common chemotherapy drug regimen used for
be present. treatment includes methotrexate, cisplatin,
 Metastasis to the lungs is very common; as many doxorubicin, and ifosfamide.
as 25% of adolescents will have lung metastasis  When at all possible, surgical procedures will
already by the time of initial diagnosis. attempt to remove the tumor without amputation.
 Other common sites of metastasis are brain and  These surgeries are referred to as limb salvage.
other bone tissue.  The bone that is removed is typically replaced by
ASSESSMENT cadaver or man-made prosthesis
 area may be painful and swollen; it may be  Rarely, if the tumor is extensive at the time of
inflamed and feel warm because tumors are diagnosis, the extremity may be amputated at the
highly vascular and therefore call increased blood joint above the tumor.
into the area.  Only a few years ago, a diagnosis of osteogenic
 history of recent trauma to the site such as a fall sarcoma was ominous; few children survived into
playing basketball or a bump to their knee during adulthood.
soccer practice and attribute pain in the knee to  Today, 70% of adolescents in whom the diagnosis
this injury for some time. is made early and who are treated rigorously can
 Features of osteosarcoma are visible on be cured
radiologic studies such as MRI, but a biopsy will
be done of the suspicious site to confirm the
diagnosis.
 To determine metastasis, a complete blood cell

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

count, urinalysis, chest X-ray, chest CT scan, and

bone scans will be done.

CHECK FOR UNDERSTANDING

The instructor will prepare 10 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.

1. The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, "I don't understand
how this could happen to us. We have been so careful to make sure our child is healthy." Which response by the nurse is
most appropriate?
A. "This must be a difficult time for you and your family. Would you like to talk about how you are feeling?"
B. "Why do you say that? Do you think that you could have prevented this?”
C. "You shouldn't feel that you could have prevented the cancer. It is not your fault."
D. "Many children are diagnosed with cancer. It is not always life-threatening."

2. A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be
the best intervention to include in the child's plan of care?
A. Administer tube feedings.
B. Offer small, frequent meals.
C. Offer fluids only between meals.
D. Allow the child to choose what to eat for meals.

3. Which nursing diagnosis is highest priority for a child undergoing chemotherapy and experiencing nausea and
vomiting?
A. Fluid and Electrolyte Imbalance
B. Alterations in Nutrition
C. Alterations in Skin Integrity
D. Body Image Disturbances

4. A child with cancer has the following lab result: WBC 10,000, RBC 5, and platelet of 20,000. When planning this child's
care, which risk should the nurse consider most significant?
A. Hemorrhage
B. Anemia
C. Infection
D. Pain

5. Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to do which
of the following before administering chemotherapy?
A. Measure abdominal girth
B. Calculate BMI
C. Ask the client about his/her height and weight
D. Weigh and measure the client on the day of medication administration

6. You are conducting a lecture about chemotherapy. Which of the following statements is correct about the rate of cell
growth in relation to chemotherapy?
A. Faster growing cells are more susceptible to chemotherapy
B. Faster growing cells are less susceptible to chemotherapy
C. Slower growing cells are more susceptible to chemotherapy
D. Non-dividing cells are more susceptible to chemotherapy

7. The nurse is caring for a patient who is scheduled for a biopsy of a tumor. The patient asks what distinguished a benign
tumor from a malignant tumor. Which info should the nurse provide?
A. Benign tumors are usually composed of more rapidly growing cells
B. Benign tumors are incapable of causing damage to surrounding tissues or organs
C. Whereas malignant tumors are usually encapsulated, benign tumors lack specific form
D. Malignant tumors are composed of disorganized, abnormal cells that may spread to other parts of the body

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 Care of Mother and Child at Risk or with
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8. The nurse is caring for a patient who requires compromised host precautions. Which action is most important for the
nurse to take before delivering the patient's breakfast tray?
A. Ask patient if she feels like eating at this time
B. Remove fresh apple and orange from tray
C. Call dietary department and ask for disposable utensils
D. Declutter room before assisting patient to couch to eat

9. For an 18-year-old with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the
threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?
A. "Client verbalizes feelings of anxiety."
B. "Client doesn't guess at prognosis."
C. “Client uses any effective method to reduce tension."
D. “Client stops seeking information."

10. A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing
diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement?
A. Related to visual field deficits
B. Related to difficulty swallowing
C. Related to impaired balance
D. Related to psychomotor seizures

C. LESSON WRAP-UP

AL Activity: Formative Assessment

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

Formative assessment (assessment FOR learning) is the collection of information prior to or during instruction, that can be
used by the instructors to make instructional decisions and in-flight adjustments. This can improve student learning,
especially those who are struggling. This activity focuses on the assessment after a lesson. The student must answer the
following questions:
1. What specific part of the Main Lesson for this session do you find the most confusing?
2. What makes your answer in #1 confusing? What is the question in your mind?
3. Since that is your most confusing lesson, what are the interventions that you must do to understand the topic?

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