Children Who Have Cancer and/or Are Dying

MODULE 13.3
PEGGY KEARNEY MSN, RN

Introduction
Neoplastic Disorders are leading cause of death from disease in children past

infancy
Almost of all childhood cancers involve blood or blood-forming organs
Choice of therapy is based on:

Type

Stage

Extent of spread of the malignancy

Prognosis childhood cancer improved

-- >70-80% children treated in major cancer centers survive longer than 5 years
(average)
Goal of treatment is curative, palliative or supportive

Etiology

Cause remains unknown

General theory is genetic changes
Some show pattern of inheritance
Children with Immune Disorders

-- HIV/AIDS
Downs & Klinefelter syndrome greater risk for
developing certain cancers
Environmental

Classification of Leukemia's
Two forms are generally

recognized

Acute lymphoblastic leukemia

(ALL)

Stem or blast cell

Acute nonlymphoid (myelogenous)

leukemia (ANLL or AML)

Complex disease with varying

heterogeneity
Classifications are increasingly
complex

Pathophysiology

Leukemia is an unrestricted proliferation of

immature WBCs in the blood-forming tissues of

the body

Proliferating cells depress the production of all formed

elements of the blood in the bone marrow
Broad term given to a group of malignant diseases of the
bone marrow & lymphatic system

Liver, spleen and lymph glands are the most

severely affected organs

CNS involvement also which may cause IICP

Clinical Manifestations

Leukemia occurs when stem cells in bone marrow

produce immature WBCs that dont function

normally
These cells proliferate & cause bone marrow to fill

with abnormal WBCs

RBCs, WBCs, platelets, plasma, stem cells

decreased

Signs &Symptoms Leukemia

Acute lymphoblastic & Acute nonlymphoblastic

Fever
Pallor
Overt signs of bleeding
Lethargy and Malaise
Anorexia and/or weight loss
Large joint or bone pain
Petechiae, frank bleeding, joint pain are cardinal signs of
bone marrow failure

Consequences of Leukemia

3 Main:
1.
2.
3.
Spleen, liver & lymph glands become infiltrated &

enlarged
eventually become fibrotic
CNS becomes infiltrated
IICP

Incidence of Leukemia
3-4 cases/100,000
More common in white males
Peak age for children is between 2 & 5 years of age
Most common childrens type of leukemia

-- majority of patients are under 10 years old

Prognosis: Page 888 (criteria at diagnosis)

2-10 year olds

Female do better than males

5 year survival rates are close to >80% for ALL

50-65% for AML

Diagnostic Evaluation

Based on history, physical manifestations

Peripheral blood smear (done with CBC)

-- Immature leukocytes
-- Frequently low blood counts
Bone marrow aspiration or biopsy

Definitive diagnosis

LP to evaluate CNS involvement

Therapeutic Management
Chemotherapy

With or without cranial irradiation

Intrathecal meds for CNS involvement

4 Phases

Induction
CNS prophylactic therapy

Intensification (consolidation)

Prevents invasion into CNS

Eradicates residual leukemia cells

Maintenance

Hematopoietic Stem Cell Transplantation (HSCT)

Donors may be relatives or non-relatives
Stem cells from umbilical cord blood
This is tx option for child who has a relapse with

acute lymphoblastic leukemia, achieves 2nd

remission; transplant given when child is in
remission

Hematopoietic Stem Cell Transplantation

(Reasons for use)
Used to establish healthy cells in both malignant &

nonmalignant disease
Ablative therapy

High-dose combination chemo (with or without radiation) to

eradicate unhealthy cells & suppress immune system to
prevent rejection of transplanted marrow

Nursing Care Management

Prepare child and family
Multiple painful tests/procedures

Explanations /Therapeutic Play

Pharmacologic Measures
Sedation
Non-pharmacologic Measures

Relieve Pain
Prevention of Complications of Myleosuppression
Infection

Adequate nutrition

Hemorrhage
Anemia

Manage Problems of Drug Toxicity

N&V
Anorexia
Mucosal Ulceration
Neuropathy
Hemorrhagic Cystitis

NURSING Diagnosis
Activity intolerance
Risk for infection
Fluid excess Strict I & O
Impaired tissue integrity/injury risk/immobility
Altered nutrition allow food child likes/tolerates
Skin care & mucous membrane
Pain/Anxiety/Fatiguelessen painful procedures
Foster growth & development
Body image
Family and child with coping

Wilms Tumor Nephroblastoma

Most common malignant renal & intraabdominal

tumor of childhood

8 cases/million
500 new cases/year

Peak age at diagnosis is age 3 years

1-2.5% have a familial origin
Usually a single tumor from renal parenchyma

Clinical Manifestations
Abdominal Swelling or Mass
Firm
Nontender
Confined to one side
See page 917 Box 27-5

Most common site for metastasis is lungs

then liver, kidney, bone (rare)

Diagnostic Evaluation
H & P
Family history
Signs of malignancy

Weight loss
Hepato/spleenomegally

Abdominal swelling

Tight diaper

Abdominal US
CT (chest & abdomen)
Hematologic studies
UA

MEDICAL MANAGEMENT
Surgery

Kidney removed

Provides tissue for dx, histology &

staging

Explore lymph nodes & abdominal

organs
Staging is exact determination of
extent of disease at the time of dx

Radiation therapy &/or

chemotherapy

NURSING ALERT!!

Post a Sign:

DO NOT
PALPATE ABDOMEN

SIDS Sudden Infant Death Syndrome

SIDS
Sudden of death of an infant younger than 1 year of age

Unexpected

death of any infant where postmortem

examination fails to determine cause of death.
Decreased by 53% due to Back to Sleep campaign

Infants at Risk for SIDS

Birth

Premature neonates
VLBW
Multiples
Low Apgar scores

Male sex
Recent viral illness
Siblings of infants who have died of SIDS
Infants of American Indian or African-American

ethnicity

Etiology & Pathophysiology

Numerous theories

Generally unknown
? Brain stem abnormality
Genetic predisposition

Risk Factors

Maternal Smoking

During pregnancy & in infants environment

Cosleeping
Prone sleeping
Soft bedding

Protective Factors
Breast Feeding
Pacifier Use
Supine Position

Back to Sleep
www.michigan.gov/safesleep

Nurse Care Management

Preventative
Education

Role model while in hospital

Not side lying

Follow up at home
Written materials
Results of autopsy
Home visits
Cards, phone calls

Keepsake Memories

Children's Understanding of & Reaction to Death

Page 558
Table 18-4