End of Life
What is palliative care?
An interprofessional approach that focuses on improving quality of life rather than prolonging life when cures are not possible.
Focus is on control of managing the client’s manifestations and offering supportive care.
What is leukemia?
The term for a group of malignancies that affect the bone marrow and lymphatic system
Peak onset in children is between ages 2 and 5 years
There are 2 types and they are classified by the type of WBCs that becomes neoplastic and is commonly divided into two groups:
acute lymphoblastic leukemia(ALL)
acute myeloid (AML)
ALL is the most common childhood malignancy.
What is Wilms' Tumor? (Nephroblastoma)
a malignancy that occurs in the kidneys or abdomen.
The tumor is usually unilateral, with 10% of cases affecting both kidneys.
Diagnosis typically occurs before age 5, with most cases diagnosed between 2 and 3 years of age.
Metastasis is rare.
What is Neuroblastoma?
A malignancy that occurs in the adrenal gland, sympathetic chain of the retroperitoneal area, head, neck, pelvis, or chest.
It is usually manifested during the toddler years, with 95% of cases prior to age 10.
Median age at diagnosis is 19 months.
It is more common in males than females.
Half of all cases have metastasized before diagnosis.
What is osteosarcoma?
This type of cancer is usually found in the long bones
Usually found in adolescence
Usually c/o bone pain, weakness, swelling, anemia and fever
What is often seen in the infant/Toddler stage of grief
Have little to no concept of death
Mirror parental emotions
React in response to the changes
Can regress to an earlier behavior
What are leukoblasts?
immature WBCs
In leukemia, the patient has an increased number of these and they infiltrate the organs and tissues
What are the symptoms often seen with Wilms' tumor?
Painless, firm, nontender abdominal swelling or mass
Fatigue, malaise, weight loss
Fever
Hematuria
Hypertension
Manifestations of metastasis include dyspnea, cough, shortness of breath, and chest pain
"Neuro" but not in the brain??? Why???
It originates from the immature nerve cells of the sympathetic nervous system
What are the expected findings of osteosarcoma?
Nonspecific bone pain that is often mistaken for an injury or growing pains
Weakness, swelling, decreased movement, or limping
Anemia, fever, or unexplained weight loss
Inability to lift a heavy object
What is often seen in the School-Age child during grief?
Manifestations of leukemia?
Low-grade fever
Pallor
Increased bruising and petechiae
Listlessness
Enlarged liver, lymph nodes, and joints
Abdominal, leg, and joint pain
Headache
Vomiting and anorexia
Unsteady gait
Pain
Enlarged kidneys and testicles
Manifestations of increased intracranial pressure
What specialized tests might you expect to see when trying to diagnose Wilms' tumor (nephroblastoma)
BUN, creatinine
CBC
Urinalysis
Abdominal ultrasonography
Abdominal and chest computed tomography (CT) scan
Inferior venacavogram (rule out involvement with the vena cava)
Bone marrow aspiration (rule out metastasis)
What are the symptoms often seen with Neuroblastoma?
Manifestations depend upon the location and stage of the condition
Palpable abdominal mass
Weight loss, constipation, anorexia
Diaphoresis, hypertension
Manifestations of metastasis include jaundice, and dark pigmented nodules on the extremities, dyspnea, edema of face and neck
How do we diagnose Osteosarcoma?
X rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) of the primary site
Bone marrow biopsy
CT of the chest and bone scans to evaluate metastasis
What is seen in the Pre school age child during grief?
Egocentric thinking
Magical thinking (can think death is their fault)
Think that death is temporary
How is leukemia diagnosed?
CBC: Anemia, Thrombocytopenia, Neutropenia, Leukemic blasts (immature WBCs), Blood smear (immature WBC)
Bone Marrow Biopsy: if leukemia is present, the specimen will show prolific quantities of immature leukemic blast cells and protein markers indicating a specific type of leukemia.
Can do CSF analysis
How is Wilm's tumor treated?
Varies according to the stage and histology of the tumor
Surgical removal of the tumor and kidney soon after diagnosis
Preoperative chemotherapy or radiation if both kidneys are involved to decrease the size of the tumors and potentially preserve one kidney
Postoperative radiation and/or chemotherapy for children who have large tumors, metastasis, recurrence, and residual disease
What specialized testing might you expect when evaluating for Neuroblastoma?
CBC and coagulation studies
Urine catecholamines (vanillylmandelic acid, homovanillic acid, dopamine, and norepinephrine)
Skeletal survey
Skull, neck, chest, abdominal, and bone CT scans
Bone marrow aspiration (rule out metastasis)
Metaiodobenzylguanidine scan (determine bone, bone marrow, and soft tissue involvement)
Biopsy of tumor
How is osteosarcoma treated?
Chemo
Radiation
Limb salvage
Limb amputation
What are common factors affecting the grieving process?
How is leukemia treated?
Chemo therapy
Stem cell transplant
Radiation if CSF is involved
What nursing interventions/monitoring is needed for patients with Wilm's tumors?
Hypertension (increased Renin production)
NEVER palpate the abdomen
How is Neuroblastoma treated?
Varies according to the tumor stage
Surgical removal of the tumor
Chemotherapy and/or radiation for metastasis and residual disease
Side effects of chemotherapy
(name 2)
Skin breakdown
Oral ulcers
Hair loss
Pain
Loss of appetite
Bone marrow suppression