Common Health Problems in Preschoolers: Nursing Care for Childhood Leukemias and Wilm's Tumor

Nursing Care of a Family When a Child Has a Malignancy

• Malignant cells grow and proliferate in a disorderly, chaotic fashion
• In children, the most frequent type of cancer is leukemia, a type of immature white blood cell (WBC) overgrowth
• Health promotion and risk management strategies include:
  • Reducing exposure to secondary cigarette smoke and urging adolescents not to begin smoking
  • Applying sunscreen and reducing sun exposure
  • Vaccinating both boys and girls against human papillomavirus (HPV)

Neoplasia

• Neoplasm refers to a new abnormal growth that does not respond to normal growth-control mechanisms
• Normal cells can recognize and communicate with each other to stop growth when crowded, but neoplastic cells do not respond or receive this communication
• Neoplasms can be either benign (limited growth) or malignant (cancerous or unlimited growth)

Causes of Neoplastic Growth

• Somatic mutation theory proposes that an accumulation of mutations in a cell leads to neoplastic transformation
• Oncogenic viruses (cancer-causing viruses) such as HPV may be directly responsible for tumor growth
• Exposure to environmental factors such as chemical irritants or cigarette smoke may contribute to neoplastic growth in adults

Assessing Children with Cancer

• Many cancers in children have been developing for some time before symptoms appear
• Symptoms may include bruising, nosebleeds, headache, pain in a knee, and constipation
• Cachexia (loss of weight and anorexia) can occur if the tumor is growing rapidly and taking nutrients from normal cells

Cell Growth

• Normal cells appear to recognize and communicate with each other to stop growth when crowded
• Neoplastic cells do not respond to this communication or cannot receive it, so they continue to grow despite being crowded
• By the time a tumor mass is detected, it is probably about 30 times the size of its original aberrant cell

Neoplastic Growth

• Neoplasms can cause damage by pressing on adjacent tissue, even if they are benign
• Brain tumors in children are often benign but can cause respiratory depression from increased pressure on the respiratory center

Physical and Laboratory Examination

• Any suspicion of a malignancy requires a thorough physical examination
• Assessing height and weight of children is an important component
• Diagnostic procedures may include radiography (X-ray), ultrasound, magnetic resonance imaging (MRI), blood analysis, and biopsy

Biopsy

• Biopsy is the surgical removal of tissue cells for laboratory analysis
• It is classified as minor surgery and is usually done on an ambulatory basis
• Bone marrow aspiration is a frequent type of biopsy used with children and is done with only local anesthesia

Staging

• Tumor staging is a procedure that documents the extent and progress of a malignant tumor
• Knowing the stage of a tumor helps the health care team design an effective treatment program, establish an accurate prognosis, and evaluate the progress or regression of the disease

Chemotherapy

• Chemotherapeutic agents are drugs capable of destroying malignant cells
• Chemotherapy is scheduled at intervals that increase the ability to destroy malignant cells throughout the cell cycle
• Agents can be administered IV, PO, or IM/SQ and are classified into different categories
• Cytotoxic precautions should be taken when handling chemotherapeutic agents, as they can cause acute skin, eye, and mucous membrane irritations, as well as nausea, headaches, and dizziness
• Nausea and vomiting can be prevented by administering an antiemetic before chemotherapy and at 4- to 8-hour intervals during therapy