Infection and Hemorrhage Management in Pediatric Cancer Patients Quiz

Managing Infection and Hemorrhage in Children with Cancer

• Complications of childhood cancer treatment include overwhelming infection due to neutropenia
• Granulocyte colony–stimulating factor (GCSF) has reduced infection incidence and duration in children with cancer
• Prevention measures in hospitals include private rooms, visitor restrictions, and strict hand hygiene
• Special germ-free environments (reverse isolation) are used during myelosuppression or bone marrow transplant
• Evaluation for potential infection sites and monitoring for temperature elevation is crucial
• Prevention of infection continues after hospital discharge, including good hand hygiene and isolation from school contacts during disease outbreaks
• Adequate protein-caloric intake is important for better host defenses and chemotherapy tolerance
• Platelet transfusions are used to prevent or control bleeding episodes in leukemia patients
• Aseptic technique is crucial for procedures to avoid infection at bleeding sites
• Meticulous mouth care is essential to prevent gingival bleeding and mucositis
• Blood transfusions may be necessary to manage anemia in children with leukemia
• Nurses need to use precautions in administering and handling chemotherapeutic agents to protect themselves and patients

Pediatric Hematopoietic Stem Cell Transplantation

• Allogeneic HSCT matches a histocompatible donor with the recipient, limited by the availability of suitable marrow donors and can lead to graft-versus-host disease (GVHD).
• Umbilical cord blood transplantation is an alternative for children with cancer, due to the relative immunodeficiency of cord blood at birth and lower risk of GVHD-related complications.
• Autologous HSCT uses the patient's own marrow, collected from disease-free tissue, and is used to treat solid tumors such as neuroblastoma, Hodgkin disease, NHL, rhabdomyosarcoma, Ewing sarcoma, and Wilms tumor.
• Peripheral stem cell transplants (PSCTs) involve collecting stem cells from the patient through apheresis after stimulating their production with CSF.
• Nursing care during HSCT is similar to that of any child receiving chemotherapy and radiotherapy, requiring sensitive care and support for the child and family during the hospitalization period.
• Apheresis involves the removal of blood from an individual, separation of its components, and reinfusion of the remainder, commonly used to remove platelets or peripheral blood stem cells from healthy donors or patients.
• Apheresis is also used therapeutically to remove diseased or toxic blood components, and is part of standard therapy for diseases such as hyperviscosity, Guillain-Barré syndrome, and certain drug overdoses.
• Difficult venous access and small blood volume can limit the use of apheresis in infants and young children, requiring education of the family and child about the therapy and technology.
• Specially trained individuals perform the apheresis procedure, focusing on the rate of removal, blood component separation, and reinfusion, while monitoring vital signs and observing the child for adverse reactions.
• Nursing measures differ depending on whether the apheresis product is autologous or allogeneic, with precautions for proper identification and rate of infusion based on the child's tolerance.
• Apheresis components have greatly prolonged the survival of patients with hematological and oncological diseases.
• Successful HSCT requires sensitive care and support for the child and family, and if the procedure is not successful, the families need care consistent with that required by the family of any child with a life-threatening disorder.