Pediatrics Exam 2: Cancer in Children
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Questions and Answers

Which of these is not a common sign of cancer in children?

  • Headaches
  • Excessive Sleep (correct)
  • Weight Loss
  • Bruising

    • Why is it important to encourage a second opinion when a child is diagnosed with cancer?

  • To have a doctor who is more familiar with the child's specific needs.
  • To find a specialist who can offer a wider range of treatment options. (correct)
  • To ensure that the initial diagnosis was accurate
  • To find a doctor who will use more aggressive treatment

    • Which of the following is an example of a covert sign of cancer in children?

  • Mood Changes
  • White Blood Cell Count (correct)
  • Skin Color Changes
  • Vomiting

    • Which of these therapies for pediatric cancers is most likely to suppress the immune system?

    <p>Steroid Therapy (C)</p> Signup and view all the answers

    Which of these therapies for pediatric cancers is often contraindicated in children under the age of 3?

    <p>Radiation Therapy (A)</p> Signup and view all the answers

    What is the most common solid tumor in children?

    <p>Brain tumor (B)</p> Signup and view all the answers

    Which of the following is a common side effect of chemotherapy for leukemia?

    <p>Alopecia (D)</p> Signup and view all the answers

    What is the classic sign of a brain tumor in children?

    <p>Morning vomiting (D)</p> Signup and view all the answers

    Which type of leukemia has a better prognosis?

    <p>Acute lymphoblastic leukemia (ALL) (C)</p> Signup and view all the answers

    What is the most common type of childhood cancer?

    <p>Leukemia (B)</p> Signup and view all the answers

    What is the most common location for brain tumors in children?

    <p>Cerebellum (D)</p> Signup and view all the answers

    Which of the following is a sign of bone marrow involvement in leukemia?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the purpose of allopurinol in the treatment of leukemia?

    <p>To reduce uric acid buildup (B)</p> Signup and view all the answers

    What is the definitive diagnosis for leukemia?

    <p>Bone marrow aspiration (B)</p> Signup and view all the answers

    Which of the following is a nursing care management intervention for a child with a brain tumor?

    <p>Providing emotional support to the child and family (A)</p> Signup and view all the answers

    A baby with hydrocephalus is scheduled for a shunt placement. What is the most common type of shunt used?

    <p>VP shunt (A)</p> Signup and view all the answers

    What is the most important assessment to perform first in an infant admitted to the ER?

    <p>Cardiovascular assessment (A)</p> Signup and view all the answers

    What is a sign of a shunt malfunction in an infant with hydrocephalus?

    <p>Increased head circumference (D)</p> Signup and view all the answers

    What is the most likely diagnosis for a subdural hematoma in an infant?

    <p>Shaken baby syndrome (A)</p> Signup and view all the answers

    Which of the following is a sign of infection in an infant with a shunt?

    <p>All of the above (D)</p> Signup and view all the answers

    What is an important piece of discharge education for parents of an infant with a shunt?

    <p>All of the above (D)</p> Signup and view all the answers

    What type of scan is often used to assess for hydrocephalus in infants?

    <p>Ultrasound (A)</p> Signup and view all the answers

    Which of the following foods should be avoided by a child with latex allergy?

    <p>Bananas (D)</p> Signup and view all the answers

    Which of the following is NOT a cause of early perinatal loss?

    <p>Low blood pressure (D)</p> Signup and view all the answers

    What is the primary treatment for uterine atony, a common cause of postpartum hemorrhage?

    <p>Fundal massage (A)</p> Signup and view all the answers

    Which of the following is NOT a symptom of grief following infant death?

    <p>Increased appetite (D)</p> Signup and view all the answers

    Which of the following is an inappropriate response to a family experiencing infant loss?

    <p>Asking, &quot;When was the last time you felt the baby move?&quot; (C)</p> Signup and view all the answers

    What is the definition of early perinatal loss?

    <p>Death of a fetus before 20 weeks of gestation. (D)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for uterine atony?

    <p>Low blood pressure (A)</p> Signup and view all the answers

    What is the primary goal of treatment for ADD/ADHD?

    <p>Improve focus and reduce impulsivity. (A)</p> Signup and view all the answers

    Which of the following is a common sign of communication delay in children?

    <p>Lack of intonation or a fluid vocal rhythm. (A)</p> Signup and view all the answers

    Which of the following is a sign of respiratory distress in a newborn?

    <p>See-saw respirations (D)</p> Signup and view all the answers

    Which of the following is NOT a sign of neonatal substance abuse?

    <p>Decreased temperature (E)</p> Signup and view all the answers

    Which of the following is a potential complication of hyperbilirubinemia?

    <p>Kernicterus (C)</p> Signup and view all the answers

    Which of the following is a cause of transient tachypnea of the newborn (TTN)?

    <p>Delayed clearance of fetal lung fluid (C)</p> Signup and view all the answers

    Which of the following is an intervention for a newborn with respiratory distress?

    <p>Administering oxygen (B)</p> Signup and view all the answers

    What is the purpose of phototherapy for newborns with hyperbilirubinemia?

    <p>To reduce the amount of bilirubin in the blood (C)</p> Signup and view all the answers

    Which of the following is true about kangaroo care?

    <p>It is a way to promote bonding between parents and their infant (A)</p> Signup and view all the answers

    Which of the following is a common cause of respiratory distress syndrome (RDS) in newborns?

    <p>Premature birth (B)</p> Signup and view all the answers

    When a patient's GCS decreases and ICP is suspected, which intervention should be implemented first?

    <p>Elevate the head of bed (HOB) (A)</p> Signup and view all the answers

    Which of the following is NOT a sign of Cushing's triad, indicating increasing ICP?

    <p>Unequal pupils (B)</p> Signup and view all the answers

    What is the appropriate nursing intervention during a tonic-clonic seizure?

    <p>Positioning the patient on their side and suctioning their airway (A)</p> Signup and view all the answers

    Which medication is considered a 'rescue medication' for seizures lasting more than 3 minutes?

    <p>Lorazepam (C)</p> Signup and view all the answers

    What is a potential side effect of long-term Dilantin therapy?

    <p>Gingival hyperplasia (C)</p> Signup and view all the answers

    Which of the following statements is TRUE about Dilantin administration?

    <p>Dilantin serum levels must be closely monitored (C)</p> Signup and view all the answers

    What is the most appropriate level of consciousness (LOC) for a patient who falls asleep easily but can be aroused with gentle stimulation?

    <p>Obtunded (D)</p> Signup and view all the answers

    Which of the following is NOT a common cause of special needs in children?

    <p>Exposure to radiation therapy (B)</p> Signup and view all the answers

    Flashcards

    Overt signs of cancer

    Visible signs indicating possible cancer in children, such as bruising or weight loss.

    Covert signs of cancer

    Hidden indicators of potential cancer, like abnormal lab results or unseen masses.

    Chemotherapy

    A cancer treatment that targets rapidly multiplying cells, harming skin and GI tract.

    Radiation Therapy

    A cancer treatment using radiation to kill nearby cells but can harm surrounding tissues.

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    Biologic agents

    New cancer treatments that are specifically designed to target cancer cells.

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    Communication delay

    Difficulty in expressing thoughts or understanding others, often seen in children.

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    Attention Deficit Disorder (ADD)

    A condition characterized by lower attention span and impulsivity, often diagnosed in children with 6 or more symptoms.

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    Ectopic pregnancy

    A pregnancy that occurs outside the uterus, often in a fallopian tube.

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    Spontaneous abortion

    Natural termination of a pregnancy before 20 weeks, often due to chromosomal issues.

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    Primary postpartum hemorrhage

    Excessive blood loss (>1000cc) occurring before 24 hours after delivery.

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    Uterine atony

    Failure of the uterus to contract effectively, leading to postpartum hemorrhage.

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    Physical symptoms of grief

    Common reactions to loss, including exhaustion, changes in appetite, and weight fluctuations.

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    Nursing support in infant death

    Encouragement for families to hold their baby and express sympathy during loss.

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    Latex Allergies

    Avoid certain foods like bananas and avocado due to latex components.

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    Pre-op Position

    The patient should be placed in a prone position before surgery.

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    VP Shunt

    A device that drains excess fluid from the brain to the abdomen.

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    Signs of Infection Post-op

    Monitor scar, swelling, fever, and overall appearance.

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    Head Circumference Measurement

    Measure weekly to assess shunt and potential complications.

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    Pediatric Glasgow Coma Scale (PGCS)

    A scoring system to assess a child's level of consciousness; 15 is ideal.

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    Epidural Hematoma

    A rapid, arterial bleed between the dura and skull; common in trauma.

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    Subdural Hematoma

    A slower, venous bleed under the dura, often from shaken baby syndrome.

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    Drug Toxicity Symptoms

    Includes nausea, vomiting, anorexia, mucosal ulceration, and neuropathy.

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    Acute Lymphoblastic Leukemia (ALL)

    A type of leukemia with better prognosis, involves immature blood cells.

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    Mannitol

    A medication used to decrease intracranial pressure.

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    Signs of Bone Marrow Involvement

    Symptoms include petechiae, infections, and fatigue due to low cell counts.

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    Cushing's Triad

    Symptoms indicating increased intracranial pressure: bradycardia, decreased RR, widening BP.

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    CNS Tumors

    Childhood brain tumors derived from neural tissue, most common solid tumor.

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    Classic Sign of Brain Tumor

    Morning vomiting due to pressure on the brain.

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    Tonic Clonic Seizure

    A seizure characterized by rhythmic jerking and stiffness.

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    Diagnostic Evaluation for Leukemia

    Bone marrow aspiration is essential for diagnosis, alongside history and physical exam.

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    Lorazepam

    A rescue medication to stop prolonged seizures.

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    Dilantin

    An anticonvulsant requiring careful monitoring of blood levels.

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    Therapeutic Management of Leukemia

    Includes chemotherapy, stem cell transplantation, and supportive care.

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    Levels of Consciousness (LOCs)

    Five categories: coma, obtunded, stupor, confusion, full consciousness.

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    Consequences of Leukemia

    Results in depressed bone marrow function, leading to anemia and increased infection risk.

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    Preoperative Nursing Care for Brain Tumors

    Includes preparing the child and family, establishing a baseline for assessment.

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    Alterations in Children

    Changes due to genetics, infections, or environment affecting development.

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    Post-Operative Care for Brain Tumor

    Involves ICU monitoring for 24 hours post-surgery, assessing neuro status.

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    Autism Symptoms

    May appear gradually or suddenly in children before age 3.

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    Kangaroo Care Benefits

    Skin-to-skin contact enhances bonding, breastfeeding, and temp regulation, and decreases hospital stay length.

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    Neonate Respiratory Distress Causes

    Common causes include RDS (lack of surfactant), MAS (meconium in lungs), and TTN (transient tachypnea).

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    Signs of Respiratory Distress

    Tachypnea, chest retractions, nasal flaring, grunting, seesaw breathing, cyanosis (late).

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    RDS: Respiratory Distress Syndrome

    Immaturity and insufficient surfactant result in RDS; more likely in diabetic mothers.

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    Neonatal Substance Abuse Signs

    Symptoms include high-pitched cry, increased secretions, hyperreflexia, temp changes, diarrhea, persistent fever.

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    Hyperbilirubinemia Types

    Physiologic jaundice occurs within 24 hrs, while pathologic occurs after, often due to incompatibility.

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    Phototherapy Purpose

    Uses bililights to convert bilirubin into a water-soluble form for excretion; requires monitoring of the baby.

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    Infants of Diabetic Mothers

    May experience hypoglycemia, macrosomia, and birth injuries due to maternal diabetes.

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    Study Notes

    Pediatrics Exam 2

    • Cancer in Children:

      • Difficult to diagnose; symptoms mimic other common illnesses
      • Overt signs (visible): bruising, bleeding, weight loss, vomiting, skin changes
      • Covert signs (not visible): white blood cell count (WBC), labs, masses

    • Cancer Therapies:

      • Encourage a second opinion
      • Chemotherapy: targets rapidly dividing cells (skin, gastrointestinal tract (GI))
      • Surgery: removal
      • Radiation therapy: destroys nearby cells. Avoid exposed areas, and use loose clothing
      • HSCT (Hematopoietic Stem Cell Transplant): bone marrow-replacing radiation treatment
      • Steroid Therapy: suppress the immune system
      • Biologic agents: specific cancer-targeting treatments
      • Complementary/alternative therapies: discuss all with doctor

    • Assessment and Implementation

      • Emotional support for the entire family, comfort, nutrition, coping mechanisms, monitor vital signs, encourage patient participation
      • Prevention of complications (for example, handwashing, soft toothbrushes, clear floors)
      • Address drug toxicity (nausea and vomiting, anorexia, mouth sores); manage side effects with medications, and feeding adjustments.

    • CNS Tumors:

      • Second most common childhood cancer (solid tumors)
      • 60% infratentorial (cerebellum, brainstem); 40% supratentorial (cerebrum)
      • Symptoms depend on tumor location and size (vision changes, headaches, seizures, behavioral changes).

    • Neuroblastoma:

      • Most common malignant extracranial solid tumor in childhood
      • Majority develop in adrenal glands or retroperitoneal sympathetic chain.

    • Wilms Tumor (Nephroblastoma):

      • 80% of diagnoses are under age 5; peak between ages 2-3
      • Associated with congenital abnormalities (such as hypospadias) and genetic links
      • Symptoms include swelling/mass in abdomen, pain during urination, frequent urination, hematuria (blood in urine).

    • Diagnosis and Management (Neuroblastoma, Wilms Tumor):

      • Use imaging (MRI, CT), biopsies, lab tests (24 hr urine collection for catecholamines) to confirm
      • Management includes surgery, chemo, radiation. The earlier the diagnosis, the better the prognosis

    • Spina Bifida:

      • Neural tube defect; requires significant support.

    • Myelomeningocele: sac protruding outside of the spinal cord.

    • Hydrocephalus: Abnormal buildup of cerebrospinal fluid(CSF) in the brain.

      • The build up will place pressure on the brain in potentially harmful way.

    • Infant ER Visit:

      • ABC's (Airway, Breathing, Circulation) assessment—priority first; Neurological assessment follows
      • Infections are very possible during this time

    • Post-Partum Hemorrhage (PPH)

      • Hemorrhage, any loss greater than 1000cc.
      • Usually occurs within 24 hours.
      • May use uterine massage, medication, blood transfusions, D&C or hysterectomy
      • Uterine atony (lack of contraction) a common cause

    • Mastitis:

      • Breast infection; often caused by improper breastfeeding.
      • SGA (Small for Gestational Age):
        • Weight is below the tenth percentile for their gestational age.
      • LGA (Large for Gestational Age):
        • Weight is above the 90th percentile for their gestational age.

    • Preterm Infants:

      • Born before 37 weeks gestation; impaired oxygenation, difficulties with feeding or breathing.

    • Infant of a Diabetic Mother (IDM):

      • Often large for gestational age.

    • Alcohol & Drug Abuse in Infants:

      • Developmental effects and withdrawal symptoms due to abuse.

    • Neonatal Absence Syndrome:

      • Characterized by early withdrawal problems.

    • Phototherapy:

      • Important in treating hyperbilirubinemia (jaundice) to prevent kernicterus. Helps prevent brain damage, too much bilirubin

    • Comfort measures for newborns:

      • Warm blankets, pacifiers and skin-to-skin contact

    • Other important topics:

      • Head circumference measurement
      • Nutritional considerations (feeding problems/special needs formulas)
      • Monitoring complications and side effects/treatment (including infection and wound care)
      • Educational/support services needed for the family
      • Emotional support

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    Description

    This quiz focuses on the nuances of diagnosing and treating cancer in children. It covers both overt and covert signs of cancer, various treatment options including chemotherapy and HSCT, and the emotional support necessary for families. Test your knowledge on pediatric oncology and essential assessment strategies.

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