Pediatric Nursing Demystified

Physical Assessment

Review of symptoms may indicate level of cancer progression.

Physical assessment may reveal cardinal symptoms of cancer:

• Unusual lump or swelling (i.e., abdominal mass or swollen lymph
  glands)


• Unexplained fatigue or pallor (due to anemia)


• Easy bruising (ecchymosis and petechiae)


• Persistent pain or limping gait


• Prolonged unexplained fever or illness


• Sudden changes in eye or vision


• Rapid or excessive weight loss
  Children experiencing relapse of cancer condition may have residual
  symptoms from previous treatments.
  Visual assessment may reveal squinting, swelling, or strabismus, indicat-
  ing eye tumor; presence of a white reflex instead of a red reflex indicates
  retinoblastoma.

Test Results

Laboratory Tests

Complete blood count: May reveal leukemia or anemia from bone

cancer.

Chemistries (i.e., sodium, potassium, glucose, blood urea nitrogen

[BUN], creatinine): May reveal liver or renal involvement and damage.

Urinalysis: May reveal renal involvement.

Other Tests

Lumbar puncture: May reveal leukemia, brain tumors, or spread to spinal

cord.

Imaging studies: Radiologic studies of the chest, abdomen, bone or

skull; intravenous pyelogram (kidney conditions); computed tomogra-

phy (CT), ultrasound, nuclear scan, and magnetic resonance imaging

(MRI)

Biopsy: Specimen of tumor is surgically removed for classification and

staging of cancer. Bone marrow aspiration or biopsy may reveal cancer

presence.

Tumor staging: The malignant tumor’s extent and progress is determined:

• Stage I tumor is contained and can be completely removed.


• Stage II tumor cannot be completely removed.


• Stages III and IV tumors reveal metastasis (tumor spread beyond
  the original site or spread systemically):
  Stage III tumor in regional lymph nodes.

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CHAPTER 8/ Oncology Conditions^151