Pediatric Nursing Demystified

Stage IV tumor has spread to distant lymph nodes, bone, bone mar-

row, liver, and other organs.

Stage IV-S presents as localized tumor with spread to liver, skin,

and bone marrow but without metastasis to bone.

• TNM system designation: Describes the tumor’s size (T), its presence
  in the lymph nodes (N), and its metastasis (M) spread to other organs,
  if any. It is not helpful for those childhood tumors that are sarcomas
  (tumors derived from connective tissue, that is, bone, muscle, cartilage,
  blood vessels, or lymphoid tissue).

Treatments

Surgical removal of tumor from involved body part(s)

Thoracotomy for removal of cancer in the lungs

Radiotherapy to destroy tumor

Chemotherapy to assist in tumor destruction:

• Vincristine


• Cisplatin


• Actinomycin D


• Cyclophosphamide


• VP-16


• Doxorubicin


• Ifosfamide


• Etoposide

Nursing alertWhile children are receiving chemotherapy, parents should not

give them aspirin due to increased risk of bleeding and possible development

of Reye syndrome.

Nursing Interventions

Provide nutritional support:

• Increased metabolism associated with cancer growth greatly
  increases nutritional needs and with cancer treatment, nutritional
  intake may be disturbed due to nausea or discomfort with eating.


• Assess for adequate nutritional intake: No further weight loss, lab
  values indicating adequate protein levels.


• Minimize exposure to germs because immune system compromise
  also results from treatment and places child at risk for infection.


• Provide emotional support because great emotional stress is also
  experienced by the child and family.


• Provide pain relief to address acute pain related to pressure of can-
  cer tumor inside the bone.

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