Pediatric Nursing Demystified

Staged by regional involvement: CT and multiple lymph node and bone

marrow biopsies:

Non-Hodgkin Lymphoma or Hodgkin Lymphoma

• Stage 1: One lymph node area or maximum of one extralymphatic
  site (IE)


• Stage II: Two or more lymph node regions, or one added extralymphatic
  site or organ involved, on same side of diaphragm or abdomen (IIE)


• Stage III: Lymph node regions on both sides of diaphragm, or one
  extralymphatic site (IIIE), spleen (IIIS), or both (IIISE)


• Stage IV: Cancer has spread throughout body with one or more extra-
  lymphatic sites with or without lymph node involvement

Treatments

Non-Hodgkin lymphoma: Similar to leukemia treatment with induc-

tion, consolidation, and maintenance phases based on lymphoblastic or

nonlymphoblastic cells:

• Lymphoblastic lymphoma: Multiple chemotherapy regimens—
  commonly cyclophosphamide or ifosfamide, vincristine, intrathecal
  chemotherapy such as L-asparaginase, prednisone, daunomycin,
  6-thioguanine,cytosine arabinoside, and BCNU.


• Nonlymphoblastic cells: Cyclic drug combinations with cyclophos-
  phamide and methotrexate plus anthracycline
  Hodgkin treatmentalso involves irradiation and chemotherapy:


• Treatment:
  Aggressive irradiation: Involved field (IF), extended field (EF)
  including involved area and adjacent nodes, or total nodal irradiation
  (TNI).
  Mechlorethamine (nitrogen mustard), vincristine (Oncovin), procar-
  bazine, and prednisone, a protocol commonly called MOPP therapy.
  Cyclophosphamide and cytarabine and other chemotherapy may
  be used.
  Five-year survival for stage I or II is 90%; stage III or IV is 60
  to 90%.
  Relapse in adulthood is possible.

Nursing Interventions

Reinforce physician’s explanation of diagnosis and treatment plan.

Explain procedure at child’s level of understanding including what will

be seen.

Address fear related to diagnostic tests, procedures, and treatments.

• Reinforce physician’s explanation of diagnosis and treatment plan.


• Explain procedure at child’s level of understanding including what
  will be seen, felt, heard, and smelled; use drawings when appropriate.

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CHAPTER 8/ Oncology Conditions^159