Pediatric Nursing Demystified

important in promoting coping skills during all stages of the condition and

treatment. Key information covered in this chapter includes the following:

Both the child and family may undergo a grieving process with the diag-

nosis of cancer and become depressed, overly protective, withdrawn,

and angry. Teaching and support by the nurse is needed to correct mis-

conceptions and keep the child and parents updated on the child’s

progress.

Emotional support is needed to encourage the child to continue to func-

tion to the maximum within limitations.

Cancer conditions affect multiple systems and require a multisystem

plan of action.

A thorough history and physical can provide critical data for diagnosis

and treatment planning.

Possible causes of cancer include exposure to carcinogens, in utero, or

after birth and including an oncogenic virus, gene theory, or familial pre-

disposition for cell mutation or predisposition due to previous cancer,

or deficient tumor suppressor cell deficit.

Leukemia is the most frequent type of cancer in children.

Physical assessment of a child with cancer may reveal cardinal symp-

toms 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
  Test results will often include low red blood cell count (anemia) second-
  ary to the cancer (if bone marrow is involved) or as a complication of
  chemotherapy.
  Bleeding may be noted if platelets are reduced.
  Diagnostic tests may include serum analysis, biopsy, and imaging
  studies.
  Treatment for cancer requires biopsy to obtain a specimen for staging to
  determine the extent to which the cancer has spread.
  Radiotherapy in combination with surgery or chemotherapy may be used
  to treat cancer.
  Nutritional deficit may result from the increased metabolism or from
  difficulty eating due to fatigue, discomfort with chewing or swallowing,
  or nausea from the cancer invasion or cancer treatment.
  Immune deficiency can result from the bone marrow invasion or from
  cancer treatment.

(^172) Pediatric Nursing Demystified