Cellular Proliferation

1
Cellular Proliferation

• Chapters 36, 23

2
Normal Cell Reproduction

• The life of the cell is described as the cell
  cycle, beginning with its formation and ending
  with the division of the cell into two daughter
  cells.
• Different tissues have different lengths of cell
  cycles, varying from 16 hours to 400 hours.

3
Development of Neoplasms

• Any group of cells can develop abnormal growth
  and reproduction this abnormal reproduction of
  cells is termed neoplasia the immune system
  normally protects the body

4
Benign or Malignant

• Benign
• -typically do not metastasize and do not tend to
  recur when surgically removed benign tumors can
  be serious and even fatal if they interfere with
  vital functions

• Malignant
• -those that tend to recur after removal and
  metastasize to distant tissues and organs tissue
  is destroyed by invasion of these tumors and
  growth tend to be rapid

5
Diagnostic Evaluation

• Complete History
• Review of Symptoms
• Physical Exam
• Laboratory Tests
• Imaging Studies
• Biopsy
• Bone Marrow Aspiration

6
Modes of Therapy

• Surgery
• Chemotherapy
• Radiation therapy
• Biologic Response Modifiers (BRM)
• Bone Marrow Transplantation (BMT)

7
Leukemias

• A malignant neoplasm of bone marrow characterized
  by proliferation of immature white cells
• Accounts for 25 to 30 of all childhood
  cancers
• Peak incidence between 2 and 5 years of age

8
Leukemias

• Nursing Care
• -Physical Assessment
• -Manage symptoms of leukemia as well as
  preventing/treating side effects of chemo
• -Supportive care for anemia
• -Platelet deficiency
• -WBC may be high, but immature

9
Leukemias - Meds

• Induction (designed to achieve remission)
• Intensification (serves to maintain the
  remission)
• Maintenance (chemo may be continued for 2 to 3
  years)

• Induction (lasts 4 to 6 weeks) and uses
  prednisone, vincristine, asparaginase
• CNS prophylaxis uses methotrexate, cytarabine,
  hydrocortisone

10
Lymphomas

• Malignant disorders characterized by
  proliferation of cells usually restricted to
  lymphoid cells but may be found in bone marrow,
  includes Hodgkins and non-Hodgkins

11
Lymphomas (S/S)

• Hodgkins
• -painless swelling of lymph nodes
• -fatigue
• -decreased appetite and weight loss
• -fever
• -night sweats

• Non-Hodgkins
• -asymptomatic if not disseminate
• -difficulty swallowing or breathing
• -swelling in neck, face, upper extremities
• -abdominal pain

12
Brain Tumors

• S/S- infants increased head circumference,
  irritability, head tilt, loss of developmental
  milestones
• S/S children headache (increase in frequency)
• abnormal neurologic exams

13
Brain Tumors

• Increased intracranial pressure (ICP)
• Postop
• -infratentorial incision head position is flat
  and on either side with neck slightly extended
• -supratentorial incision head is elevated
• -physician orders degree of elevation

14
Neuroblastoma

• Possibly genetic factors, familial predisposition
• The most commonly malignancy in infancy
• Metastases at onset in 70 to 75 of cases

• Ten per 1 million live births annually
• S/S dependent on primary site presence of
  metastases (listlessness, poor feeding, pale,
  weight loss, abdominal pain, weakness,
  irritability, fatigue, fever)

15
Neuroblastoma

• Nursing Care
• -With chemotherapy
• -With radiation
• -Minimize exposure to infection
• -Monitor bleeding

16
Osteogenic Sarcoma

• A solid tumor of the bone most common form of
  bone cancer in children
• Incidence 7 teenagers per one million
• S/S local pain, local swelling, mass at end of
  long bone, decreased range of motion
• X-rays following traumatic injury may be first
  indication of disease

17
Wilms Tumor

• A primary malignant renal tumor
• 9 1 million Caucasian children/year
• Equal frequency in males and females
• Survival rate 70 to 90
• S/S-abdominal mass

18
Retinoblastoma

• congenital malignant intra-ocular tumor
• 110,000 live births
• Overall survival rates gt 90
• S/S squinting, eyes turning inward or outward,
  painful red eye.
• Treatment Determined by stage and extent of
  disease

19
Testicular Tumors

• Not common
• Most common form of cancer in males ages 15 to 44
  years
• S/S heavy, painless testicular swelling,
  involved testicle hangs lower

20
Potential Long-term Sequelae

• Potential for stunted growth
• Potential for decreased fertility and sterility
• Potential for leg length discrepancy
• Irradiated bones are more fragile and may
  fracture easily
• Risk for dental caries and arrested tooth
  development

21
Childrens Understanding of Death

• Infants
• Preschool
• School age Child
• Adolescence

22
Family Support

• Educational needs
• Emotional support
• Spiritual support
• Sibling support
• Caregiver support

23
Care at Time of Death

• Physical changes
• Emotional changes
• Right-to-Die
• Viewing of the body
• Organ donation
• Postmortem Care

24
Care for Yourself

• Self-Awareness
• Knowledge and practice
• Support systems
• Other strategies