Pediatric oncology nursing advanced clinical handbook

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adam_text Contents PARTI 1 Leukemia Sue Zupanec · Deborah Tomlinson 1.1 Introduction ....................... 2 1.2 Acute Lymphoblastk Leukemia .......... З 1.2.1 Epidemiology .................. З 1.2.2 Etiology ...................... 4 1.2.3 Molecular Genetics ............... 6 1.2.4 Symptoms and Clinical Signs ........ 7 1.2.5 Diagnostics ................... 8 1.2.6 Staging and Classification .......... 9 1.2.7 Treatment .................... 12 1.2.8 Prognosis ..................... 16 1.2.9 Follow-Up .................... 16 1.2.10 Future Perspectives .............. 17 1.2.11 RelapsedALL .................. 17 1.3 Acute Myeloid Leukemia ............... 19 1.3.1 Epidemiology .................. 19 1.3.2 Etiology ...................... 19 1.3.3 Molecular Genetics ............... 20 1.3.4 Symptoms and Clinical Signs ........ 20 1.3.5 Diagnostics ................... 21 1.3.6 Staging and Classification .......... 21 1.3.7 Treatment .................... 22 1.3.8 Prognosis ..................... 24 1.3.9 Follow-Up .................... 24 1.3.10 Future Perspectives .............. 24 1.4 Chronic Myeloid Leukemia .............. 25 1.4.1 Epidemiology and Etiology ......... 25 1.4.2 Molecular Genetics ............... 25 1.4.3 Symptoms and Clinical Signs ........ 25 1.4.4 Diagnostics ................... 26 1.4.5 Treatment .................... 26 1.4.6 Prognosis ..................... 26 1.4.7 Future Perspectives .............. 26 1.5 Juvenile Myelomonocytic Leukemia ....... 26 1.6 Langerhans Cell Histiocytosis ............ 27 1.6.1 Epidemiology and Etiology ......... 27 1.6.2 Diagnostics ................... 28 1.6.3 Symptoms and Clinical Signs ........ 28 1.6.4 Treatment .................... 29 1.6.5 Prognosis ..................... 29 References ............................. 29 2 Lymphoma Sue Zupanec 2.1 Lymphoma ........................ 33 2.2 Hodgkin Lymphoma .................. 33 2.2.1 Epidemiology .................. 34 2.2.2 Etiology ...................... 34 2.2.3 Molecular Genetics ............... 34 2.2.4 Symptoms and Clinical Signs ........ 34 2.2.5 Diagnostics ................... 36 2.2.6 Staging and Classification .......... 38 2.2.7 Treatment .................... 39 2.2.8 Prognosis ..................... 42 2.2.9 Follow-Up .................... 43 2.2.10 Relapsed/Refractory HL ............ 43 2.2.11 Future Perspectives .............. 44 2.3 Non-Hodgkin Lymphomas .............. 44 2.3.1 Epidemiology .................. 44 2.3.2 Etiology ...................... 45 2.3.3 Molecular Genetics ............... 45 2.3.4 Symptoms and Clinical Signs ........ 46 2.3.5 Diagnostics ................... 48 2.3.6 Staging and Classification .......... 50 2.3.7 Treatment .................... 50 2.3.8 Prognosis ..................... 54 2.3.9 Follow-Up .................... 54 2.3.10 Treatment of Relapsed/Refractory NHL . 55 2.3.11 Future Perspectives .............. 55 References ............................. 56 3 Solid Tumor Eleanor Hendershot 3.1 Ewing s Sarcoma Family of Tumors ........ 60 3.1.1 Epidemiology .................. 60 3.1.2 Etiology ...................... 60 3.1.3 Molecular Genetics ............... 60 3.1.4 Symptoms and Clinical Signs ........ 61 3.1.5 Diagnosis ..................... 61 3.1.6 Staging and Classification .......... 63 3.1.7 Treatment .................... 63 3.1.8 Prognosis ..................... 64 Contents 3.1.9 Follow-Up .................... 65 3.1.10 Future Perspectives .............. 65 3.2 Osteosarcoma ...................... 65 3.2.1 Epidemiology .................. 66 3.2.2 Etiology ...................... 66 3.2.3 Molecular Genetics ............... 66 3.2.4 Signs and Symptoms ............. 67 3.2.5 Diagnostics ................... 67 3.2.6 Staging and Classification .......... 68 3.2.7 Treatment .................... 68 3.2.8 Prognosis ..................... 71 3.2.9 Follow-Up .................... 71 3.2.10 Future Perspectives .............. 71 3.3 Liver Tumors ....................... 72 3.3.1 Epidemiology .................. 72 3.3.2 Etiology ...................... 72 3.3.3 Molecular Genetics ............... 72 3.3.4 Symptoms and Clinical Signs ........ 72 3.3.5 Diagnostics ................... 73 3.3.6 Staging and Classification .......... 74 3.3.7 Treatment .................... 75 3.3.8 Prognosis ..................... 76 3.3.9 Follow-Up .................... 76 3.3.10 Future Perspectives .............. 77 3.4 Neuroblastoma ..................... 77 3.4.1 Epidemiology .................. 77 3.4.2 Etiology ...................... 77 3.4.3 Molecular Genetics ............... 77 3.4.4 Symptoms and Clinical Signs ........ 79 3.4.5 Diagnostics ................... 80 3.4.6 Staging and Classification .......... 81 3.4.7 Treatment .................... 82 3.4.8 Prognosis ..................... 85 3.4.9 Follow-Up .................... 85 3.4.10 Future Perspectives .............. 86 3.5 Renal Tumors ....................... 86 3.5.1 Epidemiology .................. 86 3.5.2 Etiology ...................... 87 3.5.3 Molecular Genetics ............... 87 3.5.4 Symptoms and Clinical Signs ........ 87 3.5.5 Diagnostics ................... 88 3.5.6 Staging and Classification .......... 89 3.5.7 Treatment .................... 89 3.5.8 Prognosis ..................... 92 3.5.9 Follow-Up .................... 93 3.5.10 Future Perspectives .............. 93 3.6 Retinoblastoma ..................... 93 3.6.1 Epidemiology .................. 93 3.6.2 Etiology ...................... 94 3.6.3 Molecular Genetics ............... 94 3.6.4 Signs and Symptoms ............. 94 3.6.5 Diagnostics ................... 95 3.6.6 Staging and Classification .......... 96 3.6.7 Treatment .................... 96 3.6.8 Prognosis ..................... 99 3.6.9 Follow-Up ....................100 3.6.10 Future Directions ................100 3.7 Rhabdomyosarcoma ..................100 3.7.1 Epidemiology ..................100 3.7.2 Etiology ......................101 3.7.3 Molecular Genetics ...............101 3.7.4 Symptoms and Clinical Signs ........101 3.7.5 Diagnostics ...................101 3.7.6 Staging and Classification ..........103 3.7.7 Treatment ....................103 3.7.8 Prognosis .....................106 3.7.9 Follow-Up ....................106 3.7.10 Future Perspectives ..............106 3.8 Non-Rhabdomyosarcomatous Soft-Tissue Sarcomas .................107 3.8.1 Alveolar Soft-Part Sarcoma ..........108 3.8.2 Desmoid Tumor (Aggressive Fibromatosis) ..................108 3.8.3 Desmoplastic Small Round Cell Tumor . . 108 3.8.4 Infantile Fibrosarcoma ............109 3.8.5 Infantile Hemangiopericytoma .......109 3.8.6 Infantile Myofibromatosis ..........109 3.8.7 Leiomyosarcoma ................109 3.8.8 Liposarcoma ...................109 3.8.9 Malignant Peripheral Nerve Sheath Tumor .................110 3.8.10 Synovial Sarcoma ...............110 3.9 Germ Cell Tumors ...................110 3.9.1 Epidemiology ..................111 3.9.2 Etiology ......................111 3.9.3 Molecular Genetics ...............112 3.9.4 Symptoms and Clinical Signs ........112 3.9.5 Diagnostics ...................112 3.9.6 Staging and Classification ..........113 3.9.7 Treatment ....................113 3.9.8 Prognosis .....................115 3.9.9 Follow-Up ....................115 3.9.10 Future Perspectives ..............116 3.10 Rare Tumors .......................116 3.10.1 Adrenocortical Carcinoma ..........116 3.10.2 Melanoma ....................117 3.10.3 Nasopharyngeal Carcinoma .........118 3.10.4 Pleuropulmonary Blastoma .........118 3.10.5 Thyroid Carcinoma ...............119 References .............................119 4 Central Nervous System Tumors Nancy E. Kline · Joan O Hanlon-Curry 4.1 Causes/Epidemiology .................129 4.2 Distribution/Classification ..............129 4.3 Staging ........................... і зо 4.4 Molecular Genetics of Brain Tumors .......130 Contents 4.5 Diagnosis .........................130 4.6 Specialist Referral ....................130 4.7 Hydrocephalus ......................130 4.8 Treatment .........................131 4.8.1 Surgery ......................131 4.8.2 Radiotherapy ..................131 4.8.3 Chemotherapy .................132 4.9 Prognosis .........................132 4.10 Specific Tumors .....................132 4.10.1 PNETs/Medulloblastomas ..........132 4.10.2 Astrocytomas/Glial Tumors .........133 4.10.3 Malignant Gliomas ...............134 4.10.4 Other High-Grade Gliomas ..........134 4.11 Follow-Up .........................138 4.11.1 The Late Effects and Rehabilitation of Survivors ...................138 4.11.2 Palliative Care ..................139 4.11.3 Future Perspectives/New Innovations ..139 References .............................140 PART II 5 Anemias Rosalind Bryant 5.1 Anemia ...........................142 5.2 Iron-Deficiency Anemia ................146 5.2.1 Epidemiology .................. 146 5.2.2 Etiology ...................... 146 5.2.3 Molecular Genetics ............... 146 5.2.4 Symptoms/Clinical Signs ........... 146 5.2.5 Diagnostic Testing ............... 147 5.2.6 Treatment .................... 148 5.2.7 Transfusion ................... 148 5.2.8 Erythropoietin (Epogen) ........... 148 5.2.9 Prognosis ..................... 149 5.3 Sickle Cell Disease ................... 149 5.3.1 Epidemiology ..................149 5.3.2 Etiology ......................149 5.3.3 Molecular Genetics ...............149 5.3.4 Symptoms/Clinical Signs ...........149 5.3.5 Diagnostic Testing ...............150 5.3.6 Complications of SCD .............151 5.3.7 Prognosis .....................158 5.3.8 Future Perspectives ..............158 5.4 Thalassemia ........................158 5.4.1 Alpha (a)-Thalassemia ............158 5.4.2 Beta Thalassemia (Cooley Anemia) .....159 5.4.3 Diagnostic Testing ...............160 5.4.4 Treatment ....................160 5.4.5 Treatment of Hemosiderosis (Iron Overload) .................160 5.4.6 Chelation Therapy ...............161 5.4.7 Clinical Advances (Hemosiderosis) .....161 5.4.8 Prognosis .....................161 5.4.9 Follow-Up ....................162 5.4.10 Future Perspectives ..............162 5.5. Hemolytic Anemia ...................162 5.5.1 Hereditary Spherocytosis ..........162 5.5.2 Autoimmune Hemolytic Anemia .....164 5.5.3 Glucose-ö-Phosphate Dehydrogenase Deficiency ....................165 5.6 Bone Marrow Failure Syndromes .........167 5.6.1 Aplastic Anemia ................167 References .............................170 6 Neutropenia Karyn Brandige 6.1 Epidemiology .......................173 6.2 Etiology ..........................174 6.3 Symptoms and Clinical Signs ............175 6.4 Diagnostic Testing ...................175 6.5 Treatment .........................176 6.6 Prognosis .........................177 6.7 Follow-Up .........................178 References .............................178 7 Thrombocytopenia Karyn Brandige 7.1 Epidemiology .......................179 7.2 Etiology ..........................180 7.3 Symptoms and Clinical Signs ............180 7.4 Diagnostic Testing ...................182 7.5 Treatment .........................182 7.6 Prognosis .........................184 7.7 Follow-Up .........................184 7.8 Future Perspectives ..................184 References .............................184 8 Bleeding Disorders Joan O Brien-Shea 8.1 Hemophilia ........................187 8.1.1 Epidemiology ..................187 8.1.2 Etiology ......................187 8.1.3 Genetics .....................188 8.1.4 Symptoms and Clinical Signs ........188 8.1.5 Diagnostic Testing ...............190 8.1.6 Treatment ....................191 8.1.7 Prognosis .....................194 8.1.8 Follow-Up ....................194 Contents 8.1.9 Future Perspectives ..............194 8.2 von Willebrand Disease ................194 8.2.1 Epidemiology ..................194 8.2.2 Etiology ......................195 8.2.3 Genetics .....................195 8.2.4 Symptoms and Clinical Signs ........195 8.2.5 Diagnostic Testing ...............196 8.2.6 Treatment ....................199 8.2.7 Prognosis .....................200 8.2.8 Follow-Up ....................200 References .............................201 PART 111 9 Chemotherapy Christine Chordas · Kristen Graham 9.1 Introduction .......................204 9.2 Cancer Cell Characteristics ..............204 9.2.1 The Cell Cycle ..................204 9.2.2 Cell Cycle Control ................205 9.3 Chemotherapy ......................206 9.3.1 Principles .....................206 9.3.2 Resistance ....................206 9.3.3 The Principles of Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics ...........206 9.3.4 Chemotherapy Techniques .........207 9.4 Clinical Trials .......................207 9.4.1 Phase I Clinical Trials ..............208 9.4.2 Phase II Clinical Trials .............208 9.4.3 Phase III Clinical Trials .............208 9.4.4 Phase IV Clinical Trials .............208 9.5 Chemotherapy Agents ................208 9.5.1 Antimetabolites .................211 9.5.2 Alkylating Agents ...............216 9.5.3 Antitumor Antibiotics .............217 9.5.4 Anthracycline Antibiotics ...........218 9.5.5 Plant Derivatives ................218 9.5.6 Antiangiogenic Agents ............219 9.5.7 Miscellaneous Agents .............220 9.6 Chemotherapy Protectants .............221 9.6.1 Allopurinol (Zyloprim) .............221 9.6.2 Amifostine (Ethyol) ...............221 9.6.3 Dexrazoxane (Zinecard) ...........221 9.6.4 Leucovorin Calcium (LCV, Wellcovorin, Citovorum Factor, Folie Acid) ........221 9.6.5 Mesna (Mesnex) ................221 9.6.6 Palifermin ....................222 9.7 Administration of Chemotherapy Agents. . . . 222 9.7.1 Preparation ...................222 9.7.2 Administration and Practice Considerations .................223 9.8 Professional Guidelines to Minimize the Risk of Medication Errors ............224 9.8.1 Prescribing Errors ................224 9.9 Safe Practice Considerations ............224 9.9.1 Mixing Chemotherapeutic Agents .....225 9.9.2 Transporting Cytotoxic Agents .......225 9.9.3 Safe Handling After Chemotherapy .... 225 9.9.4 Disposal of Cytotoxic Materials .......225 9.9.5 Spill Management ...............226 9.9.6 Procedures Following Accidental Exposure .....................226 9.9.7 Storage ......................226 9.9.8 Medical Management .............226 9.10 Administration of Chemotherapy in the Home ........................226 9.11 Immediate Complications of Chemotherapy Administration ......................226 9.11.1 Extravasation ..................227 9.11.2 Acute Hypersensitivity Reactions (HSRs) to Chemotherapy ...........230 9.11.3 Risk Factors for Hypersensitivity, Flare Reactions, or Anaphylaxis .......230 9.11.4 Recommended Steps to Prevent HSRs ..................230 9.11.5 Emergency Management of HSR/Anaphylaxis ................230 9.12 Summary ..........................231 References .............................231 10 Radiotherapy Irene Loch · Jane Khorrami 10.1 Introduction .......................233 10.2 Radiation .........................233 10.3 Principles of Treatment ................234 10.4 Treatment Planning ..................234 10.4.1 CT Simulation ..................234 10.4.2 Simulation ....................234 10.5 Treatment Methods ..................235 10.5.1 External Beam Radiotherapy (Teletherapy) ..................235 10.5.2 Fractionation ..................237 10.5.3 Total Body Irradiation (TBI) ..........237 10.5.4 Brachytherapy ..................237 10.5.5 Sealed Sources .................237 10.5.6 Unsealed Sources ...............237 10.6 Side Effects of Radiotherapy ............238 10.6.1 Acute Effects ...................238 10.7 Special Considerations ................240 10.7.1 Preparation of Children and Young People ...............240 10.8 Future Perspectives ..................240 10.8.1 Image-Guided Radiotherapy ........240 Contents 10.8.2 Intra-Operative Radiotherapy ........240 10.8.3 Proton Radiotherapy (PRT) ..........240 References............................. 241 11 Hematopoietic Stem Cell Transplantation Robbie Norville · Deborah Tomiimon 11.1 Principles of Treatment ................243 11.2 Stem Cell Collection (Harvest) ...........244 11.2.1 Bone Marrow Stem Cells ...........244 11.2.2 Peripheral Blood Stem Cells .........246 11.2.3 Umbilical Cord Blood Stem Cells ....................246 11.3 Donor Stem Cell Typing/ Tissue Typing .......................247 11.4 Donor Stem Cell Sources ...............248 11.5 Stem Cell Processing and Infusion ...........................249 11.5.1 ABO Mismatch .................249 11.5.2 Graft vs. Leukemia ...............251 11.6 Description of Treatment ...............251 11.7 Potential Side Effects .................253 11.7.1 Early Side Effects ................253 11.7.2 Intermediate Side Effects ...........257 11.7.3 Late Side Effects ................261 11.8 Special Considerations ................263 11.9 Future Perspectives ..................264 References .............................265 12 Surgical Approaches to Childhood Cancer Carol L. Rossetto 12.1 Principles of Treatment ................269 12.2 Method of Delivery ...................270 12.2.1 Preoperative Evaluation ...........270 12.2.2 Postoperative Nursing Care .........271 12.3 Potential Side Effects .................271 12.3.1 Complications of Medical Therapy Requiring Surgical Evaluation ........271 12.3.2 Complications Arising from Surgical Management of Solid Tumors ........272 12.4 Special Considerations ................273 12.4.1 Vascular Access Devices ...........273 12.5 Future Perspectives ..................274 12.5.1 New Surgical Techniques and Directions for Future Research .......274 References .............................275 13 Cell and Gene Therapy Robbie Norville 13.1 Introduction .......................277 13.2 Principles of Treatment ................278 13.2.1 Genetic Deficit Repair .............278 13.2.2 Viral-Mediated Gene Transfer ........278 13.2.3 Drug-Resistant Genes .............278 13.2.4 Angiogenetics Inhibitors ...........279 13.2.5 Gene Marking ..................279 13.2.6 Cell Therapy ...................279 13.3 Method of Delivery ...................279 13.3.1 Viral Vectors ...................280 13.3.2 Plasmid Vectors .................280 13.4 Potential Side Effects .................280 13.5 Special Considerations ................281 13.6 Future Perspectives ..................281 References .............................281 14 Biological and Targeted Therapies Lindsay Gainer 14.1 Introduction .......................283 14.2 Principles of Treatment ................284 14.3 Description of Treatment ...............285 14.3.1 Cytokines .....................285 14.3.2 Interferons....................285 14.3.3 Interleukins ...................286 14.3.4 Colony-stimulating Factors .........286 14.3.5 Fusion Proteins .................286 14.3.6 Monoclonal Antibodies ............287 14.4 Cancer Vaccines .....................288 14.5 Other Immunomodulating Agents ........288 14.5.1 Nonspecific Immunomodulating Agents ......................288 14.5.2 Retinoids .....................289 14.5.3 Thalidomide ...................289 14.6 Adoptive Immunotherapy ..............289 14.7 Molecular Targeted Therapy ............289 14.8 Method of Delivery ...................290 14.9 Potential Side Effects .................291 14.10 Future Perspectives ..................292 References .............................293 15 Complementary and Alternative Medicine Janice Post-White · Elena Ladas 15.1 15.2 Introduction . . CAM Modalities 295 .296 Contents 15.2.1 Acupuncture ..................296 15.2.2 Biological Therapies ..............297 15.2.3 Mind-Body Therapies .............299 15.2.4 Movement Therapies .............300 15.2.5 Aromatherapy ..................301 15.2.6 Massage .....................302 15.2.7 Energy Therapies ................303 15.3 Future Perspectives ..................303 References .............................304 16 Clinical Trials Biljana Dzolganovski 16.1 The Role of Clinical Trials ...............307 16.1.1 The Need for Research ............307 16.1.2 Phases of Clinical Trials ............308 16.1.3 Study Types ...................308 16.1.4 Research Ethics: Principles, Policies, and Guidelines .................308 16.1.5 Legal and Ethical Issues Regarding Participation of Children in Research . . . 310 16.1.6 Research in Pediatrics .............312 16.2 Research Networks ...................312 16.2.1 Cooperative Group Research ........312 16.2.2 Importance of Participation in Clinical Trials ...................314 16.3 Progress Made Through Clinical Trials ......315 16.3.1 Treatments and Therapy Delivery .....315 16.3.2 Quality of Life Measures and Supportive Care ................319 16.3.3 Complementary and Alternative Medicine .....................320 16.3.4 Late Effects ....................321 16.3.5 Palliative Care ..................321 16.4 Perception of Clinical Trials .............322 16.5 Future of Clinical Trials ................324 16.6 The Role of the Clinical Research Associate . . 324 16.6.1 Introduction ...................324 16.6.2 Clinical Research Associate .........325 16.6.3 The Role of the CRA ..............326 16.6.4 The Role of the Clinical Research Nurse .......................328 References .............................329 PART IV 17 Metabolic System Deborah Tomlinson 17.1 Cancer Cachexia .....................337 17.1.1 incidence .....................337 17.1.2 Etiology ......................338 17.1.3 Treatment ....................338 17.1.4 Prognosis .....................339 17.2 Obesity ...........................339 17.2.1 Obesity in Survivors of Leukemia ......339 17.3 Inferior Outcomes and Obesity ...........340 17.3.1 Incidence .....................340 17.3.2 Etiology ......................341 17.4 Tumor Lysis Syndrome ................341 17.4.1 Incidence .....................341 17.4.2 Etiology ......................341 17.4.3 Treatment ....................343 17.4.4 Prognosis .....................347 17.5 Hypercalcemia ......................347 17.5.1 Incidence .....................347 17.5.2 Etiology ......................347 17.5.3 Treatment ....................347 17.5.4 Prognosis .....................348 17.6 Impaired Glucose Tolerance .............348 17.6.1 Incidence .....................348 17.6.2 Etiology ......................348 17.6.3 Treatment ....................349 17.6.4 Prognosis .....................349 References .............................349 18 Gastrointestinal Tract Anne Marie Maloney 18.1 Mucositis ..........................354 18.1.1 Incidence .....................354 18.1.2 Etiology ......................354 18.1.3 Prevention ....................357 18.1.4 Treatment ....................357 18.1.5 Prognosis .....................358 18.2 Dental Caries .......................358 18.2.1 incidence .....................358 18.2.2 Etiology ......................358 18.2.3 Prevention and Treatment ..........359 18.2.4 Prognosis .....................359 18.3 Nausea and Vomiting .................359 18.3.1 Incidence .....................359 18.3.2 Etiology ......................359 18.3.3 Prevention ....................360 18.3.4 Treatment ....................360 18.3.5 Delayed Nausea and Vomiting .......361 18.3.6 Anticipatory Nausea and Vomiting .... 361 18.3.7 Radiation-Induced Nausea and Vomiting. . 362 18.3.8 Other Causes of Nausea and Vomiting . . 363 18.3.9 Nonpharmacoiogical Management .... 363 18.3.10 Prognosis .....................364 18.4 Constipation .......................364 18.4.1 Incidence .....................364 18.4.2 Etiology ......................364 18.4.3 Prevention ....................365 18.4.4 Treatment ....................365 18.4.5 Prognosis .....................366 Contents 18.5 Diarrhea ..........................366 18.5.1 Incidence .....................366 18.5.2 Etiology ......................366 18.5.3 Prevention ....................368 18.5.4 Treatment ....................368 18.5.5 Prognosis .....................369 18.6 Typhylitis .........................369 18.6.1 Incidence .....................369 18.6.2 Etiology ......................370 18.6.3 Prevention ....................370 18.6.4 Treatment ....................370 18.6.5 Prognosis .....................371 18.7 Perirectal Cellulitis ...................371 18.7.1 Incidence .....................371 18.7.2 Etiology ......................371 18.7.3 Prevention ....................371 18.7.4 Treatment ....................371 18.7.5 Prognosis .....................372 18.8 Acute Gastrointestinal Graft Vs. Host Disease .......................372 18.8.1 Incidence .....................372 18.8.2 Prevention ....................372 18.8.3 Treatment ....................373 18.8.4 Prognosis .....................374 18.9 Chemical Hepatitis ...................374 18.9.1 Incidence .....................374 18.9.2 Etiology ......................374 18.9.3 Prevention ....................374 18.9.4 Treatment ....................374 18.9.5 Prognosis .....................375 18.10 Pancreatitis ........................375 18.10.1 Incidence .....................375 18.10.2 Etiology ......................375 18.10.3 Prevention ....................375 18.10.4 Treatment ....................375 18.10.5 Prognosis .....................375 References .............................376 19 Bone Marrow Function Sandra Doyle 19.1 Introduction .......................380 19.2 Anemia ...........................380 19.2.1 Incidence and Etiology ............380 19.2.2 Treatment ....................380 19.3 Neutropenia .......................381 19.3.1 Incidence and Etiology ............381 19.3.2 Treatment ....................382 19.4 Thrombocytopenia ...................389 19.4.1 Incidence and Etiology ............389 19.4.2 Treatment ....................389 19.5 Transfusion Issues ...................390 19.5.1 Granulocyte Transfusions ..........390 19.5.2 Transfusion-Associated Graft vs. Host Disease ......................391 19.5.3 Cytomegalovirus and Transfusions .... 392 19.5.4 Platelet Refractoriness ............392 19.6 Disseminated Intravascular Coagulation .... 393 19.6.1 Etiology and Manifestation .........393 19.6.2 Treatment ....................394 19.7 Septic Shock .......................395 19.7.1 Etiology ......................395 19.7.2 Treatment ....................395 19.7.3 Prognosis .....................396 19.8 Immune Suppression .................396 19.8.1 Polymorphonudear Leukocytes ......396 19.8.2 Lymphocytes ..................397 19.8.3 Spleen and Reticuloendothelial System . 398 19.8.4 Other Factors Contributing to Immunocompromised States ......398 References .............................398 20 Respiratory System Margaret Parr 20.1 Pneumocystis Pneumonia ..............401 20.1.1 Incidence .....................401 20.1.2 Etiology ......................402 20.1.3 Treatment ....................402 20.1.4 Prognosis .....................404 20.2 Pneumonitis .......................404 20.2.1 Incidence .....................404 20.2.2 Etiology ......................404 20.2.3 Prevention ....................405 20.2.4 Treatment ....................405 20.2.5 Prognosis .....................405 20.3 Fibrosis ...........................406 20.3.1 Incidence .....................406 20.3.2 Etiology ......................406 20.3.3 Prevention ....................406 20.3.4 Treatment ....................406 20.3.5 Prognosis .....................406 20.4 Compromised Airway .................407 20.4.1 Incidence .....................407 20.4.2 Etiology ......................407 20.4.3 Prevention ....................407 20.4.4 Treatment ....................408 20.4.5 Prognosis .....................408 References .............................408 21 Renal System Fiona Reid 21.1 Nephrectomy .......................412 21.1.1 Incidence .....................412 21.1.2 Etiology ......................412 21.1.3 Treatment ....................412 21.1.4 Prognosis .....................416 Contents 21.2 Cytotoxic Drug Excretion ...............417 21.2.1 Pharmacokinetics/Dynamics ........417 21.2.2 Metabolism ...................418 21.2.3 Excretion .....................418 21.2.4 Drug Interactions ................420 21.2.5 Dose Modification ...............420 21.2.6 Safe Handling of Cytotoxic Excreta ....424 21.3 Nephrotoxicity ......................425 21.3.1 Incidence .....................425 21.3.2 Etiology ......................426 21.3.3 Prevention ....................427 21.3.4 Treatment ....................430 21.3.5 Prognosis .....................432 21.4 Hemorrhagic Cystitis ..................432 21.4.1 Incidence .....................432 21.4.2 Etiology ......................433 21.4.3 Prevention ....................434 21.4.4 Treatment ....................435 21.4.5 Prognosis .....................437 References .............................437 22 Cardiovascular System Alison Hall 22.1 Cardiac Toxicity /Cardiomyopathy .........441 22.1.1 Incidence .....................441 22.1.2 Etiology ......................443 22.1.3 Treatment ....................445 22.1.4 Prevention ....................445 22.1.5 Prognosis .....................447 22.2 Veno-Occlusive Disease ................447 22.2.1 Hepatic Veno-Occlusive Disease ......447 22.2.2 Pulmonary Veno-Occlusive Disease .... 449 References .............................450 23 Central Nervous System Jane Belmore · Deborah Tomlinson 23.1 Spinal Cord Compression ...............453 23.1.1 Incidence .....................453 23.1.2 Etiology ......................453 23.1.3 Treatment ....................454 23.1.4 Prognosis .....................454 23.2 Fatigue ...........................454 23.2.1 Incidence .....................455 23.2.2 Etiology ......................455 23.2.3 Treatment ....................456 23.2.4 Prognosis .....................457 23.3 Cognitive Deficits ....................458 23.3.1 Incidence .....................458 23.3.2 Etiology ......................458 23.3.3 Prevention and Treatment ..........458 23.3.4 Prognosis .....................459 23.4 Diabetes Insipidus ...................459 23.4.1 Incidence .....................459 23.4.2 Etiology ......................460 23.4.3 Treatment ....................460 23.4.4 Prognosis .....................460 References .............................460 24 Musculoskeletal System Deborah Tomlinson · SueZupanec 24.1 Bone Tumors .......................463 24.1.1 Limb Salvage Procedures ...........463 24.1.2 Amputation ...................464 24.1.3 Comparison of Limb Salvage and Amputation ...................469 24.2 Altered Bone Mineral Densityand Increased Fracture Risk ................470 24.2.1 Incidence .....................470 24.2.2 Etiology ......................471 24.2.3 Prevention and Treatment ..........471 24.2.4 Prognosis .....................472 24.3 Osteonecrosis ......................472 24.3.1 Incidence .....................473 24.3.2 Etiology ......................474 24.3.3 Treatment ....................474 24.3.4 Prognosis .....................475 References .............................475 25 Skin: Cutaneous Toxicities Martina Nathan · Deborah Tomlinson 25.1 Alopecia ..........................477 25.1.1 Etiology ......................477 25.1.3 Treatment ....................478 25.1.4 Prognosis .....................479 25.2 Altered Skin Integrity Associated with Radiation Therapy ................479 25.2.1 Incidence .....................479 25.2.2 Etiology ......................479 25.2.3 Prevention ....................479 25.2.4 Treatment ....................480 25.2.5 Prognosis .....................481 25.3 Radiation Sensitivity and Recall ..........481 25.3.1 Incidence .....................481 25.3.2 Etiology ......................481 25.3.3 Clinical Features ................481 25.3.4 Treatment ....................481 25.3.5 Prognosis .....................482 25.4 Ultraviolet Recall Reaction/Photosensitivity. .482 Contents 25.5 Cutaneous Reactions Associated with High-Dose Cytosine Arabinoside ......482 25.5.1 Incidence .....................482 25.5.2 Etiology ......................482 25.5.3 Prevention and Treatment ..........482 25.6 Nail Dystrophies .....................483 25.7 Graft Vs. Host Disease .................483 25.7.1 Incidence and Etiology ............483 25.7.2 Prevention ....................485 25.7.3 Treatment ....................486 25.7.4 Prognosis .....................486 References .............................486 26 Endocrine System Julie Watson 26.1 Introduction .......................489 26.2 Hypothalamic-Pituitary Dysfunction .......489 26.2.1 Incidence and Etiology ............489 26.3 Growth Hormone Deficiency ............491 26.3.1 Treatment ....................492 26.3.2 Prognosis .....................492 26.4 Hypothalamic-Pituitary-Gonadal Axis .....493 26.4.1 Gonadotrophin Deficiency ..........493 26.4.2 Early or Precocious Puberty .........493 26.5 Thyroid Disorders ....................494 26.5.1 Treatment ....................494 26.6 Hypothalamic-Pituitary-AdrenalAxis ......495 26.6.1 Treatment ....................495 26.7 Other Pituitary Hormones ..............495 26.7.1 Fertility ......................496 26.7.2 Treatment ....................496 26.7.3 Prognosis .....................497 References .............................499 27 Ototoxicity Colleen Nixon 27.1 Introduction .......................501 27.2 Prevention and Treatment ..............505 27.3 Future Perspectives ..................507 27.4 Prognosis .........................508 References .............................508 28.1.2 Prevention ....................512 28.1.3 Treatment ....................512 28.1.4 Prognosis .....................512 28.2 Cataracts ..........................513 28.2.1 Incidence .....................513 28.2.2 Etiology ......................513 28.2.3 Prevention ....................513 28.2.4 Treatment ....................513 28.2.5 Prognosis .....................513 References .............................513 PARTV 29 Nutrition and Hydration in Children with Cancer Cheryl Rodgers · Sara Gonzalez 29.1 Introduction .......................515 29.2 Nutritional Assessment ................516 29.2.1 Hydration Needs ................516 29.2.2 Nutrition Needs .................516 29.2.3 Nutritional History ...............517 29.2.4 Physical Examination .............518 29.2.5 Anthropométrie Measurements ......518 29.2.6 Laboratory Evaluation .............519 29.3 Principles of Treatment for Dehydration and Malnutrition ....................519 29.3.1 Rehydration ...................519 29.3.2 Oral Nutrition Replacement .........520 29.3.3 Enterai Nutrition Replacement .......520 29.3.4 Total Parenteral Nutrition/ Hyperalimentation ...............521 29.4 Special Considerations ................524 29.4.1 Common Hydration Complications .... 524 29.4.2 Common Complications of Oral/Enteral Nutritional Supplementation ........524 29.4.3 Common Complications of Total Parenteral Nutrition/Hyperalimintation . 525 29.4.4 Common Complications of Enterai and Parenteral Nutritional Supplementation . 527 29.4.5 Specific Nutritional Concerns of Long-Term Survivors ............527 29.4.6 Specific Nutritional Concerns During Palliative Care .............527 References .............................528 28 Ocular Complications Martina Nathan · Deborah Tomlinson 28.1 Ocular Toxicity Associated with High-Dose Cytarabine Arabinoside ........511 28.1.1 Incidence and Etiology ............511 30 Pain in Children with Cancer Cara Simon 30.1 Introduction .......................529 30.2 Causes of Pain in Childhood Cancer ........529 Contents 30.3 Assessment ........................530 30.4 Cultural Issues ......................536 30.5 Principles of Treatment ................536 30.6 Treatment .........................537 30.6.1 By the Ladder ..................537 30.6.2 BytheRoute ...................538 30.6.3 By the Clock ...................538 30.6.4 Opioids ......................538 30.6.5 Equianalgesia ..................538 30.6.6 Procedure-Related Pain ............540 30.6.7 Patient-Controlled Analgesia (PCA) .... 540 30.6.8 Adjuvant Medications .............542 30.6.9 Nonpharmacologic Treatment .......542 References .............................544 31 Blood Transfusion Therapy Colleen Nixon 31.1 Introduction .......................546 31.2 Blood Screening Guidelines .............546 31.3 Blood Product Processing ..............546 31.3.1 Irradiation ....................547 31.3.2 Washed Red Blood Cells ...........547 31.4 Transfusion Complications ..............547 31.4.1 Hemolytic Reactions ..............547 31.4.2 Febrile NonhemolyticTransfusion Reactions .....................548 31.4.3 Allergic Reactions ...............548 31.4.4 Transfusion Associated Graft vs. Host Disease ...................549 31.4.5 Circulatory Overload ..............549 31.4.6 Bacterial Contamination ...........549 31.4.7 Transfusion-Acquired Infections ......550 31.4.8 Iron Overload from Chronic Transfusion ...................551 31.5 Red Blood Cell Transfusion .............551 31.5.1 Packed Red Blood Cells ............551 31.5.2 Whole Blood ...................552 31.5.3 Exchange Transfusion .............552 31.6 Platelet Transfusion ..................552 31.6.1 Indications ....................552 31.6.2 Procurement ..................553 31.6.3 Dosing/Transfusion Guidelines .......553 31.6.4 Crossmatching .................553 31.6.5 Nursing Implications .............553 31.7 Granulocyte Transfusion ...............553 31.7.1 Indications ....................554 31.7.2 DosingATransfusion Guidelines .......554 31.7.3 Crosssmatching .................554 31.7.4 Nursing Implications .............554 31.8 Albumin (5 or 25% solution) and Plasma Protein Fraction (5% solution) ...........554 31.8.1 Indications ....................554 31.8.2 Dosing/Transfusion Guidelines .......554 31.8.3 Crossmatching .................555 31.8.4 Nursing Implications .............555 31.9 Fresh Frozen Plasma ..................555 31.9.1 Indications ....................555 31.9.2 0оѕ тдДгапѕЛЈѕ 1ОП Guidelines .......555 31.9.3 Crossmatching .................555 31.9.4 Nursing Implications .............555 31.10 Cryopredpitate .....................555 31.10.1 Indications ....................555 31.10.2 Dosing Guidelines ...............556 31.10.3 Crossmatching .................556 31.10.4 Nursing Implications .............556 31.11 Intravenous Immunoglobulin ............556 31.11.1 Indications ....................556 31.11.2 Оо5ІпдЯгап5йі5Іоп Guidelines .......556 31.11.3 Crossmatching .................556 31.11.4 Nursing Implications .............556 31.12 Erythropoietin ......................556 31.13 Indications ........................557 31.14 Dosing Guidelines ...................557 31.15 Nursing Implications ..................557 31.16 Palliative Care Issues for Transfusion Therapy 557 31.16.1 Anemia and Thrombocytopenia ......557 References .............................557 32 Cytokines Linda D Andrea 32.1 Principles of Treatment ................559 32.2 Future Perspectives ..................563 References .............................564 33 Care of the Dying Child and the Family Angela M. Ethier 33.1 Children s Understanding of Death ........565 33.1.1 Infants (0-12 Months) and Toddlers (12-24 Months) ...........565 33.1.2 Preschool Children (3-5 Years) .......566 33.1.3 School-Age Children (6-11 Years) .....567 33.1.4 Adolescents (12-19 Years) ..........567 33.2 Explaining Death to Children ............567 33.3 Pediatrie Palliative Care ................568 33.3.1 Principles .....................568 33.3.2 Locations of Care ................568 33.4 Grief .............................569 33.4.1 Principles .....................569 33.4.2 Assessment of Child and Family ......569 33.4.3 Interventions ..................571 33.5 Cultural and Spiritual Care ..............571 Contents 33.5.1 Principles .....................571 33.5.2 Assessment of Child and Family......571 33.5.3 Interventions ..................571 33.6 Nearing Death ......................573 33.6.1 Physical Symptoms Near the End of Life 573 33.6.2 Death-Related Sensory Experiences .... 574 33.7 Care Following the Child s Death .........575 33.7.1 Interventions Immediately Following the Child s Death ..................575 33.7.2 Bereavement Interventions .........575 33.8 Resources .........................575 33.8.1 Resources for Children ............575 33.8.2 Resources for Adults ..............576 References .............................576 Subject Index 579
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spellingShingle Pediatric oncology nursing advanced clinical handbook
Child
Neoplasms nursing
Nursing Care methods
Pediatric Nursing methods
Pediatric nursing
Tumors in children Nursing
Kind (DE-588)4030550-8 gnd
Krebs Medizin (DE-588)4073781-0 gnd
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title Pediatric oncology nursing advanced clinical handbook
title_auth Pediatric oncology nursing advanced clinical handbook
title_exact_search Pediatric oncology nursing advanced clinical handbook
title_full Pediatric oncology nursing advanced clinical handbook Deborah Tomlinson ... (eds.)
title_fullStr Pediatric oncology nursing advanced clinical handbook Deborah Tomlinson ... (eds.)
title_full_unstemmed Pediatric oncology nursing advanced clinical handbook Deborah Tomlinson ... (eds.)
title_short Pediatric oncology nursing
title_sort pediatric oncology nursing advanced clinical handbook
title_sub advanced clinical handbook
topic Child
Neoplasms nursing
Nursing Care methods
Pediatric Nursing methods
Pediatric nursing
Tumors in children Nursing
Kind (DE-588)4030550-8 gnd
Krebs Medizin (DE-588)4073781-0 gnd
Krankenpflege (DE-588)4032813-2 gnd
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Neoplasms nursing
Nursing Care methods
Pediatric Nursing methods
Pediatric nursing
Tumors in children Nursing
Kind
Krebs Medizin
Krankenpflege
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