Oncology Nurse

1. NURSING
MANAGEMENT
OF CHILD WITH
CANCER
Presented by:
Bidya Thapa
BSC Nursing 4th
year

2. OVERVIEW
Introduction of Pediatric Oncology
Definition of Pediatric Oncology
Pediatric Oncology Nurses
Childhood Cancer
Incidence of Childhood Cancer
Cause of Childhood Cancer
Common Childhood Cancer

3. OVERVIEW
Common Sign and Symptoms of Childhood Cancer
Nursing management of child with cancer
Research article

4. WHAT DO THESE RIBBONS MEANS?

5. PEDIATRIC ONCOLOGY
Pediatric Oncology is a super specialized discipline in
medicine concerned with diagnosing and treating children,
usually up to the age of 20 years with cancer.
It is most challenging
super specialities.

6. CONTD…
Cancer in children occurs as suddenly and without any
prominent symptoms in the initial stages, unlike in adults.
Childhood cancer are different from adult.

7. DEFINITION
Pediatric Oncology is a branch of medicine concerned
with the diagnosis and treatment of the cancer in children.
Pediatric oncology is a medical specialty focused on the
care of children with cancer.

8. PEDIATRIC ONCOLOGY NURSE
Pediatric Oncology Nurse are the highly specialized
person who deliver care to those pediatric patients who are
receiving cancer treatment.

9. CONTD…
 Pediatric oncology nurses deals with children of all ages
who are suffering from cancer.

10. CONTD…
 Specific responsibilities include preparing patients for
chemotherapy, administering palliative treatment and
collaborating with other members of health team.

11. CHILDHOOD CANCER
A term childhood cancer is used to describe the
cancer that occur in the child between birth to 15 years
and also sometimes includes the adolescents between 15-
19 years.

12. INCIDENCE
Worldwide, it is estimated that childhood cancer has
an incidence of more than 1,75,000 per year, and
a mortality rate of approximately 96,000 per year.
 In developed countries, childhood cancer has a mortality
of approximately 20% of cases.
On the other hand, mortality is approximately 80%, or even
90% in the world's poorest countries.

13. CAUSE
oThe cause of the most of the childhood cancer are not
known.
oInherited mutation.
oEnvironment exposure.

14. COMMON CHILDHOOD CANCER
1. Leukemia (32%)
Acute lymphoblastic leukemia (ALL) is the most
common types of cancer occur in children. Most
commonly occur at the age of 2 to 8 years old.
Acute Myeloid Leukemia (AML) can happen at any age
, but most cases happen in kids younger than 2 years or
teens.

15. CONTD..
2. Brain Tumor (18%)
It is the second most common type of tumor in the
children.
It can occur at any age in the infant
and children.

16. CONTD..
3. Lymphomas (11%)
It is the third most common type
of cancer in the children.
Most common in the children between the age 0 to 14.
The ratio of Hodgkin lymphoma to non Hodgkin
lymphoma is 1:1.

17. CONTD..
4. Neuroblastoma (6%)
Tumors that begins in the nerve tissue
of infant and very young children.
Most common in the children younger than 5 years and
rare in the kids older than 10 years of age.

18. CONTD..
5. Wilms tumor (5%)
Also known as Nephroblastoma.
Most often affects children of the age 3 to 4 years and
less common after the age 5.

19. CONTD..
6. Germ cell tumors (4%)
Germ cell tumor is rare tumor that
affects children and adolescents
younger than age 20.
Most commonly appears in testes for boys and ovaries
for girls.

20. CONTD..
7. Childhood rhabdomyosarcoma (3%)
It is a rare type of cancer found
in the soft tissue of children.
Its is most common in children under 10 years of age
and can form anywhere in the body.

21. CONTD..
8. Retinoblastoma (3%)
It rare type of eye cancer that can
affect young children usually under the age of 5.
It can either affect 1 or both eyes and most of the
children with this condition are cured.

22. CONTD..
9. Osteosarcoma (3%)
It is rare but most common type of bone cancer that
begins in the cells that form the bone.
It is extremely rare in children under the age of 3 years
and gradually increases with age.

23. CONTD..
10. Ewing sarcoma (1%)
It is the second most common
bone tumor in children that can
happen in any bone in the body.
Most common in the children of the age 10 to 20 years
of age.

24. COMMON SIGN AND SYMPTOMS
“ CHILD CANCER”
Continued , unexplained weight loss
Headaches, often with early morning vomiting
Increased swelling or persistent pain in bones, joints, back
or legs
Lump or mass, especially in the abdomen, neck, chest or
pelvis.
Development of excessive bruising , bleeding or rash

25. CONTD…
Constant/recurrent infection
A whitish colour behind the pupil
Nausea which persists or vomiting with or without seizure
Constant tiredness or noticable paleness
Eye or vision changes which occur suddenly
Recurrent or persistent fevers of unknown origin

26. NURSING MANAGEMENT

27. NURSING ASSESSMENT
1. Obtain a thorough history
 Family history of cancer.
 Occurance of sign and symptoms.
 History of exposure to carcinogens.
 Child treated with radiation and chemotherapy for
cancer previously.
 Any congenital anomalies or syndrome in child.

28. CONTD..
2. Assessment of pain
 Cause of pain.
 Site, onset, character,
association , time course and
exacerbating and relieving
factors.
 Severity of pain.
 Use of medication for pain.

29. CONTD..
3. Assessment of Sign and Symptoms
 Physical Examination(head to toe)
Inspection(Temperature , body weight, Blood pressure,
swelling, rashes , change in vision, paleness)
Palpation ( mass or lump )

30. CONTD..
4. Laboratory Assessment
 Leukocyte count
 Absolute neutrophil count
 Hematocrit
 Complete blood count

31. CONTD..
5. Assessment of Nutritional Status
 Dietary oral intake
 Anthropometric measurement
Height, Weight
Mid upper arm circumference
BMI
 Biochemical data

32. CONTD..
6. Developmental Assessment
 Assessment of the developmental milestone of the
children.
 Height and weight for age.

33. CONTD..
7. Child and parental Anxiety
 Level of anxiety and stress.
 Coping strategies
 Participation in Child care.

34. CONTD..
8. Psychosocial Assessment
 Support system
 Economical problem
 Travel and Accomodation problems
 Body image disruption

35. NURSING DIAGNOSIS
Pain related to tissue injury.
Altered Nutrition, less than body requirement related to
inability to ingest or digest food or malabsorption.
Parental anxiety related to change in health status of child.
Constipation related to change in usual foods and eating
pattern.

36. NURSING DIAGNOSIS
Fluid volume excess or deficit related to medication.
Risk for infection related to immunosuppression.

37. NURSING INTERVENTION
1. Preparing the child for treatment and diagnostic
procedures
- Provide a means for talking about
the experience.
- Consider implementing complementary and alternative
medicine intervention for pain as well as managing other
symptoms.

38. CONTD..
2. Managing pain
- Measuring the pain intensity and the frequency.
-Maintain the comfortable position.
-Provide diversionary activity.
- Teach the relaxation technique.
-Administer analgesic as prescribed.

39. CONTD..
3. Maintenance of nutritional status
-Assessment of the feeding pattern and eating habit of the
child.
- Offer the small frequent feeding.
- Monitor the daily calorie and
fluid intake.
- Provide the diet rich in protein and calorie.

40. CONTD..
- Educate the family members about the diet for cancer
patient.
- Administer the antiemetic as prescribed.

41. CONTD..
4. Preventing Infection
- Maintain barrier Nursing
- Monitor complete blood count.
- Never use rectal thermometer or drugs or enema while
caring for neutropenic patient.
- Avoid visit of family, friends, personnel and other patients
with infection.

42. CONTD..
- Enforce the importance of good hand washing.
- Observe the fever and also observe the IV site for redness
and tenderness.
- Administer antibiotic as ordered.

43. CONTD..
5. Preventing Hemorrhage
- Monitor vital signs .
- Monitor complete blood count as order.
- Observe the urine for evidence of gross
bleeding, urine routine examination for hematuria.
- Providing the blood component as needed.

44. CONTD..
6. Reducing the child’s anxiety
- Provide the continuity of care.
- Encourage family centered care.
- Facilitate play activities for the child and use opportunities
to communicate through play.

45. CONTD..
- Provide the appropriate diversional activities.
- Encourage the independence and provide opportunities that
allow the child to control his environment.

46. CONTD..
7. Decreasing Parental Anxiety
- Be available to the family members
when they want to discuss the feeling.
- Offers kindness, concerns, consideration and sincerity
toward the child and parents.
- Provide the opportunities to have parents to parents talking.

47. CONTD..
- Encourage them to participate in activities of daily living.
- Encourge the parents to discuss about their feelings ,
concerns and doubts.

48. CONTD..
8. others..
- Ensuring the hydration
- Psychological supports
- Administering chemotherapeutic drugs
- Managing the side effect

49. CONTD..
9. Discharge Teaching
- Instruct for to maintain hygiene and nutrition.
- Teach about the preventive measures.
- Tell parents to call health care provider if the child has
fever more than 101 degree Fahrenheit.
- Monitor the late side effect of chemotherapy.
- Teach the parents to involve the child in diversion therapy.

50. CONTD..
- Emotional support to the child and parents.
- Teach about the regular follow up.
- Prevent infection.

51. RESEARCH ARTICLE
Evaluation of nurses knowledge toward pain
management of leukemic child under chemotherapy
A descriptive study was conducted to evaluate nurses
knowledge toward pain management of leukemic child in
oncology wards who were receiving chemotherapy.
It was conducted in two hospitals on 40 nurses provided
care for the children with leukemia in oncology wards.
(Children Welfare Teaching Hospital and Child’s Central
Teaching Hospital) in Baghdad city.

52. CONTD..
A purposive "non-probability sample" was used. A
questionnaire format was used which consist of two parts,
the first part includes demographic information of the
sample and the second part consists of structured Items
concerning nurses' knowledge toward pain management for
leukemic child.
Reliability and validity of questionnaire was estimated
through a pilot study and a panel of expert.

53. CONTD..
The results revealed inadequate nurse's knowledge about
pain management for leukemic child under chemotherapy,
two third (75 %) of the sample has poor knowledge toward
pharmacological and non pharmacological pain
management methods.

55. EVALUATION
1. What is pediatric Oncology?
2. What are the common cancers that occur in the
childhood?
3. What are the various nursing interventions for the child
with cancer?

56. MULTIPLE CHOICE QUESTIONS
1. It is the most common types of cancer occur in children.
a. Acute lymphoblastic Leukemia
b. Brain Tumor
c. Lymphoma
d. Neuroblastoma
Ans:- a

57. CONTD..
2. It is the tumor with the rare symptoms which is less
common after the age of 5.
a. Neuroblastoma
b. Germ cell Tumor
c. Wilms Tumor
d. Osteosarcoma
Ans:- c

58. CONTD..
3. Which is the rare type of cancer found in the soft tissue of
the children?
a. Germ cell Tumor
b. Neuroblastoma
c. Ewing Sarcoma
d. Rhabdomyosarcoma
Ans:- d

59. FILL IN THE BLANKS
a) Pediatric Oncology nurse deals with children of …….
age who are suffering from cancer.
Ans:- All

60. CONTD..
b) ………. is the second most common type of tumor in
the children.
Ans:- Brain Tumor

61. TRUE OR FALSE
1. Acute Myeloid Leukemia is the most common type of
cancer occur in the childhood.
[Ans: False]

62. TRUE OR FALSE
2. Ewing sarcoma is the most common bone tumor in
children.
[Ans: False]

63. TRUE OR FALSE
3. It is important to decrease the parental anxiety in
childhood cancer.
[Ans: True]

64. ASSIGNMENT
What are the effects of treatment in childhood cancer.

65. BIBLIOGRAPHY
BOOK REFERENCE
- Sharma Sarojini. Oncology Nursing manual . 4th edition
Bharatpur Chitwan B.P. Koirala Memorial Cancer
Hospital 2014: 210-212
- Gates A Rose, Fink M. Regina. Oncology Nursing Secrets.
3rd Edition. Reed Elsevier;2008:161-169,353

66. CONTD…
NET REFERENCES
- The role of a pediatric Oncology Nurse. Available from :-
globalpremeds.com/blog/2016/06/03/working-as-a-pedc-
oncology-nurse/ ( Accessed on: 10/06/2020)
- Children Oncology Group. Childhood cancer. Available
from:- www.cancer.net ( Accessed on: 10/06/2020)

67. CONTD…
- Morrissey L, Challinor JM, De Beer E. Nursing care of
child with cancer.Pediatric Hematology .Available from:-
https://link.springer.com/chapter/10.1007/978-1-46143891-
5_13 (Accessed on 10/06/2020)
-American Cancer Society. Types of cancer that develop in
children. Available from :-
https:/www.google.com/amp/s/amp.cancer.org/cancer/cance
r-in-children/types-of-childhood-cancer.html ( Accessed on:-
10/06/2020)

68. CONTD…
JOURNAL REFERENCES
-Zaid W. Ahjil, Eqbal G. Maala. Evaluation of nurses
knowledge toward pain management of leukemic child
under chemotherapy. Iraqi National Journal of Nursing
Specialties.2012. Available from:-
https://www.researchgate.net/publication/341180611_Evalu
ation_of_nurses'_knowledge_toward_pain_management_of
_leukemic_child_under_chemotherapy/link/5eb2a97645851
523bd464abd/download ( Accessed on 12/06/2020)

69. S