A case of retinoblastoma presented in pediatrics ward, in accordance with bsc honors nursing

1. Name:Divyya
Yr : 3rd yr
Subject : child health nursing

2. EYE ANATOMY AND
PHYSIOLOGY

3. PRESENT HISTORY
Child presented with the complaints of vomiting
×15 days multiple episodes With decreased oral
acceptance ×10 days gradually progressive
H/O headache + child was under regular follow
up. MRI showed recurrence along the left optic
nerve with contiguous extension in the form of
large suprasellar mass with adjacent neovascular
extension Was effect along with leptomeningeal
dissemination – stage 4b

4. PAST ILLNESS
Significant medical history
Child had presented in June 2021 with the c/o of whitish
discoloration of part of left eye. Since 1 yr it was gradually
progressive associated with redness of eyes and photophobia
+MRI brain + orbit done was s/o bulky and slightly
malformed in the shape of left eye ball well defined altered
signal intensity lesion in the posterior chamber of left eye
ball with focal area of blooming on GRE images and non –
appreciable lenticular complex of the left eye ball with
absence of anterior and posterior chanber differentiation.

5. PAST ILLNESS
Significant surgical history
Due to the retinoblastoma in left eye
the left eye enucleation was done
and histopathology confirmed
retinoblastoma with HRF, child then
received 6 cycles of VEC i.e,
VINCRISTINE, ETOPOSIDE,
CARBOPLASTIN respectively in
July 2021

6. NTRODUCTION
Retinoblastoma is an eye cancer That begins In the
retina . It most oftenly affects children Under the
age of 5 yrs .
Retinoblastomas can occur in one or both eyes.
Although, it’s curable but is important to spot early.

7. DEFINITION
Retinoblastoma Is a rare form
of cancer That rapidly develops
from the immature cells of a
retina, the light detecting
tissue of the eye

8. HOW IT
OCCURS?
 During development of the Retina ,there are cells called retinoblasts
which mature into Nerve cells of the retina.
 But if some of these cells growout of control They can form
retinoblastoma .
 It occurs when nerve cells (Neurons) that create retina undergo
genetic mutations.
 During the early stages of child’s development Retinal neurons
divide and grow Very quickly until they stop. However, if child has
genetic mutations , retinal neurons continue to grow rapidly and
divide out of control, eventually forming a tumor .
 Because the neurons of the babIes and toddlees grow so quickly
These ages are the highest risk for developing retinoblastoma .
 The avg age is 2 and it rarely occurs after 6 .

9. Genetic mutation causes retinoblastoma
The gene that causes retinoblastoma is called RB1 gene which is
located on the chromosome 13 responsible for controlling the division
of cells in the body .
Around 40% of the children, inherits the RB1 mutated gene from a
parent.
In about 60% of cases, the gene change occurs spontaneous.
About 60% of children with heritable retinoblastoma will develop
tumors in both eyes known as bilateral retinoblastoma.
30% will develop a tumor only in one eye.

10. 1. Leukocoria
2. Strabismus
3. Eye redness
4. Eye puffiness
5. Severe headache
6. Nystagmus
7. Poor vision

14. CONGENITAL
RETINOBLASTOMA
The abnormality in RB1 gene is
congenital And is in all cells of the body
including all cells of the retina .
Because of all the cells In the body
have changed RB1 gene , these children
have the high risk of Developing cancer
in other parts of the body.
Children born with this type retinoblastoma
in both the eyes.
This is known as bilateral retinoblastoma .

15. SPORADIC
RETINOBLASTOMA
The abnormality of the RB1 gene
develops in the cell of only one eye.
Its is not known what causes this
change
The child with sporadic
retinoblastoma Develops only one
tumor in one eye only , also known as
unilateral retinoblastoma
This type of retinoblastoma is found
When the child is slightly Older as
compared to the one with heritable
form.

17. DIAGNOSIS
Eye examination
An experienced ophthalmologist will
conduct an eye exam to determine what’s
causing the child’s sign and symptoms.
Imaging tests
Scans and other imaging tests can help your child ‘s
doctor determine whether retinoblastoma has grown
to affect structures around the eye. Imaging tests
may include ultrasound and MRI.

18. HOW IS RETINOBLASTOMA
REATED?
Treatment of retinoblastoma depends on several
factors
Size if the tumor
Location of the tumor
Whether one or both eyes are affected
Tumor stage (whether it has spread to other parts or not(metastasis)
Age and overall health
Therapies for retinoblastoma include
Chemotherapy
Cryotherapy Or cold treatment
Laser therapy
Radiation therapy
Enucleation
Sometimes doctor combine treatments for effective treatment.

20. NURSING
MANAGEMENT
1. Keep the head of the bed elevated
2. Instruct the patient not to impose Stress on
operative eye
3. Instruct the patient not to lie on the affected
side of the eye
4. Change damp pads as allowed
5. Administer eye drops as per physicians
order such as antibiotics and corticosteroid
6. Administer antiemetic for nausea or
vomiting
7. Remove obstacles in the room

21. NURSING
MANAGEMENT
1. Assess the level of pain
2. Administer analgesics as per physicians order
3. Provide supplemental oxygen to child with respiratory distress.
4. Maintain proper fluid volume by ensuring adequate hydration.
5. A careful record of oral and parentetal intake and output is
maintained.
6. Explain the post operative limitations
7. Demonstrate the procedure of eye drop instillations to family
members or primay care taker