Question

Pediatric Oncology Case Study

Z.O. is a 3-year-old boy with no significant medical history. He is brought into the emergency department (ED) by the emergency medical technicians after experiencing a seizure lasting 3 minutes. His parents report no previous history that might contribute to the seizure. Upon questioning, they state that they have noticed that he has been irritable, has had a poor appetite, and has been clumsier than usual over the past 2 to 3 weeks. Z.O. and his family are admitted for diagnosis and treatment for a suspected brain tumor. A CT scan of the brain shows a 1-cm mass in the posterior fossa region of the brain, and Z.O. is diagnosed with a cerebellar astrocytoma. The tumor is contained, and the treatment plan will consist of a surgical resection followed by chemotherapy.

1. What are the most common presenting symptoms of a brain tumor?

2. Outline a plan of care for Z.O., describing at least twonursing interventions that would be

appropriate for managing fluid status, providing preoperative teaching, facilitating family coping, and preparing Z.O. and his family for surgery.

CASE STUDY PROGRESS

Z.O. returns to the unit after surgery. He is arousable and answers questions appropriately. His pupils are equal and reactive to light. He has a dressing to his head with small amount of serosanguineous drainage. His IV is intact and infusing to a new central venous line as ordered. His breath sounds are equal and clear, and O 2 saturations are 98% on room air. You get him settled in his bed and leave the room.

3. You check the postop orders, which are listed below. Which orders are appropriate, and which would you question? State your rationale.

Postoperative Orders

1. Vital signs every 15 minutes × 4, then every hour × 4, then every 4 hours.

2. Contact MD for temperature less than 36° C or over 38.5° C (96.8° F to 101.3° F).

3. Maintain NPO until fully awake. May offer clear liquids as tolerated.

4. Maintain Trendelenburg's position.

5. Reinforce bandage as needed.

6. Neuro checks every 8 hours.

4. You return to the room later in the shift to check on Z.O. Which of these assessment findings would cause concern? (Select all that apply.)

a. BP 90/55 mmHg

b. Increased clear drainage to dressing

c. Increased choking while sipping water

d. Photophobia

e. HR 130 beats/min

Z.O.'s wound and neurologic status are monitored, and he continues to improve. Z.O. is transferred to the Oncology Service on postoperative day 7 for initiation of chemotherapy.

5. Outline a plan of care that addresses common risks secondary to chemotherapy, describing

at least two nursing interventions that would be appropriate for managing risks for infection,

bleeding, dehydration, altered growth and nutrition, altered skin integrity, and body image.

Answer 1

1)Common Symptoms:1)new onset or change in frequency of headache

2)headache gradually become more common and severe

3)un explained nausea and vomiting

4)vision problems like blurred vision,double vision,or loss of peripheral vision.

2)Interventions:: Rationale

1)assess the child's head circumference 1) Providing information indicating an

fluid obstruction caused by tumor will increase head size. increase in icp  with poor prognosis.

2)notify the parents that surgery will be performed in tumor.after 2)should give adequate,simple   

that radiation and chemotherapy will be started. Information to reduce their anxiety

3)post oprative orders::1)vital signs should be checked to know changes in neurological and respiratory functions

2)inform physicians if patient has fever more than 101 degree to know there is any infection

3)patient should be kep npo until patient become conscious inorder to prevent aspiration.

4)bandage should be checked to find the presence of soakage

5)neurological functions such as consciousness,faligue,sleepy to prevent further complications.

6)trendelenburg position will increase icp .thus,after surgery head should be elevated 30 to 45 degree to decrease icp

5)Abnormal findings A,C,D and E

After chemotherapy interventions:1)risk for infection related to low immunity: hand hygienic method should be done whenever deal with patient.teach patient and relative about the importance of hand hygiene.avoid overcrowding near to these patients to prevent infection.do not keep cancer patient with the persons who has fever or any communicable disease.

2)anxiety related to distorted body image..patients hair can be lost after chemotherapy.while seeing the person he himself and other family members get disturbed.so,give psychological support and tell them that every thing will be come back once chemotherapy get finished