Potential Nursing Diagnoses

As a nurse, one responsibility is to develop nursing diagnoses that are patient specific in order to plan appropriate, individualized nursing care. A patient with neuroblastoma may indeed have one or more of the following nursing diagnoses:

     1) Risk for infection
     2) Imbalanced nutrition
     3) Activity intolerance
     4) Caregiver role strain
     5) Acute pain  

Each diagnosis is normally followed by: "related to" and "as evidenced by." The information that helps make up these diagnoses is patient specific and may change from shift to shift. I will provide an example below so that it is easier to understand just what a nursing diagnosis is for a patient. Please note that this case is completely fictional and will only useful for the purpose of explaining a nursing diagnosis.

The case and diagnosis:

A 2-year-old patient was diagnosed with neuroblastoma. His treatment plan included surgery and radiation to remove and shrink the tumor. Nurses are responsible for caring for this patient post-operation and post-radiation therapy. 

One likely diagnosis: 

Acute pain related to previous surgery as evidenced by grimace and cry from child during movement.

Once a nurse realizes actual and potential nursing diagnoses, she uses these to guide her plan of care. The remaining parts of care include the anticipated or expected outcome of the patient as well as any interventions that the nurse may provide to meet care needs. In the instance of the example case above, a likely outcome would be that the patient's pain would be controlled during the nurse's shift. This goal would be achieved by providing appropriate measures to reduce pain and would be evident when the child does not cry or grimace. Appropriate measures may be something like administering ordered pain medications as scheduled or using distraction with toys to soothe the patient.

Original picture found here

Well, we have come to the final post for my assignment... 

Thanks for reading! 

This blog is dedicated to my nephew who was diagnosed with neuroblastoma just weeks after being born. He is such a blessing and life would not be the same without him!

Nursing Care of a Child with Neuroblastoma

Understanding the implications of nursing care and what is actually going to be beneficial to the patient is going to be completely dependent on each patient's case. Below is a table of possible nursing interventions that I found by visiting this website. I found this website to be helpful in understanding what nursing care may be expected with a neuroblastoma diagnosis because the information I found was from an actual case study of a toddler with the disease.

Protect Against Infection	Promote Adequate Nutrition
Monitor blood pressure, temperature, heart rate, respiration rate, oxygen saturation and pain	Assess and document weight daily; record intake and output as necessary
Monitor lab values (electrolytes, blood cell counts, etc.)	As appropriate, meals should include food that the child enjoys
Teach patient and family about the importance of frequent hand washing	Be present during mealtimes so that child does not have to eat alone

Sources:

Table Information -
http://www.scribd.com/doc/56063564/Pediatric-Nursing-Process-Record#scribd

Picture -
http://cliparts.co/cliparts/6iy/XKn/6iyXKnKnT.jpg

Treatment

YouTube Source

Treatment options for neuroblastoma are similar to those of other cancers in the way that treatment is usually guided by the type, stage, location and size of the cancer. The U.S. National Library of Medicine website is a great resource for understanding how neuroblastoma is staged and how treatment may be guided by explaining each of the treatment options in detail. Neuroblastoma treatment may be very individualized with standard treatment (most commonly used) or clinical trials (treatment that is used in research).

The following treatment options may be used alone or in combination:
    
     Standard Treatment
          > Surgery
          > Radiation
          > Chemotherapy
          > High-dose Chemo and Radiation with Stem Cell Rescue

     Clinical Trial Treatment Therapies
          > Targeted
          > Vaccine
          > Other Drugs

Depending on the stage of neuroblastoma and its risk category these options may be used:

     Low-Risk Neuroblastoma
          > Surgery
          > Observation (if the child does not have signs or symptoms)
          > Chemotherapy
 
     Intermediate-Risk Neuroblastoma
          > Chemotherapy
          > Surgery
          > Radiation
          > Observation (only in certain circumstances with infants)

     High-Risk Neuroblastoma
          > Combination therapy of: chemo, surgery, radiation and
              stem cell rescue 
          > Clinical trial chemotherapy combined with of any of the following:
                - Stem cell rescue
                - Surgery, stem cell rescue, and radiation
                - Stem cell rescue and other clinical trial treatments

All of the above listed treatments are listed in greater detail in the Treatment Option Overview section of this website. It can be very complicated once a child receives a neuroblastoma diagnosis so working with the patient's team of health care providers can be of great help when navigating options of this terrible disease. Please visit the sources that I have listed below to get an even better understanding of neuroblastoma.
         
         

Sources:

http://www.cancer.gov/cancertopics/pdq/treatment/neuroblastoma/Patient/page4

http://www.cancer.org/cancer/neuroblastoma/detailedguide/neuroblastoma-treating-general-info

http://neuroblastoma.cancertreatment.net/

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032656/

Signs and Symptoms

As I mentioned last week, neuroblastoma can be tricky to diagnose and the earlier a diagnosis, the better the child's prognosis or outcome. The signs and symptoms of this cancer can sometimes be quite vague and may actually occur due to other causes (thus making a diagnosis difficult to detect purely based on signs and symptoms).

Some of the more common symptoms include:

    >  A lump in the abdomen or neck
    >  Loss of appetite
    >  Nausea or vomiting
    >  Weakness
    >  Fatigue
    >  Trouble breathing

Remember: signs and symptoms of cancer have many variables. Location, size, and how long the cancer has been growing may indicate that all or some, or maybe even different, symptoms may present in the child with neuroblastoma. As discussed last week, other lab and diagnostic testing should be completed in order to rule out any malignancies and to pinpoint a diagnosis which will help guide treatment.

Speaking of... next week I will focus on different treatment options.
Thanks for reading!

   

Picture found here

Sources:

http://www.cancer.org/cancer/neuroblastoma/detailedguide/neuroblastoma-signs-and-symptoms

http://www.stjude.org/stjude/v/index.jsp?vgnextoid=a06c061585f70110VgnVCM1000001e0215acRCRD&vgnextchannel=3b8fbfe82e118010VgnVCM1000000e2015acRCRD&SearchUrl=search_results.jsp&QueryText=neuroblastoma

Diagnosing Neuroblastoma

Many adults are familiar with cancer screening which can include a multitude of tests to see what the likeliness is that a person will develop or already has developed cancer. For example, once women reach the age of 40, they are recommended to get mammograms regularly. This is a diagnostic test that specifically screens for breast cancer. Likewise, men are encouraged to be screened for their risk of developing prostate cancer. Now, there are other factors that contribute to the reasoning for cancer screening but this gives you a general idea.

For children, there really is no good way to screen for neuroblastoma. Fortunately, most children are diagnosed before the age of one year but are usually diagnosed because of the signs and symptoms that present in children. The National Cancer Institute explains that there is a 24-hour urine collection that may be done for a child to help screen for neuroblastoma but this screening "does not decrease the [child's] chance of dying from the disease." However, if a child is diagnosed because of screening done before six months of age, the child will most likely have a good prognosis with the neuroblastoma that had developed.

Other diagnostic testing is done to rule out other causes and/or to confirm the diagnosis of neuroblastoma. Simple testing of urine or blood may be done as well as imaging studies which may include: a MRI, CT scan, X-rays, an ultrasound, or a bone scan. A biopsy may be done in order to test the actual tissue to find out an exact diagnosis and to guide any treatment that may be needed. Another test that may be needed and is specific to neuroblastoma is a MIBG. This is when iodine-meta-iodobenzyl-guanidine, a type of radioactive material, is injected into blood to see if the neuroblastoma has spread to other areas of the body or has metastasized.

Once test results are known then treatment plans can be put into place. Next week I will talk more about what the signs and symptoms are for this disease and then will discuss treatment options the following week.

Please, stay tuned!



Sources:

http://kidshealth.org/parent/medical/cancer/neuroblastoma.html#

http://www.cancer.gov/cancertopics/pdq/screening/neuroblastoma/Patient/page1/AllPages/Print

What Causes This Childhood Cancer?

One of the first things that a patient wants to know after being diagnosed with any illness is: what caused this? This concept is especially true for those who have been diagnosed with cancer or in the case of children, family members may be the ones asking the questions. Often times parents are worried that it was caused by some action that they did or did not take; they blame themselves for the child's neuroblastoma diagnosis. However, it is important to understand that there is not always a clear explanation for what caused a certain disease (or in this case, cancer).
 
Neuroblastoma is a mysterious cancer. Little is understood about the reason it develops and currently there are no lifestyle or environmental factors that may be contributing to its development. As you may know, lung cancer may be caused by carcinogens breathed in while smoking a cigarette (a lifestyle and/or environmental factor) but there is no apparent reason that a child will develop neuroblastoma.
 
Researchers have discovered that neuroblastomas are formed from nerve cells called neuroblasts. It is known that if neuroblasts fail to become mature cells, they may continue to divide and grow creating the childhood cancer we know as neuroblastoma. Other possible causes include gene mutations during fetal development or changes that may occur after birth because of an inherited trait from one or both parents.

It can be extremely frustrating and saddening to learn that the cause of this cancer is unknown so offering support to family members is important. There are many groups that individuals or family may join to learn more about neuroblastoma or to find support from others who are struggling with a similar diagnosis. Hospitals and clinics should be able to help direct those interested in finding specific support groups.

Next week we will explore in more detail how a neuroblastoma is diagnosed and how the disease progresses...



Locations where neuroblastomas develop
Picture source

Sources:

http://www.cancer.org/cancer/neuroblastoma/detailedguide/neuroblastoma-what-causes

http://www.uofmchildrenshospital.org/fv/groups/public/documents/images/189315.jpg

Who Is Affected?

As mentioned last week, neuroblastoma is a cancer that affects children. According to the American Cancer Society, it is one of the more common cancers diagnosed in infants but only makes up about 6% of childhood cancers. It is rarely diagnosed after the age of 10 and is found, on average, between the ages of 1-2 years (American Cancer Society). That being said, neuroblastoma is considered a rare disease and in the United States it affects less than 200,000 children (Right Diagnosis).

Early diagnosis in children is key if they want any chance at living a happy, healthy life. With neuroblastoma there are different factors that affect a child's mortality rate. Mortality rate measures the number of deaths in a particular population over a certain period of time; generally the units are 1,000 deaths per year.

Children who are diagnosed with neuroblastoma are usually categorized into one of three risk groups: low, intermediate or high. Categorization is dependent upon different factors surrounding the diagnosis of the cancer like size and location of the tumor or how the child's cancer has responded to treatment. According to the American Cancer Society, the following statistics are available for survival rates:

• Low-risk group: Children have a 5-year survival rate that is higher than 95%.
• Intermediate-risk group: The 5-year survival rate is around 90% to 95%.
• High-risk group: Children have a 5-year survival rate around 40% to 50%

As you can imagine, this information is tough for parents to receive. However, it is important to note that these kinds of statistics are always changing. There are multiple factors that contribute to said numbers and with the new discoveries and research that is always being done, there may be an even better chance for survival of children affected by this disease.

Next week I will discuss the cause of this disease and explain whether or not there are any modifiable factors (things that may be changed to decrease the risk) that may contribute to the development of neuroblastoma in children.


Sources:

American Cancer Society: http://www.cancer.org/cancer/neuroblastoma/detailedguide/neuroblastoma-key-statistics

Right Diagnosis:
http://www.rightdiagnosis.com/n/neuroblastoma/prevalence.htm

Wikipedia - Mortality Rate
http://en.wikipedia.org/wiki/Mortality_rate