Monday, May 18, 2015

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!

Tuesday, May 12, 2015

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

Wednesday, May 6, 2015

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/

Sunday, May 3, 2015

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