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 two nursing 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 a 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 saturation is 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

Cerebellar astrocytoma is a tumor in the cerebellum. astrocytoma is the most common brain tumor delop in childhood caused by the type of cell called astrocyte.
1, Symptoms include headache, seizure, memory loss, irritability, changes in mood, speech, vision, nausea, and vomiting, poor balance while walking.
2, Nursing intervention:
- Encourage the family to be with the child always, provide orientation to the surgery procedure, post-care staffs and instructions.
-Assess the child vitals with continuous monitoring and assess child neurological status every 2hours and behavioral changes and ICP level.

3,1, Vital signs every 15minutes X4, then every hour X4, then every 4 hours. this is questionable. because an immediate postoperative patient needs constant monitoring of vitals especially neuro patients. It needs comprehensive care for continuos records of their heart rate and oxygen saturation.
6, Neuro checks every 8 hours,this is questionable.
Neuro assessment must be performed every 15-30 minutes immediately after the post-operative period and once recover from anesthesia every 1 -2 hours and every 4 hours for the next 6 hours to find the neurological deficit.
2, Monitoring patient for hypothermia and hyperthermia is routine care in the postoperative period
3, maintain NPO until fully away from anesthesia and trying with clear liquid is normal to care to check patient tolerance and find out if there is any vomiting.
4, Maintain a Trendelenburg position to optimize venous drainage from the brain.
5, reinforce bandage can be done if there is any oozing from the bandaged site.

4, b, Increased clear drainage to dressing indicate CSF leak, this should be informed to the doctor.
c, Increased chocking while sipping water should be informed due to the problem in swallowing.
d, Photophobia indicates light sensitivity it is a postoperative complication that must be informed immediately.