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Published on : Feb 24, 2014
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Slide 1 - CANCER IN THE CLASSROOM: PROVIDING A SAFE ENVIRONMENT Lisa Bashore, PhD, RN, CPNP, CPON Life After Cancer Program
Slide 2 - OBJECTIVES Review the various treatment modalities given to children and adolescents with cancer Discuss how cancer treatment influences attendance and / or re entry into school Evaluate how safe the school environment is for children and adolescents with cancer
Slide 3 - CHILDHOOD CANCER Incidence by Diagnosis
Slide 4 - Treatment Surgery Radiation Chemotherapy Biotherapy Stem Cell Transplant Alternative therapy
Slide 5 - Chemotherapy Affects rapidly dividing cells Hair GI tract Mucous membranes Bone marrow Anemia Thrombocytopenia Neutropenia
Slide 6 - CHEMOTHERAPY Halts the growth of cancer cells Affects normal cells as well Inability to differentiate between normal/cancer cells
Slide 7 - CHEMOTHERAPY Given in different routes May dictate the extent of acute effects Orally Intravenously Intrathecally Intraosseous Intramuscularly
Slide 8 - RADIATION Delivery of high energy beams Damage both cancer cells and normal cells Thankfully only in area radiated are normal cells affected Given alone or in combination with chemotherapy
Slide 9 - RADIATION Given by different methods Types: 3-dimensional conformal Intensity modulated Proton beam Stereotactic radiosurgery
Slide 10 - BIOTHERAPY Immunotherapy Very targeted and used body’s immune system Like Targeted minimizes damage to healthy cells
Slide 11 - ALTERNATIVE THERAPY Many can interfere with efficacy of treatment Unsafe in general Reduce blood counts Have bacteria or fungi Unacceptable side effects
Slide 12 - Massage Probiotics Contains bacteria Could colonize the GI tract St John’s Wort Bleeding potential Interaction with immunosuppressant's
Slide 13 - COMPLEMENTARY Yoga Imagery Art and Music Therapy Meditation Massage Aromatherapy (??)
Slide 14 - PALLIATIVE CARE Provides symptom management throughout the continuum of care Comprehensive, holistic care Physical, emotional, spiritual, social aspects of living with cancer
Slide 15 - IMMEDIATE EFFECTS OF CANCER THERAPY
Slide 16 - TREATMENT EFFECTS Due to damage to normal cells/blood cells Marrow All blood lines impacted Skin Mouth or whole GI tract Immune system
Slide 17 - SIGNS, SYMPTOMS, AFFECTS Fever (INFECTION) Fatigue Paleness Easy bruising Bone/joint pain
Slide 18 - PANCYTOPENIA Neutropenia: A White cell count < 1,000 with an Absolute Neutrophil Count (ANC) low Associated with infections
Slide 19 - Thrombocytopenia Low platelets and risk for bleeding Normal: 150,000-450,000 High threshold in oncology
Slide 20 - Anemia Hemoglobin: Responsible for Oxygen transport to cells Normal is 12-16 g/dl depending on age High threshold Symptom dependent
Slide 21 - GASTROINTESTINAL EFFECTS Nausea & Vomiting Diarrhea Dehydration Constipation
Slide 22 - OTHER Stomatitis Esophagitis
Slide 23 - IMPACT ON THE CHILD Short to extended hospitalizations Administration of therapy Infection management Recovery in-between
Slide 24 - EMOTIONAL RESPONSE TO CANCER Feelings of: Guilt Anger Sadness and loneliness Age / Developmental responses to cancer
Slide 25 - Responses 1. Dependency 2. Regression of development 3. Inability to cope at all
Slide 26 - DEALING WITH RESPONSES School-Age Children
Slide 27 - Teens
Slide 28 - ATTENDING SCHOOL Children on cancer treatment can/do attend school Important for social development…NORMALCY Good communication is KEY to safe and successful school environment
Slide 29 - INFECTION PREVENTION Germs exist…exposure happens Good Hygiene Hand washing (frequently) Hand sanitizer Keep hands as clean as possible
Slide 30 - VACCINES Children with cancer CANNOT receive live vaccines No specific recommendations for exposure to others Best they are NOT exposed to others having just received live vaccines
Slide 31 - INFECTION PREVENTION NOT share pens, cups, utensils, etc…with the patient NOT be near or in contact with the infected person Education of parents of classmates
Slide 32 - INFECTION PREVENTION May be asked to avoid large crowds Classmates can visit but not all together (1-2 at a time) Child may be asked to eat restricted diet
Slide 33 - RE-ENTERING SCHOOL Notify parent if contagious diseases present Offer rest times Hand Hygiene Offer gentle play options
Slide 34 - SCHOOL INFECTION CONTROL POLICY Classmates with: Fever Runny nose, cough Diarrhea Rash NOT play with child with cancer
Slide 35 - Cont. Wash hands after using bathroom Have wipes handy for door knobs
Slide 36 - HEALTHY SCHOOL ENVIRONMENT Have emergency contacts handy When to call: Fevers > 101 F Exposure to chicken pox Bleeding (active) Central line problems Not drinking or voiding sufficiently
Slide 37 - Central Lines & Nursing Responsibility
Slide 38 - IDENTIFYING CVL INFECTION INSPECT SITE LOOK FOR: REDNESS SWELLING DRAINAGE INCREASED PAIN/TENDERNESS
Slide 39 - CLASSMATE RULE Wash hands or use hand gel Gentle play Avoid close interaction if they don’t feel well Treat the child like they always have
Slide 40 - SUPPORTING THE CHILD Encourage relaxed environment Wear a hat Take naps (leave class) Drink fluids Trips to rest room Snacks Indoors all times Changes rooms alone
Slide 41 - SCHOOL AND EMOTIONS May be hard to return Body changes and appearance Visits from staff can reduce fears May need special care Education support
Slide 42 - EMOTIONAL SUPPORT Children need to have a normal routine Feel hopeful and good about future Talk to classmates Changes in the child with cancer Myths about cancer
Slide 43 - Encourage talking and provide support They may need an emotional break Treat them like others….NORMAL
Slide 44 - SUMMARY Children and adolescents with cancer are at risk for serious acute effects…including emotional turmoil Children and adolescents with cancer may attend school when feeling well and physician approved They need normalcy in a safe and healthy environment
Slide 45 - QUESTIONS
Slide 46 - Resources www.curesearch.org www.lls.org www.beyondthecure.org www.pbtfus.org
Slide 47 - References Association of Pediatric Hematology/Oncology Nurses. (2003). Foundations of Pediatric Hematology/Oncology Nursing: A Comprehensive Orientation and Review Course. Association of Pediatric Hematology/Oncology Nurses. (2005). APON/PBMTC’s Foundations of Pediatric Blood and Marrow Transplantation: A Core Curriculum. Kupst, M. J. (2009, October). Cancer Impact on the Child: Putting the Experience into Perspective. Presented at the Association of Pediatric Hematology/Oncology Nurses, Wisconsin. www.childrensoncologygroup.org. Family Handbook for Children with Cancer