Chapter 24: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder

Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder , focusing on cellular regulation in children, details the essential nursing care required for pediatric hematologic and neoplastic disorders, contrasting childhood cancers, which primarily arise from primitive embryonal tissues like the mesoderm, with adult epithelial carcinomas. It emphasizes the process of blood cell formation from multipotent stem cells, regulated by factors like erythropoietin (EPO) and thrombopoietin (TPO). Core treatments for pediatric cancer include chemotherapy, leveraging cell cycle-specific and nonspecific agents, radiation therapy, and Hematopoietic Stem Cell Transplantation (HSCT), necessitating careful monitoring for adverse effects like myelosuppression, oral mucositis, and psychosocial distress. Essential diagnostic tools include the complete blood count (CBC) with differential, evaluating indices like mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC), alongside advanced imaging (CT, MRI) and procedures such as bone marrow aspiration and lumbar puncture. Major anemias covered include iron-deficiency anemia (common in infancy/adolescence, treated with iron supplements and PRBCs), lead poisoning (requiring chelation therapy), and inherited conditions like Sickle Cell Disease (SCD) and β-thalassemia major (Cooley anemia). Management of SCD centers on preventing vaso-occlusive crises through adequate hydration, pain management (avoiding meperidine), and infection prophylaxis (penicillin and vaccines). Thalassemia requires chronic PRBC transfusions and rigorous iron chelation to prevent hemosiderosis. Clotting disorders like X-linked recessive Hemophilia A (Factor VIII deficiency) and von Willebrand Disease (vWD) are managed primarily by preventing injury and administering factor replacement or desmopressin. Nursing care for children with specific malignancies—including Acute Lymphoblastic Leukemia (ALL), the most common type, lymphomas (Hodgkin/NHL), brain tumors, neuroblastoma, sarcomas, and Wilms tumor—focuses heavily on managing treatment toxicities, pain control, and psychosocial support. Crucial safety interventions include avoiding abdominal palpation preoperatively in Wilms tumor due to vascularity, and immediate administration of broad-spectrum antibiotics for the neutropenic child with fever. The chapter also highlights oncologic emergencies (e.g., tumor lysis syndrome, sepsis) and the importance of age-appropriate screening for reproductive cancers in adolescents.