Nursing Actions

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Cancer care is complex. The below table summarizes a small subset of the necessary nursing actions that would be required of an RN treating a child with cancer. A very helpful NCLEX review, and much more in-depth and detailed list of nursing interventions for pediatric cancer care can be found at: http://www.atitesting.com/ati_next_gen/focusedreview/data/datacontext/rm_ncc_pn_8_chp_38.pdf

Nursing Care	Reasoning
Monitor vital signs	It is important to monitor vital signs in children who are undergoing cancer treatment to assess for infection. Due to the side effects of chemotherapy, the body is at significantly higher risk for infection. Due to decreased immune system function, infections need to be treated immediately.
Daily blood draw	It is essential to monitor the blood work of children undergoing chemotherapy. A common side effect of chemotherapy is low blood counts (low platelets, hematocrit, neutrophils, etc.). Daily blood work will indicate when a blood transfusion is necessary, as well as screen for infection.
Control chemotherapy induced nausea/ vomiting	It is essential to manage the GI symptoms of chemotherapy. It is important to pre-medicate children with antiemetic medications prior to chemotherapy administration.
Assess nutritional status	Due to the GI side effects of chemotherapy, nutritional status needs to be continually assessed. It is important to encourage frequent, small meals, avoid strong odors, and provide tube feeding when deemed necessary.
Control pain	Pain management is extremely important in treatment of cancer. Pain should be assessed frequently both post-op and throughout chemotherapy treatment.
Implement bowel regimen	Constipation is a common side effect of pain management. It is important to assess output, and implement a bowel regimen if indicated. Untreated constipation can cause discomfort and obstruction.
Provide oral care	Ulceration of mucus membranes is a common side effect of chemotherapy.  Providing high quality and regular oral care will decrease the risk oral ulceration. This is especially important as ulceration creates a risk for infection which can be detrimental in immune-compromised patients.
Provide patient and family education	It is important to educate the patient and family in order to create a realistic and clear understanding of the situation. Education should include – disease process, duration of treatment, expected side effects, plan of care, and rationale for procedures and interventions.
Assess patient and family coping skills	Cancer treatment is stressful for both the patient, as well as the family. It is important to assess coping skills, and provide resources when necessary.
Involve other disciplines in care	Cancer treatment requires a multidisciplinary approach. Involve other disciplines such as spiritual care, social work, nutrition, and respiratory therapy to have the best outcome of care.

Sources:

NURSING CARE OF CHILDREN WITH SySTEM DISORDERS - Pediatric Cancers. (n.d.). Retrieved February 18, 2015, from http://www.atitesting.com/ati_next_gen/focusedreview/data/datacontext/rm_ncc_pn_8_chp_38.pdf

Wilms' Tumor (Nephroblastoma) - RNpedia.com. (2015, January 1). Retrieved February 18, 2015, from http://www.rnpedia.com/home/notes/medical-surgical-nursing-notes/wilms-tumor-nephroblastoma