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Terms in this set (23)
Malignant tumor of the eye involving the retina
Unilateral or bilateral
Sporadic (not inherited) or inherited forms
Good prognosis if treated early
During embryonic growth, retinocytes (rapidly growing cells in the eye) undergo maturation to form the retina.
These cells continue to grow uncontrolled due to a genetic mutation, forming a mass of cells or tumor on the retina.
Cells invade the vitreous humor and extend into the subretinal space, causing retinal detachment.
The cells can also extend into the choroid and spread to the orbit.
Additionally, tumor cells can enter the subarachnoid space, spreading to the opposite optic nerve, through the cerebrospinal fluid to the central nervous system, through the blood to the lung, bone, or brain, and through the lymphatic system.
Genetic mutation involving the retinocytes
Inherited form due to autosomal dominance inheritance
Retinoblastoma is the most common primary intraocular cancer that occurs during childhood, affecting approximately 1 in every 15,000 live births each year in the United States and Northern Europe.
It affects boys and girls equally.
It's most common in children younger than age 5.
Most cases are unilateral and diagnosed in children younger than age 2.
Approximately one-fourth of the cases diagnosed are bilateral (always inherited) and are diagnosed at approximately 13 months of age.
The condition is extremely rare in adults.
Secondary cancers, such as osteosarcoma, soft tissue sarcomas, malignant melanoma, leukemia, lymphoma, and brain tumors
Retinal vascular damage
Family history of retinoblastoma
Leukocoria, also called cat's eye reflex (eye with whitewash glow, with a white coloration in the center of the pupil when light is shined on it)
Orbital inflammation and swelling
Diagnostic Test Results-Imaging
Computed tomography, magnetic resonance imaging, or ultrasound of the head and eyes reveals a tumor.
Diagnostic Test Results-Diagnostic Procedures
Lumbar puncture and bone marrow aspiration identify possible metastasis.
Diagnostic Test Results-Other
Ophthalmologic examination under anesthesia reveals evidence of a tumor on the retina.
Radiation therapy (external beam or brachytherapy)
Supplemental feedings if necessary due to effects of treatment
Chemotherapy with such agents as carboplatin and vincristine with or without etoposide
Cyclosporine in combination with chemotherapy regimen
Antiemetics for relief of treatment-related nausea and vomiting
Enucleation with ocular prosthesis
Nursing Considerations-Nursing Diagnoses
Compromised family coping
Disturbed body image
Disturbed sensory perception (visual)
Imbalanced nutrition: Less than body requirements
Risk for impaired attachment
Risk for infection
Risk for injury
Nursing Considerations-Expected Outcomes
verbalize strategies to control anxiety
demonstrate positive coping skills
verbalize positive statements about self and appearance
demonstrate most optimal state of vision possible
verbalize feelings of loss over diagnosis
maintain adequate nutritional intake
demonstrate appropriate interaction behaviors with child (parents)
remain free from signs and symptoms of infection
remain free from signs and symptoms of injury.
Nursing Considerations-Nursing Interventions
Help the patient's family deal with illness and diagnosis; encourage the family to verbalize feelings and assist with working through feelings of guilt and the grief process.
Encourage the use of positive coping strategies and participation in patient care and decision-making.
Role model positive coping strategies and interactions with the child.
Provide small, frequent feedings as appropriate.
Assist with measure to promote vision; keep necessary items within the child's reach as appropriate.
Institute safety precautions as necessary.
Arrange for the child and family to speak with families who have gone through similar experiences.
Prepare the child and family for radiation or chemotherapy.
Assist with measures to control adverse effects of chemotherapy and/or radiation therapy.
Adhere to radiation precautions if the child is receiving radioactive plaques.
Prepare the child and family for surgery, including the use of an eye patch, facial swelling, and the use of a prosthesis.
Coping status and adaptation to diagnosis
Signs and symptoms of infection
Eye dressings or patch
Operative site and facial swelling
Signs and symptoms of infection
Nursing Considerations-Associated Nursing Procedures
Axillary temperature assessment, pediatric
Blood pressure assessment, pediatric
Bone marrow aspiration and biopsy, assisting, pediatric
Cardiopulmonary status monitoring, pediatric
Care plan preparation
Central venous access catheter flushing, pediatric
Central venous access catheter injection cap change, pediatric
Central venous access catheter insertion, assisting, pediatric
Central venous access catheter removal, pediatric
Central venous access device dressing change
Central venous access device, declotting
Chemotherapeutic drug administration, pediatric
Diapering an infant
IV bag preparation
IV catheter removal, pediatric
IV dressing change, pediatric
IV pump use
IV secondary line drug infusion
IV solution change
IV tubing change, pediatric
IV volume-control set preparation
Lumbar puncture, assisting, pediatric
Oral care, child age 3 and older
Oral care, toddler
Oral drug administration, older child
Oral drug administration, toddler
Oral temperature assessment, pediatric
Preoperative care, pediatric
Preparing a patient for ophthalmic surgery, OR
Priming IV tubing
Pulse assessment, pediatric
Pulse oximetry, pediatric
Rectal temperature assessment, pediatric
Respiratory assessment, pediatric
Transfer to another room, pediatric
Weight measurement, child
Wound care, pediatric
disorder, diagnosis, and treatment, including prognosis and risk for metastasis and secondary cancers
that the long-term survival rate is high (93%)
prescribed drugs, including drug name, dosage, rationale for use, route of administration, frequency of administration, and duration of therapy
possible adverse effects of chemotherapy or radiation therapy
importance of interacting and participating in the child's care
use of a prosthesis, including a fitting, usually within 3 weeks after surgery (once edema subsides)
care of the surgical site, including care of the socket and prosthesis, such as cleaning, insertion, and removal
that the ocular prosthesis is created to look exactly like the other eye and that the prosthesis doesn't move as well as the natural eye (moves up and down better than side to side)
nutritional measures, such as supplemental feedings and measures to control nausea and vomiting associated with chemotherapy
signs and symptoms of infection, such as fever and drainage from the operative site
possible genetic testing if the condition is inherited
importance of adhering to follow-up care, including a follow-up ophthalmologic evaluation.
Patient Teaching-Discharge Planning
Refer the parents to genetic counseling, as indicated.
Refer the parents to home health care for follow-up support as appropriate.
Refer the parents to local and national support groups for parents of neonates with retinoblastoma.
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