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Constipation
Constipation is the delay or difficulty in the passage of stools. Generally a delay of more than
two days from usual bowel habits is considered constipation, and constipation is frequently
accompanied by bloating and abdominal discomfort. Certain medications used in cancer
treatment cause constipation.
Things to Do
Encourage generous fluids. To increase fluid intake, take small sips of clear liquids throughout the day and add popsicles and gelatin as alternate sources of fluids. Drink warm or hot fluids, including water thirty minutes prior to the time of your usual bowel movement. Increase intake of high-fiber foods, which can help move food through the digestive tract. These foods include raw fruits and vegetables, dried fruits, high-fiber cereals, beans and whole grain breads. Increase exercise and activity as tolerated. Take laxatives as directed by your healthcare team. Do not take laxatives without consulting your healthcare team. Contact your doctor if there is no bowel movement for more than three days from your usual schedule.
Things to Avoid
Mucositis/Mouth sores
Mucositis is the irritation of the mouth and intestinal tract and can be a side effect of certain
cancer medicines. Sores in the mouth can be very painful and can interfere with eating.
Things to Do
Drink a lot of fluids to support adequate salivation. Swish mouth with ½ teaspoon salt and 1 teaspoon of baking soda added to 8 oz of water. Keep mouth and teeth clean with a soft-bristle toothbrush or gauze. Take pain medication, as recommended by your healthcare team, prior to eating. Try soft, moist foods that are easy to chew and swallow. Puree cooked foods in a blender if necessary. Serve foods that are cold and high in calories, such as ice cream, smoothies, or shakes. Keep lips moist with chapstick or other moisturizer. Your healthcare team can provide prescriptions for pain relieving rinses that contain lidocaine or other anesthetics. If you have this available, try to use it prior to meals to make eating easier. Contact your healthcare team if you are completely unable to eat due to mouth sores.
Things to Avoid
Avoid spicy or acidic foods, including citric juices or tomatoes. Nausea/Vomiting
Nausea is the feeling of an upset stomach often leading to the urge to vomit. If nausea is
controlled, most likely vomiting will be prevented.
Things to Do
Drink sips of cool, clear liquids, such as diluted juice or flat non-caffeinated soda. Drink throughout the day to stay hydrated. Drink liquids at least an hour before or an hour after mealtimes, instead of with meals. Eat small, frequent meals instead of three large meals. Try bland, dry foods like dry toast, crackers, or cereal, especially if you awake nauseated. Offer high calorie, high-protein snacks throughout the day. Eat slowing while sitting upright. Stay upright for an hour after eating. Chew foods thoroughly. Keep food and beverages chilled or cool. If foods taste “funny,” try rinsing the mouth before eating, using plastic utensils, and eating sour candy, fruits or custards. Apply a cold, moist wash cloth to the back of the neck. Brush teeth with a soft bristled brush, or rinse the mouth after vomiting. Take anti-emetic medications as prescribed to “stay ahead” of nausea. Acupressure wristbands, like the ones used for motion sickness, have shown to help reduce the severity of nausea. Distract yourself or ask someone to help distract you from your nausea. Take slow, deep breaths and stay relaxed. Contact your doctor if nausea persists without control from medications or if you are unable to take medications due to nausea.
Things to Avoid
Avoid foods with strong smells. Cook with the windows open. Avoid spicy, acidic, fatty, greasy or fried foods. Avoid favorite foods during episodes of nausea to prevent permanent dislike of them. Laxative Protocol
If constipation is problem, your doctor may recommend laxatives in addition to fluids and
dietary changes. The goal of your laxative regimen is to have a bowel movement just about
every ______ day(s). If your bowel patterns do not change appropriately with this protocol,
contact your healthcare team for a dosage adjustment.
Children older than 12 years
Day 1 - Take 10 ml Senokot® syrup at bedtime.
Day 2 - If you did not have a bowel movement, take 10 ml Senokot® syrup after breakfast and
10 ml Senokot® syrup tablets in the evening.
Day 3 - If you did not have a bowel movement, take 15 ml Senokot® syrup after breakfast and
15 ml Senokot® syrup in the evening.
Children 6-12 years
Day 1 - Take 5 ml Senokot® syrup at bedtime.
Day 2 - If you did not have a bowel movement, take 5 ml Senokot® syrup after breakfast and 5
ml Senokot® syrup tablets in the evening.
Day 3 - If you did not have a bowel movement, take 7.5 ml Senokot® syrup after breakfast and
7.5 ml Senokot® syrup in the evening.
Children 2-5 years
Day 1 - Take 2.5 ml Senokot® syrup at bedtime.
Day 2 - If you did not have a bowel movement, take 2.5 ml Senokot® syrup after breakfast and
2.5 ml Senokot® syrup tablets in the evening.
Day 3 - If you did not have a bowel movement, take 3.75 ml Senokot® syrup after breakfast and
3.75 ml Senokot® syrup in the evening.
Once you start having bowel movements, continue to use the dosing directions from the day
prior to the bowel movement as part of your daily schedule. For example, if you had a bowel
movement on Day 3, use Day 2 as your daily laxative dose.
If you are unsure about what to do, please call your healthcare team for advice.
Hydration for Cytoxan®
As part of your treatment, you will be receiving cyclophosphamide, a chemotherapy drug, also
called Cytoxan®. Cyclophosphamide can be damaging to the bladder. To prevent this, it is
given with large amounts of intravenous fluids and oral fluids. It is important to drink much
more fluid than usual prior to and after receiving cyclophosphamide, to better protect your
bladder. Participating in your care by taking in fluids orally can reduce the amount of
intravenous fluids you will need prior to cyclophosphamide administration.
Children 90 pounds or more
• Need about 64 ounces of fluid per day. • The day before your cyclophosphamide infusion, you should drink one and half times your usual requirements, or twelve-8 oz glasses of fluid. • The day of your cyclophosphamide infusion, you need to get another 96 ounces of fluid, but some of this will be given to you through your IV. The rest needs to be taken orally. • The day after your cyclophosphamide infusion, you should go back to drinking 64 ounces of
Children 40 – 90 pounds
• Need about 48 ounces of fluid per day. • The day before your cyclophosphamide infusion, you should drink one and half times your usual requirements, or nine-8 oz glasses of fluid. • The day of your cyclophosphamide infusion, you need to get another 72 ounces of fluid, but some of this will be given to you through your IV. The rest needs to be taken orally. • The day after your cyclophosphamide infusion, you should go back to drinking 48 ounces of
Children 20 pounds
• Need about 30 ounces of fluid per day. • The day before your cyclophosphamide infusion, you should get about 45 ounces of fluid. • The day of your cyclophosphamide infusion, you need to get another 45 ounces of fluid, but some of this will be given to you through your IV. The rest needs to be taken orally. • The day after your cyclophosphamide infusion, you should go back to drinking 30 ounces of • Water, juice and clear liquids are good choices. • Caffeinated beverages, such as coffee, tea, or cola are not particularly good sources of fluid. • Fill a jug or pitcher with the total amount of fluid that you need for the day and try to drink some every 30 minutes or so. This will make it easier to get a steady amount of fluid throughout the day and to track your progress. Hydration for Platinol®
As part of your treatment, you will be receiving cisplatin, a chemotherapy drug, also called
Platinol®. Cisplatin can be damaging to the kidneys. To prevent this, it is given with large
amounts of intravenous fluids and oral fluids. It is important to drink much more fluid than usual
prior to and after receiving cisplatin, to better protect your kidneys.
Children 90 pounds or more
• Need about 64 ounces of fluid per day. • The day before your cisplatin infusion, you should drink one and half times your usual requirements, or twelve-8 oz glasses of fluid. • The day of your cisplatin infusion, you need to get another 96 ounces of fluid, but some of this will be given to you through your IV. The rest needs to be taken orally. • The day after your cisplatin infusion, you should go back to drinking 64 ounces of fluid per
Children 40 – 90 pounds
• Need about 48 ounces of fluid per day. • The day before your cisplatin infusion, you should drink one and half times your usual requirements, or nine-8 oz glasses of fluid. • The day of your cisplatin infusion, you need to get another 72 ounces of fluid, but some of this will be given to you through your IV. The rest needs to be taken orally. • The day after your cisplatin infusion, you should go back to drinking 48 ounces of fluid per
Children 20 pounds
• Need about 30 ounces of fluid per day. • The day before your cisplatin infusion, you should get about 45 ounces of fluid. • The day of your cisplatin infusion, you need to get another 45 ounces of fluid, but some of this will be given to you through your IV. The rest needs to be taken orally. • The day after your cisplatin infusion, you should go back to drinking 30 ounces of fluid per • Water, juice and clear liquids are good choices. • Caffeinated beverages, such as coffee, tea, or cola are not particularly good sources of fluid. • Fill a jug or pitcher with the total amount of fluid that you need for the day and try to drink some every 30 minutes or so. This will make it easier to get a steady amount of fluid throughout the day and to track your progress. Home Input and Output Record
You will need to keep track of your fluid intake and urine output in order to see if your kidneys are functioning the way they should. Use the chart below to record this information. Call the healthcare team if you urine output is less than ________________. Date Started __________________ Cancer Medications: Safe Handling at Home
These guidelines are to help you handle cancer medications and body waste (bowel movements,
urine, vomit, body fluids or drainage) from people receiving cancer treatments. They should be
followed for the first 48 hours after cancer treatment is given. Safety is important because the
skin can be harmed or irritated if there is direct contact with the medicine or the medicine that is
excreted in bodily waste.
Handling Cancer Medications (chemotherapy)
• Wear household gloves (like dishwashing gloves) when touching cancer medications, • After handing medications, wash your hands with gloves on. • Remove gloves and wash your hands again. • Store the gloves separately from other items. • Avoid splashing when throwing out or emptying medications. • Store medications in a safe place and away from other, especially small children.
Handling Medical Equipment
• Never put a cap back onto a needle. You may stick yourself. • Place used needles into a “sharps” container or some other puncture proof container such as a coffee can with a lid sealed with tape and a hole cut into the top of the lid. • Place IV bags and tubing in a leak proof plastic trash bag, and put this bag inside another bag. • Follow your community’s regulations regarding disposal. Your home care nurse should be
Handling Body Waste
• Wear household gloves when emptying urinals or changing diapers. Afterwards, wash your hands with gloves on, then remove gloves and wash your hands again. • Empty containers of body waste (urinals, vomit pans, bedpans) into the toilet. Empty the contents close to the water to avoid splashing. Flush the toilet twice with the lid down. • Clean the toilet bowl in the usual manner. Clean up splashes with soap and water. • Clean body waste containers with soap and water and rinse well. • Use disposable diapers.
• Boys should urinate sitting down to avoid slashing of urine.
Handling Trash
• Wear household gloves to throw away trash that includes cancer medicines or contaminated • Place this waste in leak proof bags and double-bag.
• Wash your hands with gloves one. Then remove the gloves and wash your hands again.
Handling Laundry
• Clothes that become soiled with cancer medicine or contaminated body waste should be • Wash soiled laundry right away. If it cannot be washed right away, place it in a plastic bag • Wash soiled laundry twice, separately from other household items. Use normal detergent and • Wash your hands with the gloves on. Then remove the gloves and wash your hands again.

Handling Spills
• Handle spills of cancer medicines or body waste with household gloves on. • Soak up the spill with paper towels. • Clean the spill area with soap and water using paper towels and rinse well. • Follow guidelines of handling trash.
• Wash your hands with the gloves on. Then remove the gloves and wash your hands again.

Skin and Eye Contact
If you skin comes in direct contact with cancer medicine, wash your skin with soap and water for
five minutes. Call your healthcare team if skin stays red for more than one hour or if it becomes
irritated.
If your eyes come in direct contact with cancer medicine, flush your eye with water for five
minutes and call your healthcare team right away.

Helping the Infant (birth to 12 months) Cope with Treatment
Infants rely on adults, especially their parents/caregivers, to meet their basic needs, such as food,
comfort, safety, and interaction. They learn through their senses about their environment and
learn to trust when their cries are responded to. They respond to the new people and the new
environment around them, be it the hospital or clinic, but they have no concept of their illness or
its implications.
Issues
• Sense of safety
Behaviors
• Irritability
• Changes in sleep patterns
Coping
• Be with your infant as much as possible. • If you can’t be there, leave a shirt with your smell on it. • Rock or hold your infant when you are in the hospital. • Keep a familiar blanket and toys in the crib. • Have familiar people care for your child. • Limit the number of people and amount of activity in the room. • Use gentle touch and massage to comfort your infant. • Play soothing music for your infant. • Talk to and play with your infant as you would if you were at home. • Continue familiar feeding, bedtime, and bathtime routines. Share these routines with the nurses so that they can continue the routine in the same manner if you are not there. • Participate with the healthcare team in their care. • Ask that procedures be done in the treatment room. • Wake your infant before a painful procedure. • Understand that regression is a likely part of treatment. Helping the Toddler (12 months to 3 years) Cope with Treatment
Toddlers are beginning to want to do more on their own. Part of their development is the need to
do things by themselves to promote a sense of control. When they lose control over things in
their lives it can send them into a tailspin. They show how they feel through their actions
because they do not have the words to express their feelings. They don’t understand how the
body works. Toddlers tend to think that they make things happen and can create their own ideas
about why they are sick, (because I was bad).
Issues
• Fear of being hurt (Medical Treatment: tests, medicines, procedures, etc.)
Behaviors
Protest: crying, clinging fighting Despair: quiet, passive, inactive Detachment: indifference • Changes in sleep patterns
Coping
• Be with your toddler as much as possible. • If you must leave, tell your toddler where you are going and when you will be back. Because they do not understand time, say “I’ll be back after lunch.” • Leave something of yours with your toddler, like a shirt or a picture. • Provide security objects like a blanket or stuffed animal. • Have familiar people care for your child. • Continue familiar feeding, bedtime, and bathtime routines, and share them with nurses. • Offer choices when possible, i.e. “Do you want grape or apple juice with your pill?” • Do not offer choices when no choice exists, i.e. “Are you ready for your medicine?” • Give your toddler a job to do, i.e. “Hold this band-aid for me.” • Ask that procedures be done in the treatment room. • Explain procedures right, using simple words, right before they are done. • Assure your toddler that he/she did nothing wrong. • Praise your toddler frequently when he/she cooperates with procedures or exams. • Allow your toddler to express anger or other feelings safely (blocks, Play-Doh, painting.) • Tell your toddler it is alright to feel mad or sad. • Spend time with your toddler and offer reassurance. • Set limits and discipline when necessary. • Understand that regression is a likely part of treatment. Helping the Preschooler (3 years to 5 years) Cope with Treatment
Preschoolers are trying to do things on their own and take pride in doing so. They are better at
using words to tell you what they feel, but also express themselves through play. Preschoolers,
like toddlers, make up reasons for the things that happen to them (I got sick because I was bad).
They may see the hospital as punishment for something they did wrong. They often get
confused by adult words and can mistake a reference to a CAT scan as something to do with a
cat.
Issues
• Fear of pain or injury (Medical Treatment: tests, medicines, procedures, and equipment.)
• Lack of understanding of terminology and procedures
Behaviors
• Behavior changes: passivity, withdrawal, loss of appetite • Developmental regression, including bedwetting • Changes in sleep patterns, nightmares • Magical thinking (This happened because I didn’t listen to my mother.)
Coping
• Allow your child time to adjust to new changes. • Offer choices when possible, i.e. “Do you want grape or apple juice with your pill?” • Do not offer choices when no choice exists, i.e. “Are you ready for your medicine?” • Give your toddler a job to do, i.e. “Hold this band-aid for me.” • Ask that procedures be done in the treatment room. • Explain procedures right, using simple words, pictures or books. Try not to use language that may confuse them, i.e. “you will get a stick in the arm” conjures the image of a twig. • Explain procedures a little bit ahead of treatment. • Assure your toddler that he/she did nothing wrong. • Allow your toddler to express feelings through play, with dolls and toy medical supplies. • Keep equipment out of view, and cover wounds or catheters when possible. • Spend time with your child and offer reassurance. • Continue to encourage independent dressing, feeding, etc. and praise for these behaviors. • Understand that regression is a likely part of treatment. Helping the School Age Child (6 to 12 years) Cope with Treatment
School age children take pride in their independence. They love school and learning new things,
and their friends are an important part of their lives. School age children understand cause and
effect, and how their bodies work. They have the words to describe their bodies, thoughts and
feelings, but may still be confused by medical words.
Issues
• Fear of pain and injury • Fear of the unknown • Worry about falling behind in school • Guilt • Worry about body image changes
Behaviors
• Boredom, withdrawal • Acting out, aggression • Changes in sleep patterns
• Self-blame, lowered self-esteem
Coping
• Offer choices whenever possible, “What would you like for dinner?” • Do not offer choices when no choice exists, i.e. “Are you ready for your shot?” • Give your child a job to do. • Ask that procedures be done in the treatment room. • Let your child practice things that are new, even if they are scary. • Let your child go to school whenever possible. • When school is not possible, encourage your child to do schoolwork and activities. • Provide games, play and activities to occupy time in the hospital. • Have school friends call on the telephone or send cards or letters. • Encourage school friends to visit whenever you child feels well enough. • Explain procedures using simple words, pictures or books. • Explain procedures a couple of days ahead of treatment, when possible them to prepare. • Explain the purpose of medical equipment, and let them examine it when possible. • Remind your child that the illness is not his/her fault. • Be honest. • Offer comfort after traumatic procedures. • Give permission to cry and express pain. Helping the Adolescent (13 to 18 years) Cope with Treatment
Adolescents see themselves as independent individuals, striving to separate themselves from the
adults around them. Their peers are of the utmost importance to them. They want to be like
their friends and are very concerned with how they are viewed by their peers. Illness and
treatment differentiates adolescents from their peers when they want so badly to just be the same
as them. They are able to see cause and effect, and have the ability to see things from many
different points of view.
Issues
• Body image changes • Loss of privacy • Concern for the future
• Worry about falling behind in school
Behaviors
• Anger, aggression, demanding behavior • Frustration • Depression, withdrawal • Social isolation
Coping
• Listen to your adolescent, but don’t judge or criticize. • Give your teen chances to talk about physical and emotional changes. • Tell your teen feelings, guilt, anger, fear, sadness, are normal. • Offer opportunities for your teen to express feelings through talking or writing. • Answer questions openly and honestly, but simply. Your teen will ask if he or she desires • Involve your teen is the treatment plan and in discussions with the treatment team. • Allow your teen to make choices whenever possible. • Be sincere and respectful of the adolescent’s feelings. • Allow your teen to do things that makes him or her feel good about himself or herself. • Provide your teen with a phone if possible. • Allow privacy for phone calls, bathroom, procedures, or whenever he or she wants it. • Encourage friends to call or visit and allow for privacy during their visits. • Encourage your teen to continue to go to school and participate in school activities. • Encourage your teen to keep up with school work when attending school is not possible. • Promote hopefulness by sharing success stories of other teens and survivors. • Encourage your teen to seek support from other teens who are ill and understand what they Helping the Sibling Cope During Treatment of the Sick Child
Taking care of a sick child disrupts family dynamics, as parents’ time and energies are divided.
Parents must spend much of their time at the hospital with the ill child, and when they are at
home, parents may be tired, worried, and troubled. Siblings may be overlooked, and frequently
develop fears and anxieties as their questions go unanswered. There are three categories of
support you can offer the siblings of your child that could help in meeting their needs:
Emotional support means providing empathy, encouragement, understanding, care and trust.
• Be available for the sibling to share problems, concerns, and feelings. • Provide someone else to be emotionally available for the sibling when you cannot be there. • Spend time with the siblings of the sick child. • Notice the siblings’ good behaviors.
Instrumental support refers to providing direct care, financial support, and helping with daily
activities.
• Make arrangements for transportation to and from school and activities.
• Find someone to help with homework and school projects.
• Request and/or accept financial help when it is needed/offered. • Allow opportunities for the sibling to attend support groups.
• Help the sibling talk to the physicians, nurses and hospital staff if he or she desires.
Informational support means helping them better understand the situation.
• Help the child to ask questions and talk about feelings.
• Assess for and correct misconceptions, false information, and fears. • Make information available to the child. Provide more information as the child learns more • Allow the sibling to visit their brother or sister in the hospital. • Allow the sibling to help in the brother or sister’s care. • If the sibling is old enough to understand, include him or her in family conferences with the • Teach the sibling about things that might happen to the sick child. • Help the sibling to understand that he or she did not cause brother or sister’s illness. • Help the sibling to understand that he or she cannot “catch” brother or sister’s illness.

Source: http://www2.raritanval.edu/notabene/2007/written/ferguson.pdf