Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses
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J Pediatr Oncol Nurs · Jan 2007
Propofol use in pediatric patients with severe cancer pain at the end of life.
This article describes the use and effectiveness of adjuvant propofol for pain control for pediatric oncology patients at the end of life. All patients experienced severe pain and agitation, not well controlled by continuous infusion opioids and benzodiazepines. Upon starting propofol, most patients had a temporary stabilization in the dose of opioids with subjective improvement in pain control, increased alertness, and improved ability to interact. ⋯ One patient developed severe tetany, requiring propofol interruption; propofol was successfully restarted at a lower dose with an adjuvant benzodiazepine. The authors conclude that propofol is a useful and tolerable adjuvant agent for pain management in pediatric oncology patients at the end of life. It is a useful adjuvant if pain is unresponsive to continuous infusion opioids or if rapidly escalating doses of opioids are required.
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J Pediatr Oncol Nurs · Nov 2006
Assessing procedural pain in children with cancer in Beirut, Lebanon.
This study describes the relationship between different indicators of pain, including self-reports, behavioral observations, and physiological measures, in children with cancer undergoing invasive procedures. Forty-five children between the ages of 4 and 10 years were evaluated while undergoing Port-a-Cath access. The study was conducted in the outpatient clinics of the Children's Cancer Center in Beirut, Lebanon. ⋯ Nurses recoded behavioral observations as well as physiological responses to pain. There was a high degree of consistency between the self-reports and moderate to high correlations between self-reports, behavioral parameters, and physiological parameters, suggesting that accurate pain assessments can be made by both nurses and parents. The results also demonstrate adequate validity and reliability of the DOLLS scale in a Lebanese population, in addition to being the preferred assessment tool for all the children in the study.
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Little is known about the long-term impact of surviving childhood cancer. Most children diagnosed with cancer now survive into adulthood due to advances in medical treatment. Although the number of survivors of childhood cancer has increased, a review of the literature revealed a paucity of studies that explores survivorship of childhood cancer from the perspective of the adult survivor. ⋯ The results of this study demonstrate that a childhood cancer experience affects the life of each survivor, which results in specific health care needs. This knowledge is important as the number of survivors increases. Knowledge of their concerns is imperative prior to providing appropriate health care.
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J Pediatr Oncol Nurs · Mar 2006
ReviewMinimizing complications related to fever in the postoperative pediatric oncology patient.
Fever is a common postoperative complication that is generally thought to be a benign, self-limiting event. However, for pediatric oncology patients who are often immunocompromised, a postoperative fever may indicate an infection, which can lead to significant complications if not treated promptly. ⋯ No standardized approach to fever management in postoperative oncology patients currently exists, which can present a challenge for those who care for these patients. In the absence of such established practice standards, this article outlines some of the considerations that may be vital in minimizing complications related to fever in the postoperative pediatric oncology patient.
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J Pediatr Oncol Nurs · Jan 2006
Can end of life care for the pediatric patient suffering with escalating and intractable symptoms be improved?
Over twelve thousand children are diagnosed each year with cancer, and approximately 2200 children die each year from the disease. A percentage of these patients experiences escalating and intractable distress with symptoms that include pain, dyspnea, and agitation. These symptoms may continue for hours to days. ⋯ The purpose of this chart review is to systematically document and compare the record of management of rapidly escalating symptoms of pain and/or dyspnea and/or agitation prior to and after instituting the EOL Rapid Response Model of Care. Care of the EOL patient experiencing symptoms of pain, dyspnea, and agitation is challenging. The EOL Rapid Response Model of Care outlines a process of care and provides recommendations and templated physician orders for rapid titration of opioids.