3 Osteogenic Sarcoma (Osteosarcoma) Nursing Care Plans

Most of your osteosarcoma patients are kids and young adults, and they arrive scared. The disease is aggressive, the treatment is brutal, and the care plan has to cover three fronts at once: the immunosuppression from chemo, the injury risk around an amputated or surgical limb, and the anxiety that comes with losing a limb at 14.

What is Osteogenic Sarcoma?

Osteogenic sarcoma (osteosarcoma) is a primary bone malignancy that usually hits the metaphysis of the long bones: femur, humerus, and tibia. It shows up as dull aching pain and swelling in or around the affected bone or joint. It most commonly occurs between ages 10 and 20 and is more common in males than females.

Treatment combines chemotherapy before and after surgery with either amputation of the limb or, in selected cases, a bone and joint prosthesis to spare the limb. Either way, chemo bookends the surgery.

Nursing Care Plans and Management

Your priorities: prevent injury, protect the oral mucous membranes, manage anxiety, and watch for complications.

Nursing Problem Priorities

• Tumor management. Treat the tumor through surgery, chemotherapy, and radiation.
• Pain management. Control pain from the tumor, the surgery, and the treatment.
• Limb function. Preserve mobility with limb-sparing surgery when it is feasible.
• Metastasis surveillance. Watch for spread, especially to the lungs and other bones.
• Rehabilitation. Run a full rehab program to restore function after surgery.
• Psychological support. Help the patient and family cope with the diagnosis and the treatment.
• Long-term followup. Schedule regular visits, imaging, and labs to catch recurrence and manage late effects.

Nursing Assessment

Assessment cues are listed under each intervention section below.

Nursing Diagnosis

Form the nursing diagnosis from your assessment and clinical judgment. Use the labels that fit the patient in front of you.

Nursing Goals

• The child will not have a bleeding episode.
• The child's temperature will stay below 100°F.
• The child's breath sounds will be clear bilaterally.
• The child's oral mucous membranes will stay intact and irritation-free.
• The child will demonstrate proper oral hygiene by discharge.
• The child will stay injury-free, with a clean, dry stump free of redness, odor, or drainage.

Nursing Interventions and Actions

1. Preventing Infections

Antineoplastic drugs suppress the marrow, so your patient is neutropenic and bleeds easily. Chemo and radiation also break down the oral mucosa, which leads to mucositis, ulcers, and pain that makes eating, drinking, and oral care miserable. Both problems threaten the patient at the same time.

Monitor for bleeding and febrile episodes. Track WBC, platelet count, Hct, and absolute neutrophil count. These reveal bleeding and the marrow suppression and immunosuppression driving it.

Assess the oral cavity for burning pain, erythema, ulcerations, and trouble eating or drinking. Shows the effect of chemo on the mucosa.

Keep the child away from anyone with an upper respiratory infection or any other illness. A neutropenic child catches infections easily.

Avoid contact play and sports, straining at stool, and forceful nose-blowing. Each can trigger bleeding.

Tell parents to call the provider for fever, behavior changes, headache, dizziness, fatigue, pallor, bleeding, or any exposure to a communicable disease. These signal a complication of the abnormal blood profile.

Wash hands before care, use a mask and gown when appropriate, provide a private room, and watch for signs of infection. Protects a compromised immune system, especially when the neutrophil count is below 1,000/cu mm.

Avoid hard toothbrushes, rectal temperatures, and unnecessary invasive procedures. Chemo alters platelets and clotting factors, so any of these can start a bleed.

Show parents how to check urine and stool for blood with dipstick and hematest. Detects GI or urinary tract bleeding.

Let the child pick foods from an approved list. Gives them control and supports nutrition.

Have the child do oral care with a soft-bristle toothbrush or sponge-tipped swab. Cleans without tearing the mucosa.

Push foods high in protein and vitamins. Supports wound healing and recovery.

Offer sugarless candy or gum every 2 hours. Stimulates saliva and prevents dry mouth.

Give an antiseptic mouth rinse 30 minutes before meals. Comforts the mucosa and keeps it intact.

Apply topical analgesic before meals and offer cool, bland, smooth foods. Prevents trauma and pain while eating.

Teach parents how to do mouth rinses and apply topical medications. Keeps oral care going at home.

Explain how chemo affects the oral mucosa and how it is treated. Sets expectations for the side effects.

2. Preventing Injuries

This patient is at real injury risk from fractures, neuropathy, and muscle weakness, on top of the surgical stump and the bleeding and infection risk from chemo. Falls and stump complications are the things you are guarding against.

Assess the surgery type, stump healing, type of bandaging or cast, drains, and the fit of any prosthetic device. Tells you how to care for the stump and plan rehab.

Check the dressing for bleeding, redness, pain, and drainage at the stump every 2 to 4 hours. Maintain the ordered dressing pressure or wrap, and change the dressing only when ordered. Catches infection or hemorrhage at the amputation site.

Let the child voice the difficulty of sudden lifestyle changes and permanent disability. Helps them adjust to the change in body image.

Do stump and socket care with mild soap and warm water, rinse, and pat dry. Prevents infection from the prosthetic device.

Do daily range-of-motion exercises as the physical therapist directs. Promotes stump healing and prevents contractures.

Maintain Trendelenburg and prone positioning as ordered. Avoid elevation, external rotation, and abduction of the stump. Prevents the contractures that hip flexion causes.

Teach the child stump positioning and ROM of the muscles and joints. Prevents joint complications and keeps the child mobile.

Teach parents and child stump care, toughening exercises, and how to apply the stocking, prosthesis, and device. Builds proper home care of the stump and prosthesis.

Stress doing daily activities and avoiding unnecessary restrictions. Gets the child back to former activities within the limits of the amputation.

Discuss clothing changes and teach crutch walking and getting around. Supports body image and a return to activity.

Reassure the child that anger, denial, and hostility are normal after this kind of loss. Lets them grieve.

Encourage parents and child to keep up chemotherapy and rehab. Both drive recovery.

3. Reducing Anxiety

The anxiety here comes from an uncertain prognosis, the physical and emotional toll of treatment, the threat of long-term disability, and the financial and social weight on the whole family. Name it and work it.

Assess the parents' and child's anxiety level and how it shows. Identify what information would relieve it. For the child, the triggers are procedures, fear of mutilation or death, and the strange hospital environment, and they show up as restlessness and trouble playing, sleeping, or eating.

Assess whether the child needs special counseling. Supports coping and adjustment to a changed life.

Encourage parents to stay, and leave a phone number for questions. Gives the child emotional comfort.

Communicate at the child's developmental level. Answer questions calmly and honestly, using pictures, models, and drawings. Builds understanding and trust.

Let the child voice concerns about the illness, procedures, treatment, and what surgery means. Venting reduces anxiety.

Give the child structure and a say in their own care and routines. Restores some control.

Assign consistent staff. Familiar faces build trust and comfort.

Orient the child to the surgical unit and ICU, the equipment, the noises, and the staff. Cuts the fear of the unknown.

Teach parents and child the disease process, the surgery, and what to expect before and after, including chemo and its side effects. Nausea, vomiting, diarrhea, stomatitis, alopecia, and phantom pain are all possible and mostly temporary. Understanding them ahead of time relieves fear.

Explain every procedure in simple, direct, honest terms, and repeat as needed. Covers the diagnostic workup, including CBC, platelets, scans, and X-rays.

Tell parents and child exactly how much limb will be removed. A temporary prosthesis is fitted right after surgery, the permanent one in 6 to 8 weeks, and recreational and physical therapy follow. Honest preparation keeps them from feeling betrayed later.

Introduce the child to another patient with the same disease and amputation. Peer support from someone who has been there carries real weight.