Brain Cancer/oncologic emergencies Flashcards
What are the 4 pathophysiological processes of brain cancer?
- Direct Brain injury
- Cerebral Edema
- Hydrocephalus
- Increased intracranial pressure
Define cerebral edema as it relates to cancer. What are the associated symptoms?
compression of normal brain tissues from swelling around the tumor
- decreased LOC
- pupillary changes
- posturing
- irregular breathing
- coma
- death
What is hydrocephalus?
build up of fluid in the brain due to blockage of the cerebral spinal fluid from tumor growth and edema
- headache
- loss of memory
- loss of balance
- confusion
- urinary incontinence
What is a cardiac tamponade?
fluid buildup in the pericardial sac, meaning that cardiac output is compromised.
Your patient is exhibiting signs and symptoms of cardiac tamponade. What might you be observing? What is your priority action?
significant shortness of breath, increased HR, chest pain, changes in HR and rhythm, low BP, anxiety, fatigue, diaphoretic, cold extremities, dizzy, weak,
***dopamine, diuretics, oxygen, chemo/radiation depending on underlying cause
Your patient suddenly starts to complain of a “banding pain” around his abdomen. What complication are you suspicious of with this complaint? What other symptoms would you expect?
Spinal cord compression
- numbness/tingling in extremities, bladder spasm/dysfunction, Relieved by sitting/standing, which is different from disk disease
- **treat as unstable fracture, MRI/CT, at LEAST 16mg dexamethasone, manage pain, catheter (don’t move the patient), radiation
What is Superior Vena Cava Syndrome?
compression of the vena cava as a result of tumor growth or swelling related to radiation treatment.
What are some signs and symptoms of Superior Vena Cava Syndrome?
buldging eyes, congestion in the head, neck, shoulders, increased JVP, tachycardic, shortness of breath, increased RR, hypotension, headache, disturbed vision, chest pain
What is the priority treatment in response to a patient with SVCS?
reduce size of whatever is causing the obstruction in the first place (radiation), anticoagulation therapy, steroids, TPA,
In reviewing your patient’s labwork in the morning, you notice severe hypercalcemia. What are some reasons for this?
-bone cancer, as it causes bone breakdown, causing increased amounts of calcium to leak into the bloodstream. This can also be caused by brain, thyroid and lung cancer r/t paraneoplastic syndrome and hormone release.
What are some signs and symptoms of hypercalcemia? What is the common treatment for this?
muscle twitching, nausea,
-rehydration, bisphosphonates (help draw calcium out of the blood vessels back into the bones),
What is SIADH? How may this patient present?
syndrome of inappropriate ADH
- when tumors start to stimulate the release of ADH inappropriately, causing increased water retention and subsequent LOW sodium.
- anorexia, cognitive deficits, muscle cramps, lethargy, tremors
How do you treat a patient with SIADH?
fluid restrictions, find and treat the underlying cause
What is tumor lysis syndrome?
when high burden tumors are treated, and the tumor disintegrates rapidly and the tumor products that remain in the bloodstream accumulate in the kidneys
What would you find in the labs of your patient with tumor Lysis Syndrome?
increased uric acid, alterations in kidney values (GFR, creatinine, BUN), hyperkalemia, hyperphosphatemia, hypocalcemia,
How do you treat a patient who has tumor lysis syndrome?
PREVENTION IS KEY
- pre-hydrate to promote and protect kidney function
- allopurinol to reduce uric acid
What is disseminated intravascular coagulation?
When proteins that form blood clots become overactive throughout the body, causing increased production of clots. These clots can either clog up vessels and cut off blood supply to vital organs, or they could be consumed by the body, causing a hugely increased risk of bleeding.
What are the signs and symptoms of DIC?
*PREVENTION IS KEY- leukemia patients are at high risk d/t their disease process, rule out signs and symptoms of sepsis (fever, tachycardia/hypotension, increased RR, cold, clammy), low platelets, prolonged PTT
How is DIC treated?
treat cause, anticoagulation, PRBCs, *Prostate cancer patients.
Why is the traditional TNM system not effective for staging brain tumors?
because brain cancer tends to spread to other areas of the brain and not to lymph nodes or other parts of the body
Your patient has been prescribed Mannitol for treatment of her brain cancer. How does this medication work? What do you want to be sure to monitor with this medication?
decreases cerebral edema by increasing plasma osmolarity and drawing extracellular fluid back into the plasma where it can be excreted by kidneys
KIDNEY FUNCTION, because this medication depends on a certain level of kidney function in order to be effective
How does furosemide work in the treatment of increased ICP? What should you monitor for when your patient is on this medication?
decrease CSF production and enhance excretion of sodium and water from the brain
- S&S of electrolyte imbalances, dysrhythmias
What is the role of hyperventilation in the treatment of increased intracranial pressure?
-reduces CO2, which induces cerebral vasoconstriction and reduces cerebral vasculature volume, which in turn reduces IICP.
What is the monroe-kellie hypothesis?
believes that cranial contents are maintained in a dynamic equilibrium, meaning that an increase in the volume of any one component must cause a decrease in volume of the other two
