Cancer Flashcards
Pre Op for CA
dx, surg for CA? location mets n/v pain-how control, with what airway meds
lung CA concern
oxygenation
Breast CA concern
anxiety, IV/BP placement
GI/Liver CA concern
metabolic, elyte, fluid changes
dec Albumin=edema
BP issues and free drug
Brains CA concern
HA, sz
don’t use drugs that lower sz threshold
Throat/Thyroid CA concerns
swallowing and airway
surgery invasive: minimally, moderately, highly
min: little tissue trauma, min BL
mod: some disruption of physiology, some BL, may need invasive monitoring, ICU
HIgh: signif disruption of physiology, can require transfusion, ICU admit
Lung CA/procedure
1associated with CAD
2pulm insufficiency after resection- check RA O2sat
3high BL: H&H, T&S, T&C
Bronchial/neck CA
1AIRway mgmt- imagining
2dysphagia, difficulty breathing
3signif BL
4lack of access to airway during case
CA ROS: Heme
anemic-BM suppression for chemo
neutropenia, thrombocytopenia
Thrombosis: pancreatic CA
**labs: CBC
CA ROA: Pulm
pulm edema, CHF, pleural effusion, pneumonitis
Squamous cell: hyperca
Adenocarcinoma: hypercoagulable, osteoarthistis
Large cell: gynecomastic
Small cell: inappropriate ADH, eptopic corticotropic, Eaton-Lambers syndrome (muscle weakness)
CA ROS: Neuromuscular
peripheral neuropathy
SC compression
Eaton-Lambers syndrome- muscle weakness like myasthenia gravis
CA ROS: Anorexia/wt loss
DONT turn off hyperalimentation, if do of hypoglycemic
CA ROS: Elyte
hyperca due to bone mets
Na and K changes due to N/V
CA ROS: adrenal insufficiency
tumor or from corticosteroids
CA ROS: cardiac
pericardium
mediastinum
1malignant of paricardium(rare): electric alternans, paroxysmal A fibs, pericardial tampande(most common with Lung CA, dont dec BP)
2SVC compression: if mets spread to mediastinum= get venous engorgement above waist, dyspnea, airway obstruction
3drug induced cardiomyopathy
Drug induced Cardiomyopathy
impairment of LV function even 3 yrs after dc
**Doxorubicin and Daunorubicin: dose related
CHF, acute cardiomyopathy-ranging in severity
*Enhances myocardial depression of anesthetics
*use drug least cardio-depressive
CA Pulm tox
1Methotrexate: pulm edema, infiltrates, effusions
- Bleomycin: endothelial damage looks like pna, pulm fibrosis, Inc A-a gradient,
* *induced hypERoxic pulm injury give ONLY
5-fluorouacil
immunosuppression, leukopenia
Cyclophosphamide
with high doses: ENCEPHALOPATHY, acute delirium
Methrotrexate
with high doses: ENCEPHALOPATHY
reversible but prolonged use–dementia
Cisplatin
RENAL toxic, dose limiting effect
*avoid other drugs that could cause renal damage
it will: Dec GFR in 3-5days, cause ARF- may need dialysis
*give hydration and mannitol to protect agains advancement of renal tox
ALSO: dose dependent dorsal root gangli-large fiber neuropathy
Vinca Alkaloids (Vincristine)
peripheral neuropathy, sensory/motor
Autonomic neuropathy-usually reversible, dizziness, BP problems
Alkylating agents: Cytoxan
plasma cholinesterase inhibition…which is what reverse succ
*not endogenous reversal of such–prolonged duration
CA Pulm complications MEDs
Bleomycin, Busulfan, BCNU pneumonitis, fibrosis s/s cough, dyspnea, basilar rales tx: corticosteroids ***AVOID high FiO2 and use Colloids
Cardiac complications
Doxorubicin (Adriamycin), Danuorubicin
ECG disturbances: SVT
initial symptoms suggest URI–leads to CHF
CA Tx N/V
metoclopromide, droperidol, Aofran
*have high anxiety related to N/V concerns
Control N/V
CA Pain mgmt
Visual analogue scale (VAS)
what works for them
have tolerance high dose–until pain control
nerve block- neurolysis
Radiation
in neck—airway concern
can cause fibrosis: limited ROM, cardiomyopathy
Cystitis
CA Labs/test: use judgment
Hct Plt WBC LFT PT Chem7-elytes, BUN/Cr BGL ABG CXR, ECG
CA CXR
tracheal deviation mass aortic aneurysm fx pulm edema PNA atelectasis
CA ECG
afib, aflutter, heart blocks, ST changes,
recent PE, LVH
CA Airway
dyphagia, difficulty breathing
tracheal obstruction
colon obstruction—considered full stomach
one-lung vent–need to use double lumen tube
