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NURA-606-01 Advanced Health Assessment > Lecture 2: Preoperative Assessment of the Patient with Cancer AL > Flashcards

Lecture 2: Preoperative Assessment of the Patient with Cancer AL Flashcards

1
Q

TEST BANK ?s

A

TEST BANK ?s

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2
Q

Treatments:

surgery
chemotherapy
radiation therapy

Toxicities and adverse effects that have the potential to affect nearly every ?

A

Treatments:

surgery
chemotherapy
radiation therapy

Toxicities and adverse effects that have the potential to affect nearly every organ system.

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3
Q

Adverse effects: Bleomycin***

A

Pulm. HTN, pulm. fibrosis

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4
Q

Adverse effects: Cisplatin***

A 
Dysrhythmias
mg wasting
mucositis
ototoxicity
p. neuropathy 
SIADH 
renal tubular necrosis 
thromboembolism
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5
Q

Adverse effects: Cyclophosphamide (Cytoxan)***

A 
Encephalopathy/delirium
hemorrhagic cystitis
myelosuppression
pericarditis
pericardial effusion
SIADH
pulm. fibrosis
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6
Q

Adverse effects: Doxorubicin (Adriamycin)***

A

Cardiomyopathy

myelosuppression

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7
Q

Adverse effects: Fluorouracil***

A 
Acute cerebellar ataxia
ischemic and nonischemic EKG changes
Chest pain
gastritis
myelosuppression
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8
Q

Adverse effects: Methotrexate***

A 
Encephalopathy
hepatic dysfunction
mucositis
platelet dysfunction
hypersensitivity pneumonitis
renal failure
myelosuppression
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9
Q

Adverse effects: Tamoxifen***

A

Thromboembolism

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10
Q

Adverse effects: Vincristine***

A 
autonomic dysfunction
myocardial ischemia 
p. neuropathy
bronchospasm
SIADH
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11
Q

Adverse effects: Radiation therapy

**Review Table 28.3, Slide 10!

A

Sinusoidal obstruction syndrome -> severe liver failure

Review Table 28.3, Slide 10!

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12
Q

Preoperative Assessment: History and comorbidities

malignancy in the head or neck ->?

mediastinal masses obstructing great vessels
• dyspnea, dysphagia, stridor, wheezing, coughing→?
• compression of SVC→?

Preop testing: a lot of tests

Anesthestic concerns:

A

Preoperative Assessment: History and comorbidities

malignancy in the head or neck
• airway exam and possible need for tracheostomy
• Recurrent laryngeal n. damage

mediastinal masses obstructing great vessels
• dyspnea, dysphagia, stridor, wheezing, coughing→ recumbent pos.
• compression of SVC→JVD, facial, chest, neck, upper ext edema

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13
Q

Airway Assessment:

A
  • tracheal deviation or compression
  • SOB
  • difficulty breathing (sign of airway obstruction)
  • dysphagia
  • Preop airway assessment, cervical ROM, cervical X-ray, ENT consult
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14
Q

***SVC Comp Syndrome + Tracheal Comp = ?

A

***SVC Comp Syndrome + Tracheal Comp = Superior Mediastinal Syndrome

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15
Q

Airway: radiation to head and neck→ ?

A 
radiation to head and neck→ permanent tissue fibrosis 
• carotid artery ds 
• hypothyroidism 
• difficult ventilation 
• difficult intubation
*May not be recognized on physical exam
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16
Q

Slide 16: just read through

A

Slide 16: just read through

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17
Q

Preoperative Assessment: Functional status
chemo and radiation take a toll on patient
• Assess __________ status→ ________ tolerance

A

Preoperative Assessment: Functional status
chemo and radiation take a toll on patient
• Assess functional status→ exercise tolerance

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18
Q

Preoperative Assessment: Geriatrics
Greater comorbidities, frailty, polypharmacy
• risk of ?
• “Chemobrain” = ?

A

Preoperative Assessment: Geriatrics
Greater comorbidities, frailty, polypharmacy
• risk of delirium
• “Chemobrain”—chemo-induced cognitive dysfunction
- doc preop!

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19
Q 
Preoperative Assessment: Education and prevention 
management of ? 
exercise routine \_\_\_\_ to surgery
• improves ? 
• “prehabilitation” 
• tobacco cessation
A

Preoperative Assessment: Education and prevention
management of comorbidities
exercise routine prior to surgery
• improves surgical recovery and improves overall survivorship
• “prehabilitation”
• tobacco cessation

20
Q

Preoperative Assessment: Previous Cancer treatments
Prior cancer treatment and dates
• long-term _________
• acute _________

A

Preoperative Assessment: Previous Cancer treatments
Prior cancer treatment and dates
• long-term side effects
• acute side effects

21
Q

Preoperative Assessment: CV system
• HR, pulse, and carotid arteries

If bruits are present→___________
• if severe stenosis and large intraop fluid shifts are expected, then ___________ is considered.
• mild stenosis→ _______________ therapy

Significant fatigue and loss of functional status
• echo ordered and results are WNL? ___________
• thoughts? ___________
• Cardiac stress testing might be considered (?)
• Lab________

A 
hold breath x 15 sec
revascularization
pharmacological
does NOT mean no concerns
deconditioning
YES
BNP (HF)
22
Q

Cardiovascular System: Doxorubicin (Adriamycin) ***
• cardiotoxicity may be acute or chronic:

  • radiation (mediastinal)→?
  • periodic ?
A
  • QT prolongation
  • cardiomyopathy
  • dysrhythmias
  • ischemia-related EKG changes
  • HTN (monoclonal antibodies & tyrosine kinase inhibitors) -> Difficult to manage→ ACEIs and CCBs

accelerated CAD, valvular fibrosis, conduction abnormalities

echocardiography

23
Q 
Respiratory System*
• Drug? 
• pulmonary toxicity 
- pneumonia 
- pulmonary fibrosis

Tests?

• avoidance of exposure to intraop high conc of ?**

preop admin of?

A 
Respiratory System*
• Bleomycin 
• pulmonary toxicity 
- pneumonia 
- pulmonary fibrosis
  • baseline and serial pulmonary function testing
  • chest radiography
  • pleural effusion ?

• avoidance of exposure to intraop high conc of O2**

preop corticosteroids

24
Q 
Respiratory
• Pulmonary System 
- Adenocarcinoma (30-50%)→ history of ? 
- Large cell – ? 
- Small cell -\_\_\_\_\_\_\_\_\_\_ weakness? 
- Pain in ?
- Do you have frequent .......?
- Do you have X, Y, Z syndromes?
A

• Pulmonary System

  • Adenocarcinoma (30-50%)→ history of blood clots?
  • Large cell –gynecomastia?
  • Small cell -muscle weakness?
  • Pain in hands, fingers, knees, ankles?
  • Do you have frequent lung infections or pleural effusions?
  • Paraneoplastic syndrome, Eaton Lambert Syndrome, Myasthenia gravis?
25
Q

Review Table 28.4 Slide 26!

A

Review Table 28.4 Slide 26!

26
Q

Renal System

cisplatin*, high-dose methotrexate
• ______ insuff → usually resolves with ________ of tx

cyclophosphamide* 
• \_\_\_\_\_ 
• \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 
• Medication concerns:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 
• Renal labs?

• tumor cell lysis?

A

Renal System

cisplatin*, high-dose methotrexate
• renal insuff → usually resolves with cessation of tx

cyclophosphamide* 
• SIADH 
• inhibit pseudocholinesterase 
• Medication concerns: Mivacurium
• Renal labs: BUN, Cr, GFR

• tumor cell lysis
- radiation & chemo -> increase uric acid, Phos, K

27
Q 
Hematologic System
• \_\_\_\_suppression
• nadir?
• CA produces \_\_\_\_\_\_\_\_\_\_\_\_\_\_ state 
- \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ events are increased six-fold in pts w/CA
A 
Hematologic System
• myelosuppression
• nadir: RBCs, WBCs, Plts
• CA produces hypercoagulable state 
• thromboembolic events are increased six-fold in pts w/CA
28
Q

Hematologic—preoperative questions?

A 
Bruising/bleeding
Clots (Hx)
Transfusions/anemia
Chemo (last)
Prone to infections?
29
Q

Neurological System

• __________—virtually all patients experience paresthesias

  • peripheral neuropathy
  • encephalopathy
  • ______________-induced neuromuscular toxicity (_____________ 60-100mg/day)
  • radiation + methotrexate→?
A

Neurological System

• vincristine—virtually all patients experience paresthesias

  • peripheral neuropathy
  • encephalopathy
  • corticosteroid-induced neuromuscular toxicity (prednisone 60-100mg/day)
  • radiation + methotrexate→ irreversible dementia
30
Q

Neurological—preoperative questions?

A 
Numb/tingling
MS
agents on in the past
Muscle weakness
EL or MG?
31
Q

GI System

Almost all ______ and _______ produce GI SEs: ?

___________, __________, __________
• *nutritional supplementation via enteral or parenteral routes improves surgical outcomes

radiation→ ?
• *? syndrome
• *reactivation of ?

A

GI System

Almost all chemo and radiation produce GI SEs.
• mucositis
• n/v
• diarrhea

e’lyte imbalances, dehydration, malnutrition
• *nutritional supplementation via enteral or parenteral routes improves surgical outcomes

radiation→ stenotic lesions throughout the GI tract
• *Sinusoidal obstruction syndrome
• *reactivation of Hep B

32
Q

GI—preoperative questions?

A

nutritional status
have you been on hyperalimentation?
have you ever had a central line?
difficulty swallowing

33
Q

Endocrine System

*Steroids are frequently used
• Addition to chemotherapy regimen→ ?
• Might unmask undiagnosed diabetes…..Lab?
• Might make known ________more difficult to treat
• Increases risk of ________ insufficiency
(suppression of ?)

Radiation to neck head might alter thyroid function
• Concerns?

A

*Steroids are frequently used
• Addition to chemotherapy regimen→
-reduce inflammation
-reduce n/v
-boost appetite
• Might unmask undiagnosed diabetes…..Lab? A1C
• Might make known diabetes more difficult to treat
• Increases risk of adrenal insufficiency (suppression of hypothalamic-pituitary-adrenal axis)

Radiation to neck head might alter thyroid function
• Concerns? Prior steroid use?

34
Q

Endocrine—preoperative questions?

A

Have you been taking steroids?

Do you have a hx of diabetes?

35
Q

Glance over table 28.5 Slide 37

Preanesthetic evaluation of the CA patient

A

Glance over table 28.5 Slide 37

Preanesthetic evaluation of the CA patient

36
Q

Slide 38: multi hit hypothesis for cancer deconditioning

A

Slide 38: multi hit hypothesis for cancer deconditioning

37
Q

Preoperative

Correction of?

A
  • Nutrient deficiencies
  • Electrolyte abnormalities
  • Anemia
  • Coagulopathies
  • Steroid replacement
38
Q 
Cancer Laboratory & Tests: review
•Hematocrit -> Anemia 
•Platelet Count -> Thrombocytopenia 
•WBC count 
•Neutropenia 
•Liver function 
•PT/ PTT/ INR (coag studies) 
•BNP
•CXR 
•12-lead ECG 
•Renal function-BUN/Creatinine clearance 
•Electrolytes 
-Ca++hypercalcemia due to bone mets and osteolytic activity. 
-K+, Na++, Ca++, Mg
•Blood glucose 
•ABGs 
•ECHO 
•PFTs
A 
Cancer Laboratory & Tests
•Hematocrit -> Anemia 
•Platelet Count -> Thrombocytopenia 
•WBC count 
•Neutropenia 
•Liver function 
•PT/ PTT/ INR (coag studies) 
•BNP
•CXR 
•12-lead ECG 
•Renal function-BUN/Creatinine clearance 
•Electrolytes 
-Ca++hypercalcemia due to bone mets and osteolytic activity. 
-K+, Na++, Ca++, Mg
•Blood glucose 
•ABGs 
•ECHO 
•PFTs
39
Q

Cancer Laboratory & Tests: review
❑Chest Xray: tracheal deviation or compression, masses, aortic aneurysm, fractures (ribs, clavicle, vertebrae), cardiomegaly, pulmonary edema, pneumonia, atelectasis, chronic disease

A

Cancer Laboratory & Tests:
❑Chest Xray: tracheal deviation or compression, masses, aortic aneurysm, fractures (ribs, clavicle, vertebrae), cardiomegaly, pulmonary edema, pneumonia, atelectasis, chronic disease

40
Q

Cancer Laboratory & Tests: review
❑EKG-Abnormalities that will alter anesthetic plan include: Afib, Aflutter, Heart Blocks, ST-T segment changes indicating ischemia, infarct or recent PE, PV & PACs, LVH, RVH, WPW, prolonged QTI or shortened PRI, peaked T waves

A

Cancer Laboratory & Tests:
❑EKG-Abnormalities that will alter anesthetic plan include: Afib, Aflutter, Heart Blocks, ST-T segment changes indicating ischemia, infarct or recent PE, PV & PACs, LVH, RVH, WPW, prolonged QTI or shortened PRI, peaked T waves

41
Q

Oncologic Emergencies

• spinal cord compression->

A

Oncologic Emergencies

• spinal cord compression—urinary or bowel incontinence, peripheral neuropathies, gait disturbances

42
Q

Oncologic Emergencies

• Cardiac tamponade—>

A

Oncologic Emergencies

• Cardiac tamponade—muffled heart tones, elevated JVD, distended neck veins, progressive dyspnea

43
Q

Oncologic Emergencies

• Neutropenia sepsis—>

A

Oncologic Emergencies

• Neutropenia sepsis—may present with low-grade fever or none, cough, arthralgia

44
Q

Oncologic Emergencies

• CNS metastasis—>

A

Oncologic Emergencies

• CNS metastasis—headaches, visual disturbances, balance and gait disturbances, confusion, n/v

45
Q

Oncologic Emergencies

• Tumor lysis syndrome—>

A

Oncologic Emergencies
• Tumor lysis syndrome—elevated uric acid, K+, & phos levels. Most often seen 12-72 hours post chemo tx for hematologic malignancy

46
Q

Oncologic Emergencies

• SVC syndrome—>

A

Oncologic Emergencies

• SVC syndrome—obstruction of SVC (swelling of hands, neck face, dyspnea, cough)

NURA-606-01 Advanced Health Assessment (9 decks)

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