Onc Emergencies Flashcards
SIADH
Too much anti-diuretic
No pee
Urine is concentrated
NA increase in urine
But decrease in serum
With decrease osmolarity
SE?
Opposite of Diuresis. Results from tumor secretion of Arginine vasopressin (AVP)
Retaining fluid… so cause Na diluted to drop
Na
Urine 20
Serum 135-145
Serum osmolarity 30’s
SE:
Confusion
Seizure
Personality changes
Common with: Lung cancer common - NSCLC Vincristine vinblastin Cyclo Cis IL-2
Symptom: Thirst Headache Muscle cramp More is Lethargy
Tx:
-Hypertonic saline to replace Na
2-3 hours - Stop Na reach 125-130 with lasix
-Demeclocycline- normal daily fluid intake
Nurse intervention
- seizure as Na drop
- Neuro check
- fluid restriction. Patient Na drop- thirst- PT will live to drink
DIC
Common- mucin secreting Adenocarcinoma of prostate, lung and breast
- clot clot to (when cloting factors run out) bleed bleeed bleed
- IV access and minimize bleeding with replacing clotting factors
- FSP produced and accumulated
Cause
- infection
- sepsis
- mucin are on carcinoma
- ALL
- shunts
sym
- bleed from all sides
- decrease renal function
Lab
Decrease PLT, HH, fibrinogen,prolong PTPTT
Increase FSP and FDP
Tx
Underlying condition
Plamapheresis
TTP
Only involve platelet unlike DIC
- rare red blood clots within the circulation leads to low PLT count
Cause
- SCT
- med - cyclosporine
Tx
- plasma exchange
- transfusion
- Folic acid
- aspirin
Septic shock
Gram negative - 40%
Most infections arise from endogenous flora of the patient gut
2 or more of follow
- temp >38 or <36
- HR >90
- RR>20 or PaCO2 <32 Mahfouz
- WBC > 12k <4K
Thx
- prophy abx
- empirical abx after culture, fungal
- fluid -crystal loud s collids
- maintain bp - dt cap leak
TLS
Fetal Metabolic complication result from rapid destruction of tumor cell leading
- hyperurivemia (tx:allopurinol-prevention, rasburicase - prevention and Tx)
- hyperk
- hyperP :::
- hyPOcalcemua
Patient with bulky disease - LPD BURKITT
SYM
- neuromuscular- muscle weakness, twitching, lethargy
- cardio- arrythymia
- renal-oliguria., crystal in urine, flank pain, ARF
Tx:
- maintain urine 30 per hour
- IV hydration 24-48 hrs b4 induction
- 3-6 L/day 125-150 ml/m2/hr
- no K in IV
Nursing in
- strict IO
- seizure prevention
- check urine ph<7
Hypercalemia
Serum cal >11
Ironized cal>5.3
Cal bind albumin
Cause
- hyper parathyroidism
- lung, breast, MM
- excessive TUM
- relationship with albumin
Sym; Fatigue Consolation Polyuria Anura Hypertension Confusion Stupor Coma
Tx: Bisphosphonates (zomeda, aredia) Calcitonin Control bone pain IV hydration
Nurs Intervention:
Increase mobility-isometric exercise
Weight
Avoid constipation
Cardiac Tamponade
Triad of symptoms
- hypotension
- muffled heart sounds
- JVD
Tx
Pericardiocentesis
ABC
Spinal cord compression
- SCC
95% caused by Mets disease
Sym:
Localized pain
Late: loss of pressure, muscle atrophy
Never ignore oncology patient with back pain
Focal
Persistent
Radiating
Referred pain
Tx;
High dose steroid/Glucose
- external beam radiation
Nurse intervention
- never ignore back pain
- neuro status
- steroid and rad
Superior vena cava syndrome
- structural onc emergency caused by impaired venous return to the heart
- lung, breast, NHL
- rad induced fibrosis
Sym
- Popeyes
- swollen face neck upper body
- dyspnea
- laryngeal edema
- neck stiffness
Tx
- thrombolysis
-stent placement oxygen
Steroids and diuretic
Nur intervention - access
- rep distress
- progressive edema
- changes I. Tissue perfusion
ICP
Early morning headache
Pressure headache - head about to explode
Thx
- steroids
- mannitol
- surgical decompression
Nur intervention
- increase the head of the bead 30 degree to promote venous drainage
- neuro status
- pain management
- headed needing narcotic - not relieve by aceto
Superior vena cava syndrome (SVCS)
Early signs: Swelling of head, neck and upper torso
Late signs: Respiratory distress, stridor, cyanosis
Common complication of lung cancer
Caused by undifferentiated neoplasms arising in proximal right bronchi
