oncologic emergencies Flashcards
types of oncologic emergencies
-hematologic
-fluid and electrolyte
-tumor related
types of hematologic oncologic emergencies
-neutropenia
-hyperviscosity
-bleeding risk
types of fluid and electorate oncologic emergencies
-hypercalcemia
-SIADH
-fluid excess
types of tumor related oncologic emergencies
-pain crisis
-tumor lysis syndrome
-mechanical obstruction
who’s at risk for anemia - neutropenia/thrombocytopenia
-cancers or chemotherapies that cause myelosuppression
-anticipate outcomes
presentation for anemia - neutropenia/thrombocytopenia patients
-anemia, neutropenia, thrombocytopenia lab results
-fatigue/weakness
-bleeding - gums, puncture sites
anemia - neutropenia/thrombocytopenia priority assessments
-VS especially temperate (fever), cardiac, lungs, skin
-CBC with differential
-CMP
-blood cultures and lactate levels
anemia - neutropenia/thrombocytopenia priority interventions
-monitor for bleeding - oral care, puncture sites - apply pressure
-prepare to administer blood or blood products to replete loss
-administer medications to support cell production
-protect from infection - treat accordingly
who’s at risk or hyperviscosity syndrome?
patients with multiple myeloma, leukemia; other blood disorder
what is the presentation of patients with hyperviscosity syndrome
-triad: mucosal bleeding, Neuro systems, visual disturbances
-bleeding from the nose or mouth, headache, visual changes, GI bleeding, paresthesias, heart failure
hyperviscosity syndrome priority assessment
-physical assessment - neurological; retinal assessment
-serum protein levels; serum viscosity; CBC, CMP, coagulation profile
-serum renal functions: renal tubule dysfunction/obstruction
hyperviscosity syndrome priority interventions
-symptom control
-IV hydration
-plasmapheresis or elective phlebotomy
-treatment of underlying condition
-thromboembolism risk
who is at risk for bleeding?
-thrombocyotpenia r/t leukemia, myelosuppression
-local tumor invasion
-antitumor treatments - radiation chemotherapy
what is the presentation of a patient at risk for bleeding?
-hematemesis, hematochezia, melena, hematuria, vaginal bleeding
-bruising. petechiae, epistaxis
what is the priority assessments of someone who is a bleeding risk
-source of bleeding
-CBC, coagulation profile, hepatic functions, CMP
bleeding risk priority interventions
-iV replacement of blood or blood products
-preparation for endoscopy/colonoscopy
-imagine of area of bleeding
-direct coagulation of bleeding - embolization, cautery
-holding of affecting agent to allow bone marrow recovery
-radiation therapy
-medications
who is at risk for hypercalcemia?
-breast, lung, head and neck cancers; leukemias and lymphomas; multiple myelomas; and bony metastases of any cancer
presentation of early hypercalcemia
-fatigue, muscle weakness, anorexia, and constipation
presentation of late hypercalcemia
confusion, nausea, & vomiting, resulting in dehydration, renal failure, cardiac arrhythmia, & eventual coma
hypercalcemia priority assessments
-serum chemistry specifically calcium levels
-parathyroid levels
-neurological assessments noting changes
hypercalcemia priority interventions
-reduce calcium levels
-target underlying cause
-prepare to administed: furosemide, pamidronate, calcitonin, phosphates
-hemodialysis for severe heart failure or renal failure
who’s at risk for SIADH
mostly seen with lung and brain cancers
SIADH presentation
nausea & vomiting (early); lethargy, hostility, seizures & coma
SIADH priority assessments
-labs: serum chemistry specifically sodium, serum and urine osmolality
-neurological assessments noting changes
SIADH priority interventions
-monitor for hyponatremia and low blood osmolality
-prepare to administer: furosemide, normal saline, hypertonic sodium chloride solution for severe hyponatremia
-monitor vital signs and blood sodium level
-monitor for fluid overload due to hypertonic sodium chloride
who’s at risk for pericardial effusion/cardiac tamponade
-lung cancers: large cell, adenocarcinoma
-lymphatic involvement
-leukemia, lymphoma
-primary or metastatic heart malignancies
what is their presentation pericardial effusion/cardiac tamponade
-tachycardia, tachypnea, hypotension, chest pain, distant heart sounds, narrow pulse pressure, SOB
-anxiety, restlessness, confusion
-presents like heart failure
pericardial effusion/cardiac tamponade priority assessments
-cardiac, lungs, VS
-pericardial effusion on imaging
pericardial effusion/cardiac tamponade priority interventions
-hemodynamic monitoring
-symptom management; I/O supportive medications
-prepare patient for pericardial window
who’s at risk for pleural effusion
-lymphomas
-cancers of the lung
-breast and ovaries
what is the presentation of someone with pleural effusion?
-dyspnea - depends on volume of effusion
-chest wall pain, hemoptysis, weight loss, malaise, anorexia, N/V
pleural effusion priority assessments
-cardiac, lungs, VS
-pleural effusions on imagine
pleural effusion priority interventions
-hemodynamic monitoring
-symptom management, I/O, supportive medications
-prepare patient for: thoracentesis, thorascopy for biopsy, indwelling pleural catheter, pleurodesis
how much liquid do they drain using an indwelling pleural catheter?
no more than 1000mLs at a time
who is at risk for a pain crisis?
all oncologic patients
presentation of patients in pain crisis
-varies
-could be coupled with fear and anxiety
pain crisis priority assessments
-use pain scales to assess pain and discomfort characteristics: location, quality, frequency, duration, etc., at baseline and on an ongoing basis
-assure patient that you know the pain is real and will assist them in reducing it
important part of pain crisis
help them stick to pain management
pain crisis priority interventions
-anticipate pain management needs
-monitor CNS, cardiovascular and respiratory response
-manage breakthrough pain levels and timing medications
-utilize non-pharmacologic approaches
who is at risk for tumor lysis syndrome
-people with larger tumors
-certain chemotherapy agents
-older age
-high-grade lymphomas
-acute leukemias
presentation of tumor lysis syndrome
-GI distress
-dehydration
-hypotension
-flank pain
-muscle cramps
-weakness
-seizures
-mental status changes
-cardiac dysrhythmias
tumor lysis syndrome priority assessments
-neurologic, pain, GI
-monitor CMP especially potassium, uric acid & phosphorous
-assess AKI
-cardiac monitoring
-monitor I/O
-monitor for neuromuscular irritability
-medications to reduce potassium, uric acid & phosphorous levels (diuretics, allopurinol, sodium polysystrene, rasburicase)
-may require hemodialysis
who’s at risk for superior vena cava syndrome?
metastases from breast or lung cancer
superior vena cava syndrome presentation
-periorbital & facial edema
-erthythema of the upper body
-dyspnea
-epistaxis
superior vena cava syndrome priority assessments
-skin
-head
-thorax assessments
-VS
superior vena cava syndrome priority interventions
-position high-fowler’s
-administer IV corticosteroids
-prepare patient for thrombolysis or placement of venous stent
-high-dose radiation therapy for emergency temporary relief
who’s at risk for spinal cord compression
primary metastatic vertebral tumors
spinal cord compression presentation
-changes in sensation
-muscle strength
-reduced deep tendon reflexes
-worsening back pain
-bowel or bladder retention
spinal cord compression priority assessments
-neurologic and pain, bowel or bladder as appropriate
-prepare patient for possible MRI
spinal cord compression priority interventions
-prepare to administer high dose Iv steroids
-pain control
-prepare patient for possible surgical intervention and/or radiation therapy to relieve cord compression
