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Complex DMR > Oncologic emergencies > Flashcards

Oncologic emergencies Flashcards

1
Q

Types of body systems effected by oncologic emergencies

A

– Metabolic, neurologic, cardiovascular, respiratory, genitourinary,
gastrointestinal, hematological

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2
Q

Causes of oncologic emergencies

A

– Increased tumor size

– Tumors may secrete substances that mimic substances in the body

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3
Q

How do oncologic emergencies usually present

A

May be first s/s of cancer

May be sign cancer has advanced

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4
Q

What are the treatment goals in an oncologic emergency

A

• Immediate intervention to prevent loss of life or quality of life
• STAT aggressive supportive measures followed by definitive treatment
of the underlying malignancy

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5
Q

3 types of metabolic emergencies

A

Tumor lysis syndrome
SIADH
Hypercalcemia

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6
Q

Risk factors of tumor lysis syndrome

A 
acute leukemias most common 
Testicle cancer
Small cell lung CA
Breast CA
aggressive lymphoma
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7
Q

What happens in tumor lysis syndrome

A

Either as a result or treatment or as a result of worsening tumor, cells lyse and release contents which exceeds capacity for kidneys elimination

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8
Q

How does tumor lysis syndrome present

labs and manifestations

A

Increased K, cramps, N/D paralysis, paresthesias, ECG changes
Hyperphosphatemia: Oliguria/anuria/azotemia
Hypocalcemia: Tinnitus, twitching, seizures, parathesias and hypotension
Hyperuremia: N/V, AMS, edmea

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9
Q

Interventions for tumor lysis syndrome

A

Aggressive IV hydration, to regulate electrolyte levels and perfuse kidney
Allapurinol 300 mg PO: prevent uric acid synthesis
Rasburicase: 30 min infusion for TLS
Hemodialysis for acute episodes

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10
Q

SIADH

A

Too much antidieuretic hormone the prevalence of 1-2% of persons with cancer

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11
Q

Risk factors of SIADH and medications that can cause this

A

Small-cell lung cancer (60%), pancreatic, prostate, brain cancers
• Is adverse effect of cyclophosphamide (Cytoxan), vincristine, cisplatin

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12
Q

What happens in the body during SIADH

A

Water intoxication
ADH is secreted without response to usual feedback mechanism
Kidneys continue to retrun water to the body which dilutes the Na levels

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13
Q

SIADH symptoms when it is slow onset

A 
• Subtle mental and cognitive changes, i.e. memory loss, apathy, impaired abstract
thinking
• Fatigue, myalgia
• Headache
• Thirst
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14
Q

SIADH symptoms when it is rapid/severe onset

A

Asterixis (flap/tremor of hand when wrist extended)
Confusion
Seizures, coma

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15
Q

Diagnostic findings of SIADH

A

Serum Na <130 mmoL/L
Urine Na >20 mmoL/L
Urine osmolality exceeds that of plasma

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16
Q

SIADH Interventions

A

Treat the tumor—combination chemotherapy; RT
Fluid Restriction (<1000mL or <500 mL if there is a poor response
Declomycin in divided doses is given for refractory low Na
3%hypertonic Na by slow infusion to treat Neurosymptoms (seizure/coma)
Furosemide (Lasix) w/ normal saline infusion

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17
Q

how common is Hypercalcemia and what is the survival rate

A

• Is most common metabolic emergency; experienced by 25% of persons
with cancer
• 50% of patients diagnosed will die within one month of onset
• Mean survival 1-6 months

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18
Q

What is the cause of hypercalcemia

& special consideration

A

Altered calcium metabolism in bones kindeys, intestines esp in the presence of metastatic disease
Parathyroid hromone like substance screted by cancer cells (paraneoplastic syndrome)

Renal func/dehydration/physical activity

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19
Q

What are the diagnostic criteria fo hypercalcemia

A

Calcium levels of >11
K, Na, PO4 decreased
BUN/Creatinine Increased

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20
Q

What are the clinical manifestations of hypercalcemia

A 
Loss of appetite
Nausea and vomiting
Constipation and abdominal pain
Increased thirst and frequent urination
Fatigue, weakness, and muscle pain
Confusion, disorientation, and difficulty thinking
Headaches
Depression
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21
Q

Systems issues with hypercalcemia

A 
Kidney stones
Irregular heartbeat
Myocardial Infarction
 Loss of consciousness
 Coma
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22
Q

What do you assess in hypercalcemia

A

Assess levels of dehydration, renal function and CV status

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23
Q

What medications do you give for hypercalcemia

A

IV rehydration: IV hydration with NS 3L/24 hrs
Loop diuretics to enhance secretion of Ca
Bisphosphonates: decrease Ca levels (safest)
-IV aredia/zometa
Gallium nitrate: to prevent bone breakdown
calcitonin: band-aid response, shouldn’t be given as the primary treatment, usually given with biphosphates
Hemodialysis: if ca cannot be corrected with meds

24
Q

Name the neurologic emergencies

A 
Spinal cord compression
Related to brain tumors
• Increased intracranial pressure (ICP)
• Seizures
• Altered mental status
Paraneoplastic syndromes
25
Q

Spinal cord compression risk factors

A

• “Liquid” tumors, i.e. lymphomas or multiple myeloma
• Solid tumors with bony metastases, such as prostate, lung, breast, renal
cell

26
Q

What causes a spinal cord compression in an oncologic emergency

A

From rapidly growing mass pressing against spinal cord

Results in collapse of vertebrae

Most commonly caused by bone metastasis in the spine

30% of patients will have metastases in >1 area of the spine

27
Q

How will a patient with spinal cord compression present

A

95% of patients present with back pain
• Intense, localized and persistent
• May radiate to lower back, buttocks, legs or arms

• Sensory or motor: Numbness/difficulty walking
if Lumbosacral – incontinence of bowel or bladder, urinary retention, leg pain or numbness
(can become permanent w/o immediate tx)

28
Q

How is spinal cord compression diagnostics

A 
Radiological 
Spinal films 
CT with myelography 
**MRI is gold standard ****
Biopsy of the lesion 
Surgical
29
Q

Types Cardiovascular emergencies

A

Cardiac tamponade

SVC syndrome

30
Q

Cardiac tamponade risk factors

A

Lung ca
Breast ca
Hematologic ca

31
Q

What can cause cardiac tamponade

A

Can result from pressure of metastases outside of heart;

pericarditis secondary to radiation therapy

32
Q

How much fluid causes cardiac tamponade

A

Normally 50 ml of fluid between visceral (serous) and fibrous
parietal layers; tamponade can result from as little as 200 ml

“Stress relaxation” over weeks to months with parietal stretch;
sac can hold 2 L or more before tamponade occurs

33
Q

what happens in Cardiac tamponade

A

Fluid collection → Compression → Decreased CO

34
Q

cardiac tamponade most common clinical manifestation

A

Exertional dyspnea most common symptom; occurs in 80% of

patients

35
Q

Beck’s triad cardiac tamponade

A

Beck’s triad of hypotension, increased jugular venous

pressure, decreased heart sounds in acute tamponade

36
Q

Beck’s triad cardiac tamponade

A

Beck’s triad of hypotension, increased jugular venous

pressure, decreased heart sounds in acute tamponade

37
Q

Clinical manifestations of cardiac tamponade

A 
Exertional dyspnea 
Chest heaviness, distant heart sounds, tachycardia,
pericardial friction rub
Narrow pulse pressure
Shortness of breath, anxiety
Tachycardia
Beck’s triad
38
Q

Cardiac Tamponade

Diagnostics tests & what they show

A 
Chest- X Ray: Enlarged cardiac silhouette with increased transverse diameter (water
bottle heart)
ECG:
• Nonspecific ST and T wave changes
• Tachycardia
• Low QRS voltage
• Atrial dysrhythmias
 Echocardiogram: dec filling/dec CO
 Pericardiocentesis: Tx &amp; dx drain fluid and test is confirmation
39
Q

Cardiac tamponade ecg shows

A 
ECG
• Nonspecific ST and T wave changes
• Tachycardia
• Low QRS voltage
• Atrial dysrhythmias
40
Q

How to treat cardiac tamponade

A

Pericardiocentesis with placement of indwelling drainage
catheter
Sclerosing therapy, balloon pericardotomy, or surgical window (stop the buildup of blood)
Prognosis poor with paradoxical hemodynamic instability in
postoperative period

41
Q

Nursing interventions for after pericardiocentisis

A

Oxygen therapy
IV hydration
Vasopressor therapy

42
Q

Causes of SVC syndrome

A

thrombosis caused by implantable IV
devices, i.e. tunneled CV catheters, port catheters,
pacemaker leads

Mediastinal mass obstructing blood flow; most common
causes are lung cancer, non-Hodgkin’s lymphoma, metastatic
breast cancer

Previous radiation therapy to the mediastinum

43
Q

What happens in they body to lead to SVC syndrome

A

Presence of mediastinal mass or thrombosis results in high
venous pressures and upstream vessel engorgement
Collateral vein dilation results in an effort to reduce this
pressure

44
Q

SVC Syndrome clinical manifestations common symptoms

A 
Common Symptoms
 Facial edema
 Facial redness
 Periorbital edema
 Distention of veins in head, neck
and chest
 Dyspnea at rest, cough
45
Q

SVC Syndrome clinical manifestations rare symptoms

A 
Rare symptoms 
Difficulty Swallowing 
Chest pain
Hoarseness
Cyanosis
Hemoptysis
46
Q

Superior Vena Cava Syndrome

Diagnostics

A 
Chest x-ray
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Venography
Ultrasound
47
Q

Superior Vena Cava Syndrome

Interventions

A 
► Elevation of head: to dec pressure above SVC
► Corticosteroids: dec swelling 
► Diuretics: dec fluid vol
Thrombosis req intervention 
► Thrombolysis
► Stents
► Bypass surgery
tx based on symptoms
48
Q

Type of respiratory emergencies

A

Airway obstruction
Massive hemoptysis
Toxic lung injury

49
Q

Airway Obstruction clinical manifestations

A 
Dyspnea 
Cough  
Wheezing 
Hemoptysis 
Stridor
50
Q

Airway Obstruction diagnostics

A

Bronchoscopy

Biopsy

51
Q

Airway Obstruction Intervention

A 
Airway Securement 
Surgery if indicated (rare)  Radiation 
Obstruction reduction techniques 
Stent 
Laser vaporization  
Photodynamic therapy 
Cryotherapy 
Endobronchial brachytherapy
52
Q

Massive hemoptysis risk factors

A

Bronchogenic carcinoma
Metastatic cancer to bronchus or trachea
Platelet dysfunction

53
Q

Massive hemoptysis definition

A

≥ 500mL of blood over a 24hour period or

A bleeding at a rate of ≥ 100mL/hour

54
Q

Massive Hemoptysis

Intervention

A 
Maintain airway patency
 Localize the source of bleeding
 Control the bleeding
 Pulmonary angiography and embolization
 Surgery
55
Q

Toxic lung injury risk factors

A 
Radiation Therapy
• Cobalt
Chemotherapy drugs
• Arsenic trioxide
• Bleomycin – 20% of patients receiving this therapy
• Idarubicin
Pre-existing lung disease (i.e. COPD)

Complex DMR (12 decks)

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