Oncologic Emergency Flashcards
What is neutropenia?
- Abnormally low level of neutrophils
- Problem: DECREASED ABILITY TO FIGHT INFECTION
Manifestations of severe neutropenia?
- Will first see FEVER.
- Respiratory infection will see TACHYPNEA.
What is Absolute Neutrophil Count (ANC) and what levels indicate severe neutropenia?
- Determined by multiplying WBC X percentage of neutrophils
- Normal range: between 2,500 – 6,000 cells/mL
- Severe neutropenia: below 500 cells/mL
What signs of infection might be absent in neutropenic patients?
Many normal signs of infection (pus, redness, etc.) may not show up when an infection starts.
Neutropenia management?
- Antibody testing
- Bone marrow testing
- Discontinuing suspicious drug
- Empiric antibiotic therapy
Neutropenia nursing considerations?
- Neutropenic precautions (no fresh fruit, flowers, vegetables)
- Gloves, gown, mask for visitors; no ill visitors
- Client’s door closed
- Vital signs
What is Superior Vena Cava Syndrome (SVCS)?
A group of symptoms that occur due to the obstruction of SVC through thrombosis, tumor invasion of vena cava, or external compression of SVC by tumor
Which cancers are most likely to cause SVCS?
Most often related to cancer in thoracic cavity
What are the early and late signs of SVCS?
- Facial and/or periorbital edema
- Cough
- SOB
- Distended veins of the head, neck & chest
- Headache, seizures
- LATE: Cyanosis & mental status changes
When do SVCS symptoms typically occur?
in the morning
Why do SVCS symptoms typically occur at that particular time?
- When someone is laying down, all the blood is able to flow how it usually flows
- In the case of SVCS, the tumor compresses on superior vena cava which causes the backup of blood into the neck veins
- When they wake up, there’s all this backup of blood which causes these symptoms
- As the day goes on and you’re sitting up and moving around, the blood starts to go its normal path and pass around the tumor
How is SVCS treated?
- Radiation to the site of obstruction
- Chemo to the cancers more sensitive
What is spinal cord compression?
Tumors cause compression through direct extension or metastatic disease in vertebral column
Direct extension: the tumor itself grows and directly presses on the spinal cord
Metastatic disease: cancer spreads (metastasizes) to the bones of the spine, causing fractures or structural damage that leads to compression of the spinal cord
Which population is most at risk for SCC?
Patients with tumors in the thoracic cavity or metastasis
What are the common symptoms of spinal cord compression?
- Intense localized back pain
- Motor weakness
- Change in bowel and bladder habits
How is spinal cord compression treated?
- Radiation
- Rx: Corticosteroids, pain management
- Decompressive laminectomy
Spinal cord compression nursing considerations?
- Suspicion with pain unrelieved by medication
- Immediate attention; do not delay
What is Tumor Lysis Syndrome (TLS)?
Caused by massive tumor cell lysis by chemo or radiation with the spilling of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation.
What electrolyte imbalances occur in TLS?
- hyperuremia
- hyperkalemia
- hyperphosphatemia
- hypocalcemia
What is the key prevention strategy for TLS?
- Pre-treat - IVF hydration
- Monitor & treat abnormal electrolyte values
- Monitor URINE OUTPUT closely
What are the signs of hypercalcemia?
- anorexia
- apathy
- depression
- ECG changes
- fatigue
- muscle weakness
- N/V
How is hypercalcemia treated?
- treat primary disease
- hydration (3L/day)
- diuretics (especially loop diuretics)
- filters out calcium
- infusion of bisphosphonate
