Oncological Emergencies

Question 1

Tumor Lysis Syndrome

Answer 1

Massive tumor cell lysis due to chemotherapy,
Phosphate leaks from the cell.

First sign is increased potassium(causes cardiac dysrhythmia) and purines leak from the cell. Worry about AKI and Dysrhythmia from calcium and potassium.

Tumor lysis syndrome results from rapid release of the biproducts from cell destruction by cancer therapy.
Remember the ECG changes of hyperkalemia.
It causes hyperphosphatemia and hypocalcemia.
Hyperuricemia can lead to AKI

Question 2

Interventions

Answer 2

Encourage fluids to flush out the uric acid
Renal diet low in potassium and phosphorus
Administer diuretics
Administer allopurinol (increases excretion of purines)
Adminster IV glucose and regular insulin to treat high potassium(drives potassium back into the cells).
Perform dialysis(if hyperuricemia persists).

Question 3

Hypercalcemia

Answer 3

a late sign of extensive malignancy in patient with bone metastasis. The bone releases calcium into the blood stream. Parathyroid hormone is secreted from tumor cells.
Decreased mobility contributes to hypercalcemia.

Question 4

Early Signs and Symptoms of Hypercalcemia

Answer 4

Fatigue, anorexia, nausea, vomiting, constipation, confusion and polyuria

Question 5

Serious Signs and Symptoms of Hypercalcemia

Answer 5

muscle weakness, DTRS, paralytic ileus,ECG changes(shortened QT), dehydration

Question 6

Interventions

Answer 6

Monitor ECG and calcium levels
Encourage ambulation
Encourage fluids

Question 7

Medications to Treat Hypercalcemia

Answer 7

Furosemide, Corticosteroids, Calcitonin and dialysis may be needed

Question 8

Superior Venae Cava Syndrome

Answer 8

Very serious oncological emergency. Occurs when SVC is compressed by a tumor growth. Usually from a lymphoma or lung cancer.
signs and symptoms results from obstruction of blood flow from the venous of the head, neck and upper trunk.

Question 9

Signs and Symptoms

Answer 9

Edema in the face(periorbital edema)
Tightness of the collar(stop sign)
Late
Edema of the arms and hands(an emergency), notify the provider. It means dyspnea is on its way.
Erythma of the upper body and epistaxis(life-threatening)-notify the provider immediately. You will see the color from the nipple up will be red and below will be pale.
They can have hemorrhage, cyanosis, mental status changes, decreaed cardiac output and hypotension

Question 10

Interventions

Answer 10

Semi- Fowler’s position
Corticosteroids
Diuretics
Why you need to call the physcian quickly?
They need mid-sternal radiation with a stent placement in their vena cava

Question 11

DIC

Answer 11

Often seen in sepsis, neutropenic patient .(less WBC 2000 or less ANC 100), after a chemotherapy,
DIC is caused by abnormal activation of clot formation.
End result is decreased platelets and clotting factors.

Question 12

Interventions

Answer 12

Identify sepsis early(increased HR, increased RR, narrow pulse pressure, confusion)
Maintain strict aseptic technique
Monitor for signs and symptoms of infection and bleeding
Administer ABT(after you get blood culture)
Administer anticoagulants in the early phase of DIC
Administer cryoprecipitate when DIC progresses
Cryoprecipitate is like a blood product that contain Von Willbrand factor and fibronigen. Cryoprecipitate is given in hemorrhage and DIC and hemophilia A.

Question 13

Pericardial Effusion and cardiac Tamponade

Answer 13

results from invasion of cancer cells into pericardial sac which results in fluid collection in the pericardial sac,

Question 14

Signs and Symptoms

Answer 14

SOB,unable to lay flat, left-sided chest pain,

If they develop Tamponade they will have JVD, hypotension and muffled heart sounds.

Question 15

Interventions

Answer 15

Perform pericardiacentesis or pericardial window. After the surgery, BP will come up and you can hear the heart sounds and JVD will be alleviated

Question 16

SIADH

Answer 16

Some tumors can secrete, produce or mimic ADH. related to water intoxication, weight gain, personality changes, confusion, extreme muscle weakness.

Question 17

Signs and Symptoms of SIADH

Answer 17

Same signs and symptoms of after Craniotomy
weakness, muscle cramps, anorexia and fatigue, sodium is 115-129, possible seizure.
Severe symptoms appear when the sodium level reaches 110,you will see seizures, coma and death

Question 18

Interventions

Answer 18

Fluid restriction(free water), refrain from using tap water and use sterile Normal saline,
Increase sodium
Administer tolvaptan (ADH antagonist)
Monitor sodium level
Monitor I&O
Remember as they retain more fluid the sodium is going down
treat the underlying cause(chemotherapy and radiation)
Liberalize salt in their food(gatorade, salt shaker, soda soup)

Question 19

Spinal cord Compression

Answer 19

results when a tumor directly enters a spinal cord or when the vertebra column collapses from tumor entry. it results to impingement on the spinal cord.

Question 20

Signs and Symptoms of Spinal Cord Compression

Answer 20

Back pain(warning sign). They will have that before any neurodeficit sign.
Neuro deficit signs will relate to the level of injury they have
Numbness and tingling of the extremities
Loss of bowel and bladder control and sensation
muscle weakness

Question 21

Interventions

Answer 21

Monitor for back pain and neuro deficits
Administer high dose corticosteroids
radiation and chemotherapy to reduce the tumor
surgeries to remove the tumor
Instruct on the use of back and neck braces PRN