Oncological Emergencies Flashcards
1
Q
Oncologic emergencies
A
- Cardiac tamponade
- Hypercalcemia
- Spinal cord compression
- Superior vena cava syndrome
- Syndrome of inappropriate antidiuretic hormone secretion
- Tumor lysis syndrome
2
Q
Cardiac tamponade
Definition
A
- Acute low cardiac output syndrome caused by an excessive accumulation of fluid in the pericardial space or constriction of the pericardium by fibrous tissue, which results in restriction of the heart’s ability to pump
- Ventricular filling impaired
- Decreased CO and systemic perfusion
- Cancer and its treatment are the most common causes of pericardial effusion and subsequent cardiac tamponade.
- Radiation therapy in large cumulative doses to the chest may cause pericarditis.
- Certain chemotherapies (anthracyclines) can cause cardiomyopathy and pericardial effusion
3
Q
Cardiac tamponade
Diagnosis
A
Echocardiogram (Most sensitive): Water bottle heart, enlarged heart, widened mediastinum
Chest radiograph and ECG may be used for initial evaluation. This will reveal a “water bottle heart” an enlarged heart and a widened mediastinum.
4
Q
Cardiac tamponade
Clinical findings
A
EARLY
- Dyspnea (most common)
- Cough, hiccups, dysphagia, or hoarseness
- Retrosternal chest pain. Pain relieved by leaning over and intensified by lying supine.
- Agitation, dizziness, or other signs of hypoxia.
- Weakness and fatigue
- Muffled or decreased heart sounds, or pericardial friction rub
- Weak apical pulse
LATE
- Progressive dyspnea, tachypnea, orthopnea
- Tachycardia
- Hepatomegaly, abd pain
- Progressive restrosternal CP
- Neck vein distention
- Decreased SBP, increased DBP
- Narrowing pulse pressure
- Pulsus paradoxus > 10 mmHg
- JVD
- Edema
- Cool, clammy skin
- Changes in LOC
- Oliguria/anuria
- Cardiac arrest
5
Q
Cardiac tamponade
Management
A
- Diuretics
- Corticosteroids
- Oxygen therapy
- Anxiolytics
- Analgesics
- Blood product administration
- Fluid support
- Vasoactive drugs (Dopamine)
- Emergency pericardiocentesis with ECG, echocardiogram or fluoroscopic guidance.
- Sclerosing the pericardium
- Pericardial window
- Total pericardectomy
Nursing Management:
- Accurate/ongoing assessment: cardiopulmonary and hemodynamic status
- Early recognition
- Strict monitoring: v/s, pulse pressure, pulsus paradoxus
- Respiratory status
- LOC
- Fluid balance
- ECG
- Volume expanders
- Elevating HOB
- Calm environment
- Education of pt and family regarding procedures
6
Q
Hypercalcemia
Definition
A
- Greater than normal amounts of calcium in the blood. > 11.0
- Common etiologies include metastatic bone disease in pts with breast cancer, renal cell, multiple myeloma, lymphoma, or prostate cancer; hyperparathyroidism; prolonged immobility; dehydration; and poor nutrition with low serum albumin.
7
Q
Hypercalcemia
Clinical findings
A
- Bone pain (most common symptom in metastatic disease)
- Mild hypercalcemia (11-11.9)
Lethargy, weakness, fatigue, restlessness, difficulty concentrating, polydipsia, polyuria, nocturia, mild hypertension. - Moderate hypercalcemia (12-13.9)
Confusion, drowsiness, cramping, abd pain, muscle weakness, polydipsia, dehydration. - Severe hypercalcemia ( >13.9)
Seizures, coma, ataxia, bradycardia, heart block, renal failure, paralytic ileus.
8
Q
Hypercalcemia
Diagnostic tests
A
- Serum calcium > 11 mg/dL
- Normal 8.5 - 10.5, pts may be asymptomatic up to 14 to 16
- Elevated urinary calcium
- Prolonged PR interval
- Shortened QT interval
9
Q
Hypercalcemia
Management
A
- Long term: Treating the underlying cancer with appropriate chemotherapy or radiation therapy.
- Immediate: NS administration to reverse dehydration, increase renal flow, and promote excretion of excess calcium.
- Lasix may be ordered to block calcium reabsorption in the kidneys; however, it is administered only after dehydration has been corrected.
- In extremely urgent situations, calcitonin may be administered. Rapid onset, shorter action. Less effective than other antiresorptive therapies. Inhibits osteoclast activity and promotes urinary excretion of calcium.
- Dialysis may be required if pt is experiencing severe hypercalcemia with renal insufficiency.
- Nursing care focuses on
- keeping the pt safe
- managing symptoms
- monitoring for side effects of the therapies and minimizing the risk of recurrence.
- Monitor vs, fluid status, cv status, metal status and neurological status.
- Place pt on seizure and safety prec (high risk of fractures)
- Increase pt’s activity and mobility
- Pain management
- Stool softeners and antiemetics
- Due to likelihood of recurrence, educate pt and family on s&s to report to healthcare team.
10
Q
Superior vena cava syndrome
Definition
A
- Internal or external obstruction of the SVC causing reduced blood return to the heart.
- Usually secondary to pulmonary lung or metastatic tumors
- External pressure: from a tumor or enlarged lymph node
- Internal pressure: thrombus
- Decreased blood return to the heart
- Resulting congestion
- Decreased CO
- Life threatening pulmonary and cerebral compromise
- Not common but often the presenting sign of malignancy.
11
Q
Superior vena cava syndrome
Clinical findings
A
- Upper body edema and venous engorgement ** hallmark signs ** (includes tongue swelling and papilledema)
- Dyspnea (most common symptom)
- Cough, hoarseness
- Tachypnea, stridor, increasing respiratory distress
- Neck and chest vein distention
- Hypotension
- Tightness of the neck (Stokes’ sign)
12
Q
Superior vena cava syndrome
Diagnostic tests
A
- Chest radiograph (to confirm a mass)
- CT scan or MRI (to precisely show location and size of tumor or enlarged lymph nodes)
- Bipsy/cytology
- Venogram (to confirm presence of thrombosis)
- MRI or US may also assist in locating a thrombus.
13
Q
Superior vena cava syndrome
Management
A
- If malignant disease => radiation therapy or chemotherapy
- Treatment of choice without tissue diagnosis is irradiation
- Corticosteroids and diuretics may also be used to decrease inflammation and edema
- If chronic or recurrent => stenting
- If r/t catheter thrombosis => thrombolytic therapy (streptokinase, urokinase)
- Nursing interventions include:
- Measures to reduce dyspnea
- Maintain adequate cardiopulmonary function
- Improve comfort
- Monitor I&O, vs, mental status and side effects of meds
- HOB 45
- Supplemental O2
- Remove rings, watches, and constricting clothing
- Avoid invasive or constrictive procedures (venipunctures, IV, BP measurement)
- Central venous catheter to avoid IV insertion.
- Maintain a calm, quiet environment
14
Q
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
Definition
A
- Condition characterized by excessive production and release of antidiuretic hormone (ADH)
- It changes body’s fluid and electrolyte balance by INCREASING WATER RETENTION, resulting in hyponatremia.
- Lung cancer is the most common cause
- Normal serum Na levels: 135 - 145
- Severe SIADH can result in cerebral edema and death.
15
Q
SIADH
Clinical findings
A
- Mild hyponatremia (125 - 134)
- Thirst
- h/a, irritability, lethargy, behavioral changes
- Decreasing UO, weight gain
- Peripheral edema
- Muscle cramps
- Anorexia
- Moderate hyponatremia (115 - 125)
- Confusion, irritability, weakness, tremors
- Combativeness, agitation, hallucinations, areflexia
- Severe hyponatremia (<115)
- Seizures, coma
- Oliguria
- Respiratory failure, inability to maintain airway or mobilize secretions
- Death
