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CJA > oncologic emergencies > Flashcards

oncologic emergencies Flashcards

1
Q

types of oncologic emergencies

A

-hematologic
-fluid and electrolyte
-tumor related

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2
Q

types of hematologic oncologic emergencies

A

-neutropenia
-hyperviscosity
-bleeding risk

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3
Q

types of fluid and electorate oncologic emergencies

A

-hypercalcemia
-SIADH
-fluid excess

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4
Q

types of tumor related oncologic emergencies

A

-pain crisis
-tumor lysis syndrome
-mechanical obstruction

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5
Q

who’s at risk for anemia - neutropenia/thrombocytopenia

A

-cancers or chemotherapies that cause myelosuppression
-anticipate outcomes

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6
Q

presentation for anemia - neutropenia/thrombocytopenia patients

A

-anemia, neutropenia, thrombocytopenia lab results
-fatigue/weakness
-bleeding - gums, puncture sites

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7
Q

anemia - neutropenia/thrombocytopenia priority assessments

A

-VS especially temperate (fever), cardiac, lungs, skin
-CBC with differential
-CMP
-blood cultures and lactate levels

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8
Q

anemia - neutropenia/thrombocytopenia priority interventions

A

-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

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9
Q

who’s at risk or hyperviscosity syndrome?

A

patients with multiple myeloma, leukemia; other blood disorder

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10
Q

what is the presentation of patients with hyperviscosity syndrome

A

-triad: mucosal bleeding, Neuro systems, visual disturbances
-bleeding from the nose or mouth, headache, visual changes, GI bleeding, paresthesias, heart failure

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11
Q

hyperviscosity syndrome priority assessment

A

-physical assessment - neurological; retinal assessment
-serum protein levels; serum viscosity; CBC, CMP, coagulation profile
-serum renal functions: renal tubule dysfunction/obstruction

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12
Q

hyperviscosity syndrome priority interventions

A

-symptom control
-IV hydration
-plasmapheresis or elective phlebotomy
-treatment of underlying condition
-thromboembolism risk

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13
Q

who is at risk for bleeding?

A

-thrombocyotpenia r/t leukemia, myelosuppression
-local tumor invasion
-antitumor treatments - radiation chemotherapy

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14
Q

what is the presentation of a patient at risk for bleeding?

A

-hematemesis, hematochezia, melena, hematuria, vaginal bleeding
-bruising. petechiae, epistaxis

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15
Q

what is the priority assessments of someone who is a bleeding risk

A

-source of bleeding
-CBC, coagulation profile, hepatic functions, CMP

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16
Q

bleeding risk priority interventions

A

-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

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17
Q

who is at risk for hypercalcemia?

A

-breast, lung, head and neck cancers; leukemias and lymphomas; multiple myelomas; and bony metastases of any cancer

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18
Q

presentation of early hypercalcemia

A

-fatigue, muscle weakness, anorexia, and constipation

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19
Q

presentation of late hypercalcemia

A

confusion, nausea, & vomiting, resulting in dehydration, renal failure, cardiac arrhythmia, & eventual coma

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20
Q

hypercalcemia priority assessments

A

-serum chemistry specifically calcium levels
-parathyroid levels
-neurological assessments noting changes

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21
Q

hypercalcemia priority interventions

A

-reduce calcium levels
-target underlying cause
-prepare to administed: furosemide, pamidronate, calcitonin, phosphates
-hemodialysis for severe heart failure or renal failure

22
Q

who’s at risk for SIADH

A

mostly seen with lung and brain cancers

23
Q

SIADH presentation

A

nausea & vomiting (early); lethargy, hostility, seizures & coma

24
Q

SIADH priority assessments

A

-labs: serum chemistry specifically sodium, serum and urine osmolality
-neurological assessments noting changes

25
Q

SIADH priority interventions

A

-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

26
Q

who’s at risk for pericardial effusion/cardiac tamponade

A

-lung cancers: large cell, adenocarcinoma
-lymphatic involvement
-leukemia, lymphoma
-primary or metastatic heart malignancies

27
Q

what is their presentation pericardial effusion/cardiac tamponade

A

-tachycardia, tachypnea, hypotension, chest pain, distant heart sounds, narrow pulse pressure, SOB
-anxiety, restlessness, confusion
-presents like heart failure

28
Q

pericardial effusion/cardiac tamponade priority assessments

A

-cardiac, lungs, VS
-pericardial effusion on imaging

29
Q

pericardial effusion/cardiac tamponade priority interventions

A

-hemodynamic monitoring
-symptom management; I/O supportive medications
-prepare patient for pericardial window

30
Q

who’s at risk for pleural effusion

A

-lymphomas
-cancers of the lung
-breast and ovaries

31
Q

what is the presentation of someone with pleural effusion?

A

-dyspnea - depends on volume of effusion
-chest wall pain, hemoptysis, weight loss, malaise, anorexia, N/V

32
Q

pleural effusion priority assessments

A

-cardiac, lungs, VS
-pleural effusions on imagine

33
Q

pleural effusion priority interventions

A

-hemodynamic monitoring
-symptom management, I/O, supportive medications
-prepare patient for: thoracentesis, thorascopy for biopsy, indwelling pleural catheter, pleurodesis

34
Q

how much liquid do they drain using an indwelling pleural catheter?

A

no more than 1000mLs at a time

35
Q

who is at risk for a pain crisis?

A

all oncologic patients

36
Q

presentation of patients in pain crisis

A

-varies
-could be coupled with fear and anxiety

37
Q

pain crisis priority assessments

A

-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

38
Q

important part of pain crisis

A

help them stick to pain management

39
Q

pain crisis priority interventions

A

-anticipate pain management needs
-monitor CNS, cardiovascular and respiratory response
-manage breakthrough pain levels and timing medications
-utilize non-pharmacologic approaches

40
Q

who is at risk for tumor lysis syndrome

A

-people with larger tumors
-certain chemotherapy agents
-older age
-high-grade lymphomas
-acute leukemias

41
Q

presentation of tumor lysis syndrome

A

-GI distress
-dehydration
-hypotension
-flank pain
-muscle cramps
-weakness
-seizures
-mental status changes
-cardiac dysrhythmias

42
Q

tumor lysis syndrome priority assessments

A

-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

43
Q

who’s at risk for superior vena cava syndrome?

A

metastases from breast or lung cancer

44
Q

superior vena cava syndrome presentation

A

-periorbital & facial edema
-erthythema of the upper body
-dyspnea
-epistaxis

45
Q

superior vena cava syndrome priority assessments

A

-skin
-head
-thorax assessments
-VS

46
Q

superior vena cava syndrome priority interventions

A

-position high-fowler’s
-administer IV corticosteroids
-prepare patient for thrombolysis or placement of venous stent
-high-dose radiation therapy for emergency temporary relief

47
Q

who’s at risk for spinal cord compression

A

primary metastatic vertebral tumors

48
Q

spinal cord compression presentation

A

-changes in sensation
-muscle strength
-reduced deep tendon reflexes
-worsening back pain
-bowel or bladder retention

49
Q

spinal cord compression priority assessments

A

-neurologic and pain, bowel or bladder as appropriate
-prepare patient for possible MRI

50
Q

spinal cord compression priority interventions

A

-prepare to administer high dose Iv steroids
-pain control
-prepare patient for possible surgical intervention and/or radiation therapy to relieve cord compression

CJA (31 decks)

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