Unit 10 Chapter 20 Oncologic Emergencies Flashcards

1
Q

List 3 Oncologic emergencies

A
  • Superior Vena Cava Syndrome-
  • Tumor Lysis Syndrome-
  • DIC-
  • Syndrome of Inappropriate antidiuretic
    Hormone-
  • Spinal Cord Compression-
  • Hypercalcemia-
  • Sepsis
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2
Q

What is DIC -Disseminated Intravascular
Coagulation

A

Disseminated intravascular coagulation (DIC) is a problem with the blood- clo ing process. DIC is triggered by many severe illnesses, including cancer. In patients with cancer DIC often is caused by sepsis from a variety of organisms (bacterial, fungal, viral, or parasitic).

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3
Q

Prevention of DIC

A

STRICT ASESPSIS TECHNIQUE

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4
Q

Emergent s/s of DIC that can lead to fatal hemmorrhage?

A

This widespread clott ing depletes circulating clo tting factors and platelets.
As this happens, extensive bleeding occurs.
Bleeding from many sites is the most common problem and ranges from oozing to fatal hemorrhage.

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5
Q

What is the tx for DIC

A

When sepsis is present and DIC is likely, management focuses on reducing the infection and halting the DIC process.
-IV antibiotic therapy is initiated. During the early phase of DIC, anticoagulants (especially heparin) are given to limit clotting and prevent the rapid consumption of circulating clotting factors.
-When DIC has progressed and hemorrhage is the primary problem, clo tting factors are given. .

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6
Q

What is SIADH-Syndrome of Inappropriate Antidiuretic Hormone

A

fluid retention

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7
Q

What is a common cause of SIADH?
A. Cancer
B. Hemmrohage
C. Infection
D. Respiratory Depression

A

A. Cancer

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8
Q

S/s of Hyponatreima

A

Mild symptoms include weakness, muscle cramps, loss of appetite, and fatigue. With greater fluid retention and decreased sodium levels, weight gain, nervous system changes, personality changes, confusion, and extreme muscle weakness occur. As the sodium level drops toward 110 mEq/L (mmol/L), seizures, coma, and death may follow depending on how rapidly hyponatremia occurs.

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9
Q

Should a client with SIADH be on seizure precaution?
A. YES
b.NO

A

A. YES

due to hyponatremia and electrolye dialation

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10
Q

s/s of SIADH

A

Mild symptoms include weakness, muscle cramps, loss of appetite, and fatigue. With greater fluid retention and decreased sodium levels, weight gain, nervous system changes, personality changes, confusion, and extreme muscle weakness occur.

As the sodium level drops toward 110 mEq/L (mmol/L),
seizures, coma, and death may follow depending on how rapidly hyponatremia occurs.

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11
Q

Critical Rescue SIADH

A

Monitor patients at least every 2 hours to recognize signs and symptoms of increasing fluid overload (bounding pulse, increasing neck vein distention [jugular venous distention (JVD)], presence of crackles in lungs, increasing peripheral edema, or reduced urine output) because pulmonary edema can occur very quickly and lead to death. When symptoms indicate that the fluid overload from SIADH either is not responding to therapy or is becoming worse, respond by notifying the primary health care provider immediately.

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12
Q

What is the adverse effect of Mannitol
A. Hyperthermia
B. Altered level of consciousness
C. Pulmonary edema
D. Aortic Stenosis

A

C. Pulmonary edema

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13
Q

Managment of SIADH

A

Management includes fluid restriction, increased sodium intake, and drug therapy. Immediate cancer treatment with radiation or chemotherapy may cause enough tumor regression that ADH production returns to normal.

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14
Q

What is Spinal Cord Compression

A

Spinal cord compression (SCC) is an oncologic emergency that requires immediate intervention to relieve pain and prevent permanent neurologic damage.

Damage from SCC occurs either when a tumor directly enters the spinal cord or spinal column or when the vertebrae collapse from tumor degradation of the bone.

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15
Q

s/s of Spinal Cord Compression

A

-Back pain
-weakness,
-loss of sensation,
-urinary retention,
-constipation.
-decreased deep tendon reflexes
-reduced pinprick and vibratory sensations

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16
Q

What medications are used for Spinal Cord Compression?
A. High dose prednisone
B. Acetaminophen
C.High dose radiation
D. Diphenhydramine
E. High dose chemotherapy

A

.A. High dose prednisone
C.High dose radiation

Treatment is often palliative, with high-dose corticosteroids given first as an IV bolus to reduce swelling around the spinal cord and relieve symptoms, followed by a tapered dose over time. High-dose radiation may be used to reduce the size of the tumor in the area and relieve compression.

17
Q

Surgery management of Spinal Cord Compression

A

Surgery may be performed to remove the tumor and trim the bony tissue so less pressure is placed on the spinal cord or to repair the spine if the spinal column is unstable. External back or neck braces may be used to reduce the weight carried by the spinal column and to reduce pressure on the

18
Q

What is hypercalcemia

A

Hypercalcemia (increased serum calcium level) occurs frequently in patients with cancer. It is a metabolic emergency and can lead to death.

19
Q

What is the normal calcium range?

A

9-10.5

20
Q

Can dehydration worsen hypercalcemia?
A. Yes
B. No

A

A. Yes

21
Q

What is the s/s of Hypercalcemia

A

include fatigue, loss of appetite, nausea, vomiting, constipation, and increased urine output. skeletal pain, kidney stones, abdominal discomfort, and altered cognition that can range from lethargy to coma. More serious problems include severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, and ECG changes

22
Q

Tx for hypercalmenia

A
  •  AGGRESSIVE Oral hydration: 2-3L
     AGRESSIVENS if IV hydration needed
    Loop diuretics
     Calcitotinin pushes the calcium back in the bone
23
Q

Which of the following Diueretics is contraindicated for clients with Hypercalcemia?
A. Spirinolactone
B. Bumetadine
C. Furesomide
D. Hydrochlorothiazide

A

D. Hydrochlorothiazide: calcium sparing can worsen clients condition

24
Q

What is Superior Vena Cava Syndrome?

A

Compression or obstruction by tumor growth or clots in the
vessel.

it is life threateneing

25
Q

S/s of Superior Vena Cava Syndrome?

A
  • Edema of the face, arms, hands
  • Head fullness
  • Engorged blood vessels
  • Erythema
  • Dyspnea
  • Cyanosis
  • Increased ICP
  • Hypotension
  • Hemmorhage
26
Q

Nursing Care for SVCS

A

-avoid venipuncture in upper extremities due to engorged blood vessels
-avoid obtaining upper BP
-Palliative care needs to be discussed due to end stage cancer

27
Q

When SVCS occurs is this an imminent sign of end of life cancer?
A. no
B. yes

A

B. yes

SVCS is often associated with late-stage disease when the cancer is wide-spread. Palliative care and withdrawal of treatment may have to be discussed.

28
Q

Tx for SVCS

A

Careful monitoring and assessment Some medications are effective in reducing
symptoms
Corticosteroids
Diuretics
Chemotherapy: long term control of cancer causing the compression

High-dose external radiation therapy Metal stent in vena cava

29
Q

What is Tumor Lysis Syndrome

A

occurs when the tumor is reduced too rapidly with radiation therapy

30
Q

s/s of Tumor Lysis Syndrome?

A

Serum potassium levels increase, due to untreated TLS causing
-hyperkalemia, which can lead to cardiac dysfunction causing hyperuricemia. These uric acid crystals precipitate in the kidney, blocking kidney tubules and leading to AKI.
 Lethargy, muscle weakness
 N/V, anorexia, diarrhea
 Cloudy urine, flank pain
 ECG changes, muscle cramps, twitching

31
Q

Managment of TLS

A

 Aggressive intravenous hydration 24-28hrs before
chemotherapy
 Educate patients to drink at least 3L of fluid a day, keep fluid intake consistent throughout the day, and draw up a schedule for fluid intake.
 Sodium bicarbonate helps prevent uric acid precipitation.
 Allopurinol helps to reduce uric acid production and promote its excretion.
If TLS occurs

 Meds are given to remove potassium and uric acid from the
body (IV insulin with dextrose, kayexalate with sorbitol, sodium
bicarbonate, and rasburicase)
** The patient may need ICU and dialysis

32
Q

medication management of TLS

A

 Hydration is key before and after treatment
 Osmotic diuretics – use cautiously to improve flow to kidneys
 Allopurinol may be administered