16 Oncologic Emergencies

Question 1

Clinical presentation is blurred vision, papiledema, SOB/ cyanosis, ataxia, mental status changes. Asp associated with AML, ALL and CLL during blast crisis. What emergency?

Answer 1

Hyperleukocytosis, WBC greater than 100,000

Question 2

Medical management of hyperleukocytosis?

Answer 2

hyperhydration to maintain urine output 1-2 ml/kg/hr to help prevent kidney damage, correct electrolytes, allopurinol for uric acid, leukapheresis/exchanges as needed

Question 3

Urine output goal

Answer 3

1-2 ml/kg/hr

Question 4

Who has the greatest risk of developing intracranial bleeding/sudden death due to hyperleukocytosis?

Answer 4

AML, WBC greater than 250,000

Question 5

What are the ‘hallmark symptoms’ of hyperleukocytosis

Answer 5

leukocyte accumulation in microvasculature of lungs, CNS

Question 6

What is hyperuricemia?

Answer 6

uric acid greater than 8

Question 7

what is hyperkalemia

Answer 7

potassium greater than 6

Question 8

what is hyperphosphatemia

Answer 8

PO4 greater than 6.5

Question 9

what is hypocalcemia

Answer 9

Ca less than 7

Question 10

What is acute tumor lysis syndrome? What does it do to uric acid, potassium, phosphate, and calcium?

Answer 10

metabolic issues due to rapid breakdown of cancer cells, can lead to renal failure and cardiac dysfunction.

hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia

Question 11

What is a normal phosphate

Answer 11

less than 5. for an adult it is 2.5-4.5 but kids can be a little higher naturally. High phosphate would be greater than 5 for adults or greater than 7 in children

Question 12

What are the usual malignancies associated with ATLS

Answer 12

T cell, large tumor burdens, high WBC, and lymphomas. neuroblastoma is the usual primary solid, but its still rare

Question 13

rapid onset oliguria, back pain, hematuria and arrhythmias 24-48 hours after starting treatment

Answer 13

ATLS. renal symptoms include back/flank pain, hematuria or oliguria, and anuria - often have cardiac symptoms or neuro symptoms related to electrolyte imbalance

Question 14

What is the ‘hyperhydration’ indicated for ATLS?

Answer 14

3000 mL/m2/day

Question 15

What 2 meds do you use to treat high uric acid

Answer 15

allopurinal (prevents high level) and rasburicase (actually decreases level)

Question 16

What should urine output and spec grav be for ATLS

Answer 16

3-5 ml/kg/hr, and 1.01 or greater

Question 17

What is a god urine pH when managing ATLS

Answer 17

7-7.5. below 7 decreasses uric acid excretion, and above 7.5 can lead to stones

Question 18

What are chvosteks and trousseau’s signs?

Answer 18

hypocalcemia. The Chvostek sign is a facial muscle twitch, and the Trousseau sign is carpal pedal spasms when arterial blood flow in the arm is temporarily occluded (as when taking blood pressure [BP]) that occur with hypocalcemia.

Question 19

What are the common organisms that cause sepsis

Answer 19

gram neg from internal flora like e coli, enterobacter, and pseudomonas

Slide 17??

Question 20

Should you use diuretics with cardiac tamponade

Answer 20

No. Positioning, o2 and hydration. Needs paracentesis

Question 21

What is a major cause of hemoptosys? Tx?

Answer 21

Aspergillosis. Protect airway, stop bleeding, and transfuse as necessary

Question 22

Treatment of septic shock

Answer 22

Fluid resuscitation to maintain perfusion, usually 20ml/kg over 5-20 min. Antibiotics.

Question 23

Burrkitts lymphoma is assoc with which onco emergency

Answer 23

TLS.

Question 24

What are the first priorities of any onc emergency

Answer 24

ABCs

Question 25

Vincristine, vinblastine, CPM, ifosfamide, cisplat, steroids and mephalan can all cause what onc emergency

Answer 25

SIADH and as a result hyponatremia

Question 26

RLQ pain that spreads throughout abdomen within a few hours, with some fever/diarrhea, is what

Answer 26

Typhlitis

Question 27

How to diagnose typhlitis

Answer 27

CT

Question 28

Treatment of typhlitis

Answer 28

NG suction, fluid replacement and antimicrobial therapy, can need entire bowel removed

Question 29

Which diagnosis is at highest and 2nd highest risk of spinal cord compression

Answer 29

Ewing’s, neuroblastoma

Question 30

Why are anxiety confusion and lethargy signs of superior vena cava syndrome

Answer 30

Increase in CO2

Question 31

D dimer is over 500, platelets under 20,000 and PT/PTT is 1.5-2 times normal. What is the diagnosis? What other lab value do you expect

Answer 31

DIC. Fibrinogen will be less than 75000 (low)

Question 32

Treatment of DIC?

Answer 32

most important to treat underlying cause. manage symptoms, blood products, clotting products. Keep PT-PTT 1.5-2 times normal. Used to use heparin, but often not any more because treating the cause is more effective.

Question 33

What do bowel sounds sound like with typhlitis?

Answer 33

can be high pitched 'tinkling' sounds, but may also be absent or diminished

Question 34

What is an important nursing assessment in typhlitis

Answer 34

bowel girth

Question 35

Treatment of SVCS?

Answer 35

treat underlying cause (shrink tumor with radiation or get rid of thrombus from CVAD with antithrombolytics) consider steroids

Question 36

When to sedate SVCS patients?

Answer 36

never, only if you are prepared to intubate

Question 37

Nurse management of SVCS

Answer 37

position, elevate head of bed, oxygen

Question 38

What is profound hyponatremia

Answer 38

Na less than 120, leads to cerebral edema and death

Question 39

What meds are most commonly associated with anaphylaxis

Answer 39

antibiotics

Question 40

What is the most common cause of septic shock in AML? How to treat?

Answer 40

alpha hemolytic strep - gram neg. give vanc.

Question 41

Definition/criteria of septic shock?

Answer 41

Sepsis with systolic BP less than 90 that doesn’t respond to fluids

Question 42

Main electrolyte imbalances with TLS

Answer 42

High K, low calcium

Question 43

Pt with decreased UOP, increased weight gain and anorexia and thirst may have?

Answer 43

siadh