Cancer

Question 1

Pre Op for CA

Answer 1

dx, surg for CA?
location
mets
n/v
pain-how control, with what 
airway
meds

Question 2

lung CA concern

Answer 2

oxygenation

Question 3

Breast CA concern

Answer 3

anxiety, IV/BP placement

Question 4

GI/Liver CA concern

Answer 4

metabolic, elyte, fluid changes
dec Albumin=edema
BP issues and free drug

Question 5

Brains CA concern

Answer 5

HA, sz

don’t use drugs that lower sz threshold

Question 6

Throat/Thyroid CA concerns

Answer 6

swallowing and airway

Question 7

surgery invasive: minimally, moderately, highly

Answer 7

min: little tissue trauma, min BL
mod: some disruption of physiology, some BL, may need invasive monitoring, ICU
HIgh: signif disruption of physiology, can require transfusion, ICU admit

Question 8

Lung CA/procedure

Answer 8

1associated with CAD
2pulm insufficiency after resection- check RA O2sat
3high BL: H&H, T&S, T&C

Question 9

Bronchial/neck CA

Answer 9

1AIRway mgmt- imagining
2dysphagia, difficulty breathing
3signif BL
4lack of access to airway during case

Question 10

CA ROS: Heme

Answer 10

anemic-BM suppression for chemo
neutropenia, thrombocytopenia
Thrombosis: pancreatic CA
**labs: CBC

Question 11

CA ROA: Pulm

Answer 11

pulm edema, CHF, pleural effusion, pneumonitis
Squamous cell: hyperca
Adenocarcinoma: hypercoagulable, osteoarthistis
Large cell: gynecomastic
Small cell: inappropriate ADH, eptopic corticotropic, Eaton-Lambers syndrome (muscle weakness)

Question 12

CA ROS: Neuromuscular

Answer 12

peripheral neuropathy
SC compression
Eaton-Lambers syndrome- muscle weakness like myasthenia gravis

Question 13

CA ROS: Anorexia/wt loss

Answer 13

DONT turn off hyperalimentation, if do of hypoglycemic

Question 14

CA ROS: Elyte

Answer 14

hyperca due to bone mets

Na and K changes due to N/V

Question 15

CA ROS: adrenal insufficiency

Answer 15

tumor or from corticosteroids

Question 16

CA ROS: cardiac
pericardium
mediastinum

Answer 16

1malignant of paricardium(rare): electric alternans, paroxysmal A fibs, pericardial tampande(most common with Lung CA, dont dec BP)
2SVC compression: if mets spread to mediastinum= get venous engorgement above waist, dyspnea, airway obstruction
3drug induced cardiomyopathy

Question 17

Drug induced Cardiomyopathy

Answer 17

impairment of LV function even 3 yrs after dc
**Doxorubicin and Daunorubicin: dose related
CHF, acute cardiomyopathy-ranging in severity
*Enhances myocardial depression of anesthetics
*use drug least cardio-depressive

Question 18

CA Pulm tox

Answer 18

1Methotrexate: pulm edema, infiltrates, effusions

2. Bleomycin: endothelial damage looks like pna, pulm fibrosis, Inc A-a gradient,
   * *induced hypERoxic pulm injury give ONLY

Question 19

5-fluorouacil

Answer 19

immunosuppression, leukopenia

Question 20

Cyclophosphamide

Answer 20

with high doses: ENCEPHALOPATHY, acute delirium

Question 21

Methrotrexate

Answer 21

with high doses: ENCEPHALOPATHY

reversible but prolonged use–dementia

Question 22

Cisplatin

Answer 22

RENAL toxic, dose limiting effect
*avoid other drugs that could cause renal damage
it will: Dec GFR in 3-5days, cause ARF- may need dialysis
*give hydration and mannitol to protect agains advancement of renal tox
ALSO: dose dependent dorsal root gangli-large fiber neuropathy

Question 23

Vinca Alkaloids (Vincristine)

Answer 23

peripheral neuropathy, sensory/motor

Autonomic neuropathy-usually reversible, dizziness, BP problems

Question 24

Alkylating agents: Cytoxan

Answer 24

plasma cholinesterase inhibition…which is what reverse succ
*not endogenous reversal of such–prolonged duration

Question 25

CA Pulm complications MEDs

Answer 25

``` Bleomycin, Busulfan, BCNU pneumonitis, fibrosis s/s cough, dyspnea, basilar rales tx: corticosteroids ***AVOID high FiO2 and use Colloids ```

Question 26

Cardiac complications

Answer 26

Doxorubicin (Adriamycin), Danuorubicin ECG disturbances: SVT initial symptoms suggest URI--leads to CHF

Question 27

CA Tx N/V

Answer 27

metoclopromide, droperidol, Aofran *have high anxiety related to N/V concerns Control N/V

Question 28

CA Pain mgmt

Answer 28

Visual analogue scale (VAS) what works for them have tolerance high dose--until pain control nerve block- neurolysis

Question 29

Radiation

Answer 29

in neck---airway concern can cause fibrosis: limited ROM, cardiomyopathy Cystitis

Question 30

CA Labs/test: use judgment

Answer 30

``` Hct Plt WBC LFT PT Chem7-elytes, BUN/Cr BGL ABG CXR, ECG ```

Question 31

CA CXR

Answer 31

``` tracheal deviation mass aortic aneurysm fx pulm edema PNA atelectasis ```

Question 32

CA ECG

Answer 32

afib, aflutter, heart blocks, ST changes, | recent PE, LVH

Question 33

CA Airway

Answer 33

dyphagia, difficulty breathing tracheal obstruction colon obstruction---considered full stomach one-lung vent--need to use double lumen tube