Cancer Assessment Flashcards

Question

Hematologic assessment and consideratoins

Answer 1

MYELOSUPPRESSION - dec RBCs (O2 carrying capacity) - dec WBCs (inc risk of infection) - dec platelets (ability to clot) -Nadir (lowest point) - (usually 7-14 days after last chemo treatment) CA PRODUCES HYPERCOAGULABLE STATE - thromboembolic events are increased 6 fold in pts with CA - esp primary brain tumors, ovarian adenocarcinoma, pancreatic CA, colon CA, gastric, CA, lung CA, prostate CA, and kidney

Answer 2

Do you have hx of anemia? Have you ever been told you have low blood counts? Are you dizzy when you stand up? (also considers orthostatic hypotension, exercise tolerance) History of a blood transfusion? Are you prone to infections? Thrombocytopenia Do you bruise easily? Do you get nose bleeds frequently? Have you been noticing bleeding when you brush your teeth?

Answer 3

VINCRISTINE - virtually all patients experience paresthesias, peripheral neuropathy, encephalopathy **important to document pre existing status of neuropathies prior to anesthesia, consider appropriate positioning as to not worsen neuropathies** corticosteroid-induced neuromuscular toxicity (prednisone 60-10mg/day) - -do you have difficulty getting out of a chair? - -could cause some weakness of respiratory muslces - -will likely need stress dose of steroids radiation + methotrexate --> irreversible dementia

Answer 4

Do you have numbness and tingling? Do you pain? What do you currently use for pain? Hx of stroke? Deficits? Recent changes to memory? - want to document prior to anes. Cognitive side effects? - want to document prior to anes. Are you on steroids?

Answer 5

MAKE SURE YOU'RE ASKING RELEVANT QUESTIONS, and not just asking questions just to ask. Will the answer to their question affect your anesthetic plan or not?

Answer 6

Almost all chemo and radiation produce GI SEs - mucositis - n/v - diarrhea Electrolyte imbalances, dehydration, malnutrition ---nutritional supplementation via enteral or parenteral routes improves surgical outcomes Radiation --> stenotic lesions throughout the GI tract - sinusoidal obstruction syndrome - reactivation of Hep B - --s/s of jaundice (eyes and skin), malaise, n/v?

Answer 7

Recent weight loss or weight gain? N/V/D? What works for them? If patient tells you they have been nauseous that day or threw up that day ---> consider RSI, more aggressive antiemetic plan, fluid/electrolyte balance How has your PO intake been? (will you need to be more aggressive with IV fluids?)

Answer 8

Steroids are frequently used --addition to chemotherapy regimen (reduce inflammation, reduce n/v, boost appetite) - -might unmask undiagnosed diabetes - --lab: blood glucose, A1C --increases risk of adrenal insufficiency (suppression of hypothalamic - pituitary -adrenal axis) ---> inadequate cortisol production or stress hormone response---> may need to supplement Radiation to head/neck might alter thyroid function - Concerns about hypothyroid during sx? - ---hypotension, poor temp regulation, just might not respond as expected to stressors, asp risk - slower gastric emptying

Answer 9

Hx of problems with thyroid? (recent weight gain, feeling sluggish, always the one in the room who says its too cold) Hx of DM or high blood sugar levels?

Answer 10

- chemotherapy - radiation - surgery - cancer - age, sarcopenia - medical comorbidities - sedentary lifestyle - cancer fatigue

Answer 11

- nutrient deficiencies - electrolyte abnormalities - anemia - coagulopathies - steroid replacement?

Answer 12

bone -- be mindful of hypercalcemia

Answer 13

bone -- be mindful of hypercalcemia

Answer 14

brain also, be mindful of NMB with small cell lung CA, tend to be very sensitive (myasthenic syndrome)

Answer 15

``` tracheal deviation or compression masses aortic aneurysm fractures (ribs, clavicle, vertebrae) cardiomegaly pulmonary edema PNA atelectasis chronic disease ```

Answer 16

``` abnormalities that will alter anesthetic plan include: a fib a flutter heart blocks ST - T segment changes indicating ischemia, infarct or recent PE PVCs, PACs LVH, RVH WPW prolonged QT or shortened PRI peaked T waves ```

Answer 17

- spinal cord compression - cardiac tamponade - neutropenia sepsis - CNS metastasis - tumor lysis syndrome - SVC syndrome

Answer 18

- poor IV access - at risk for lymphedema - AVOID IVS AND BP CUFF ON SURGICAL ARM - check type of chemo for complications

Answer 19

- associated CAD - pulm insufficiency after lung tissue resection - potential for massive blood loss during surgical resection --> adequate IV access, T&C, blood ready to go, appropriate tubing - special equipment needed pre op PFTs, DLCO, VO2 max, CXR, ABGs, O2 sat, cardiac stress testing, hbg/hct, T&C

Answer 20

may be aspiration risk - give pre op aspiration risk prophylaxis, but NO REGLAN may be dehydrated from colon prep and/or obstruction - pre op IV fluid! may need T&S, T&C, depending on type of sx

Answer 21

robotic surgeries special positioning (steep trendelenburg) - facial edema/consider conservative IV fluids

Cancer Assessment Flashcards

(46 cards)