Exam 3 - Oncology complications Flashcards Preview

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Flashcards in Exam 3 - Oncology complications Deck (24)
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1
Q

What causes malignant spinal cord compression?

A

Result of tumor spreading to the spine; directly compressing the spinal cord

2
Q

What are the clinical presentations of malignant spinal cord compression?

A
  • Back pain (worse when supine)
  • Motor deficits → lower extremity weakness, leg heaviness, difficulty walking
  • Autonomic dysfunctions → urinary frequency, urgency, bladder or bowel incontinence (late stage)
3
Q

What imaging could be ordered to visualize a malignant spinal cord compression?

A

MRI

4
Q

What is the goal of management for malignant spinal cord compression?

A

Maintain neurologic function, control growth of tumor, spine stabilization, pain control

5
Q

Malignant spinal cord compression management

A
  • Corticosteroids (dexamethasone) to reduce vasogenic edema
  • Radiotherapy for patients with radiosensitive tumors
  • Surgery for spinal instability
6
Q

What is superior vena cava syndrome?

A

Blood flow through the SVC is obstructed (commonly associated with lung cancer and lymphomas)

7
Q

Superior vena cava syndrome clinical manifestations

A
  • Swelling of the neck
  • Swelling of the trunk, upper extremities or chest, dyspnea
  • Chest pain, cough, dilated chest vein collaterals, new onset paresthesia, dysphagia, confusion, dizziness, hoarseness, night sweats
8
Q

Superior vena cava syndrome physical examination components

A
  • Venous distention in upper body, facial edema, cyanosis, arm and hand edema, telangiectasia of the chest and upper back, hoarse voice, stridor
  • Increased cerebral edema → confusion, dizziness, headaches, mental status changes, lethargy, coma
9
Q

Superior vena cava management

A
  • Empiric treatment with airway obstruction or cerebral edema; if neither, treatment directed at underlying cause
  • Radiation or chemotherapy
  • Intravascular stenting → relief of symptoms within 24-48 hours of placement
10
Q

Malignant spinal cord compression clinical manifestations

A
  • Back pain (worse when supine)
  • Motor deficits → lower extremity weakness, leg heaviness, difficulty walking
  • Autonomic dysfunctions → urinary frequency, urgency, bladder or bowel incontinence (late stage)
11
Q

Malignant spinal cord compression management

A
  • Goals: maintain neurologic function, control growth of tumor, spine stabilization, pain control
  • Corticosteroids (dexamethasone) to reduce vasogenic edema
  • Radiotherapy for patients with radiosensitive tumors
  • Surgery for spinal instability
12
Q

Clinical manifestations of hypercalcemia

A
  • Lethargy, confusion, constipation, weakness, hypovolemia, polyuria, polydipsia, cardiac dysrhythmias
  • Muscle weakness, hyporeflexia, mental status change
13
Q

Hypercalcemia management

A
  • Oral or parenteral rehydration → increase renal clearance of calcium, decrease calcium levels through dilution, restore intravascular volume
  • Hospitalization for patients with serum calcium >14 mg/dL or have mild fatigue and constipation
    • IV bisphosphonates
14
Q

Lab findings associated with tumor lysis syndrome

A

Results in hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia

  • Commonly due to chemotherapy
15
Q

Tumor lysis syndrome clinical manifestations

A

Due to electrolyte abnormalities

  • Nausea, vomiting, constipation, diarrhea
  • Low urine output
  • Weight gain
  • Acute renal failure (hyperphosphatemia)
  • Muscle cramps (hypocalcemia)
  • Seizures, tetany, arrhythmias (hyperkalemia, hypocalcemia)
16
Q

Tumor lysis syndrome management

A
  • Aggressive hydration to preserve renal function (IV isotonic fluid)
  • Monitor electrolytes to prevent cardiac dysrhythmias
  • Oral sodium-potassium exchange resin, insulin glucose therapy, loop diuretics for hyperkalemia
17
Q

Malignancy associated with SIADH definition

A

Impaired water excretion that occurs when ADH is ineffectively suppressed → water retention and hyponatremia

18
Q

SIADH clinical manifestations

A
  • Thirst, anorexia, mild nausea and vomiting, weight gain without edema, muscle cramps, headache, mild lethargy
    • Once sodium <115 mg/dL → hyporeflexia, confusion, oliguria, seizures, coma
19
Q

SIADH management

A
  • Mild to moderate (120-135 mEq/L) → limit fluid intake to <1000 mL/24 hours
  • Potassium chloride for hypokalemia
  • Oral salt supplementation
  • Loop diuretics
  • Severe SIADH → hypertonic saline
20
Q

What is a Wilms tumor?

A
  • Most common malignancy of the GU tract → firm, smooth mass in abdomen or flank
  • Occurs in children between 2-5 years old
21
Q

Wilms tumor clinical manifestations

A
  • Unilateral abdominal mass (usually displaceable)
  • Painless
  • Fever, dyspnea, diarrhea, vomiting, weight loss, malaise
    • NO constitutional symptoms
  • Hematuria
22
Q

Wilms tumor physical exam findings

A
  • Firm, smooth abdominal or flank mass that does NOT cross midline → painless, displaceable
  • Hypertension
  • Left varicocele in males if spermatic vein obstructed
  • Lack of iris color (aniridia) → indicates WAGR syndrome (Wilms tumor, GU abnormalities, aniridia, intellectual disability)
23
Q

Wilms tumor diagnostic studies

A
  • Ultrasound (cystic vs solid mass)
  • CT scan of chest, abdomen, pelvis to stage
  • UA (hematuria)
24
Q

PCP role in the management of Wilms tumor

A
  • Support and educate family/caregivers
  • Establish relationship with patient’s oncologist
  • Ensure child is reaching developmental milestones
  • Keep UTD with WCC/vaccines
  • Monitor for cancer recurrence (increased lifetime risk of cancer if patient has had pediatric cancer)