Lecture 2: Preoperative Assessment of the Patient with Cancer AL Flashcards Preview

NURA-606-01 Advanced Health Assessment > Lecture 2: Preoperative Assessment of the Patient with Cancer AL > Flashcards

Flashcards in Lecture 2: Preoperative Assessment of the Patient with Cancer AL Deck (46)
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1

TEST BANK ?s

TEST BANK ?s

2

Treatments:

surgery
chemotherapy
radiation therapy

Toxicities and adverse effects that have the potential to affect nearly every ?

Treatments:

surgery
chemotherapy
radiation therapy

Toxicities and adverse effects that have the potential to affect nearly every organ system.

3

Adverse effects: Bleomycin***

Pulm. HTN, pulm. fibrosis

4

Adverse effects: Cisplatin***

Dysrhythmias
mg wasting
mucositis
ototoxicity
p. neuropathy
SIADH
renal tubular necrosis
thromboembolism

5

Adverse effects: Cyclophosphamide (Cytoxan)***

Encephalopathy/delirium
hemorrhagic cystitis
myelosuppression
pericarditis
pericardial effusion
SIADH
pulm. fibrosis

6

Adverse effects: Doxorubicin (Adriamycin)***

Cardiomyopathy
myelosuppression

7

Adverse effects: Fluorouracil***

Acute cerebellar ataxia
ischemic and nonischemic EKG changes
Chest pain
gastritis
myelosuppression

8

Adverse effects: Methotrexate***

Encephalopathy
hepatic dysfunction
mucositis
platelet dysfunction
hypersensitivity pneumonitis
renal failure
myelosuppression

9

Adverse effects: Tamoxifen***

Thromboembolism

10

Adverse effects: Vincristine***

autonomic dysfunction
myocardial ischemia
p. neuropathy
bronchospasm
SIADH

11

Adverse effects: Radiation therapy
**Review Table 28.3, Slide 10!

Sinusoidal obstruction syndrome -> severe liver failure
Review Table 28.3, Slide 10!

12

Preoperative Assessment: History and comorbidities

malignancy in the head or neck ->?

mediastinal masses obstructing great vessels
• dyspnea, dysphagia, stridor, wheezing, coughing→?
• compression of SVC→?

Preop testing: a lot of tests

Anesthestic concerns:

Preoperative Assessment: History and comorbidities

malignancy in the head or neck
• airway exam and possible need for tracheostomy
• Recurrent laryngeal n. damage

mediastinal masses obstructing great vessels
• dyspnea, dysphagia, stridor, wheezing, coughing→ recumbent pos.
• compression of SVC→JVD, facial, chest, neck, upper ext edema

13

Airway Assessment:

• tracheal deviation or compression
• SOB
• difficulty breathing (sign of airway obstruction)
• dysphagia
• Preop airway assessment, cervical ROM, cervical X-ray, ENT consult

14

***SVC Comp Syndrome + Tracheal Comp = ?

***SVC Comp Syndrome + Tracheal Comp = Superior Mediastinal Syndrome

15

Airway: radiation to head and neck→ ?

radiation to head and neck→ permanent tissue fibrosis
• carotid artery ds
• hypothyroidism
• difficult ventilation
• difficult intubation
*May not be recognized on physical exam

16

Slide 16: just read through

Slide 16: just read through

17

Preoperative Assessment: Functional status
chemo and radiation take a toll on patient
• Assess __________ status→ ________ tolerance

Preoperative Assessment: Functional status
chemo and radiation take a toll on patient
• Assess functional status→ exercise tolerance

18

Preoperative Assessment: Geriatrics
Greater comorbidities, frailty, polypharmacy
• risk of ?
• “Chemobrain” = ?

Preoperative Assessment: Geriatrics
Greater comorbidities, frailty, polypharmacy
• risk of delirium
• “Chemobrain”—chemo-induced cognitive dysfunction
- doc preop!

19

Preoperative Assessment: Education and prevention
management of ?
exercise routine ____ to surgery
• improves ?
• “prehabilitation”
• tobacco cessation

Preoperative Assessment: Education and prevention
management of comorbidities
exercise routine prior to surgery
• improves surgical recovery and improves overall survivorship
• “prehabilitation”
• tobacco cessation

20

Preoperative Assessment: Previous Cancer treatments
Prior cancer treatment and dates
• long-term _________
• acute _________

Preoperative Assessment: Previous Cancer treatments
Prior cancer treatment and dates
• long-term side effects
• acute side effects

21

Preoperative Assessment: CV system
• HR, pulse, and carotid arteries

If bruits are present→___________
• if severe stenosis and large intraop fluid shifts are expected, then ___________ is considered.
• mild stenosis→ _______________ therapy

Significant fatigue and loss of functional status
• echo ordered and results are WNL? ___________
• thoughts? ___________
• Cardiac stress testing might be considered (?)
• Lab________

hold breath x 15 sec
revascularization
pharmacological
does NOT mean no concerns
deconditioning
YES
BNP (HF)

22

Cardiovascular System: Doxorubicin (Adriamycin) ***
• cardiotoxicity may be acute or chronic:

• radiation (mediastinal)→?
• periodic ?

• QT prolongation
• cardiomyopathy
• dysrhythmias
• ischemia-related EKG changes
• HTN (monoclonal antibodies & tyrosine kinase inhibitors) -> Difficult to manage→ ACEIs and CCBs

accelerated CAD, valvular fibrosis, conduction abnormalities

echocardiography

23

Respiratory System*
• Drug?
• pulmonary toxicity
- pneumonia
- pulmonary fibrosis

Tests?

• avoidance of exposure to intraop high conc of ?**

*preop admin of?*

Respiratory System*
• Bleomycin
• pulmonary toxicity
- pneumonia
- pulmonary fibrosis

• baseline and serial pulmonary function testing
• chest radiography
• pleural effusion ?

• avoidance of exposure to intraop high conc of O2**

*preop corticosteroids*

24

Respiratory
• Pulmonary System
- Adenocarcinoma (30-50%)→ history of ?
- Large cell – ?
- Small cell -__________ weakness?
- Pain in ?
- Do you have frequent .......?
- Do you have X, Y, Z syndromes?

• Pulmonary System
- Adenocarcinoma (30-50%)→ history of blood clots?
- Large cell –gynecomastia?
- Small cell -muscle weakness?
- Pain in hands, fingers, knees, ankles?
- Do you have frequent lung infections or pleural effusions?
- Paraneoplastic syndrome, Eaton Lambert Syndrome, Myasthenia gravis?

25

Review Table 28.4 Slide 26!

Review Table 28.4 Slide 26!

26

Renal System

cisplatin*, high-dose methotrexate
• ______ insuff → usually resolves with ________ of tx

cyclophosphamide*
• _____
• ________________
• Medication concerns:________________
• Renal labs?

• tumor cell lysis?

Renal System

cisplatin*, high-dose methotrexate
• renal insuff → usually resolves with cessation of tx

cyclophosphamide*
• SIADH
• inhibit pseudocholinesterase
• Medication concerns: Mivacurium
• Renal labs: BUN, Cr, GFR

• tumor cell lysis
- radiation & chemo -> increase uric acid, Phos, K

27

Hematologic System
• ____suppression
• nadir?
• CA produces ______________ state
- _______________ events are increased six-fold in pts w/CA

Hematologic System
• myelosuppression
• nadir: RBCs, WBCs, Plts
• CA produces hypercoagulable state
• thromboembolic events are increased six-fold in pts w/CA

28

Hematologic—preoperative questions?

Bruising/bleeding
Clots (Hx)
Transfusions/anemia
Chemo (last)
Prone to infections?

29

Neurological System

• __________—virtually all patients experience paresthesias
-peripheral neuropathy
-encephalopathy

• ______________-induced neuromuscular toxicity (_____________ 60-100mg/day)

• radiation + methotrexate→?

Neurological System

• vincristine—virtually all patients experience paresthesias
-peripheral neuropathy
-encephalopathy

• corticosteroid-induced neuromuscular toxicity (prednisone 60-100mg/day)

• radiation + methotrexate→ irreversible dementia

30

Neurological—preoperative questions?

Numb/tingling
MS
agents on in the past
Muscle weakness
EL or MG?