oncologic emergencies

Question 1

types of oncologic emergencies

Answer 1

-hematologic
-fluid and electrolyte
-tumor related

Question 2

types of hematologic oncologic emergencies

Answer 2

-neutropenia
-hyperviscosity
-bleeding risk

Question 3

types of fluid and electorate oncologic emergencies

Answer 3

-hypercalcemia
-SIADH
-fluid excess

Question 4

types of tumor related oncologic emergencies

Answer 4

-pain crisis
-tumor lysis syndrome
-mechanical obstruction

Question 5

who’s at risk for anemia - neutropenia/thrombocytopenia

Answer 5

-cancers or chemotherapies that cause myelosuppression
-anticipate outcomes

Question 6

presentation for anemia - neutropenia/thrombocytopenia patients

Answer 6

-anemia, neutropenia, thrombocytopenia lab results
-fatigue/weakness
-bleeding - gums, puncture sites

Question 7

anemia - neutropenia/thrombocytopenia priority assessments

Answer 7

-VS especially temperate (fever), cardiac, lungs, skin
-CBC with differential
-CMP
-blood cultures and lactate levels

Question 8

anemia - neutropenia/thrombocytopenia priority interventions

Answer 8

-monitor for bleeding - oral care, puncture sites - apply pressure
-prepare to administer blood or blood products to replete loss
-administer medications to support cell production
-protect from infection - treat accordingly

Question 9

who’s at risk or hyperviscosity syndrome?

Answer 9

patients with multiple myeloma, leukemia; other blood disorder

Question 10

what is the presentation of patients with hyperviscosity syndrome

Answer 10

-triad: mucosal bleeding, Neuro systems, visual disturbances
-bleeding from the nose or mouth, headache, visual changes, GI bleeding, paresthesias, heart failure

Question 11

hyperviscosity syndrome priority assessment

Answer 11

-physical assessment - neurological; retinal assessment
-serum protein levels; serum viscosity; CBC, CMP, coagulation profile
-serum renal functions: renal tubule dysfunction/obstruction

Question 12

hyperviscosity syndrome priority interventions

Answer 12

-symptom control
-IV hydration
-plasmapheresis or elective phlebotomy
-treatment of underlying condition
-thromboembolism risk

Question 13

who is at risk for bleeding?

Answer 13

-thrombocyotpenia r/t leukemia, myelosuppression
-local tumor invasion
-antitumor treatments - radiation chemotherapy

Question 14

what is the presentation of a patient at risk for bleeding?

Answer 14

-hematemesis, hematochezia, melena, hematuria, vaginal bleeding
-bruising. petechiae, epistaxis

Question 15

what is the priority assessments of someone who is a bleeding risk

Answer 15

-source of bleeding
-CBC, coagulation profile, hepatic functions, CMP

Question 16

bleeding risk priority interventions

Answer 16

-iV replacement of blood or blood products
-preparation for endoscopy/colonoscopy
-imagine of area of bleeding
-direct coagulation of bleeding - embolization, cautery
-holding of affecting agent to allow bone marrow recovery
-radiation therapy
-medications

Question 17

who is at risk for hypercalcemia?

Answer 17

-breast, lung, head and neck cancers; leukemias and lymphomas; multiple myelomas; and bony metastases of any cancer

Question 18

presentation of early hypercalcemia

Answer 18

-fatigue, muscle weakness, anorexia, and constipation

Question 19

presentation of late hypercalcemia

Answer 19

confusion, nausea, & vomiting, resulting in dehydration, renal failure, cardiac arrhythmia, & eventual coma

Question 20

hypercalcemia priority assessments

Answer 20

-serum chemistry specifically calcium levels
-parathyroid levels
-neurological assessments noting changes

Question 21

hypercalcemia priority interventions

Answer 21

-reduce calcium levels
-target underlying cause
-prepare to administed: furosemide, pamidronate, calcitonin, phosphates
-hemodialysis for severe heart failure or renal failure

Question 22

who’s at risk for SIADH

Answer 22

mostly seen with lung and brain cancers

Question 23

SIADH presentation

Answer 23

nausea & vomiting (early); lethargy, hostility, seizures & coma

Question 24

SIADH priority assessments

Answer 24

-labs: serum chemistry specifically sodium, serum and urine osmolality
-neurological assessments noting changes

Question 25

SIADH priority interventions

Answer 25

-monitor for hyponatremia and low blood osmolality -prepare to administer: furosemide, normal saline, hypertonic sodium chloride solution for severe hyponatremia -monitor vital signs and blood sodium level -monitor for fluid overload due to hypertonic sodium chloride

Question 26

who's at risk for pericardial effusion/cardiac tamponade

Answer 26

-lung cancers: large cell, adenocarcinoma -lymphatic involvement -leukemia, lymphoma -primary or metastatic heart malignancies

Question 27

what is their presentation pericardial effusion/cardiac tamponade

Answer 27

-tachycardia, tachypnea, hypotension, chest pain, distant heart sounds, narrow pulse pressure, SOB -anxiety, restlessness, confusion -presents like heart failure

Question 28

pericardial effusion/cardiac tamponade priority assessments

Answer 28

-cardiac, lungs, VS -pericardial effusion on imaging

Question 29

pericardial effusion/cardiac tamponade priority interventions

Answer 29

-hemodynamic monitoring -symptom management; I/O supportive medications -prepare patient for pericardial window

Question 30

who's at risk for pleural effusion

Answer 30

-lymphomas -cancers of the lung -breast and ovaries

Question 31

what is the presentation of someone with pleural effusion?

Answer 31

-dyspnea - depends on volume of effusion -chest wall pain, hemoptysis, weight loss, malaise, anorexia, N/V

Question 32

pleural effusion priority assessments

Answer 32

-cardiac, lungs, VS -pleural effusions on imagine

Question 33

pleural effusion priority interventions

Answer 33

-hemodynamic monitoring -symptom management, I/O, supportive medications -prepare patient for: thoracentesis, thorascopy for biopsy, indwelling pleural catheter, pleurodesis

Question 34

how much liquid do they drain using an indwelling pleural catheter?

Answer 34

no more than 1000mLs at a time

Question 35

who is at risk for a pain crisis?

Answer 35

all oncologic patients

Question 36

presentation of patients in pain crisis

Answer 36

-varies -could be coupled with fear and anxiety

Question 37

pain crisis priority assessments

Answer 37

-use pain scales to assess pain and discomfort characteristics: location, quality, frequency, duration, etc., at baseline and on an ongoing basis -assure patient that you know the pain is real and will assist them in reducing it

Question 38

important part of pain crisis

Answer 38

help them stick to pain management

Question 39

pain crisis priority interventions

Answer 39

-anticipate pain management needs -monitor CNS, cardiovascular and respiratory response -manage breakthrough pain levels and timing medications -utilize non-pharmacologic approaches

Question 40

who is at risk for tumor lysis syndrome

Answer 40

-people with larger tumors -certain chemotherapy agents -older age -high-grade lymphomas -acute leukemias

Question 41

presentation of tumor lysis syndrome

Answer 41

-GI distress -dehydration -hypotension -flank pain -muscle cramps -weakness -seizures -mental status changes -cardiac dysrhythmias

Question 42

tumor lysis syndrome priority assessments

Answer 42

-neurologic, pain, GI -monitor CMP especially potassium, uric acid & phosphorous -assess AKI -cardiac monitoring -monitor I/O -monitor for neuromuscular irritability -medications to reduce potassium, uric acid & phosphorous levels (diuretics, allopurinol, sodium polysystrene, rasburicase) -may require hemodialysis

Question 43

who's at risk for superior vena cava syndrome?

Answer 43

metastases from breast or lung cancer

Question 44

superior vena cava syndrome presentation

Answer 44

-periorbital & facial edema -erthythema of the upper body -dyspnea -epistaxis

Question 45

superior vena cava syndrome priority assessments

Answer 45

-skin -head -thorax assessments -VS

Question 46

superior vena cava syndrome priority interventions

Answer 46

-position high-fowler's -administer IV corticosteroids -prepare patient for thrombolysis or placement of venous stent -high-dose radiation therapy for emergency temporary relief

Question 47

who's at risk for spinal cord compression

Answer 47

primary metastatic vertebral tumors

Question 48

spinal cord compression presentation

Answer 48

-changes in sensation -muscle strength -reduced deep tendon reflexes -worsening back pain -bowel or bladder retention

Question 49

spinal cord compression priority assessments

Answer 49

-neurologic and pain, bowel or bladder as appropriate -prepare patient for possible MRI

Question 50

spinal cord compression priority interventions

Answer 50

-prepare to administer high dose Iv steroids -pain control -prepare patient for possible surgical intervention and/or radiation therapy to relieve cord compression