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Palliative > Oncological emergencies > Flashcards

Oncological emergencies Flashcards

(53 cards)

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1
Q

What is the best test for spinal cord compression?

A

MRI without contrast

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2
Q

What test should be done for assessing for spinal cord compression if the pt can’t tolerate MRI?

A

CT– can be done if they can’t tolerate or if MRI is not available

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3
Q

What are the treatments for Spinal Cord Compression?

A

-steroids
-radiation therapy
-administer analgesics as ordered
-surgical interventions

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4
Q

What is meant by autonomic dysfunction caused by SCC?

A

bladder and bowel functions not working

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5
Q

When is spinal cord compression life-threatening?

A

if the compression involves C3 and higher

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6
Q

What are the common symptoms of SCC?

A

back pain, bladder dysfunction, bowel dysfunction, leg weakness

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7
Q

What should be done for a suspected SCC?

A
  1. report suspected SCC to MD and administer Dexamethasone STAT 10-20mg IV/SC or 80-100mg IV/SC depending on severity of symptoms
  2. Fast track to MRI within 24 hours
  3. Refer to radiology/neurosurgery
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8
Q

What is the treatment for bone pain?

A

opioids and adjuncts including NSAID, corticosteroids, and bisphosphonates

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9
Q

What are the interventions for SCC?

A

-analgesia
-radiotherapy
-dexamethasone
-bowel regimen
-positioning (supine, log roll patient when repositioning)
-may require a catheter

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10
Q

Why must hypercalcemia be treated?

A

can cause life-threatening arrhythmias

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11
Q

What is the common process of hypercalcemia?

A

about 80% of cases is caused by production of the Parathyroid hormone by the tumour
–>PTHrp is secreted, looks like parathyroid hormone which increases osteoclastic activity which liberates bone calcium

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12
Q

What is the second process for developing hypercalcemia?

A

skeletal metastases activate osteoclasts through cytokines which increases serum calcium

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13
Q

What are the signs and symptoms of hypercalcemia?

A

-polyuria
-polydipsia
-delirium r/t dehydration
-N/V, abdominal pain, anorexia
-fatigue, weakness
-bone pain
-arrhythmia

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14
Q

What are the main goals of treatment of hypercalcemia?

A

1) rehydrate
2) control serum calcium levels

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15
Q

What is the treatment for hypercalcemia?

A

Rehydrate:
IV 8-10 hours at 125mL/hr
OR SQ max 1000mL/day hypodermoclysis

Control serum calcium via IV Bisphosphonates because they are cytotoxic to osteoclasts and disrupt their activity inhibiting the release of calcium

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16
Q

Which Bisphosphonate should be used for controlling serum calcium levels?

A

Pamidronate at a slow IV infusion or Zoledronic Acid for patients who cannot tolerate Pamidronate (the advantage is that this is a fast infusion in around 15 min)

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17
Q

What is a pleural effusion?

A

an accumulation of fluid in the pleural space (space that surrounds each lung)
-can reach up to 1000-1500 mL)

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18
Q

What does a pleural effusion indicate for the prognosis of a palliative patient with cancer?

A

about 3-6 month survival rate at the time of onset of the pleural effusion

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19
Q

What are the signs and symptoms of a pleural effusion?

A
  1. Refractory dyspnea is the most common
    symptom.
  2. Restricted Chest Expansion
  3. Pleuritic Pain (pain upon inspiration)
  4. Decreased a/e upon auscultation (and/or crackles
    in upper lobes)
  5. Dullness upon percussion
  6. Jugular Vein Distension (JVD) if the MPE is large
    enough (~1000 mL of fluid accumulation)
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20
Q

Which diseases are most likely to cause pleural effusions

A

tumor or malignant cells

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21
Q

Define malignant pleural effusion

A

pleural effusion caused by end stage cancer– survival of about 3-6 months

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22
Q

What is the most common presenting symptom of pleural effusions?

Study These Flashcards
A

severe dyspnea

23
Q

What would you hear if you put your stethoscope over a pleural effusion?

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A

you would hear absolutely nothing

24
Q

What are the signs and symptoms of pleural effusions?

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A

-pain on inspiration
-chest movement restriction
-tracheal shift
-dullness to percussion, decreased air entry on auscultation
-if the pleural effusion is large– JVP may be elevated

25
What are the diagnostic tests for pleural effusions?
1) chest x-ray=definitive 2) ultrasound may be used to guide thoracentesis if fluid accumulation is small, but not needed if accumulation is large 3) CT scan if both CXR and ultrasound are inconclusive
26
What can we do to help manage symptoms of pleural effusions?
-opioids and benzodiazepines -thoracentesis -pleurodesis
27
Describe a thoracentesis
-catheter is used to drain accumulated fluid, can be continuous or intermittent -do NOT drain more than 1000mL of fluid (check site guidelines) Nursing responsibilities: must observe pt for tolerance (discomfort, dizziness, cough) as it can limit the amount drained
28
Describe a Pleurodesis
-for dyspnea unrelieved by thoracentesis in pts with prognosis >3 months -done after drainage/thoracentesis -a slurry is injected into the catheter used for thoracentesis that contain chemicals that cause scarring and inflammation-- the goal of this treatment is to fuse the two membrane linings together -not used for palliative pts because of poor prognosis (<3 months) and the quick re-accumulation of fluids -in palliative pts this will result in multiple pockets of fluid accumulation
29
What are the causes of bowel obstruction?
-most common cause is intra-abdominal cancers (pelvic, colorectal, stomach) -causes mechanical or functional obstructions
30
What is the assessment that can be done for determining if there is a malignant bowel obstruction?
Occult blood test: detects small amounts of blood in stool even in the earliest stage of malignancy (stage 1 or 2)
31
What are the pharmacological interventions for bowel obstruction?
1. Octreotide (50-200 mg SC Q8H) - Somatostatin, anti-diarrheal - ↓ gastric secretions, ↓ swelling / edema, ↓ pain r/t spasms 2. Buscopan (10-20 SC Q4H; max: 120mg/day) - Anti-spasmodic - ↓gastric secretions, ↓ pain r/t spasms (painful peristalsis) - Less expensive than octreotide 3. Dexamethasone - Corticosteroid - Use if BO is r/t tumor, helps to ↓ swelling from tumor. - Can reverse complete obstruction to partial by decreasing inflammation of bowel = enlarging lumen
32
What does Dexamethasone do?
decreases the edema in the bowel wall to help fecal matter move through the bowel
33
What medication should be used for N/V with a bowel obstruction?
Haloperidol or Methotrimpeprazine -do NOT use a prokinetic like Metoclopramide
34
What is the care plan for a complete bowel obstruction?
- NPO, Complete bowel rest - Hydrate pt with IV / hypodermoclysis to prevent dehydration (1-2 L / day) - Give artificial saliva
35
What is the care plan for a partial bowel obstruction?
- Sips of fluid - Soft diet as tolerated - Priority: analgesic, mouth care (ice chips)
36
What invasive procedures can be done for a bowel obstruction?
1. GI decompression & NG: if there is ++ pressure and persistent NV 2. Colonic Stent: if obstruction is r/t malignancy and well defined; patency lasts for patient’s life 3. Bowel Resection: if obstruction is r/t malignancy and well defined
37
What is hemoptysis?
blood expectorated from the lower respiratory tract
38
What is mild vs moderate vs severe hemoptysis?
-->severe is an emergency!! takes 30-60 min to die
39
What causes hemoptysis?
Caused by the bursting of fragile, damaged, or collateral vessels under high pressure. Most common in patients with lung cancer and TB
40
What are the signs and symptoms of hemoptysis?
1. Cough 2. Dysphagia (difficulty swallowing) 3. Hoarseness 4. SOB 5. Dyspnea 6. Wheezing 7. Chest Pain 8. Coffee-coloured Emesis (as the blood reaches the back of the throat, the natural response is to swallow = introducing the blood to the GI tract. Blood is irritating to the stomach = emesis)
41
What are the diagnostic tests for hemoptysis?
1) bronchoscopy 2) CT if bronchoscopy is too invasive for pt
42
What is the treatment for of mild/chronic hemoptysis?
- Radiotherapy = shrink tumor - Chemotherapy = slow tumor growth - Tranexamic Acid = slowly forms clots by putting fibrin threads back together so patient does not bleed out. Only used for SLOW bleeds and if patient can swallow (route: PO)
43
What is the treatment for a severe bleed in hemoptysis?
- Indicates patient will die within 30-60 minutes - Provide reassurance to pt and family. DO NOT LEAVE PT when calling for help, use call bell. - Opioids and sedatives / benzodiazepines that patient ALREADY HAS (give via the fastest route: subcut or preferably IN via MAD) - Bleed kit: dark linens to ↓ visual impact - Warm blanket: pt will become cold and hypotensive - Suction: only if gagging occurs
44
What is a superior vena caval obstruction?
Indicative of laryngeal edema or central air way obstruction. Warrants notification of doctor and family. May need admission to ICU and intubation.
45
What are the symptoms of superior vena caval obstruction?
1. Feelings of “fullness” in head, headache 2. Dizziness, blurred vision, syncope (fainting) 3. Coughing, dysphagia (difficulty swallowing) 4. Chest pain, dyspnea
46
What are the physical findings of a vena caval obstruction?
1. Jugular vein distension 2. Edema: face, arms 3. Distended anterior chest wall veins, aggravated when leaning forward (tripod position) 4. Distended veins in hands, will not go away when arms are raised 5. Positive Pemberton’s Sign
47
Describe Pemberton's sign
- Face is normal coloured when arms at side - Ask pt to lift arms above head: will exaggerate constriction of SVC and cause pt’s face to turn red. Pt will feel dizzy. Non-invasive test for SVCO
48
What causes vena caval obstruction?
Common in lung cancer and lymphomas. Obstruction caused by an extrinsic compression of tumor/tumor nodes on SVC, direct invasion of tumor or non-malignant: thrombosis of CVAD / subcut catheter
49
What does NSCLC stand for?
non-small cell lung cancer
50
What tests are done to diagnose vena caval obstruction?
1. CT scan with contrast or MRI (contrast allergy) 2. Would not use a chest x-ray b/c these pts will always have abnormal findings. Most common abnormal finding: mediastinal widening, pleural effusion.
51
What are the treatments for SVCO r/t malignancy?
1. Radiotherapy = shrink tumor 2. Chemotherapy = slow tumor growth 3. Stent = for pts who cannot tolerate medication, radio/chemotherapy or are too ill. Helps keep SVC open, allowing for blood flow to the right atrium.
52
What are the treatments for SVCO r/t thrombosis?
1. Tenecteplase: direct thrombolysis. 2. Anti-coagulant: if there is no risk for anti- coagulant use. - Initial: UF heparin / LMWH - Long term: LMWH / Coumadin
53
What intervention should NOT be done for SVCO?
-do NOT put the pt in tripod position as this will aggravate anterior chest vein distention -avoid inserting IV/SC into affected limbs or chest

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