oncological emergencies Flashcards
(21 cards)
pericardial effusion
due to spread of cancer there is decreased space in the pericardium, this can lead to cardiac tamponade
signs and symptoms of pericardial effusion
dyspnea, cough, orthopnea, chest discomfort, JVD, tachycardia, muffled heart sounds, liver engorgement, friction rub, pulmonary edema, pulsus paradoxus, progressive hypotension/shock
cxr, EKG
treatment of cardiac tamponade
corticosteriods, diruetics, NSAIDs, pericardial window, pericardialcentesis, aspiration/testing of fluid to ensure it is cancerous, pericardectomy
complications associated with pericardectomy
anesthesia risk dysrythmia bleeding infection hemothorax
sclerotherapy
injected into the pericardium to “harden” prevents reaccumilation of fluid
complications of sclerotherapy
localized pain, fever, PVCs, pericarditis, myelosuppression
superior vena cava syndrome
caused by obstruction of blood flow through the superior vena cava
common cause- malignancy with compression of the vessel by tumor or lymph node mass
lymph chains in chest w
s/s of superior vena cava syndrome
face edema, upper arms, chest, collateral veins in neck of chest visible, metal stents may be placed percutaneous, patient with mental status change, ICP, or upper airway constriction
spinal cord compression
can lead to serious deficits of bowl and bladder
can be the first identifier of cancer- thought to be lower back pain
signs and symptoms of SCC
-pain is worse with movement , cough, having a bowel movement, neck flexion
-pain worsens over days-weeks
urinary retention- early sign
loss of bowel continence- late sign
assessment of SCC
pain assessment physical w palpitation and percussion of spine sensory assessment mri prompt trx can lessen deficits
brain mets s/s
h/a, blurred vision, n/v, ataxia, dysphagia, personality changes, seizures
trx of brain mets
corticosteriods
anticonvulsants
whole brain radiation
surgical resection
hypercalcemia s/s
altered LOC, difficulty concentrating, confusion, personality changes, hallucinations, psychosis, fatigue, lethargy, muscle weakness, pathologic fracture, anorexia, nausea, decreased gastric emptying, abdominal pain, polyuria, lack of intervention may lead to renal failure coma or cardiac arrest
tumor lysis syndrome
refers to rapid breakdown of the intracellular electrolyte
may occur spontaneously or rapidly in proliferating tumors after chemo
spontaneous lysis
occurs before cancer treatment, hyperkalemia, hyperphosphatemia, hypocalcemia present at time of diagnosis
medical and nursing trx of tumor lysis syndrome
identify pt at risk, correct abnormalities, give allopurinol to prevent uric acid crystals, ad NaHco3 to IV fluid, avoid IV potassium bc of potential hyperkalemia, kayexalate, monitor electrolyte, treat hypocalcemia with IV calcium gluconate, hemodialysis if not responding to trx
risk factors for tumor lysis syndrome
pretreatment elevation of uric acid and LDH, renal insufficiency/failure, dehydration
DIC
hyper coagulation or no coagulation, little clots can form in the organ capillaries or there is uncontrollable bleeding
treatment of DIC
underlying conditions and infection, sepsis, volume depletion, labs and fibrogen, hypoxemia, if pt has reoccurent fibrolytic events, IV heparin, LMW heparin, unit of PRBC, FFP, replaces clotting factors
nursing management of DIC
bleeding, petecheai, ecchmyosis, purpura, pallor, frank blood oozing, observe mouth and mucus membranes, ascultate lungs for crackles, wheezes, stridor, tachycardia, hypotension, changes in peripherial pulses, i/o, periphrial edema, palpate abdomen, measure girth daily, observe for change in loc, irriability
