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S4E3 Flashcards

(110 cards)

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1
Q

Oncologic emergencies involving Cardiovascular

A

Malignant pericardial effusion
Pericardial tamponade
Superior vena cava syndrome

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2
Q

Oncologic emergencies involving CNS

A

Increase intracranial pressure
Metastatic spinal cord compression

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3
Q

Oncologic emergencies involving ortho

A

Pathologic fractures

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4
Q

Oncologic emergencies involving renal

A

Ureteral obstructions
⬇️
Pelvic tumors

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5
Q

Oncologic emergencies involving respiratory 🫁

A

Airway obstruction
Pneumothorax
Malignant pleural effusion

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6
Q

Oncologic emergencies involving GI 🤰🏽

A

Bowel obstruction
Bowel perforation

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7
Q

Metabolic Oncologic emergencies

A

Hyperuricemic Syndrome
Hypoglycemia
Hypercalcemia
Tumor lysis syndrome
Lactic acidosis
Hyponatremia & SIADH
Hyperkalemia
Hypokalemia

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8
Q

Types of Hypokalemia metabolic oncologic emergencies

A

Tumor associated
Treatment related (hyperemesis/diarrheal losses)

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9
Q

Hematologic Oncologic emergencies

A

Leukosis
Disseminated intravascular coagulation
Hyper viscosity syndrome
Myelosuppression(Profound thrombocytopenia )
Thromboembolic disease
Acute hemolytic anemia

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10
Q

Infectious Oncologic emergencies

A

Myelosupression⬇️
Febrile neutropenia / Nadir Sepsis
Disseminated viral infections

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11
Q

Leukemia

A

Cancer of WBC
Uncontrolled replication of Immature WBC

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12
Q

Cause of leukemia

A

Unknown

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13
Q

Dx test for leukemia

A

Repeated CBC
Positive Bone biopsy
Lymph node biopsy
Lumbar puncture : meningeal involved

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14
Q

Leukemia symptoms

A

Wt loss
Fever
Frequent infections
Easy SOB
Weakness
⬇️perfusion
⬇️o2 sat
Bone/joint pain
Muscle weakness
Fatigue
Loss of appetite
Swollen lymph nodes
Spleen/liver enlargement
Easy bruising/bleeding
Purplish patches/spots
Night sweats
Headache
Orthostatic hypotension
Pallor

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15
Q

Leukemia signs

A

⬇️⬆️WBC
⬆️Monocytes
⬆️lymphocytes
⬆️neutrophils
⬇️RBC
⬇️platelets
⬇️H&H
Thrombocytopenia
Anemia

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16
Q

What is ALL

A

Acute lymphocytic leukemia
<15 years old
Mostly lymphoblast and bone marrow
Acute =most troublesome
Rapid onset = rapid rapid rapid
⬇️RBC
⬇️platelets
⬆️ immature WBC
Quicker intervention =better outcome

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17
Q

What is AML

A

Acute Myelogenous Leukemia
15-39 years old
Mostly myeloblasts in bone marrow
Acute= troublesome
Rapid onset= rapid rapid rapid
Infection
Bleeding
Pain from enlarged spleen/liver
Hyperplasia of gums
Bone pain

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18
Q

What is CLL

A

Chronic lymphocytic leukemia
Most common
>50 years old
Mostly lymphocytes in bone marrow
B-cell lymphocytes
Dx w/o symptoms
Tx: chemo & monoclonal antibodies

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19
Q

What is CML

A

Chronic myelogenous leukemia
>50 years old
Mostly granulocytes in bone marrow
SOB
Confusion
Long bone pain
Liver/spleen enlargement

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20
Q

Leukemia risk factors

A

Genetic viral
Immunological
Environmental:
Radiation exposure
Chemicals
Other carcinogens

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21
Q

Leukemia TX

A

Multi drug chemo
Radiation
Bone marrow transplant

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22
Q

Goal of TX for leukemia

A

Preserve organ/system function
Remission
Control bone marrow/systemic disease
Targeted tx to specific system

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23
Q

Leukemia nursing care for risk of infection

A

Major cause of death
Initiate neutropenic precautions
Hand washing
Strict aseptic technique
Avoid invasive procedures
Common site’s :
RESP tract
GI
Skin

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24
Q

Signs of infection in leukemia pt, what to do next?

A

Notify provider immediately

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25
Leukemia nursing care for Risk of bleeding🩸
During nadir Risk when platelet is <50,000 cells/mm3 Maybe need platelet transfusion Monitor labs, signs of bleeding Fall precautions Handle pt gently Bleeding precautions
26
Leukemia nursing care for Fatigue & Nutrition
Small, frequent meals ⬆️ calorie ⬆️ protein ⬆️ carbs Assist with ADLs PRN Allow rest periods Blood product administration per order Check albumin
27
Leukemia nursing care as prescribed
Chemo administration Abx administration Blood product administration Prepare pt for bone marrow transplant Provide resources for psychosocial: Financial Family
28
29
Lymphomas
Neoplasms of T /B lymphocytes Starts in: Lymph nodes Lymph tissue off spleen GI tract Liver Bone marrow Classified by degree of cell differentiation & origin of predominant malignant cell (Hodgkin vs Non)
30
Lymphoma non specific symptoms
Lymphadenopathy *** Systemic: Fever Night sweats Wt loss
31
Lymphoma other symptoms
Lots of appetite/anorexia Fatigue Resp distress/dyspnea Itching
32
Hodgkin’s
Single or chain of lymph nodes May metastasize to lymph tissue: Tonsils Spleen Bone marrow
33
What Special characteristic is seen in Hodgkin’s?
Reed-Sternberg cell in nodes
34
Hodgkin’s possible exposures
Viral infection Previous exposure to alkylating chemo
35
Hodgkin’s Clinical manifestations
Positive lymph node biopsy Pruritis Pain after alcohol consumption Enlarged lymph nodes Hepatosplenomegaly Malaise, fatigue, weakness Loss of appetite, significant wt loss Fever, night sweats
36
Non-Hodgkin’s lymphoma (NHL)
Diverse group of blood cancers Risk factors : Immunodeficiencies
37
NHL stage I
In one lymph node or organ
38
NHL stage II
In _>_2 groups of nodes in same half of body
39
NHL stage III
In lymph nodes on both sides of the body
40
NHL stage IV
Spread outside of lymph node system into an organ that is not adjacent
41
NHL symptoms
Highly variable May not appear until stage III or IV Fever Night sweats Unintentional wt loss Lymphadenopathy
42
NHL tx
Chemo Radiation Monoclonal antibodies Intrathecal chemo
43
NHL nurse care
Monitor: Labs Client response to disease process Client response to tx Complications Educate: Tx regimen Resources for support Future annual screenings
44
Multiple myeloma
Cancer of plasma cells Crowd space, not enough room for other cells Develop into tumors Destroy bone Invade lymph nodes, spleen, liver
45
Where is multiple myeloma discoverable?
Blood & urine
46
Multiple myeloma signs
⬇️immunoglobulin ⬇️antibodies ⬆️Uris acid ⬆️calcium Can lead to renal failure
47
Multiple myeloma etiology is…
Unknown
48
Multiple myeloma clinical manifestations
Bone pain: Spine Ribs Pelvis Osteoporosis, pathological fractures Anemia Thrombocytopenia Granulocytopenia Weakness Fatigue Renal failure Infection Neuro: Confusion Neuropathies
49
Multiple myeloma RX Tx
Chemo Radiation IV fluids Diuretics Blood transfusion (anemia) Analgesics for pain Antibiotics for infections
50
Multiple myeloma nurse care
Control symptoms Prevent complications Maintain neutropenic Bleeding precautions Fall precautions Monitor for signs of: Bleeding Infection Skeletal fracture Renal failure
51
Normal calcium
52
Normal glucose
70-100
53
Lactic acidosis
54
Potassium levels
3.5-5
55
Normal WBC
56
Normal RBC
57
Normal platelets
58
Leukostasis
Congestion of immature white blood cells
59
Myelosupression
Bone marrow suppression
60
Hyperuricemic syndrome
⬆️uric acid in blood Log in joins or renal system
61
Normal uric acid
2.4-7 mg/dL
62
Hyperuricemic syndrome may cause…
Acute gout arthritis Renal urate Lithiasis Acute uric acid nephrophathy
63
Host related risk factors for Hyperuricemic syndrome
Pre existing Hyperuricemia Pre existing volume depletion/dehydration CKD ARF following cytotoxic therapy Acidic urine
64
Tumor related risk factors for Hyperuricemic syndrome
⬆️tumor cell proliferation ⬆️tumor sensitivity to cytotoxic therapy Large tumor burden Advanced disease Metastatic disease Intensive cytotoxic therapy
65
S/s of acute attack during Hyperuricemic syndrome
Abrupt onset Often at night Severe pain Redness Swelling Warmth of involved joint
66
Tx for Hyperuricemic syndrome
Prevent Prophylaxis: allopurinol Start 2 days prior to tx Continue for 2 weeks Protect Adequate hydration Reduce Rasburicase for high risk pt Already Hyperuricemic Relieve Painful inflammation NSAIDs if no kidney/liver disease Corticosteroids/colchicine if kidney disease
67
TLS
Tumor lysis syndrome Rapid necrosis of tumor cell Massive intracellular material release into circulation. Life threatening load of: Hyperkalemia Hyperurecemia Hyperphosphatemia Hypocalcemia Acidosis Azotemia Ascites Acute renal Arrhythmias
68
Dx of TLS
⬆️Uric acid _>_476 or 8 ⬆️K+ _>_6 ⬆️Phos kids: _>_2.1, adult: _>_1.45 ⬇️_<_1.75 AND 1 or more of these: ⬆️Crea >1.5 Dysthymias Seizures (new onset)
69
Hyperkalemia s/s
Wide QRS complex**** Peak T waves**** ST changes**** Prolonged PR**** Loss of P wave**** Dysrhythmias Htn Sudden death Muscle cramps/weakness Paresthesia Paralysis Anorexia NVD Hyperactive bowel sounds Abdominal pain or cramps
70
Hyperkalemia interventions
ABCs Telemetry Check ECG Safety/fall risk Verify IV access C BIG K DI Calcium Gluconate Beta-2 agonists/bicarbonate Kayexalate (slow) Diuretics/dialysis/dextrose Insulin
71
Hyperphosphatemia s/s
Htn Dysrhythmias Muscle cramps Seizures Tetany Lethargy NVD Ca/Phos precipitates Acute Renal Failure Edema
72
Hyperphosphatemia interventions
IVF Strict I/Os hourly 2ml/kg/hr Daily wt Seizure precautions Telemetry Restricted phos diet Recheck labs Q4-6 hrs PO phos binders: Aluminum hydroxide Aluminum carbonate Calcium acetate
73
Hyperuricemia s/s
Htn Endocarditis Gout Lethargy Malaise Somnolence Seizures Anorexia NVD Acute renal failure Wt gain Edema Flank pain Hematuria Cloudy urine
74
Hyperuricemia interventions
IVF Strict I/Os Seizure precautions Pain management
75
Hypocalcemia s/s
Dysrhythmia Hypotension Syncope Muscle spasms Muscle cramps Positive Chvosteks/Trousseau Paresthesia Tetany AMS Confusion Delirium Hallucinations Seizures Anorexia Diarrhea Abd cramps Laryngospasm Bronco spasm
76
Hypocalcemia interventions
ABCs Telemetry Verify IV access Safety/fall risk
77
Normal potassium
3.5-5
78
‼️WATCH OUT FOR ….. in TLS‼️
Acute decline in UOP Oliguria Anuria
79
CBC
80
Chem panel
81
Abg
82
Calcium
2.4-7
83
DIC
Disseminated IV coag Systemic activation of coagulation Leads to widespread thrombus formulation Platelet & coat consumption =bleeding
84
DIC risk factors
Malignancy vs cytoxocity Pregnancy Sepsis
85
86
DIC labs in order
⬆️PT/PTT ⬆️INR ⬇️fibrinogen ⬇️platelet count ⬆️fibrin degradation products ⬇️Hct
87
Skin clinical manifestations in DIC
Micro emboli: Cyanosis of digits or nose Mottling Necrosis Gangrene Coolness Edema Hemorrhagic : Bleeding from venture sites, surgical incisions, mucous membranes, or draining tubes Petechia Epistaxis Hematoma
88
Neurological clinical manifestations in DIC
Micro emboli: Stroke Alter level of consciousness Confusion TIA Hemorrhagic : Subarachnoid bleeding Alter level of consciousness Headache
89
Vascular clinical manifestations in DIC
Micro emboli: Diminished or absent peripheral pulses Tachycardia Hemorrhagic : Tachycardia Hypotension
90
Pulmonary clinical manifestations in DIC
Micro emboli: PE Acute respiratory distress syndrome Chest pain SOB Oxygen saturation Hemorrhagic : Hemoptysis Bloody secretions from endotracheal tube
91
GI clinical manifestations in DIC
Micro emboli: Borrow infarction Constipation Diarrhea Melena Vomiting Abd distention Hemorrhagic : G.I. bleed Abd distention Occult blood
92
Renal clinical manifestations in DIC
Micro emboli: Hematuria Oliguria ⬆️BUN&Crea Hemorrhagic : Hematuria
93
DIC key management
1. remove the trigger/treat underlining cause 2. Maintain organ perfusion. 3. Restore the balance of normal homeostasis. 4. Provides supportive management of complications.
94
DIC tx
Treat underlining cause Stop clotting Lovenox Subcu SCD Low dose heparin infusion Antithrombin III Stop bleeding Blood products: RBC, FFP, Prevent Antifibrinolytic agents
95
DIC total nursing interventions
Recognize Asses/monitor Protect/Prevent Implement Evaluate Repeat
96
97
Malignant pleural effusion s/s
Crackles SOB Worsening dyspnea Tripod Nonproductive, dry cough Orthopnea Pain worse with breathing Chest heaviness Worsening activity tolerance DOE Malaise Diminished breath sounds
98
Malignant pleural effusion interventions
ABG***** O2 sat Asscultate front & back Pain Positioning Imaging
99
Malignant pleural effusion tx
Centesis Fluid drainage below area Check for therapeutic outcome: ABCs pain relief Drainage amount Chemo/radiation/sx
100
Malignant cardiac tamponade s/s
SOB Fatigue Restlessness Palpitation Symptoms of pericarditis
101
Beck’s triad in Malignant cardiac tamponade
JVD Poor Cardiac output Tachycardia w/ low BP Poor peripheral perfusion Distant muffled heart sounds Becks triad
102
TLS
Rapid necrosis of tumor cells Release of massive intracellular material into circulation
103
TLS signs
⬆️hyperkalemia ⬆️Hyperuricemic ⬆️hyperphosphatemia ⬇️calcemia Acidosis
104
Dx Malignant cardiac tamponade
CXR ECG Echocardiogram
105
Tx Malignant cardiac tamponade
Needle pericardiocentesis Pericardial catheter Pericardial window
106
Pericardiocentesis nursing interventions
Continue to monitor patient There will be more fluid build up Tele: Continuous cardiac monitoring Assess/monitor for complications: Dysrhythmias Hemothorax Pneumothorax Coronary artery puncture Lung puncture VS: Q15 x2 Q30 x2 Q1h x2 complications immediately Q4 as less drainage/abscence effusion Drainage Bag at or below heart level Monitor cath for occlusion Assess characteristics of drainage Cath care: sterile dressing, change only if soiled or after 96 hrs!!
107
Normal calcium
8.8-10.4
108
Hypercalcemia s/s
Constipation Arrhythmia Confusion Lethargy Pathological fractures
109
Principles of managing hyperkalemia
Stabilize Calcium gluconate *immediate Shift Insulin *15-30min Albuterol 15-30mim Eliminate Furosemide (lasix)*15min-1hour Kayexalate *1-2 hrs
110
Symptomatic Hypocalcemia tx
Calcium gluconate lowest dose

MedSurg (8 decks)

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