Nursing 22: Oncology (Oncological Emergencies) – Flashcards
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Oncological Emergencies
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These are medical situations that take priority over anything else going on. They include: - Sepsis - DIC - SIADH - Spinal Cord Compression - Superior vena Cava Syndrome - Tumor Lysis Syndrome - Hypercalcemia (as well as Hypocalcemia) - Intractable Pain
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Sepsis
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This is an oncological emergency where a patient goes into septic shock. With this, you must obtain a blood and urine culture FIRST, then give an antibiotic. You are looking for a band shift to the left
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Disseminated Intravascular Coagulation (DIC)
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This is an oncological emergency caused by a gram negative infection (like from Raw Fruits and veggies) - It is an abnormal clot formation in microthrombi, leading to mulit organ system failure and death
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DIC Signs and Symptoms
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These include - Peechia, echymosis, bleeding, hemorrhage, oliguria, convulsion - PT & PTT - PROLONGED - Platelets and Fibrinogen - DECREASED
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DIC Patient Care
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This includes: - An attempt to measure blood loss - Labs - Wound care, pressure to the site - Turn and Position - Frequent mouth care - Antibiotics AFTER a culture - Emotional support * If they survive, NO aspirin
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
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This is an oncological emergency where there is a hyper-secretion of ADH by the posterior pituitary glad. - It causes fluid retention and hyponatermia (Normally 135 - 145). The level it will usually be is around 110. - This is most common with brain and lung cancer
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SIADH Signs and Symptoms
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These include: - Edema, weight gain, crackles, jugular vein distention - Anorexia, fatigue, muscle cramp, Decreased urine, changes in mental status, seizures
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SIADH Nursing Interventions
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These include: - Diuretics, usually lasix - Restrict fluid intake 800ml-1L a day - Monitor: Electrolytes, I&O, daily weight, neuro status - Never let them get up alone
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Spinal Cord Compression
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This is an oncological emergency where a tumor invades the spinal cord, vertebral column collapses. With this, there is extreme pain, worse with movement.
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Spinal Cord Compression Signs and Symptoms: Early
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This includes Back pain or neck pain
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Spinal Cord Compression Signs and Symptoms: Late
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These include: - Loss of sensation - Incontinence - Sexual Impotence - Paralysis - Muscle Atrophy
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Spinal Cord Compression Treatment
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With this, use deep breathing and incentive spirometer to prevent respiratory problems. Also, log rolling Pharmacologically: - High dose corticosteriods to reduce edema and pain - Chemotherapy as adjunt to radiation and surgery - Analgesics
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Hypercalcemia
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This is an oncological emergency that is a late manifestation of malignancy with bone metastasis. This develops very slowly
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Hypercalcemia Signs and Symptoms
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These include: - Fatigue, constipation, decreased deep tendon reflexs - EKG changes: Tachycardia then Bradycardia which leads to cardiac arrest
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Hypercalcemia Treatment
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This is done only when symptoms occur. You give oral or IV hydration, Calcitonin, and Dialysis possibly if its very high.
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Superior Vena Cava Syndrome
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This is an oncological emergency where the SVC is compressed or obstructed by a tumor growth. There is a blockage of blood flow in the neck, head, and upper arms. It is painful and life threatening. Symptoms usually occur in the morning.
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Superior Vena Cava Syndrome Signs and Symptoms: Early
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These include: - Edema of the face, neck, eyes, arms, and hands - Stokes sign - tightness of the shirt and blouse - Dyspnea - Neck and vein distention
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Superior Vena Cava Syndrome Signs and Symptoms: Late
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These include: - Severe headache - Stridor - Hemorrhage - Cyanosis - Hypotension - Change in mental status
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Superior Vena Cava Syndrome Treatment
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With this, high dose radiation to the mediastinal area is used as a treatment.
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Tumor Lysis Syndrome
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This is an oncological emergency where cancer cells become destroyed, but in the process, large amounts of potassium and uric acid are released from those destroyed cells. This can cause acute renal failure, and cardiac dysrhythmias.
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Tumor Lysis Syndrome Treatment
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With this, monitor urine pH to prevent ARF. You want a pH below 6.57. - Also, hydration is important. Have patients drink the day before, of, and 3 days after treatment at scheduled times. - do an EKG - Medication - Alopurinol to decrease uric acid.
