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Oncology Emergencies
Oncologic Emergencies
| Question | Answer |
|---|---|
| when in treatment to oncological emergencies occur during treatment | At any point in treatment |
| Global reasons that onc emergencies occur | metabolic/hormonal problems result of obstruction/pressure consequence of cytopenias |
| Def HYPERLEUKOCYTOSIS | peripheral WBC >100,000/mm3 |
| Associated Malignancies HYPERLEUKOCYTOSIS | AML/ALL CML |
| Clinical Presentation HYPERLEUKOCYTOSIS | SOB/tachypnea/cyanosis blurred vision/papilledema ataxia/agitation/confusion delirium/stupor |
| Medical Management HYPERLEUKOCYTOSIS | IV hyperhydration (~3000 mls/M2/day) maintain urine output at 1-2 mls/kg/hr NaHCO3/allopurinol/rasburicase correct electrolytes leukapheresis/exchange transfusions blood product support anti-leukemia treatment |
| Nursing Management/Interventions HYPERLEUKOCYTOSIS | assess cardiopulmonary/neurologic status monitor fluid/electrolyte balance recognize change in status/implement appropriate interventions |
| Potential Complications HYPERLEUKOCYTOSIS | hemorrhage/intracranial bleed pulmonary leukostasis metabolic alterations renal failure sudden death |
| Definition TUMOR LYSIS SYNDROME (TLS) | rapid breakdown of malignant cells causing inadequate renal function manifested by |
| lab values in TUMOR LYSIS SYNDROME (TLS) | hyperuricemia (uric acid > 8 mgs/dl) hyperkalemia (K+ >6 mEq/ml) hyperphosphatemia (PO4 > 10 mgs/dl) hypocalcemia (Ca++ < 8 mgs/dl) |
| CYTOTOXIC THERAPY/ SPONTANEOUS TUMOR CELL BREAKDOWN leads to what end organ effects | hyperuricemia -> uric acid crystals-> renal failure-> dialysis Hyperphosphemia->calcium/phosphate cyrstals-> renal failure-> dialysis Hyperkalemia-> ventricular arrhythmia-> death |
| malignancies assoicated with TLS | B cell leukemia/Burkitt’s lymphoma T cell leukemia/lymphoma leukemia with WBC > 100,000/mm3 neuroblastoma (rare) |
| Clinical Presentation TLS | RAPID ONSET abdominal pain/cramping/fullness/vomiting/ascites back/flank pain/oliguria/anuria cardiac arrhythmias/tachycardia/pleural effusion numbness/tingling/tetany weakness/fatigue altered level of conscience seizures |
| Medical Management TLS | IV hyperhydration (~3000 mls/M2/day) urine alkalization NaHCO3/allopurinol/rasburicase correct electrolyte/metabolic abnormalities +/- dialysis |
| Nursing Management/Interventions TLS | accurate I&O/monitor weights monitor urine pH/specific gravity assess for symptoms of hypocalcemia Chvostek’s sign Trousseau’s patient/family support |
| Definition SEPTIC SHOCK | systemic response to pathogenic micro-organisms and endotoxins in the blood leads to perfusion, cellular hypoxia, and death usually associated with gram negative organisms arising from endogenous flora |
| Risk factors SEPTIC SHOCK | ANC < 100/mm3 prolonged neutropenia (> 7 days) immunosuppression asplenism infancy mechanical device poor skin integrity/mucositis |
| VS in sepsis vs septic shock | Sepsis Temperature: < 36 C or > 38 C HR: tachycardia RR: tachypnea BP: normal Septic shock Temperature: < 360 C or > 380 C HR: tachycardia RR: tachypnea BP: hypotension unresponsive to fluid resuscitation |
| PHYSICAL CHANGES in sepsis vs septic shock | Sepsis: Warm, flushed skin Weak/malaise Adequate urine output Septic shock Cool, clammy skin Bilateral rales, hypoxia Anasarca Oliguria -> anuria |
| Mental status changes in sepsis vs septic shock | sepsis: Minor confusion/restlessness. Septic shock: Confusion, anxiety, agitation, delirium, decreased LOC |
| COMPENSATED SEPTIC SHOCK/ HYPERDYNAMIC EARLY STAGE | Early stage of shock Patient usually pancytopenic Often initial presentation May not appear “sick”. Chills/ fever, drop in Po2, UO beginning to drop, slight drop in perfusion, early signs of confusion, 10% drop in blood volume, Normal RR, BP & pulse |
| COMPENSATED SEPTIC SHOCK: HYPERDYNAMIC INTERMEDIATE STAGE | Patient usually pancytopenic, appears “sick”,May need intubation, Still reversible. Chills, fever, ^ thurst, pulmonary congestion, decrease UO decreased perfusion, clammy/ mottled, confusion, 15-20% drop blood vol, ^ RR, hypoxia, NORMAL BP& pulse, |
| DECOMPENSATED SEPTIC SHOCK CARDIOGENIC/LATE STAGE | Patient usually pancytopenic,Organisms gram - Metabolic/lactic acidosis May not be reversible. Resp failure, pul edema, DIC, oliguria, renal fail, edema, delerium, coma, 25% drop in blood vol/ CO, BP very low, Rapid thready pulse, trunk cool |
| Medical Management SEPTIC SHOCK | symptom management pressor support medications fluid boluses/hyperhydration isotonic crystalloid solution (NS) 20 mls/kg IV blood product support +/- dialysis/ventilator support treat underlying cause antibiotics/+/- antifungal agents +/- CXR |
| SEPTIC SHOCK: Nursing Management/Interventions | obtain blood cultures administer IV antibiotics close monitoring of VS identify early trends good communication with team patient/family support |
| Definition DISSEMINATED INTRAVASCULAR COAGULATION (DIC) | lteration in blood clotting mechanisms with increased amounts of thrombin and plasmin in the circulation decreased platelets increased prothrombin decreased fibrinogen |
| DISSEMINATED INTRAVASCULAR COAGULATION (DIC)is manifested by | diffuse intravascular coagulation tissue ischemia |
| Risk Factors DIC | malignancies infection trauma |
| Clinical Presentation DIC | petechiae/ecchymosis/purpuric rash diffuse bleeding plt count <20,000/mm3 PT/PTT 1 1/2-2 times normal fibrinogen < 75,000 mgs/dl D-dimer > 500 g/L |
| Medical Management DIC | symptom management blood product clotting factor replacements +/- heparin |
| Nursing Management/Interventions DIC | accurate patient assessment communicating lab values/findings patient/family support |
| TYPHLITIS def | inflammation of the cecum leading to necrotizing colitis caused by bacterial invasion of the mucosa most commonly occurs in neutropenic leukemic patients |
| TYPHLITIS risk factors | severe/prolonged neutropenia acute leukemia induction infection/mucositis |
| TYPHLITIS Clinical Presentation | profound neutropenia/fevers severe RLQ abdominal pain/distended abdomen high pitched “tinkling” bowel sounds N&V/diarrhea |
| TYPHLITIS Medical Management | broad spectrum antibiotics supportive management/bowel rest radiology evaluation +/- surgery |
| Nursing Management/Interventions TYPHLITIS | accurate patient assessment pain management/abdominal girths oral/skin/peri-anal care patient/family support |
| SPINAL CORD COMPRESSION (SCC) DEF | neurological emergency occurs in ~ 5% of patients usually NOT life threatening goal is to preserve neurological function |
| SPINAL CORD COMPRESSION (SCC) Risk Factors | primary CNS tumor of the spinal cord neuroblastoma lymphoma metastatic sarcoma |
| SPINAL CORD COMPRESSION (SCC)Clinical Presentation | pain which may be local, referred, or diffuse motor deficits weakness/ataxia hypotonic/hyporeflexia paralysis/muscle atrophy sensory deficits bowel/bladder dysfunction loss of pain/temperature sensation paresthesia |
| SPINAL CORD COMPRESSION (SCC) Medical Management | neuro exam/MRI steroids +/- surgical decompression/XRT treat underlying disease |
| SPINAL CORD COMPRESSION (SCC)Nursing Management/Interventions | accurate patient assessment positioning/ROM/skin care safety related to altered mobility patient/family support |
| SUPERIOR VENA CAVA SYNDROME (SVCS) Definition | compression of superior vena cava (SVC) |
| SUPERIOR VENA CAVA SYNDROME (SVCS)Risk Factors | tumors arising in the anterior mediastinum or involving mediastinal lymph nodes NHL, Hodgkin’s disease, T cell ALL, thoracic neuroblastoma, germ cell tumor obstruction of airway thrombosis |
| SUPERIOR VENA CAVA SYNDROME (SVCS)Clinical Presentation | cough/dyspnea/orthopnea wheezing/stridor anxiety/confusion edema/plethora cyanosis of face/neck/upper arm/chest |
| SUPERIOR VENA CAVA SYNDROME (SVCS)Medical Management | symptom management treat underlying cause +/- steroids/XRT |
| SVCS Nursing Management/Interventions | accurate respiratory assessment O2, High fowlers patient/family support |
| SIADH Definition | continuous release of ADH without a relationship to plasma osmolality with Na++ leading to cerebral edema/seizures |
| SIADH Associated with: | Increased UO, Increased wt without edema, hyponatremia & H2O intoxification |
| SIADH Risk factors | vincristine/cyclophosphamide CNS tumors/ALL trauma/surgery |
| SIADH Medical Management | restrict fluids treat symptoms/underlying cause |
| SIADH Nursing Management/Interventions | know “high risk” population accurate assessment/I&O/weights understand significance of labs patient/family support |
| ANAPHYLAXIS Definition | hypersensitivity reaction to foreign proteins occurs within seconds/minutes of administration or at any point during infusion |
| Risk Factors ANAPHYLAXIS | ABX/antifungals repeated blood product infusions radiographic contrast media latex hypersensitivity |
| ANAPHYLAXIS Clinical Presentation | erythema/flushing/urticaria/pruritis anxiety/agitation wheezing/dyspnea laryngeal edema/stridor tachycardia N&V/diarrhea |
| ANAPHYLAXIS Medical Management | administer “test” doses of high risk medications pretreat with diphenhydramine/hydrocortisone +/- steroids/cimetidine epinephrine readily available |
| epinephrine readily available ANAPHYLAXIS Nursing Management | know risk potential of drug/patient maintain airway/02 stop infusion immediately have emergency drugs/equipment accessible STAY CALM!!!!! |
Created by:
JennRN