Oncologic Emergencies

Transcription

1 Oncologic Emergencies

2 Objectives Identify the major oncologic emergencies Describe the assessment for each emergency Outline the standard of care of patients experiencing oncologic emergencies

3 Structural Spinal Cord Compression Superior Vena Cava Syndrome Increased Intracranial Pressure Cardiac Tamponade Malignant Pleural Effusion Bleeding/Thrombosis

4 Metabolic Desseminated Intravascular Coagulation Syndrome of Inappropriate Antidiuretic Hormone Secretion Tumor Lysis Syndrome Hypercalcemia Sepsis Anaphylaxis/Infusion Reaction

5 Spinal Cord Compression

6 Spinal Cord Compression SCC Description Extension of tumor into epidural space Pathologically collapsed vertebral bone impinging the spinal cord Manifestation Back pain, weakness, sensory loss, autonomic dysfunction, paraplegia Evaluation/Diagnosis MRI

7 Spinal Cord Compression SCC Treatment Steroids Surgery Radiation chemotherapy Nursing Management Recognize early signs Pain management Emotional support rehab

8 Superior Vena Cava Syndrome

9 Superior Vena Cava Syndrome SVC Description Tumor or thrombus invasion or impingement Venous output restriction/congestion Decreased cardiac output Manifestation Dyspnea Edema Dysphagia Headache Dizziness syncope

10 Superior Vena Cava Syndrome SVC Evaluation/Diagnosis CT with contrast Treatment (based on the cause) Radiation Chemotherapy Surgery-stent placement Thrombolytics Nursing Management Airway protection Cardiovascular support Emotional support

11 Increased Intracranial Pressure

12 Increased Intracranial Pressure ICP Description Tumor or fluid causing compression within the brain case Manifestation Altered mental status, nausea, headache, hypertension, focal neurological deficits Evaluation/Diagnosis CT, Brain MRI, NO LP

13 Increased Intracranial Pressure ICP Treatment Reduce fluid in the brain Osmotic diuretics-mannitol corticosteroids Surgery Radiation Nursing Management Neuro assessment Bed/chair elevation Support for neuro deficits

14 Cardiac Tamponade

15 Cardiac Tamponade Description Excessive fluid in the pericardial sac Decreases cardiac output Manifestation Dyspnea, anxiety, tachycardia, restlessness, fatigue, chest pain, restless, MS changes, lethargy, LOC changes Evaluation/Diagnosis Echocardiogram, chest xray, pulsus paradoxus

16 Cardiac Tamponade Treatment Immediate pericardiocentesis Sclerosis Pericardial catheter or window pericardiectomy Nursing Management Early recognition Assessment of cardiac, respiratory and neuro systems Tube/dressing management

17 Malignant Pleural Effusion

18 Malignant Pleural Effusion Description Fluid collection in the pleural space that can lead to respiratory distress/failure Manifestation Dyspnea, cough, pleuritic chest pain, orthopnea, anxiety, fear of suffocation Evaluation/Diagnosis Chest xray, CT

19 Malignant Pleural Effusion Treatment Thoracentesis Chest tube/tunneled pleural catheter Nursing Management Respiratory and cardiac assessment Tube/device care Patient/family education Comfort measures

20 Bleeding

21 Bleeding Description Reduction of platelets, esp. <20K Heme malignancies Altered platelet function (NSAIDs, antibx) Tumor invasion Anti-VEGF treatment regimens Manifestation Gums, nose, GI, cranial, intraperitoneal

22 Bleeding Evaluation/Diagnosis Risk assessment Platelet counts Clotting factor deficiency hemoccult Treatment Transfusion, growth factors, tx the source or cause Nursing Management safety

23 Thrombosis

24 Thrombosis Description 7 fold risk in cancer patients for venous thromboembolism ( VTE) Manifestation DVT Pulmonary Embolism

25 Thrombosis Evaluation/Diagnosis Radiology/ECG Blood gases Ultrasound/angiography Treatment Embolectomy Subsequent anticoagulation/vitamin K Nursing Management Respiratory/hemodynamic support

26 Disseminated Intravascular Coagulation DIC Description Coagulation disorder involving widespread intravascular thormobisis Manifestation Bleeding, organ damage/failure

27 Disseminated Intravascular Coagulation DIC Evaluation/Diagnosis Rapid plt decline Prolonged coagulation tests Fibrin degradation products/d-dimer Treatment Underlying disease Blood components Restore anticoagulation

28 DIC Nursing Management Symptom recognition Monitoring Oxygen Administration of blood products/factors

29 Syndrome of Inappropriate Antidiuretic Hormone SIADH Description Tumor secretion of antidiuretic hormone Manifestation Water retention/hyponatremia/concentrated urine Evaluation/Diagnosis Electrolytes/serum and urine osmolality

30 Degree of Sodium Level Hyponatremia Normal sodium meq/l Mild meq/l Signs/Symptoms Thirst, anorexia, nausea, fatigue, weakness, muscle cramps, headache Moderate Weight gain, oliguria, neurologic symptoms meq/l Severe <120 meq/l Secondary to cerebral edema, papilledema, delirium, hypoactive reflexes, ataxia, gait disturbances, seizures, coma, death

31 SIADH Treatment Underlying disease Fluid restriction/hypertonic saline Demeclocycline and vaptans Nursing Management Fluids I/O high sodium diet Neuro checks

32 Tumor Lysis Syndrome-TLS Description Rapid, high volume destruction of cancer cells after treatment Manifestation Hyper: potassium, phosphate, uric acid Hypo: calcium Evaluation/Diagnosis CBC, Chemistry, urinalysis

33 Tumor Lysis Syndrome-TLS Treatment Hydration/diuresis Allopurinol/rasburicase Alkalinization of the urine Nursing Management Know patients at risk prophylaxis

34 Hypercalcemia Description Release of calcium in advanced bone involving cancers Manifestation Organ systems CNS kidneys

35 Evaluation/Diagnosis Hypercalcemia Serum/corrected calcium Renal function/status Treatment Hydration/diuresis Treat underlying disease Biphosphonates-long term Nursing Management

36 Sepsis Description Body s failure to mount adequate immune response to an overwhelming infection Manifestation Fever/tachycardia/tachypnea/shaking chills Hypotension/hypoperfusion/organ failure Metabolic acidosis

37 Septic Shock Cascade

38 Sepsis Evaluation/Diagnosis CBC w/differential, chemistry Cultures radiology Treatment IV fluids, pressors Blood products antibiotics Nursing Management

39 Anahylaxis

40 Anaphylaxis/Infusion Reaction Description Systemic immune reaction to the infusion of agents Manifestation Mild: sense of doom or not right, itching, wheezing Severe: bronchospasm, angioedema, hypotension

41 Anaphylaxis/Infusion Reaction Evaluation/Diagnosis Based on symptoms Tryptase/allergy testing Treatment Antihistimines/steroids Epinenphrine Cardiovascular/respiratory support Nursing Management

42 Questions???