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This document provides information on oncologic emergencies for nurses. It defines an oncologic emergency as an acute medical problem that occurs in cancer patients and requires timely treatment to prevent loss of life or quality of life. The major classifications of oncologic emergencies discussed are cardiovascular, hematologic, central nervous system, infectious, and metabolic emergencies. Specific emergencies explained in more detail include malignant pericardial effusions, cardiac tamponade, neutropenic sepsis, and superior vena cava syndrome. Nursing care management is also outlined for each emergency.
Deskripsi Asli:
Oncologic Emergencies, signs and symptoms, Treatment and Nursing Management
This document provides information on oncologic emergencies for nurses. It defines an oncologic emergency as an acute medical problem that occurs in cancer patients and requires timely treatment to prevent loss of life or quality of life. The major classifications of oncologic emergencies discussed are cardiovascular, hematologic, central nervous system, infectious, and metabolic emergencies. Specific emergencies explained in more detail include malignant pericardial effusions, cardiac tamponade, neutropenic sepsis, and superior vena cava syndrome. Nursing care management is also outlined for each emergency.
This document provides information on oncologic emergencies for nurses. It defines an oncologic emergency as an acute medical problem that occurs in cancer patients and requires timely treatment to prevent loss of life or quality of life. The major classifications of oncologic emergencies discussed are cardiovascular, hematologic, central nervous system, infectious, and metabolic emergencies. Specific emergencies explained in more detail include malignant pericardial effusions, cardiac tamponade, neutropenic sepsis, and superior vena cava syndrome. Nursing care management is also outlined for each emergency.
Discuss the major classifications and sub-classifications of oncologic emergencies Discuss the treatment and nursing care management for each specific emergency
What is an Oncologic Emergency?
With a greater range of treatments available, many forms of cancer can now be characterized as chronic or long-term conditions with periods of treatment leading to periods of remission, sometimes followed by recurrence and further treatment. Occasionally, more urgent, acute, medical problems occur in patients with cancer and these require timely diagnosis, intervention and treatment if medium or long-term survival is not to be adversely affected. Such problems can be described as oncological emergencies.
A clinical condition resulting from a metabolic, neurologic, cardiovascular, hematologic, and/or infectious change caused by cancer or its treatment that requires immediate intervention to prevent loss of life or quality of life.
ANTICIPATE potential emergencies & RECOGNIZE them early!
- Regular monitoring of lab values every shift by RN. Oncologic Emergencies
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- Need for RN & AP communication & documentation throughout the shift updating eachother, sharing gut feelings of observations something just doesnt seem right - Identification of risk factor(s): Is there a history of MI, multiple surgeries, DVTs, drug abuse, etc. - Review of admission history if RN has not cared for assigned patient; review, patient 24flow sheet, & post-pain scores. - Educate patients/families of potential problems and need to notify RN/AP as soon aspossible.
CLASSIFICATIONS
Cardiovascular System Emergencies Hematologic Emergencies Central Nervous System Emergencies Infectious Emergencies Metabolic Emergencies
CARDIOVASCULAR SYSTEM
Pericardial Effusion Cardiac tamponade
Oncologic Emergencies
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Malignant Pericardial Effusions
Often are undiagnosed in patients with cancer. Most effusions develop from metastatic lung or breast cancer Other causes include malignant melanoma, leukemia, lymphoma, radiation therapy to the chest wall, and chemotherapy agents.
Cardiac Tamponade
Cardiac tamponade: An acute form of a pericardial effusion caused by cancer (most commonly lung cancer) and/or fluid accumulation around the heart consisting of malignant cells. Is the accumulation of fluid in the pericardial space. fluid compresses the heart = expansion of the ventricles and cardiac filling during diastole = ventricular volume and cardiac output = the heart pump fails and circulatory collapse and failure develops. With gradual onset, fluid accumulates steadily and the outer layer of the pericardial space stretches to compensate for the rising pressure. Large amounts of fluid accumulate before symptoms of heart failure occur. With rapid onset, pressures rise too quickly for the pericardial space to compensate.
Oncologic Emergencies
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Most common causes of Cardiac Tamponade - cancerous tumors - cancer treatment Radiation therapy of 4,000 cGy or more to the mediastinal areas has also been implicated in pericardial fibrosis, pericarditis, and resultant cardiac tamponde. Untreated pericardial effusion and cardiac tamponade lead to circulatory collapse and cardiac arrest.
Nursing Care Management
Assess for hypotension, muffled heart sounds, tachycardia, dyspnea, and decreased level of consciousness. Monitor vital signs and oxygen saturation frequently Assess for pulsusparadoxus Monitor ECG tracings Assess heart and lung sounds, neck vein filling, LOC, respiratory status and skin color and temperature Monitor and record intake and output Review ABG and electrolyte levels Elevate head of bed to ease breathing Minimize patients physical activity; administer supplemental oxygen as prescribed Provide frequent oral hygiene Oncologic Emergencies
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Reposition and encourage the patient to cough and take deep breaths every 2 hoursas needed, maintain patent IV access, reorient patient and provide supportive measures and appropriate instruction. Obtain a chest X-ray and/or echocardiogram and an EKG.
Collaborative Management
Pericardiocentesis(aspiration or withdrawal of the pericardial fluid by a large-bore needle inserted in the pericardial space) Windows or openings in the pericardium can be created surgically to drain fluid into the pleural space Catheters may also be placed in the pericardial space and sclerosing agents (tetracycline, talc, bleomycin, 5-fluorouracil or thiotepa) injected to prevent fluid reaccumulation Radiation therapy or antineoplastic agents
Superior vena cava Syndrome
Superior vena cava syndrome: Caused by direct obstruction on the wall of the superior vena cava (SVC) associated with tumor compression. This may be due to compression of the superior vena cava, caused by primary or secondary tumours. Oncologic Emergencies
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Caused by the gradual compression of the superior vena cava, leading to edema and retrograde flow. Lung cancer - most common malignant cause, although lymphoma, metastatic mediastinaltumors, and indwelling catheters also can cause superior vena cava syndrome.
SVC Syndrome: Etiology
Malignant tumors are cause of SVC syndrome in 78-85% of cases. Malignancy o Lung CA caused by extrinsic compression or intrinsic invasion Greatest risk is with small cell lung ca (up to 20% will develop SVC syndrome) o Lymphoma typically caused by compression by lymph nodes o Thymoma, primary mediastianal germ cell neoplasms o Solid tumors with mediastinal nodal metastases Breast CA is the most common solid tumor.
SVC Syndrome: Management
Historically SVC syndrome was considered a potentially life-threatening emergency Standard of care was immediate radiotherapy The emergent approach is not appropriate for most patients Oncologic Emergencies
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Exception to the rule Stridor -Central airway obstruction or laryngeal edema True medical emergency Immediate action needed -Possible intubation and ICU admission -Immediate therapy to target obstruction needed Tumors with good response: Non Hodgkins lymphomas, germ cell neoplasms and limited-stage small cell cancer (usually responsive to chemo with or without radiation). Symptoms improve in 1-2 weeks. Anticoagulation Intraluminal metal stents -Used in cases where unable to give chemo or radiation -Now some data showing that placing a stent better when patient first diagnosed because of quicker resolution of symptoms. -Combination endovascular therapy (thrombolysis, angioplasty and stent placement)
Nursing Care Management
Assess for dyspnea, facial and upper extremity edema, neck vein distention, and cough. Oncologic Emergencies
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Monitor and maintain proper breathing pattern: assess for signs of resp. distress, maintaining supplemental oxygen. Advise on the limitation of activities and maintain a high head in Fowlers position. Monitor neurological functions, in search of cerebral edema signs. Monitor Vital Signs Conduct hydric and electrolytic balance. Avoid invasive or constricting procedures in the affected extremity, such as peripheral venous access and BP. For pts that require anticoagulant therapy, establish bleeding precautions and conduct coagulation exams. Advise the pt and family of the syndrome and their treatment (Client Education) Provide emotional support , and Promote comfort and security by providing a calm and relaxing environment.
Collaborative
Administer medications: o Corticosteriods, diuretics, anticoagulants Radiation treatment may also be indicated in an effort to reduce the size of the tumor. Obtain a chest X-ray and/or CT scan of the chest and abdomen.
Oncologic Emergencies
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Infectious Emergencies
Neutropenic sepsis/sepsic shock
Sepsis: Caused by decreased tissue perfusion as a result of a severe infection. Neutropenia: ANC < 500 or <1000 w/ a predicted nadir of <500 cells ANC = (WBC) x (% of neutrophils + % of bands) Nadir usually occurs 5 to 10 days after last chemo dose and usually recovers in 5 days (certain leukemia/lymphoma regimens cause longer lasting and more profound neutropenia) Fever: Single temp of 38.3 o C (101.3 o F) Sustained Temp of 38.0 o C (100.4 o F) for > 1 hour
Diagnosis
Fever is commonly the only symptom. Common infections present atypically (asymptomatic UTIs, meningitis w/o nuchal rigidity, bacteremia with only fatigue as a symptom) Avoid digital rectal exams/manipulations Careful oral exam and exam of catheter sites if any Pan Cultures Oncologic Emergencies
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Etiology
BACTERIA: Until 1980s, GNR (P.aeruginosa) were the most commonly identified pathogens 1995-2000, Gram + organisms = 62-76% of all bloodstream infections Trend toward Gram + due to introduction of long-term indwelling lines (Hickmans,Mediports) FUNGAL: - Risk increases w/ duration and severity of neutropenia, prolonged antibiotic use, and number of chemotherapy cycles -Candida (lines), aspergillus (immunocompromised, skin,sinus) >>>histo, blasto, coccidio, TB(prolonged steroids, other high risk patients) High risk patients Already in-patients when fever and neutropenia develop Outpatients who need acute hospital care for problems in addition to the fever and neutropenia Outpatients with uncontrolled cancer (e.g. acute leukaemia not in remission, those with tumours progressing during anticancertherapy) On immunosuppressive agents e.g. cyclosporin A, steroids Patients with specific foci of infection e.g. intravascular catheter infection, tunnel infection, new pulmonary infiltrate Neutropenia likely to last for more than 10 days Oncologic Emergencies
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Recent fludarabine treatment Phase I or II clinical trial patients (inform investigator) Presence of any of the following features; o abdominal pain, nausea and vomiting, diarrhoea o neurological or mental changes o allogeneic BMTs or autologous BMT o pregnancy o HIV o recent treatment with antibiotics (in previous 72 hours) o renal failure (creatinine clearance <30ml/min) o hepatic failure o respiratory insufficiency o haemodynamic instability o inability to take oral medications All febrile patients with neutrophil counts <500/mm3 and those whose counts are <1000/mm3 but are falling rapidly. Afebrile patients with neutrophil counts <500/mm3 should also be treated if they have symptoms compatible with infection.
Oncologic Emergencies
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TREATMENT
Numerous regimens studied: monotherapy found equivalent to two drug regimens (i.e.: piperacillin/tazobactam, cefepime, meropenem) In critically ill, add one aminoglycoside (better G negative coverage) Addition of Gram (+) as initial empiric coverage In patients with lines and cathetersin patients without port/catheter/line or mucositis has no proven clinical benefit instead canVRE Vancomycin or Linezolid : Fungal coverage (candida or aspergillusssp.): o Routinely added after 5-7 days of persistent neutropenic fever w/o clear source o Post mortem of fatalities after prolonged febrile neutropenia (1966-1975) o 69% had evidence of systemic fungal disease o Rx with liposomal amphotericin B (most common), o No to fluconazole = efficacy Colony Stimulating Factors (GM-CSF): o NOT routinely used for neutropenic fever unless the patient had previous bout of neutropenic fever with prior chemo cycle. o Not shown to decrease mortality o Beneficial effects are quite modest o Used in neutropenic septic shock/severe sepsis (hypotension, organ dysfunction) Oncologic Emergencies
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o Used in patients whose bone marrow recovery is expected to be especially prolonged.
Nursing Care Management
Instruct patient and family about s/sx of septicemia, methods for preventing infection and, actions to take if s/sx of infection occur. Assess for tachypnea, tachycardia, hypotension, organ dysfunction, and hyper/hypothermia. Monitor temp and hemodynamic and respiratory status on a frequent basis in pt with impending shock. Monitor ABG values and pulse oximetry to determine tissue oxygenation. Monitor fluid and electrolytes status by MIO and serum electrolytes. SepsisNursing Care Management Carry out neurologic assessment to detect changes in orientation and responsiveness. Obtain blood, urine and wound cultures, chest X-ray, and CT scan if necessary. Most of these patients will require intensive care monitoring.
Collaborative
Administer IVF, blood products, vasopressor and inotropic agents as prescibed to maintain BP and tissue perfusion, as well as broad-spectrum antibiotics which may be prescribed initially to combat the underlying infection. Oncologic Emergencies
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Note: Supplemental O2 and mechanical vent are often necessary. Mortality is associated with causative organism, site of infection, & level/duration of neutropenia).
Central Nervous System
Spinal Cord Compression
Spinal cord compression: Occurs when the spinal cord is compressed directly by the tumor.
Neoplastic epidural spinal cord compression Defined as thecal sac indentation radiographically (spinal cord or caudaequina) Thoracic spine: 60% Lumbar spine: 30% Cervical spine: 10% Cord compression is a common complication in oncology patients (5-10% of all cancer patients: prostate, lung, breast) is a cause of pain and irreversible loss of neurologic function. Back pain is the precursor to spinal cord injury in almost all (96%)patients w/ spinal mets. Pain similar to disc disease: except pain supine, upright NOT immediately life threatening unless it involves C3 or above
Oncologic Emergencies
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Epidemiology
Vertebral mets are common than ESCC Prostate cancer: 90% Breast Cancer: 74% Lung Cancer: 45% Lymphoma: 29% Renal cell: 29% Gastro-: 25% Many cases of unrecognized ESCC Difficult to define incidence Autopsy review studies suggest around 5% of cancer patients die with ESCC
Diagnosis
Back pain + known malignancy = SCC until proven otherwise =Plain films NOT enough =Exam has poor accuracy with localizing level =MRI without contrast is the best test for SCC when suspected =Can do CT (myelography) if pt cannot tolerate MRI, or not candidate for MRI, or not available.
Oncologic Emergencies
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TREATMENT Steroids Radiation Therapy Surgery Treatment is usually with RT. A laminectomy may be an alternative. Steroids may be given to reduce inflammation and swelling around the spinal cord. (Note: Corticosteriod, DEXAMETHASONE, can cause changes in serum glucose. Monitor blood glucose levels)
Important to recognize
Early recognition leads to better outcomes Efficacy of treatment depends most on patients neurological function at presentation Median time from symptoms to diagnosis is around 2 months More than half of patients who present to hospital are non-ambulatory Best predictor is pre-treatment functional/neurologic status Rapid onset and quick progression = poor Prognosis 75% of patients treated correctly while still ambulatory, will remain ambulatory Only 10% of patients presenting with paraplegia will regain ambulatory status
Oncologic Emergencies
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Nursing Care Management
Assess for back pain, paralysis, and urinary and/or bowel incontinence. Safe and comfortable movement of the patient, in cases of impaired physical mobility. Establishment of bowel training program, if there is a loss of sphincter control. Considering that it often requires RT, the nurse should be attentive to skin care as well as N & V. Provision of nursing emotional support and guidance to decrease anxiety of pt and family members, making them active agents in their health-disease process. Patients functional capacity and the high possibility of home care for rehabilitation must be continuously evaluated.
Collaborative Management
Obtain an MRI of the entire spine or an X-ray if an MRI is contraindicated. Administer glucocorticoid therapy (Decadron) orally or intravenously to help reduce edema. Surgery may be a treatment option, but radiation is typically indicated and is considered emergent.
Oncologic Emergencies
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Metabolic Emergencies
Obstructive Uropathy
Obstructive Uropathy: Obstructive uropathy occurs when urine cannot drain through a ureter (a tube that carries urine from the kidneys to the bladder). Urine backs up into the kidney and causes it to become swollen (hydronephrosis).
- Obstructive uropathy can affect one or both kidneys.
Common causes:
Benign prostatic hyperplasia (enlarged prostate) Bladder or ureteral cancer Colon cancer Cervical cancer Uterine cancer Note : Any cancer that spreads
Oncologic Emergencies
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Manifestations
Mild to severe pain in the middle of the body (flank pain), felt on one or both sides Fever Nausea or vomiting Weight gain or swelling (edema) May also have problems passing urine
Nursing Care Management
Educate patient and family on the s/sx of obstructive uropathy. Nurses must be attentive of foleycatheters, because once its obstructed, it has a significant potential for causing permanent renal injury. Surgical correction is specific to the type of obstruction and generally consists of removal of the obstruction, re-implantation of ureters as necessary, and occasionally creation of a urinary diversion. Postoperatively, assess urine output for color, clots, clarity, and amount. Encourage fluids once the pt can tolerate them orally. Administer analgesics and/antispasmodics as needed for bladder spasms. Teach patient and family care of draining tubes if they will be discharged with it.
Oncologic Emergencies
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Tumor Lysis Syndrome
Tumor Lysis syndrome: Caused by the lysis of tumor cells, creating metabolic complications. This most often occurs in the lymphoma and leukemic population.
Tumor Lysis Syndrome: Prevention &Management
The best management is prevention. FLUIDS and HYDRATION: Aggressive hydration and diuresis Improve intravascular volume, renal blood flow, GFR (decrease [solute] in distal nephron/renal microcirculation) +/- diuretics (contraindicated in hypovolemia and obstructed uropathy)
TLS Hyperuricemia
Mechanism Following initial therapy of sensitive tumors gout renal tubular damage and acute renal failure Diagnosis -Monitor serum uric acid levels -Uric acid precipitate stones radiolucent Oncologic Emergencies
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Therapy -Diuresis -Alkalization -Dialysis -Prophylaxis -- Allopurinol 600 mg daily 2 days before treatment and continue for 2 weeks after treatment
Nursing Care Management
Evaluate and stimulate kidney functions: - hydration and daily weighing of thepatient. - assess for signs of fluid overload Assess for signs and symptoms of severe metabolic imbalance: hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Obtain complete metabolic panel and urinalysis. Monitor biochemical parameters related to the syndrome: - serum levels of phosphate, K, Uric acid, Caand creatinine, urine PH, arterial gasometry Monitor Cardiac and neurological functions Avoid food rich in K and be mindful of drugs that can cause renal impairment. Provide emotional support to the patient and family.
Oncologic Emergencies
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Collaborative Management
Administer medications according to clinical conditions: - Allopurinol (hyperuricemia) - Sodium Bicarbonate (Metabolic Acidosis) - Aluminum Hydroxide (Hyperphosphatemia) - Diuretics ( Fluid Overload) Administer prophylactic Allopurinol for patients with large tumor burden, IV hydration, and (for patients with renal failure) hemodialysis. Conduct ECG in patients with hyperkalemia.
Hematologic Emergencies
DIC (disseminated Intravascular Coagulation
DIC: Pathological activation of coagulation and bleeding at the same time in response to disease. Coagulation and fibrinolysis are dysregulated. This may be caused by endotoxins released in the blood and cancer. Also defined as the inappropriate, accelerated, and systemic activation of the coagulation cascade, resulting in thrombosis and, subsequently, bleeding & hemorrhage.
Oncologic Emergencies
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Manifestations
Uncontrolled bleeding and rapid consumption of clotting factors. Bleeding from gums/nosebleeds, dyspnea, hemoptysis, tachypnea, lethargy, confusion Prolonged PT & PTT, platelets, fibrin level, & fibrin split products ( D-dimer level)
Nursing Care Management
Monitor VS & MIO Assess for excess bleeding, bruising, and signs of clotting and organ failure. DIC can be an acute or chronic process. Assess skin color and temp; lung, heart, and bowel sounds; LOC, headache, visual disturbances, chest pain, decreased urine output, abdominal tenderness. Inspect all body orifices for bleeding. Review lab results. Minimize physical activity to decrease risk of injury and O2 requirement. Prevent bleeding; apply pressure to all venipuncture sites and maintain skin integrity as much as possible. Assist the patient to turn, cough, and deep breathing exercise on regular schedule Reorient the pt if needed, maintain safe environment and provide appropriate pt education and supportive measures.
Oncologic Emergencies
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Collaborative Management
Obtain a coagulation panel, including a DIC profile -- very important. Administer Heparin. Although controversial, Heparin can interrupt the clotting cascade and prevent further microemboli -- coagulation is in the name. Platelets and fresh frozen plasma may also be administered in the case of severe bleeding.
Paraneoplastic Syndrome
- Malignant cells produce enzymes, hormones, and other substances. SIADH Cushing Syndrome Hypoglycemia Hypercalcemia
SIADH
SIADH: Caused by excessive release of antidiuretic hormone (ADH) from the posterior pituitary. This may be found in patients with brain tumors and small-cell carcinomas of the lung. It is also related to some chemotherapy drugs. - Occurs when antidiuretic hormone (ADH) is secreted w/o response to the bodys usual feedback mechanisms, resulting in water intoxication Oncologic Emergencies
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- The kidneys continue to return water to the body, diluting the Na. - Associated with pancreatic /prostate/brain cancers/Infusions of Cytoxan, Vincristine, or Cisplatin can cause SIADH.
Nursing Care Management
Nursing Care is directed toward management of fluids and the side effects of hyponatremia and its treatment. Assess for hyponatremia and associated symptoms, such as nausea, vomiting, headache, confusion, cerebral edema, hypertension, urine osmolality, and fluid overload. Obtain complete metabolic panel and urinalysis. Pt must maintain fluid restriction of 500ml to 1L/day so strict monitoring of I & O. Further assessments and interventions include daily weights, monitoring of blood and urine chemistry levels; Frequent review of cardiopulmonary, neuromuscular and renal systems Placing the patient on seizure precautions. Teach the patient and family which signs of hyponatremia to report and how to respond to seizures
Oncologic Emergencies
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Collaborative Management
Fluid Excretion (Diuretics) IV infusion of hypertonic saline (3% - 5%) if severe, to prevent pulmonary edema; strict MIO. Administer medications like Declomycine (Demeclocycline), Lithane (Lithium), and Urea
Cushing syndrome
Cushing syndrome is caused by constant, high levels of the steroid hormone cortisol. A tumor on one of the adrenal glands causes about 15% of all cases of Cushing syndrome. Adrenal tumors release cortisol. Adrenal tumors may be noncancerous (benign) or cancerous (malignant). Noncancerous tumors that may cause Cushing syndrome include: Adrenal adenomas Micronodular hyperplasia Cancerous tumors that may cause Cushing syndrome include: Adrenal carcinomas Adrenal tumors are rare. In children with high cortisol levels, adrenal tumors are more common than pituitary tumors or ectopic ACTH secretion. In adults, adrenal tumors are less likely to be the cause of high cortisol levels. Pituitary tumors Oncologic Emergencies
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(Cushing's disease) are more often seen in adults. Adrenal tumors are found in women more often than in men.
Treatment
Cushing syndrome due to an adrenal tumor is treated with surgery to remove the tumor and often the entire adrenal gland. Glucocorticoid replacement treatment is usually needed until the other adrenal gland recovers from surgery. If surgery is not possible (such as in cases of adrenal cancer), medicines can be used to stop the release of cortisol. These include: -Aminoglutethimide -Ketoconazole -Mifepristone -Mitotane Radiation therapy usually does not work for cancerous adrenal tumors and is not appropriate for noncancerous tumors.
Nursing Care Management
Monitor VS, especially BP for HTN MIO and weight for EDEMA. Oncologic Emergencies
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Lab values especially the blood glucose for hyperglycemia, serum sodium for hypernatremia, serum K for hypokalemia, and serum calcium for hypocalcaemia. Protect from trauma to prevent bruising and fracture.
Collaborative Management
Administer medications Prepare the client for RT as prescribed Prepare the client for surgery.
Hypoglycemia
Hypoglycemia can arise in the patient with cancer through several etiologies. Some tumors are capable of ectopic production of substances that affect glucose metabolism. Insulin is made in excess by insulinomas and nesidioblastosis. Mesenchymal tumors like sarcoma, including gastrointestinal stromal tumor and solitary fibrous tumor, can produce insulin-like growth factors S/SX both arise from neuroglycopenia and adrenergic counterregulation. Neurologic manifestations range from confusion and blurred vision to seizures and coma.
Oncologic Emergencies
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Nursing Care Management
Assess catecholamine response to hypoglycemia such as diaphoresis, palpitations, and dilation of the pupils. Observe seizure precautions. Monitor blood glucose levels. Notify the physician if severe hypoglycemic reaction occurs.
Collaborative Management
The treatment of cancer-related hypoglycemia can include surgical removal of the underlying tumor, or chemotherapy and radiation for unresectable tumors. Interim management may include the administration of glucagon at a dose of 1 mg iv/im, dextrose infusion, diazoxide (3 mg/kg/day initially), and cessation of nonselective beta-blockers that blunt adrenergic response to low blood sugar. Exogenous glucocorticoids and regimented frequent carbohydrate intake have also been proposed as interventions.
Hypercalcemia : approach to patients
When initially discovering patients with hypercalcemia first have to rule out malignancy and PTH Occurs in 10-20% of cancer patients Oncologic Emergencies
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Most common cancers include lung, breast and hematologic malignancies.
Signs & Symptoms
Acute hypercalcemia: nausea, vomiting, constipation, polyuria, polydipsia,Nephrogenic DI, muscle weakness, arrythmias, short QT, AKI. Chronic hypercalcemia: kidney stones, bone pain, & psychosis. Can also decrease consciousness to coma if hypercalcemia is very severe stones, bones, groans and psychiatric overtones
Treatment
Lower serum calcium concentration Treat complications if present Treat underlying disease Three therapies for inhibition of bone resorption Calcitonin Bisphosphonates Gallium nitrate
Oncologic Emergencies
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Nursing Care Management
Keep patient safe, manage the symptoms of hypercalcemia. Monitor for side effects of the administered therapies and minimize the risk of recurrence. Monitor VS, Fluid status, cardiovascular status, mental status, and neurological status. Place the patient in seizure and safety precautions and protect the patient falls and injury due to high risk of fracture. Increase the patient physical activity and mobility with ATTENTION TO SAFETY. Pain management is a priority if patient suffers pain from bony metastases or fractures. Due to likelihood of recurrence, to educate the patient and their family on its s/sx is essential.
Oncologic Emergencies: Urgency Approach
Right Now This Minute Airway obstruction, neutropenic sepsis, tamponade, cord compression, CNS metastases with symptoms
Oncologic Emergencies
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Today coagulopathies, tumor lysis, DIC, leukostasis, TTP, hyperviscosity, severe thrombocytopenia, sickle cell complications, INR over 9
If Not Today, Tomorrow SVC syndrome, most hypercalcemia, most CNS mets without edema, INR 5-9 SVC syndrome, most hypercalcemia, most CNS mets without edema, INR 5-9