oncologic emergencies

Information about oncologic emergencies

Published on August 31, 2010

Author: yadavbhoomika2709

Source: authorstream.com


AHMEDABAD INSTITUTE OF NURSING SCIENCE : AHMEDABAD INSTITUTE OF NURSING SCIENCE SUBJECT:MEDICAL SURGICAL NURSING TOPIC :ONCOLOGIC EMERGENCIES SUBMITTED TO, SUBMITTED BY, MRS.DAXA MAM PATEL JIGISHA B. M.SC NURSING T.Y.BSC NURSING LECTURER ROLL NO:19 AINS. AINS. ONCOLOGIC EMERGENCY : ONCOLOGIC EMERGENCY DEFINITION: Oncologic emergency defined as an acute ,life-threatening events related to patient’s neoplasm or its t/m. Oncologic emergencies : Oncologic emergencies Superior vena cava Syndrome (SVCS) Spinal cord compression Hypercalcemia Pericardial Effusion & Cardiac Temponade Disseminated Intravascular Coagulation (Consumption coagulopathy) Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) Tumor Lysis Syndrome 1.SUPERIOR VENA CAVA SYNDROME (SVCS) : 1.SUPERIOR VENA CAVA SYNDROME (SVCS) DEFINITION : The superior vena cava is the major vein that carries blood from the upper part of the body into the heart .A restriction of the blood flow (occlusion) through this vein can cause superior vena cava syndrome. CAUSES : CAUSES Compression of the superior vena cava by tumor Enlarged lymph nodes. Intraluminal thrombus that obstructs venous circulation. Drainage of the head , neck , arms , & thorax. SVCS can also occur with lung cancer , breast cancer , Kaposi's sarcoma , thymoma , lymphoma & mediastinal metastases. If untreated , SVCS may lead to cerebral anoxia , laryngeal edema , bronchial obstruction , & death : If untreated , SVCS may lead to cerebral anoxia , laryngeal edema , bronchial obstruction , & death CLINICAL MANIFESTATIONS : CLINICAL MANIFESTATIONS Dyspnea , cough , hoarseness ,chest pain, facial swelling Edema of neck , arms , hands , & thorax Sensation of skin tightness & difficulty swallowing Nasal stuffiness ,Orthopnea Cynosis , drooping eyelid Possibly engorged & distended jugular , temporal , & arm veins Increased intracranial pressure , visual disturbances , headache & altered mental status Vertigo , Tinnitus , Fainting DIAGNOSTIC FINDINGS : DIAGNOSTIC FINDINGS Clinical findings Chest x-ray CT scan MRI Venography OR Doppler Ultrasound MANAGEMENT : MANAGEMENT Surgical management : Surgical management Less common, such as vena cava bypass graft to redirect blood flow around the obstruction. Medical management : - Give radiation therapy to shrink tumor size & relieve symptoms. - Give chemotherapy for chemosensitive cancers. eg. lymphoma, small cell lung cancer or when the mediastinum has been irradiated to maximum tolerance. - Give Anticoagulant or thrombolytic therapy for intraluminal thrombosis. - Give supportive measures such as oxygen therapy, corticosteroids & diuretics. Nursing management : Nursing management - Identify patients at risk for superior vena cava syndrome. - Monitor & report clinical manifestation of SVCS. - Monitor cardiopulmonary & neurologic status. - Avoid upper extremity venipuncture & BP measurement. - Facilitate breathing by positioning the patient properly. This helps to promote comfort & reduce anxiety produced by difficulty breathing resulting from progressive edema. - Promote energy conservation to minimize shortness of breath. - Monitor the patient’s fluid volume status & administer fluids cautiously to minimize edema. - Assess for thoracic radiation- related problems such as dysphagia & esophagitis. - Monitor for chemotherapy related problems such as myelosuppressioon. 2.SPINAL CORD COMPRESSION : 2.SPINAL CORD COMPRESSION DEFINITION : Spinal cord compression is a condition that causes pressure on the spinal cord or its nerve. CAUSES : CAUSES Tumor Lymphoma Intervertebral collapse or interruption of blood supply to the nerve tissues Breast cancer , lung , kidney , prostate cancer associated with spinal cord compression. CLINICAL MANIFESTATION : CLINICAL MANIFESTATION Inflammation , edema , venous stasis & impaired blood supply to nervous tissues Neck pain , pain exacerbated by movement , coughing , sneezing Neurological dysfunction , numbness , tingling , feeling of coldness in the affected area , weakness bowel dysfunction DIAGNOSTIC FINDINGS : DIAGNOSTIC FINDINGS Percussion tenderness at the level of compression MRI Myelogram Spinal cord x-rays Bone scans CT scan MANAGEMENT : MANAGEMENT Medical management : Medical management - Give Radiation therapy to reduce tumor size to halt progression & corticosteroid therapy to decrease inflammation & swelling at the compression site. - Give chemotherapy as adjuvant to radiation therapy for patients with lymphoma or small cell lung cancer. 2. Surgical management : - Surgery if symptoms progress despite radiation therapy, or if vertebral fracture leads to additional nerve damage. - Surgery is also an option when the tumor is not radiosensitive. 3.Nursing management : 3.Nursing management - Perform ongoing assessment of neurologic function to identify existing & progressing dysfunction. - Control pain with pharmacologic & non-pharmacologic measures. - Prevent complications of immobility resulting from pain & decreased function. eg. Skin breakdown, urinary stasis, thrombophlebitis, decreased clearance of pulmonary secretions. - Maintain muscle tone by assisting with range of motion exercises in collaboration with physical & occupational therapist. - Provide encouragement & support to patient & family coping with pain & altered functioning, lifestyle, roles & independence. 3. HYPERCALCEMIA : 3. HYPERCALCEMIA If patients with cancer , hypercalcemia is a potentially life-threatening metabolic abnormality resulting when the calcium released from the bones is more than the kidneys. CAUSES : CAUSES Bone destruction by tumor cells & subsequent release of calcium Production of prostaglandins Tumor that produce parathyroid Excessive use of vitamins & minerals Dehydration , Renal impairment , Primary hyperparathyroidism , Thyrotoxicosis CLINICAL MANIFESTATION : CLINICAL MANIFESTATION Fatigue weakness confusion decreased level of responsiveness Hyporeflexia Nausea Vomiting Constipation CON…. : CON…. Polyuria Polydipsia Dehydration Dysrhythmias DIAGNOSTIC FINDINGS : DIAGNOSTIC FINDINGS Serum calcium level exceeding : 11 mg / dl MANAGEMENT : MANAGEMENT Medical management : Medical management - Therapeutic aims in hypercalcemia include decreasing the serum calcium level & reversing the process causing hypercalcemia. - Administering fluids to dilute serum calcium & promote its excretion by the kidneys & resulting dietary calcium intake. - Calcitonin can be used to lower the serum calcium level & is particularly useful for pts with heart disease or renal failure who can’t tolerance sodium loads. - Calcitonin is administered by IM injection rather than subcutaneously, because pts with hypercalcemia have poor perfusion of subcutaneous tissue. - Corticosteroids may be used to decrease bone turnover & tubular reabsorption for pts with sarcoidosis, myelomas, lymphomas & leukemias. Nursing management : Nursing management - To monitor for hypercalcemia in pts who are at risk. - Educate the pt about to take more fluids can help prevent hypercalcemia, or at least minimize its severity. - Hospitalized pts who are at risk for hypercalcemia are encouraged to ambulate as soon as possible; outpatients & those cared for in their homes are informed of the importance of frequent ambulation. - Fluids containing sodium should be administered unless contraindicated, because sodium favors calcium excretion. - Encourage pts to consume 2-3 lit. of fluid daily. - Explain the use of dietary like fiber diet & pharmacologic interventions such as stool softener & laxatives for constipation. - Give antiemetic therapy if nausea & vomiting occur. 4. PERICARDIAL EFFUSION & CARDIAC TEMPONADE : 4. PERICARDIAL EFFUSION & CARDIAC TEMPONADE DEFINITION : Pericardial effusion & Cardiac temponade is the compression of the heart caused by blood or fluid accumulation in the space between the pericardium. It is a life-threatening condition. CAUSES : CAUSES Cancerous tumors Lung , Breast , Esophagus cancer Cancer t / m is most common cause Acute MI CLINICAL MANIFESTATION : CLINICAL MANIFESTATION Neck vein distention during inspiration (Kussmaul’s sign) Decreased systolic pressure Anxiety Chest pain Difficulty in breathing Weak pulse Palpitation Fainting dizziness DIAGNOSTIC FINDINGS : DIAGNOSTIC FINDINGS ECG Chest x-ray CT scan Coronary angiography MANAGEMENT : MANAGEMENT Surgical management : Surgical management - Windows or openings in the pericardium can be created surgically as a palliative measure to drain fluid into the pleural space. Catheters may also be placed in the pericardial space & sclerosing agent such as tetracycline, bleomycin, 5-fluorouracil injected to prevent fluid from reaccumulating. 2. Medical management : - In malignant effusions, pericardiocentesis provides only temporary relief. - Radiation therapy or antineoplastic agents, depending on how sensitive the primary tumor is to these t/m. - In mild effusion, prednisone & diuretic medications may be prescribed & the pts status carefully monitored. Nursing management : Nursing management - Monitor vital signs & O2 saturation frequently. - Assess for pulses paradoxus. - Monitor ECG tracings. - Assess heart & lung sounds, neck vein filling, level of consciousness, respiratory status & skin color & tem. - Monitor & record intake & output. - Elevate the head of the pt’s bed to ease breathing. - Minimize pt’s physical activity to reduce O2 requirements; administer supplemental O2 as prescribed. - Provide frequent oral hygiene. - Reposition & encourage the pt to cough & take deep breaths every 2 hr. 5. DISSEMINATED INTRAVASCULAR COAGULATION : 5. DISSEMINATED INTRAVASCULAR COAGULATION DEFINITION : DIC is a bleeding disorder resulting from the widespread overstimulation of the body’s clotting & anticlotting mechanisms in response to illness & stress. OR DIC is a serious disorder in which the proteins that control blood clotting become abnormally active. CAUSES : CAUSES Cancer of leukemia , prostate , GI tracts , lungs Sepsis Hepatic failure CLINICAL MANIFESTATION : CLINICAL MANIFESTATION Bruising Bleeding of intravenous site , gums , GI , nose , rectum Blood in stool & urine Hemorrhage Infarction Shortness of breath Increased heart rate Abdomen & Back pain DIAGNOSTIC FINDINGS : DIAGNOSTIC FINDINGS Prothrombin time – high Partial thromboplastin time Positive protamine sulfate Examination of blood sample Platelet count-low Serum fibrinogen – low MANAGEMENT : MANAGEMENT MEDICAL MANAGEMENT : - Chemotherapy, Biologic response modifier therapy, Radiation therapy are used to treat the underlying cancer. - Use antibiotic therapy for sepsis. - Give Anticoagulants such as heparin or antithrombin-3, decrease the stimulation of the coagulation pathways. - Transfusion of fresh-frozen plasma, packed red blood cells & platelets may be used as replacement therapy to prevent or control bleeding. NURSING MANAGEMENT : - Monitor vital signs. - Measure & record intake & output. Assess skin color & temp., lung, heart & bowel sounds; level of : Assess skin color & temp., lung, heart & bowel sounds; level of consciousness, headache, visual disturbances, chest pain, decreased urine output & abdominal tenderness. - Inspect all body orifices, tube insertion sites, incisions & bodily exertion for bleeding. - Minimize physical activity to decrease injury risks & O2 requirements. - Prevent bleeding; apply pressure to all venipuncture sites & avoid nonessential invasive procedures; avoid tape on the skin & advise gentle but adequate oral hygiene. - Assist the pt to turn, cough & take deep breaths every 2 hr. - Provide safe environment. - Provide appropriate education to the pt. - Provide supportive measures to the pt. 6. SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE (SIADH) : 6. SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE (SIADH) DEFINITION : SIADH is characterized by excessive release of antidiuretic hormone from the posterior pitutary gland or another source. This result is hyponatremia. CAUSES : CAUSES Lung cancer CLINICAL MANIFESTATION : CLINICAL MANIFESTATION Serum sodium levels lower that 120 meq / l : Personality changes Irritability Nausea Anorexia Vomiting Fatigue Muscular pain Headache Confusion Lethargy CON…. : CON…. Serum sodium level lower than 110 meq / l : Seizure Abnormal reflexes Papilledema Coma & death DIAGNOSTIC FINDINGS : DIAGNOSTIC FINDINGS Decreased Blood Urea Nitrogen Serum sodium level Increased urine osmolarity & urinary sodium level MANAGEMENT : MANAGEMENT MEDICAL MANAGEMENT : - Fluid intake range limited to 500-1000 ml/day to increased the serum sodium level & decrease fluid overload. - If neurologic symptoms are severe, parenteral sodium replacement & diuretic therapy are indicated. - Electrolyte levels are monitored carefully to detect secondary magnesium, potassium & calcium imbalances. NURSING MANAGEMENT : - Maintain intake & output chart. - Assess level of consciousness, lung & heart sounds, vital signs, daily weight & urine specific gravity. - Assess for nausea, vomiting,anorexia,edema,fatigue & lethargy. : - Assess for nausea, vomiting,anorexia,edema,fatigue & lethargy. Monitor lab. Test results, including serum electrolyte levels, osmolarity & blood urea nitrogen, creatinine & urinary sodium levels. Minimize the pt’s activity. Provide appropriate oral hygiene. Maintain environmental safety & restrict fluid intake if necessary. 7. TUMOR LYSIS SYNDROME : 7. TUMOR LYSIS SYNDROME DEFINITION : Tumor lysis syndrome is the development of electrolyte & metabolic disturbances that may occur following the t / m of cancer & can result in life-threatening condition. CAUSES : CAUSES Non- hodgkin’s lymphoma Acute leukemia Breast cancer Testicular cancer Lung cancer Neuroblastoma CLINICAL MANIFESTATION : CLINICAL MANIFESTATION NEUROLOGIC : Fatigue Weakness Memory loss Altered mental status Seizures Numbness & Tingling CON…. : CON…. CARDIAC : Increased blood pressure Dysrhthmias Cardiac arrest GI : Anorexia Nausea & vomiting Diarrhea Abdominal cramps CON… : CON… RENAL : Flank pain Oliguria Anuria Renal failure Acidic urine PH DIAGNOSTIC FINDINGS : DIAGNOSTIC FINDINGS LAB TEST : High potassium levels High uric acid levels Low calcium levels MANAGEMENT : MANAGEMENT Medical management : - To prevent renal failure & restore electrolyte balance. - Diuretic therapy, with a carbonic anhydrase inhibitor; to alkalinize the urine. - Administration of a cationexchange resin, such as sodium polystyrene sulfonate to treat hyperkalemia by binding & eliminating potassium through the bowel. - Administration of hypertonic dextrose & regular insulin temporarily shifts potassium into cells & lowers serum potassium levels. Nursing management : Nursing management - Identify at risk pt, including those in whome tumor lysis syndrome may develop up to 1 week after therapy has been completed. - Assess pt for signs & symptoms of electrolyte imbalances. - Assess urine PH to confirm alkalization. - Monitor serum electrolyte & uric acid levels for evidence of fluid volume overload secondary to aggressive hydration. - Instruct pts to report symptoms indicating electrolyte disturbances. THANK YOU : THANK YOU

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