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Oncologic Emergencies Diagnosis and Management

Oncologic Emergencies Diagnosis and Management. Hypercalcemia Spinal Cord Compression Superior vena cava syndrome Disseminated intravascular coagulopathy (DIC) Cardiac tamponade Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Hypercalcemia. Calcium in serum is increased

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Oncologic Emergencies Diagnosis and Management

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  1. Oncologic EmergenciesDiagnosis and Management Hypercalcemia Spinal Cord Compression Superior vena cava syndrome Disseminated intravascular coagulopathy (DIC) Cardiac tamponade Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  2. Hypercalcemia • Calcium in serum is increased • Serum calcium greater than 11 and signs are • Fatigue • Confusion • Muscle weakness • Decreased tone • Constipation • Nausea/vomiting • Abdominal pain • Diminished deep tendon reflexes

  3. Hypercalcemia • Cancer blocks the uptake of calcium by the bone tissue which causes an increased serum level • Bone breaks down and dumps calcium into the serum • Prostaglandin may be released which forces calcium from the bone

  4. Hypercalcemia • Kidneys try to get rid of excess calcium and polyuria follows • Leads to dehydration • Increasing levels lead to • Stupor, coma, kidney stones, renal failure

  5. Hypercalcemia • Affects cardiac system • Hypertension • Bounding pulse/tachycardia • Conduction is affected, leading to arrhythmias

  6. Hypercalcemia • If level is less than 13, then IV saline is given and the sodium pushes the calcium out • If level is 13 or greater: Lasix is given (loop diuretics) Thiazide diuretics are not given because they cause calcium retention • If 15 or greater, then IV mithramycin is given

  7. Hypercalcemia • Monitor strict I/O • Watch for fluid overload • Tachycardia, increased BP, and crackles • Limit dietary sources of vitamin D and calcium

  8. Spinal Cord Compression • Occurs secondary to pressure from expanding tumors

  9. Early Symptoms • Back and leg pain • Coldness • Numbness • Tingling • Paresthesia

  10. Later comes bowel and bladder dysfunction, weakness, and paralysis

  11. Early detection is key • Treatment is aimed at reducing the size of the tumor

  12. Superior vena cava syndrome • Compression or obstruction of the superior vena cava (SVC) • Usually associated with cancer of the lungs and lymphomas • Signs and symptoms are the result of blockage to the venous circulation of the head, neck and upper trunk

  13. Signs and Symptoms • Early = periorbital edema and facial edema • Later = edema of neck, arms, and hands • Difficulty swallowing and shortness of breath • Late signs = cyanosis, altered mental status, headache and hypotension

  14. Treatments • High dose radiation • Corticosteroids • Prepare for tracheostomy • Initiate seizure precautions

  15. Disseminated intravascular coagulopathy (DIC) • Severe disorder of coagulation, often triggered by sepsis • Depletes the clotting factors and platelets, allowing extensive bleeding to occur • Tissue hypoxia occurs as a result of the blockage of blood vessels from the clots

  16. DIC • Normal clotting speeds up • Strands of fibrin lodge in capillaries which increase clot risk • The clotting factor is being used up, so bleeding occurs

  17. DIC • There is an increase in fibrin split products, which are an accumulation of coagulation degradation products and these have an anticoagulant effect • Patients at risk are • Septic • Transfusion reactions • Reactions to meds such as vincristine, methotrexate, predinsone • Certain cancers release substances that can lead to DIC

  18. DIC • Diagnosed by low platelets which occur due to high fibrin split products • EARLIEST SIGN IS PROLONGED BLEEDING FROM VENAPUNCTURE SITE IN A PATIENT WHO IS NOT ON ANTICOAGULANTS

  19. DIC • Low platelet count • Low PT • Petechiae/ecchymosis • Stroke like symptoms • Severe hemorrhage • Shock • hypotension

  20. DIC • Treat with heparin • Platelets • FFP • Blood • Bleeding precautions

  21. Cardiac Tamponade • Pericardial effusion secondary to metastases or esophageal cancer which leads to compression of the heart, restricting heart movement and resulting in cardiac tamponade

  22. Signs and Symptoms • Anxiety, cyanosis, dyspnea, hypotension, tachycardia, impaired level of consciousness and increased central venous pressure

  23. Treatment • Pericardiocentesis • Administration of vasopressor agents

  24. Nursing Interventions • Administer oxygen • Maintain IV line • Monitor Vital Signs • Administer meds as ordered – vasopressor agents

  25. SIADH • Thoracic or mediastinal tumors may push on major vessels and impede cardiac output • Cytoxin and Vincristine precipitate this • The pituitary thinks that there is a decrease in fluid volume and tries to fix the problem by secreting antidiuretic hormone

  26. SIADH • This stops urine output • The body is holding onto fluids, so the sodium level is diluted • Too much fluid leads to water intoxication • The sodium level is 120-130: anorexia, nausea, vomiting, weakness, lethargy

  27. SIADH • If less than 120: confusion and psychotic behavior • IF not treated, seizure and coma • Treatment • Limit fluids to 500cc/day and ice chips • I/O • Diuretics are not ordered until condition is severe because more electrolyte imbalance will ensue

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