Summary NUR 4120 Final New Material

NUR 4120 Final New Material Chapters: 15, 33, 14, (Week 7-8, Class 13-15) Lecture Notes  Book Notes  Other Oncologic Emergencies • State board loves oncology • When taking care of oncology pt o Chronic phase  terminal not doing well  Pain management is a big deal  We do not hold the pain meds, give around the clock as schedule  If its schedule q4h make sure you give it every 4 hours  Treat break though pain o Nursing dx  esp when it comes to chronic/terminal pt state board wants you to recognize ACUTE PAIN o Family support  big deal  Educate the family o Understand oncology emergencies  At any given time this can occur • Concerns o Metabolic Concerns  Disseminated Intravascular Coagulation (DIC)  risk for bleeding  tx w/ FFP or cryoprecipitate  Syndrome of Inappropriate Antidiuretic Hormone (SIADH) • Hyponatremia, weakness, muscle cramps, loss of appetite, fatigue, weight gain, LOC disturbances • Increased urine specific gravity • Fluid restriction  this pt is on fluid overload • IF SODIUM GETS TOO LOW 3% NS  Septic/Neutropenic Shock*  Tumor Lysis Syndrome (TLS)* • Oncology emergency  Anaphylaxis  Hypercalcemia* o Structural Concerns  Cardiac Tamponade  Spinal Cord Compression (SCI)* • Superior vena cava syndrome (SVC)  Superior Vena Cava Syndrome (SVC)*  Increased Intracranial Pressure (ICP) o Basically take away that it’s a compression that’s normally caused by a tumor, enlarge lymp nodes o Compression or invasion of SVC by tumor, enlarged lymph nodes, thrombus o Typically associated with lung cancer  Breast cancer  Kaposi’s sarcoma  Lymphoma  Mediastinal metastases o May lead to cerebral anoxia, laryngeal edema, bronchial obstruction, death o Clinical manifestations  Impaired venous drainage  SOB/dyspnea  Cough/hoarseness  laryngeal edema  Chest pain  Edema • Neck, face, arms, hands, thorax • This is important to know • Everything is swelling up, swelling to neck and face  airway problem • Pay attention to where the edema is  usually in the chest and above • FACIAL EDEMA IS ONE OF THE FIRST SIGNS • Sensation of skin tightness, difficulty swallowing, and stridor • Early S/S generally occur in the AM, edema noted especially around the EYES (periorbital). Also collar of shirts will feel tighter  Distended jugular veins  Dilated thoracic vessels: causes venous patterns on chest wall  Increased ICP • Visual disturbances • Headache  This is an airway problem  #1 to monitor O2  ABC IS A BIG DEAL  C/M seen above closer to the vena cava  This is a venous problem not arterial o High areas for metastasis  brain, lungs, liver, bone o Diagnostics  Confirmed by clinical findings  Chest x-ray o Management  Medical • Radiation therapy • ALOC  decreased  Thoracic CT  Thoracic MRI o shrink tumor or enlarged lymph nodes and relieve symptoms • Chemotherapy • Anticoagulant/Thrombolytic therapy • Intravascular stents