ONCOLOGIC EMERGENCIES (5 QUESTIONS)
What are the clinical manifestations and interprofessional management of the following
complications?
Neutropenic Fever Superior Vena Cava Spinal Cord compression:
Syndrome: compression or compression of the spinal
S/S: invasion of the superior cord and its nerve roots
- Fever: one axillary or vena cava; obstructs
venous circulation S/S:
oral temperature of 101
- Localized back or neck
or higher or 100.4F
S/S: pain
lasting 60 minutes or
- Progressive dyspnea - Motor loss (weakness to
more
- Facial or periorbital paralysis)
- ANC < 500; neutrophil
edema - Sensory paresthesia or
count
- Headache or seizures loss
TX:
- Dilated thoracic vessels - Neurologic dysfunction
-
Broad spectrum
on the chest wall (depends on level of
antibiotics should be
- Mediastinal mass on compression)
administered within 60
CXR - Bowel or bladder
mins once NF is
TX: dysfunction
identified (ex:
-
Radiation TX:
cefepime)
-
Chemotherapy -
Radiation and
CAUSES:
-
Anticoagulant therapy corticosteroids >
- Receiving
-
Percutaneous decreases compression
chemotherapy for
intravascular stent - Surgical decompression
hematologic
MANAGEMENT: - Activity limitations
malignancies
- Avoid upper extremity - Pain Management
venipuncture and BP MANAGEMENT:
measurement - Frequently assess
- Facilitate breathing; neurological status
high fowlers position - Prevent complications
- Monitor fluid status of immobility
- Assess for thoracic - Assist with range-of-
radiation related motion exercises
problems - Intermittent
catheterization & bowel
CAUSES: training
- Lung cancer
- Lymphoma or CAUSES:
thrombosis - Lung, breast, bone, and
- Metastatic Breast prostate cancers
Cancer - Lymphomas or
- Increase risk with melanomas
central line and
radiation
, Tumor Lysis Syndrome: the Hypercalcemia Carcinoid Syndrome:
release of tumor intracellular rare cancerous tumor
contents leading to S/S: secretes serotonin &
potentially fatal electrolyte other chemicals into the
imbalances bloodstream
S/S: S/S:
- Hyperphosphatemia - Hot flashes
- Hyperkalemia - Spider-like facial
- Hyperuricemia veins
- Hypocalcemia - Purple lesions
(convulsions, - Diarrhea
arrhythmias, tetany, - Dyspnea
stridor &, spasms - - Tachycardia
numbness/tingling) - Apathy, depression, and - Wheezing
- Weakness and muscle fatigue
cramps - Arrhythmias Causes:
- Diarrhea and N/V - Calcium above 10.4
- Can lead to AKI - Neuro or endocrine
- Positive Trousseau’s & Causes: tumors commonly in
Chvostek’s sign the lungs or GI tract
- Lung and breast cancers
Causes: - Multiple myeloma TX:
- Excessive secretion of
- Chemotherapy and PTH - Chemotherapy
radiation - Increased risk with - Radiation
mobility and dehydration - Back surgery
TX:
TX: MANAGEMENT:
- Identify patients at risk
- IV fluids - Identify clients at risk - Monitor for major
- Allopurinol - Monitor electrolyte complication of
- IV sodium bicarbonate, imbalances bowel obstruction
insulin dextrose - Oral hydration > 3-4 L
(potassium) daily
- Treat electrolyte - Bisphosphonate therapy
imbalances (Zoledronate and
Pamidronate)
- IV diuretics
- Weight bearing exercises
- Monitor pt safety and
comfort
- Avoid dietary
supplements (ex:
nonsteroidal drugs &
thiazide diuretics)
SIADH/DI
, DIABETES INSIPIDUS: SIADH:
S/S: S/S:
- Hypernatremia - Hyponatremia
- Diluted urine - Fluid overload symptoms
- Weight loss - Thick, sticky urine
- Low specific gravity - Weight gain
Causes: - High specific gravity
- Pituitary tumor Causes:
- Decrease in ADH - Bronchogenic cancer with malignancy
TX: - Increase in ADH
- Fluid & electrolyte replacement TX:
- Vasopressin - Fluid restriction
MANAGEMENT: - Diuretic agent (mannitol)
- Monitor I/Os - Hypertonic saline solution
- Frequent neuro assessments MANAGEMENT:
- Monitor labs (Na+) - Monitor I/Os
- Frequent neuro assessments
- Monitor labs (Na+)
Think: DRY INSIDE
Think: SOAKED INSIDE
Care of Clients with Alteration in metabolism and nutrition: Viral Hepatitis, Acute Liver
Failure, & Pancreatitis (14-15)
What are the modes of transmission or sources of infection for hepatitis?
Viral Hepatitis: a systemic viral infection that causes necrosis and inflammation of liver
cells with characteristic symptoms and cellular and biochemical changes
o A and E: fecal-oral route
o B and C: bloodborne
o D: only people with hepatitis B are at risk
o Hep G and HB-virus-C
Non-Viral hepatitis: toxic and drug induced
What clinical manifestations would a client exhibit with acute hepatitis?
Fever, malaise, fatigue, loss of appetite, vomiting, diarrhea, abdominal pain
Rapid development of jaundice and hepatic encephalopathy (hyperacute liver failure)
Profound anorexia
ALF affects other body systems: kidneys, cardiovascular system, and neurologic
(cerebral edema)
Develop a plan of care to manage the symptoms of viral hepatitis.
Rapid recognition
Intensive care management
Use of antidotes
What are the clinical manifestations and interprofessional management of the following
complications?
Neutropenic Fever Superior Vena Cava Spinal Cord compression:
Syndrome: compression or compression of the spinal
S/S: invasion of the superior cord and its nerve roots
- Fever: one axillary or vena cava; obstructs
venous circulation S/S:
oral temperature of 101
- Localized back or neck
or higher or 100.4F
S/S: pain
lasting 60 minutes or
- Progressive dyspnea - Motor loss (weakness to
more
- Facial or periorbital paralysis)
- ANC < 500; neutrophil
edema - Sensory paresthesia or
count
- Headache or seizures loss
TX:
- Dilated thoracic vessels - Neurologic dysfunction
-
Broad spectrum
on the chest wall (depends on level of
antibiotics should be
- Mediastinal mass on compression)
administered within 60
CXR - Bowel or bladder
mins once NF is
TX: dysfunction
identified (ex:
-
Radiation TX:
cefepime)
-
Chemotherapy -
Radiation and
CAUSES:
-
Anticoagulant therapy corticosteroids >
- Receiving
-
Percutaneous decreases compression
chemotherapy for
intravascular stent - Surgical decompression
hematologic
MANAGEMENT: - Activity limitations
malignancies
- Avoid upper extremity - Pain Management
venipuncture and BP MANAGEMENT:
measurement - Frequently assess
- Facilitate breathing; neurological status
high fowlers position - Prevent complications
- Monitor fluid status of immobility
- Assess for thoracic - Assist with range-of-
radiation related motion exercises
problems - Intermittent
catheterization & bowel
CAUSES: training
- Lung cancer
- Lymphoma or CAUSES:
thrombosis - Lung, breast, bone, and
- Metastatic Breast prostate cancers
Cancer - Lymphomas or
- Increase risk with melanomas
central line and
radiation
, Tumor Lysis Syndrome: the Hypercalcemia Carcinoid Syndrome:
release of tumor intracellular rare cancerous tumor
contents leading to S/S: secretes serotonin &
potentially fatal electrolyte other chemicals into the
imbalances bloodstream
S/S: S/S:
- Hyperphosphatemia - Hot flashes
- Hyperkalemia - Spider-like facial
- Hyperuricemia veins
- Hypocalcemia - Purple lesions
(convulsions, - Diarrhea
arrhythmias, tetany, - Dyspnea
stridor &, spasms - - Tachycardia
numbness/tingling) - Apathy, depression, and - Wheezing
- Weakness and muscle fatigue
cramps - Arrhythmias Causes:
- Diarrhea and N/V - Calcium above 10.4
- Can lead to AKI - Neuro or endocrine
- Positive Trousseau’s & Causes: tumors commonly in
Chvostek’s sign the lungs or GI tract
- Lung and breast cancers
Causes: - Multiple myeloma TX:
- Excessive secretion of
- Chemotherapy and PTH - Chemotherapy
radiation - Increased risk with - Radiation
mobility and dehydration - Back surgery
TX:
TX: MANAGEMENT:
- Identify patients at risk
- IV fluids - Identify clients at risk - Monitor for major
- Allopurinol - Monitor electrolyte complication of
- IV sodium bicarbonate, imbalances bowel obstruction
insulin dextrose - Oral hydration > 3-4 L
(potassium) daily
- Treat electrolyte - Bisphosphonate therapy
imbalances (Zoledronate and
Pamidronate)
- IV diuretics
- Weight bearing exercises
- Monitor pt safety and
comfort
- Avoid dietary
supplements (ex:
nonsteroidal drugs &
thiazide diuretics)
SIADH/DI
, DIABETES INSIPIDUS: SIADH:
S/S: S/S:
- Hypernatremia - Hyponatremia
- Diluted urine - Fluid overload symptoms
- Weight loss - Thick, sticky urine
- Low specific gravity - Weight gain
Causes: - High specific gravity
- Pituitary tumor Causes:
- Decrease in ADH - Bronchogenic cancer with malignancy
TX: - Increase in ADH
- Fluid & electrolyte replacement TX:
- Vasopressin - Fluid restriction
MANAGEMENT: - Diuretic agent (mannitol)
- Monitor I/Os - Hypertonic saline solution
- Frequent neuro assessments MANAGEMENT:
- Monitor labs (Na+) - Monitor I/Os
- Frequent neuro assessments
- Monitor labs (Na+)
Think: DRY INSIDE
Think: SOAKED INSIDE
Care of Clients with Alteration in metabolism and nutrition: Viral Hepatitis, Acute Liver
Failure, & Pancreatitis (14-15)
What are the modes of transmission or sources of infection for hepatitis?
Viral Hepatitis: a systemic viral infection that causes necrosis and inflammation of liver
cells with characteristic symptoms and cellular and biochemical changes
o A and E: fecal-oral route
o B and C: bloodborne
o D: only people with hepatitis B are at risk
o Hep G and HB-virus-C
Non-Viral hepatitis: toxic and drug induced
What clinical manifestations would a client exhibit with acute hepatitis?
Fever, malaise, fatigue, loss of appetite, vomiting, diarrhea, abdominal pain
Rapid development of jaundice and hepatic encephalopathy (hyperacute liver failure)
Profound anorexia
ALF affects other body systems: kidneys, cardiovascular system, and neurologic
(cerebral edema)
Develop a plan of care to manage the symptoms of viral hepatitis.
Rapid recognition
Intensive care management
Use of antidotes
