Final Exam Review- AGACNP Spring 2023 updated to pass

Final Exam Review- AGACNP Spring 2023 Oncologic Emergency- Hematologic- Febrile neutropenia and sepsis Febrile Neutropenia- Temp > 100.4F and ANC < 1000 Neutropenia + Infection = Emergency Considered sepsis until proven otherwise ... Sepsis = Most common cause of nonmalignant death Diagnosis Early recognition is key Think Sepsis Management Guidelines Q1H after first 60 minutes = 7.6 % increased mortality Obtain cultures PRIOR to treatment ! Treatment : Broad Spectrum ATB coverage Gram negative / positive coverage + MRSA PNA- atypical coverage until ruled out GI / enteric cause- Need GNB anaerobic coverage Consider antivirals / antifungals if a possible cause Oncologic Emergency- Hematologic- Hyperleukocytosis and Leukostasis Elevated WBC ( > 100K ) Tissue damage occurs due to local hypoxia , hyperpermeability , and release of lysosomes and procoagulants Intravascular sludging and leukocytosis can develop along with white thrombus formation . Symptoms- most common are neuro / pulm Dizziness , blurred vision , tinnitus , ataxia , AMS , retinal hemorrhage , papilledema Fever , tachypnea , dyspnea , hypoxia , CHF , priapism Diagnosis CBC ( do a manual platelet count ! ) Chemistry ( falsely elevated potassium- keep on ice ! ) Chest XR / CT Treatment - goal is to reduce WBC by 20 % to 60 % in the first few hours Supplemental oxygen , allopurinol , urinary alkalinization , hydration Whole brain irradiation for CNS involvement . Immediate cytoreductive therapy + leukapheresis / hydroxyurea Brainpower Read More Oncology Emergency- Structural- Leptomenigneal Disease and CNS lesions Presence of solid tumors or cancer cells in CSF → Cause increased ICP due to : Mass Effect , Hydrocephalus Symptoms- ALTERED MENTAL STATUS Central herniation- due to hemispheric mass Slow deterioration in LOC , headache , and focal neurologic deficits . Progression- results in global neurologic changes , Cheyne - Stokes respiration , small reactive pupils Uncal herniation- due to mass in temporal lobe / lateral fossa of the frontal lobe Rapid loss of consciousness , lateral pupillary dilatation , and ipsilateral hemiparesis . Tonsillar herniation- posterior fossa mass Occipital headache , vomiting , and hiccups → Followed by LOC and respiratory compromise Diagnosis : Head CT , Brain MRI NO Lumbar Puncture - risk for herniation , increased pressure Treatment : IV corticosteroids , mannitol , HOB > 30 degrees , decompression / shunting , consider mass removal Oncology Emergency- Structural- Superior/Inferior Vena Cava Syndrome