Oncological Emergencies

A nurse on the oncology unit is caring for a client who is receiving chemotherapy treatment. Which of the following are early signs that the client is developing tumor lysis syndrome? SATA

- Diarrhea - Muscle cramps - Nausea and Vomiting From hyperkalemia, hyperphosphatemia, hypermagnesium, acute renal disease, hypocalcemia , hyperuricemia

1. A nurse on the oncology unit is caring for a client who is receiving treatment for small cell lung cancer. Which of the following is an early sign that the client is developing SVC syndrome?

- Facial edema

Initial treatment for any shock?

- Fluids

The nurse documents the following assessment for a 78-year-old client admitted with SVC syndrome secondary to lung cancer. Nurse's progress note: client awake and alert sitting in chair at bedside for past 3 hours. Complains of back pain 3/10. Responds appropriately to commands. Bilateral crackles at base cleared with cough, bilateral pedal edema 1+ bilaterally. Periorbital edema noted. Client states I cannot remove my wedding ring it is stuck on my hand. Which of the following problems are consistent with the diagnosis of SVC syndrome?

- Periorbital swelling (Edema) - Ring stuck on the left hand (Swollen)

A 28-year-old man was recently diagnosed with leukemia. He is admitted to the hospital for further analysis and chemotherapy initiation. He only complains of fatigue. Laboratory evaluation reveals pancytopenia, hyperkalemia (K 6.8), uric acid 13, hyperphosphatemia (12), and elevated lactate dehydrogenase (LDH). What is the most likely cause of his electrolyte abnormalities? A. Tumor lysis syndrome B. Acute renal failure C. Hypercalcemia

A. Tumor lysis syndrome Explanation The most likely cause of the patient's electrolyte abnormalities is tumor lysis syndrome. Tumor lysis syndrome occurs when large amounts of tumor cells are destroyed rapidly, leading to the release of intracellular contents such as potassium, phosphate, and uric acid into the bloodstream. This can result in hyperkalemia, hyperphosphatemia, and elevated uric acid levels. Additionally, the increased breakdown of cells can lead to elevated lactate dehydrogenase levels. Acute renal failure and hypercalcemia can also cause electrolyte abnormalities, but the given clinical presentation and laboratory findings are more consistent with tumor lysis syndrome.

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.

ANS: B Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression.

Spinal Cord Compression

Clinical manifestations: -Back pain -Neuro deficits...N-W-T is the result of tumor compression on the spinal cord or in the epidural space. • Any abnormal neurological symptoms in a patient with cancer should be considered an SCC until proven otherwise. Treatment is usually palliative because it is associated with metastatic disease. • Bed rest • Corticosteroids • Radiation therapy • Surgery (laminectomy)

The hospice nurse is caring for a patient with cancer in her home. The nurse has explained to the patient and the family that the patient is at risk for hypercalcemia and has educated them on that signs and symptoms of this health problem. What else should the nurse teach this patient and family to do to reduce the patients risk of hypercalcemia? A. Stool softeners are contraindicated. B. Laxatives should be taken daily. C. Consume 2 to 4 L of fluid daily D. Restrict calcium intake

Consume 2 to 4 L of fluid daily

1. The nurse on the oncology unit notes a calcium level of 13. Which of the following should the nurse plan to include when caring for this client?

Increase hydration and increase mobility

What are the 4 main oncological emergencies?

Septic shock Extravasation Spinal Cord Compression Hypercalcemia Superior vena cava

The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breath and the nurses rapid assessment reveals that the patients jugular veins are distended. The nurse should suspect the development of what oncologic emergency?****** A. Increased intracranial pressure B. Superior vena cava syndrome (SVCS) C. Spinal cord compression D. Metastatic tumor of the neck

Superior vena cava syndrome (SVCS)

The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurses assessment should include examination for the signs and symptoms of what complication?****** A. Tumor lysis syndrome (TLS) B. Syndrome of inappropriate antiduretic hormone (SIADH) C. Disseminated intravascular coagulation (DIC) D. Hypercalcemia

Tumor lysis syndrome (TLS)

. A 71-year-old man who has lung cancer was admitted to the hospital with worsening dyspnea. He complains of progressive dyspnea for a few months. What is the most likely diagnosis? A. Pericardial tamponade B. Congestive heart failure C. Superior vena cava (SVC) syndrome D. None of these

c

Hypercalcemia

• Elevated serum calcium level above 11 mg/dL • Results when bone resorption exceeds both bone formation and the ability of the kidneys to excrete extracellular calcium released from the bones.

Tumor Lysis Syndrome

• Occurs when large numbers of neoplastic cells are killed rapidly, leading to release of intracellular ions and metabolic byproducts into the systemic circulation. • Characterized by rapid development of o hyperuricemia, o hyperkalemia, o hyperphosphatemia, o hypocalcemia o and acute renal failure

Superior Vena Cava Syndrome

• obstruction and thrombosis of the superior vena cava by a tumor or an enlarged lymph node resulting in impaired venous drainage of the head, arms and thorax Clinical Manifestations: • vary, can be very dramatic and life-threatening, • dyspnea, cough • feeling fullness in head • hoarseness chest pain, cyanosis • edema of head and upper extremities • visual disturbances • dizziness • lethargy