Oncological Emergencies
These are medical situations that take priority over anything else going on. They include:
- Sepsis
- DIC
- SIADH
- Spinal Cord Compression
- Superior vena Cava Syndrome
- Tumor Lysis Syndrome
- Hypercalcemia (as well as Hypocalcemia)
- Intractable Pain
Sepsis
This is an oncological emergency where a patient goes into septic shock. With this, you must obtain a blood and urine culture FIRST, then give an antibiotic.
You are looking for a band shift to the left
Disseminated Intravascular Coagulation (DIC)
This is an oncological emergency caused by a gram negative infection (like from Raw Fruits and veggies)
- It is an abnormal clot formation in microthrombi, leading to mulit organ system failure and death
DIC Signs and Symptoms
These include
- Peechia, echymosis, bleeding, hemorrhage, oliguria, convulsion
- PT & PTT - PROLONGED
- Platelets and Fibrinogen - DECREASED
DIC Patient Care
This includes:
- An attempt to measure blood loss
- Labs
- Wound care, pressure to the site
- Turn and Position
- Frequent mouth care
- Antibiotics AFTER a culture
- Emotional support
* If they survive, NO aspirin
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
This is an oncological emergency where there is a hyper-secretion of ADH by the posterior pituitary glad.
- It causes fluid retention and hyponatermia (Normally 135 - 145). The level it will usually be is around 110.
- This is most common with brain and l
SIADH Signs and Symptoms
These include:
- Edema, weight gain, crackles, jugular vein distention
- Anorexia, fatigue, muscle cramp, Decreased urine, changes in mental status, seizures
SIADH Nursing Interventions
These include:
- Diuretics, usually lasix
- Restrict fluid intake 800ml-1L a day
- Monitor: Electrolytes, I&O, daily weight, neuro status
- Never let them get up alone
Spinal Cord Compression
This is an oncological emergency where a tumor invades the spinal cord, vertebral column collapses. With this, there is extreme pain, worse with movement.
Spinal Cord Compression Signs and Symptoms: Early
This includes Back pain or neck pain
Spinal Cord Compression Signs and Symptoms: Late
These include:
- Loss of sensation
- Incontinence
- Sexual Impotence
- Paralysis
- Muscle Atrophy
Spinal Cord Compression Treatment
With this, use deep breathing and incentive spirometer to prevent respiratory problems.
Also, log rolling
Pharmacologically:
- High dose corticosteriods to reduce edema and pain
- Chemotherapy as adjunt to radiation and surgery
- Analgesics
Hypercalcemia
This is an oncological emergency that is a late manifestation of malignancy with bone metastasis. This develops very slowly
Hypercalcemia Signs and Symptoms
These include:
- Fatigue, constipation, decreased deep tendon reflexs
- EKG changes: Tachycardia then Bradycardia which leads to cardiac arrest
Hypercalcemia Treatment
This is done only when symptoms occur. You give oral or IV hydration, Calcitonin, and Dialysis possibly if its very high.
Superior Vena Cava Syndrome
This is an oncological emergency where the SVC is compressed or obstructed by a tumor growth. There is a blockage of blood flow in the neck, head, and upper arms. It is painful and life threatening. Symptoms usually occur in the morning.
Superior Vena Cava Syndrome Signs and Symptoms: Early
These include:
- Edema of the face, neck, eyes, arms, and hands
- Stokes sign - tightness of the shirt and blouse
- Dyspnea
- Neck and vein distention
Superior Vena Cava Syndrome Signs and Symptoms: Late
These include:
- Severe headache
- Stridor
- Hemorrhage
- Cyanosis
- Hypotension
- Change in mental status
Superior Vena Cava Syndrome Treatment
With this, high dose radiation to the mediastinal area is used as a treatment.
Tumor Lysis Syndrome
This is an oncological emergency where cancer cells become destroyed, but in the process, large amounts of potassium and uric acid are released from those destroyed cells. This can cause acute renal failure, and cardiac dysrhythmias.
Tumor Lysis Syndrome Treatment
With this, monitor urine pH to prevent ARF. You want a pH below 6.57.
- Also, hydration is important. Have patients drink the day before, of, and 3 days after treatment at scheduled times.
- do an EKG
- Medication - Alopurinol to decrease uric acid.