NUR 4120 FINAL NEW MATERIAL AA

NUR 4120 FINAL NEW MATERIAL AA




NUR 4120 FINAL NEW MATERIAL AA




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
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,NUR 4120 FINAL NEW MATERIAL AA


 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  Superior Vena Cava
 Spinal Cord Compression Syndrome (SVC)*
(SCI)*  Increased Intracranial
Pressure (ICP)
 Superior vena cava syndrome (SVC)
o Basically take away that it’s a compression that’s normally caused by a tumor, enlarge lymp nodes




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,NUR 4120 FINAL NEW MATERIAL AA


o Compression or invasion of SVC by tumor, enlarged lymph nodes, thrombus
o Typically associated with lung cancer
 Breast cancer  Lymphoma
 Kaposi’s sarcoma  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  ALOC  decreased
 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  Thoracic CT
 Chest x-ray  Thoracic MRI
o Management
 Medical
 Radiation therapy
o shrink tumor or enlarged lymph nodes and relieve symptoms
 Chemotherapy
 Anticoagulant/Thrombolytic therapy
 Intravascular stents

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, NUR 4120 FINAL NEW MATERIAL AA


 Surgery
 Supportive
o 02  o Corticosteroids
sometimes this o Diuretics
is the best we
can do
 Nursing  focus on
 Identify at risk patients
 Monitor for s/s
 Avoid upper extremity venipuncture/BP measurement
o We need to AVOID this!!
o Instruct patient to avoid tight or restrictive clothing and jewelry on fingers,
wrist, and neck.  it will get stuck and impair circulation
o Take blood pressure in lower extremities
 Proper positioning
o Semi-fowlers, high fowlers
o Facilitate breathing and drainage from upper portion of body by instructing
patient to maintain some elevation of head and upper body with semi-Fowler
position; avoid completely supine or prone position (this helps to promote
comfort and reduce anxiety associated with dependent and progressive
edema).
 Monitor fluid status
 Monitor for radiation/chemo side-effects
o N/V, diarrhea, altered LOC
o Palliative radiation  not curative but can shrink the tumor
o UNDERSTAND SVCS IS AN ONCOLOGY EMERGENCY INVOLVING THE AIRWAY
o DECREASED LOC AND C/O  assess and correct
o MAY NEED TO GIVE SUPPORTIVE CARE, O2, DIURETICS, MAKE SURE YOURE NOT DOING
ANYTHING TO THE UPPER EXTREMITIES LIKE PUNCTURES AND BP
o HIGH FOWLERS
o MONITOR FOR CHEMO/RADIATION S/S
 N/V/D, FATIGUE
 Tumor Lysis Syndrome  ONCOLOGIC EMERGENCY
o Tumor cells are being destroyed rapidly, bc the tumor cell is being destroyed so rapidly K+ and
uric acid are altered  hyperkalemia, hyperphosphatemia
o LEADS TO ELECTROLYTE IMBALANCES
o Can be fatal
o Etiology
 Potentially fatal complication

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