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Oncological Emergencies- Oncology Nursing

1. Oncological emergencies refer to urgent clinical situations in cancer patients caused by cancer or its treatment. 2. Some examples discussed are hypercalcemia, tumor lysis syndrome, lactic acidosis, hypoglycemia, syndrome of inappropriate antidiuretic hormone secretion, superior vena cava syndrome, spinal cord compression, severe cystitis, bladder hemorrhage, disseminated intravascular coagulation, and cardiac tamponade. 3. The document provides details on symptoms, signs, and treatment approaches for each of these conditions.

Education◦
ONCOLOGICAL EMERGENCIES SWATILEKHA DAS, RN B.Sc (H)Nursing, M.Sc (MSN) ASST. PROFESSOR
ONCOLOGICAL EMERGENCIES The patients with cancer may develop an emergent clinical situation due to the Cancer per se or as a complication of therapy.
HYPERCALCAEMIA • Hypercalcaemia, also spelled hypercalcemia, is a high calcium (Ca2+) level in the blood serum. The normal range is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemia. Those with a mild increase that has developed slowly typically have no symptoms
SYMPTOMS & SIGNS • Fatigue • Lethargy • Polyuria • Constipation • Stupor • Coma • Renal failure • Cardiac arrhythmia
TREATMENT • Calcitonin (Miacalcin). • Calcimimetics. • Bisphosphonates. ... • Denosumab (Prolia, Xgeva). ... • Prednisone • IV fluids and diuretics.
TUMOR LYSIS SYNDROME Tumor lysis syndrome is a group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream.
SYMPTOMS & SIGNS • Hyperuricaemia & hyperphosphatemia produce nausea, vomiting & acute renal failure • Hypercalcaemia causes muscle cramps, cardiac arrhythmia & tetany. • Hyperkalaemia results in cardiac arrhythmia & flaccid paralysis.
TREATMENT • IV Fluid, normal or half normal saline around 3000ml per day. • Correction of electrolytes and acid-base abnormality & IV sodium bicarbonate to maintain an alkaline urine pH. • Oral allopurinol is given 300-600mg in divided doses.
• Monitoring serum uric acid, serum creatitine, serum electrolytes and electrocardiogram after every few hours. • IV calcium gluconate is given for hypocalcaemia.
LACTIC ACIDOSIS Lactic acidosis is a medical condition characterized by the buildup of lactate (especially L-lactate) in the body, with formation of an excessively low pH in the bloodstream. It is a form of metabolic acidosis, in which excessive acid accumulates due to a problem with the body's oxidative metabolism.
SYMPTOMS & SIGNS • Hyperventilation • Severe weakness • Hypotension • Stupor • Shock
TREATMENT • The treatment consists of administering sodium bicarbonate and monitoring of pH.
HYPOGLYCAEMIA Hypoglycaemia, sometimes called a hypo or low, is a condition that occurs when a person's blood glucose level (BGL) has dropped too low, below 4mmol/L. It is important to treat a hypo quickly to stop the BGL from falling even lower and the person becoming seriously unwell.
SYMPTOMS & SIGNS • Weakness • Excessive swaeting • Seizures • Coma
TREATMENT • Administration of IV hypertonic glucose , corticosteroids and glucagon.
SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE(SIADH) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body makes too much antidiuretic hormone (ADH). This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water.
SYMPTOMS & SIGNS • Lethargy • Irritability • Nausea/anorexia • Confusion • Muscle weakness • Cardiac arrhythmia • Convulsion • Death
TREATMENT • It is treated by fluid restriction(500-1000ml/day). • If water restriction is not effective then demeclocycline is prescribed to interfere with antidiuetic effect of ADH. • Lithium can be used as an alternate therapy. • Patient improves within 7-10 days with normalisation of sodium. • An IV infusion of hypertonic saline is given in severe cases to prevent pulmonary edema • After the control of SIADH the cancer is treated.
SUPERIOR VENA CAVA SYNDROME Superior vena cava syndrome (SVCS) is obstruction of blood flow through the superior vena cava (SVC). It is a medical emergency and most often manifests in patients with a malignant disease process within the thorax.
SUPERIOR VENA CAVA SYNDROME
SYMPTOMS & SIGNS • Swelling of face & neck • Dry cough • Dyspnea • Hoarseness of voice • Nasal congestion • Headache • Cyanosis • Confusion • Stupor
TREATMENT • Local radiotherapy • Chemotherapy • Percutaneous transluminal ballon angioplasty & insertion of stents
SPINAL CORD COMPRESSION • Spinal cord compression occurs when a mass places pressure on the cord. A mass can include a tumor or bone fragment. Compression can develop anywhere along the spinal cord from the neck to the lower spine.
SYMPTOMS & SIGNS • Localised pain & tenderness in back • Loss of bladder & bowel control • Painful movements of the spine • Sensory & motor deficits
TREATMENT • Administration of high dose of dexamethasone / methylprednisolone • Local radiation therapy • Chemotherapy • Surgical intervention
SEVERE CYSTITIS & BLADDER HAEMORRHAGE • Cystitis is a sudden inflammation of the urinary bladder. Most of the time, a bacterial infection causes it. This infection is commonly referred to as a urinary tract infection (UTI). Irritating hygiene products, a complication of certain diseases, or a reaction to certain drugs can also cause acute cystitis. • Hemorrhagic cystitis is the sudden onset of hematuria combined with bladder pain and irritative bladder symptoms. Hematuria is blood in the urine. The amount of blood can range from a minute amount that occurs occasionally to frank bright red blood that occurs continuously. There are a variety of causes of hematuria.
SYMPTOMS & SIGNS • Incontinence & hematuria • Sometimes hematuria can be severe .
TREATMENT • Administration of urinary anagesics, such as phenazopyridine hydrochloride & antispasmodics • In patients with severe hemorrhage packed red blood cell transfusion is required. • Irrigation with bladder with Formalin (0.37%) solution may stop bleeding in many cases.
DISSEMINATED INTRAVASCULAR COAGULATION Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels.
SYMPTOMS & SIGNS • Bleeding, from many sites in the body. • Blood clots. • Bruising. • Drop in blood pressure. • Shortness of breath. • Confusion, memory loss or change of behavior. • Fever.
TREATMENT • Treatment includes correction of the cause and replacement of platelets, coagulation factors (in fresh frozen plasma), and fibrinogen (in cryoprecipitate) to control severe bleeding. Heparin is used as therapy (or prophylaxis) in patients with slowly evolving DIC who have (or are at risk of) venous thromboembolism.
CARDIAC TEMPONADE Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. The condition is a medical emergency, the complications of which include pulmonary edema, shock, and death.
SYMPTOMS & SIGNS • Anxiety and restlessness. • low blood pressure. • weakness. • chest pain radiating to your neck, shoulders, or back. • trouble breathing or taking deep breaths. • rapid breathing. • discomfort that's relieved by sitting or leaning forward. • fainting, dizziness, and loss of consciousness.
TREATMENT • The treatment for cardiac tamponade involves draining the excess fluid from the pericardium, stabilizing blood pressure, and treating the underlying cause.
Oncological Emergencies- Oncology Nursing