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Oncology Understanding Medical Surgical Nursing 4th ed., Ch 11

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1 Oncology Understanding Medical Surgical Nursing 4th ed., Ch 11
OBJECTIVES: 1. Explain the differences between benign & malignant tumors. 2. List risk factors for the development of cancer. 3. State 7 warning signs of CA. 4. Define terms used to name & classify CA. 5. List the most common sites of CA in men & women. 6. List nursing responsibilities in the care of patients having diagnostic tests to detect possible CA. 7. Explain the nursing care of clients undergoing each type of CA therapy: surgery, radiation, chemotherapy, biologic response modifiers.

2 Health Statistics American Cancer Society: Males: over ½ Prostate, lung, & colorectal Women: ~½ breast, lung, & colorectal Children (0-14yrs) Colorectal CA is the 3rd most common CA in both men & women.

3 Health Statistics U.S. 2014 Deaths
CA is the 2nd leading cause of death in the US, exceeded only by heart disease. Breast, Prostate, Lung, & Colorectal CA’s account for ½ of all deaths, men & women.

4 Older Adult Considerations
More cases of CA CA î with aging S&S of CA may be misdiagnosed

5 Cells that reproduce abnormally & in an uncontrolled manner.
Cancer (CA) Large group of diseases characterized by uncontrolled growth & spread of abnormal cells. (American Cancer Society) Neoplasms or Tumors Cells that reproduce abnormally & in an uncontrolled manner.

6 Normal Cell Growth Uniform shape Cell cohesiveness Controlled growth Well differentiated Programmed cell death (apoptosis)

7 Cancer Pathophysiology
CA cells divide & multiply, in an abnormal manner. Mutation of Cellular Genes Abnormal Cell Growth No Cell Division Limit Lack of Contact Inhibition

8 Cancer Cell Growth Abnormal appearance Lack of cohesiveness Rapid, disorderly division Poorly differentiated No apoptosis

9 Benign Tumors Slow, steady growth Remains localized Usually contained within a capsule Smooth, well-defined; movable when palpated Resembles parent tissue Crowds normal tissue Rarely recurs after removal Rarely fatal

10 Malignant Tumors Rate of growth varies – usually rapid Metastasizes
Rate of growth varies – usually rapid Metastasizes Rarely contained within a capsule Irregular; more immobile when palpated Little resemblance to parent tissue May recur after removal Fatal without treatment

11 Metastasis Process by which tumor cells are spread to distant parts of body; used to describe movement of CA cells from primary to secondary site. Invade Blood or Lymph Vessels Move by Mechanical Means Lodge & Grow in New Location

12 Carcinogenesis The process by which normal cells are transformed into CA cells. Etiology: Carcinogen Exposure Initiation Promotion

13 Carcinogenesis Initiation Carcinogens: CA causing agents Repair itself Permanently ∆’ed, don’t cause CA Transformed & produce new line of CA cells

14 Promotion Process by which CA promoters aid in alternation or injury to DNA.

15 Progression The expression of malignant mutation acquiring more aggressive characteristics over time.

16 Cancer Types Carcinoma Sarcoma Melanoma Leukemia Lymphoma
Carcinoma Sarcoma Melanoma Leukemia Lymphoma

17 Most Common Cancers Men Prostate Lung Colon Women Breast Lung Colon

18 Skin Cancer Malignant lesion of skin; may or may not metastasize
Types: basal cell, squamous cell, malignant melanoma Assessment: change in color, size, shape of preexisting lesion; pruritus; local soreness Interventions Instruct in preventive measures (limiting exposure to sun, use of sunscreens) Instruct to monitor lesions for changes, nonhealing lesions; report to primary health care provider immediately Assist with surgical excision of lesion as prescribed

19 Leukemia Malignant exacerbation in number of leukocytes, usually at immature stage, in bone marrow Data collection Normal, elevated, or reduced white blood cell count; decreased H/H; thrombocytopenia; positive bone marrow biopsy; anorexia; fatigue; bleeding; fever; lymphadenopathy; splenomegaly; bone pain, swelling 19

20 Lymphoma: Hodgkin’s Disease
Malignancy of lymph nodes; originates in single lymph node or single chain of nodes Data collection Presence of Reed-Sternberg cells in nodes Fever; malaise; night sweats; anorexia; anemia & thrombocytopenia; enlarged lymph glands, including nodes, spleen, liver 20

21 Hodgin’s disease cont’d
characterized by painless, progressive enlargement of lymphoid tissue Interventions Provide care before & after external radiation as prescribed Provide care before & after chemotherapy as prescribed Monitor for signs of infection, bleeding Follow bleeding precautions

22 Non-Hodgkin’s lymphoma (NHL)
Any of a heterogeneous group of malignant tumors involving lymphoid tissue.

23 Lung Cancer Malignant tumor of lung; may be primary or metastatic
Causes Cigarette smoking; exposure to environmental pollutants; exposure to occupational pollutants Data collection Cough; dyspnea; hoarseness; hemoptysis; chest pain; anorexia; wt loss; weakness Interventions Place in Fowler’s position Administer oxygen as prescribed 23

24 Lung CA Small-cell lung CA: hormonal cells Non-small lung CA: -squamous-cell: larger airways -adenocarcinomas: (large-cell carcinomas), in secretory portion -bronchoalveolar carcinomas: small air sacs, or alveoli

25 Multiple Myeloma Malignant proliferation of plasma cells, tumors within bone Data collection Bone, skeletal pain, especially in ribs, spine, pelvis Osteoporosis Recurrent infections; fatigue; anemia; thrombocytopenia; granulocytopenia; elevated uric acid & calcium serum levels

26 Risk factors Smoking Exposure to radiation
Exposure to environmental & chemical carcinogens Smokeless tobacco Frequent heavy consumption of alcohol

27 Risk factors Dietary habits Pickled, smoked, charbroiled High-fat, low-fiber diets High-fat diets Diet low in vitamins A, C, & E

28 Risk Factors Oncoviruses Irritants Hormones Altered Immunity

29 Genetic Susceptibility:
Hereditary Cancers ~ 90% of cancers are not inherited Genetic Susceptibility: Postmenopausal breast CA Lung CA – Smokers Leukemia – identical twin Neuroblastoma – siblings Colon CA – breast CA

30 American Cancer Society Cancer’s 7 Warning Signals: CAUTION
Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening lump in breast or elsewhere Indigestion or swallowing difficulties Obvious ∆ in warts or moles Nagging cough or hoarseness

31 Prevention Early Detection Regular Screening Genetic Testing Healthy Lifestyle

32 Breast Self-Examination (BSE)
Performing BSE 7 to 10 days after menses If postmenopausal or posthysterectomy, select specific day of month, perform regularly Client instructions In shower or bath, examine breasts Use pads of second, third, and fourth fingers to press firmly on every part of breasts, using right hand to examine left breast and vice versa Use small circular motions in a spiral or up and down motion so that entire breast is examined, checking for any lump, knot, thickening of tissue 32

33 Breast Self-Examination (BSE) (continued)
Look at breasts in mirror, raising arms over head to determine any changes in size, dimpling of skin, changes in nipple, asymmetry; repeat with hands on hips Lying down, feel breasts as when in shower or bath; when examining right breast, place right hand behind your head and vice versa for left breast Any changes noted should be reported immediately to health care provider

34 Testicular Self-Examination (TSE)
Performing testicular self-examination Select day of month; perform on that day every month Client instructions In shower, gently lift each testicle; each one should feel like an egg: firm but not hard, smooth with no lumps Using both hands, place middle fingers on underside of each testicle, thumbs on top; gently roll testicle between thumb and fingers to feel for swelling, lumps, or mass Any changes noted should be reported immediately to health care provider

35 Prevention Protectant Foods Folic Acid Omega-3 Fatty Acids Fruits & Vegetables Vaccines

36 Diagnosis of CA Biopsy: sample of tissue for pathological examination. Incisional bx: removal of a portion of tissue for examination. Excisional bx: removal of complete lesion, with little or no margin of surrounding normal tissue removed.

37 Diagnosis of Cancer Needle aspiration bx: aspiration of fluid or tissue by means of needle. Endoscopy: directly visualize an internal structure through a body cavity or through a small incision; can also obtain cells or tissue.

38 Diagnostic Imaging Bone scanning Tomography Computed tomography (CT) scan Radioisotope studies Cytological studies

39 Magnetic resonance imaging (MRI) Positron Emission Tomograph (PET)
Diagnostic Imaging Ultrasound testing Magnetic resonance imaging (MRI) Positron Emission Tomograph (PET)

40 Laboratory Tests Alkaline phosphatase Serum calcium Serum calcitionin Carcinoembryonic antigen (CEA) PSA & CA-125 Stool examination

41 Staging
Tumor Nodes Metastasis Indicate tumor size, spread to lymph nodes, & extent of metastasis. Direct tx, predict prognosis, & contribute to CA research.

42 T* Subclasses T×: tumor can’t be adequately assessed To: no evidence of primary tumor Tis: carcinoma in situ T1, T2, T3, T4: progressive î in tumor size & involvement regional lymph

43 Nt Subclasses N×: regional lymph nodes cannot be assessed No: no regional lymph nodes cannot be assessed N1, N2, N3: î involvement regional lymph nodes

44 M‡ Subclasses M×: not assessed Mo: no (known) distant metastasis M1: distant metastasis present, specify site(s)

45 Grading Histopathology G1: well differentiated G2: mod well-differentiated G3: poorly differentiated G4: undifferentiated

46 Staging Classification for CA
Stage 1: malignant cell confined Stage 2: limited spread, local area, nearby lymph nodes. Stage 3: larger or spread to nearby tissues or both; regional lymph node likely involved. Stage 4: metastasized to distant parts of body.

47 Therapeutic Interventions
Surgery Radiation Therapy Chemotherapy

48 Cancer Therapies Surgery removal of all malignant cells; may include removal of tumor, surrounding tissue & regional lymph nodes. Preventive, Diagnostic, Curative Palliative: relieve or reduce intensity of uncomfortable symptoms. [not a cure] Reconstructive

49 Laser Surgery Laser beam vaporizes tissue with little bleeding & low risk of infection. ophthalmology gynecology urology neurosurgery otolaryngology

50 Nursing Interventions
Monitor VSs Monitor labs Monitor client’s wt. Monitor I&O Monitor for bleeding, S&S of infection Psychosocial issue

51 Nursing Interventions
When surgery may result in a Δ of body image, client may benefit from support groups: The American Cancer Society Reach to Recovery The Lost Chord Club I Can Cope Look Good, Feel Good The Ostomy Club

52 Radiation Therapy Cure or control CA that has spread to local lymph nodes or to tx tumors that can’t be removed. Preop to ↓ size of tumor Postop to destroy malignant cells not removed by surgery.

53 External Radiation tx’s based on radiologist’s recommendations. ~ 5x/wk for 2 to 8 wks. Directed toward superficial lesions or targeted to deeper structures within body. Body marked, not washed off

54 Nursing Interventions
External Radiation Nursing Interventions Marking areas to be radiated Explain procedure & instruct pt on how to protect markings Skin care & protection from sunlight Avoid applications of heat or cold

55 Nursing Interventions Cont’d
External Radiation Nursing Interventions Cont’d Diet- high protein & calories Fluid intake: 2 or 3 quarts/day Assess for lethargy & fatigue Provide frequent periods of rest

56 Nursing Interventions Cont’d
External Radiation Nursing Interventions Cont’d Mucositis Frequent oral care Advise use of neutral mouthwash (diphenhydramine (Benadryl) & water Discourage use of alcohol & tobacco. Avoid very cold foods & drinks.

57 Unsealed internal radiation Sealed radioactive materials

58 Internal radiation safety measures (Sealed)
Private room Sign on door – radiation area Time - film badges. (30 mins./shift) 4. The pt. Must be as self-sufficient as possible. 5. The radioactive material may leave the pt. Accidentally; immediately notify physician & radiation safety personnel.

59 Pts will receive the following instructions
Restricted to your room. Use disposable eating utensils. These utensils should be placed in special waste container after use. Wear gloves when handling items that are not protected by coverings, such as personal items the pt. may wish to take home.  Flush toilet 2 or 3 times after each use. This will insure that all radioactive urine is washed from toilet bowl. Avoid physical contact with visitors.

60 Visitors have the following restrictions
Visits should be limited to 30 hour/day. No pregnant women or persons under age 18 should visit the patient without special permission. Remain at least 6 ft. from the pt. Must be protected with gowns, shoe covers, & gloves. Should not handle any items in the room. Must not smoke, eat, or drink while in the client's room.

61 Radioactive implant (brachytherapy)
Usually combined with a course of external radiation therapy to ↑ dosage to a specific site. Visitors limited to 60 mins. Standing away from area. Liquid Radiation Tx (Zevalin therapy) Non-Hodgkins’s lymphoma

62 Internal radiation safety measures
Unsealed Additional considerations: Gloves Contaminated materials may require special care. (lead-lined container & long-handled forceps); Follow hospital policy for radioactive waste cleanup

63 Radiation Safety Time Distance Shielding

64 Radiation Side Effects
Normal cell sensitivity: Alopecia (hair follicle), Bone marrow suppression Lining of the digestive & urinary tracts, ovaries, testes, & lymph tissue

65 Radiation Side Effects
Fatigue Nausea, Vomiting, Anorexia Mucositis Xerostomia Skin Reactions

66 Robotic Surgery Computerized, 3-D, 360-degree ROM A surgeon-guided robotic machine Improved surgical accuracy Better pt. outcomes ↓ recovery times

67 Drugs used to ↓ or slow growth of metastatic CA.
Chemotherapy Drugs used to ↓ or slow growth of metastatic CA. Hematopoietic system Hair follicles GI system

68 Chemotherapy Medications
Alkylating agents Antitumor Antibiotics Antimetabolites Hormonal agents Vinca Alkaloids Antineoplastic drugs

69 Chemotherapy Medications
Different Antineoplastic Classes Are Given Different classes affect different stages of the CA’s life cycle Allows lower dosages of each agent Reducing toxicity Slowing development of resistance

70 Alkylating Agents Most widely used antineoplastic drug Form bonds or linkages with DNA Called alkylation Changes the shape of DNA Prevents normal DNA function Kill or slow down replication of tumor cells Adverse effect Bone marrow suppression Damage epithelial cells lining GI tract Cyclophosphamide (Cytoxan), nitrogen mustard

71 Antimetabolites Chemically similar to essential building blocks of the cell Resemble purines or pyrimidines Building blocks of DNA & RNA CA cells use this drug to construct proteins or DNA Block DNA synthesis Kill CA cells or slow growth Methotrexate (Mexate)

72 Antitumor Antibiotics
Not widely prescribed Interact with DNA in a manner similar to alkylating agents Doxorubicin (Adriamycin)

73 Plant Alkaloids/Natural Products
Structurally very different Common ability to arrest cell division Sometimes called mitotic inhibitors Vincristine (Oncovin)

74 Hormones & Hormone Blockers
Used to slow growth of hormone-dependant tumors Certain tumors stimulated by natural hormones Specific hormones or hormone blockers can block receptor sites Hormones used in CA chemotherapy Use of testosterone or antiestrogen to slow breast cancer (Tamoxifen) Estrogen to slow growth of prostate CA Other major class is corticosteroids

75 Biologic Response Modifiers & Miscellaneous Antineoplastics
Biologic response modifiers stimulate the body’s immune system Limit the severe immunosuppressive effects of other anticancer drugs Immunotherapy Some used to minimize the toxic effects of other antineoplastics

76 Miscellaneous Anticancer Drugs
Have Different Mechanisms of Actions Asparaginase deprives CA cells of an essential amino acid Mitotane (Lysodren) - similar to the insecticide DDT Poisons CA cells by forming links to proteins

77 Miscellaneous Anticancer Drugs
Others given to counteract the toxicity of antineoplastics Colony Stimulating Factors: G-CSF, GM-CSF Oprelvekin (Neumega) - stimulates platelet production Epoetin alfa; Erythropoientin EPO (Epogen) - stimulates RBC production Interleukin-2 – stimulates T-cells

78 Next Generation Drugs tyrosin kinase inhibitors: a chemical that helps govern growth of CA cells. Targets a specific “receptor” site found on surface of CA cell. Iressa -bowel, breast, head, ovary, prostate, bladder & kidney Herceptin (trastuzumab) –breast CA Gleevec –chronic myelogenous leukemia

79 Chemotherapy Side Effects
Antineoplastic drugs: doxorubicin (Adriamycin): red urine Bone marrow suppression Leukopenia Thrombocytopenia Anemia N/V & diarrhea

80 Chemotherapy Side Effects
Alopecia Stomatitis Reproductive Alterations Neurotoxicity

81 BITES Bleeding Infection Tiredness Emesis Skin Changes

82 Colony Stimulating Factors
G-CSF GM-CSF Erythropoietin Interleukin-II

83 Biotherapy [immunotherapy] tx with agents derived from biological sources or affecting biological responses. Biological response modifiers (BRM) ↑ & restores, or modifies host defenses against the tumors (CSFs, Neupogen, erythropoetin, GM-CSFs)

84 Biotherapy Biological response modifiers (BRM) 2. Directly, toxic to tumors (interleukins, IL-2, bacille Calmette-Gue’rin vaccine [BCG]). 3. Modifies tumor biology (interferons alpha, beta, & gamma)

85 Non-traditional approaches
Alternative Therapies: Biofeedback Reflexology Herbal supplements Enzyme therapy Reiki Cultural factors Spiritual factors

86 Bone Marrow Transplantation (BMT)
Tx leukemia -though high-dose chemotherapy, total body irradiation Types of donor stem cells Allogeneic, syngeneic, autologous Procedure Harvest: marrow harvested through multiple aspirations from iliac crest to retrieve sufficient bone marrow for transplantation Conditioning: refers to immunosuppressive therapy regimen to eradicate all malignant cells

87 Bone Marrow Transplantation
Replacing diseased or damaged bone marrow with normally functioning bone marrow. Stem Cell Transplants Used in some solid tumor CA’s

88 Bone Marrow Transplantation
Risks: Infection, Septic Protective Isolation Prophylactic systemic antibiotics & antiviral agents Routine cultures (blood, urine, throat, & stool)

89 Bone Marrow Transplantation
Nursing interventions Reinforce info., explained by physicians regarding expectations of specific tx’s. Allow pt express their feelings & enc. them to follow guidelines of conventional medical practice.

90 Bone Marrow Suppression
Nursing Intervention Bone Marrow Suppression Monitor CBC, & WBC Allow for periods of rest Prevent overtiring Protect from infection Protective isolation

91 Hematopoietic System Leukopenia (low WBC’s d/t depression of bone marrow) Life-threatening infections Normal WBC: 4,500 – 11,000/mm³

92 Neutropenia: a low absolute neutrophil count ANC
measured is in the setting of chemotherapy for CA. A normal absolute neutrophil count (ANC) is above 1,500. An ANC less than 500 is defined as neutropenia & significantly ↑’s the risk of infection.

93 Neutropenia ↓  pneumonia, septicemia, infections. Tx: colony-stimulating factors (CSFs) Granulocyte colony-stimulating factors (G-CSF) Granulocyte CSF (filgrastim [Neupogen]), Granulocyte-macrohage CSF (GM-CSF) (sargramostim[leukine or Prokine]) SQ or IV.

94 Nursing Interventions
Neutropenic precautions: protective isolation Monitor VS Report î temp Assess for signs of infection

95 Anemia: ↓ RBCs  Fatigue
Tx: recombinant human erythropoietin, or epoetin alfa (Epogen, Procrit) SQ or IV. (side effect: ↑ BP) Transfusions Normal hemoglobin: g/dL female; g/dL male Normal hematocrit: % female; 42-52% males

96 Thrombocytopenia low platelets, d/t depression of bone marrow.
Potential for bleeding  50,000 mm³ Less than 20,000 mm³  spontaneous bleeding Tx: Transfusion Normal Platelet Count: , ,000 mm³

97 Nursing Interventions
Thrombocytopenia Nursing Interventions Monitor for bleeding Venous punctures or injections – apply pressure for 5 mins Instruct use of soft tooth brush, & electric razor.

98 Integumentary System Alopecia loss of hair d/t destruction of hair follicles, never permanent.

99 Stomatitis Tx: Viscous Xylocaine
GI System Stomatitis Tx: Viscous Xylocaine Candida infection of mouth & esophagus Tx: nystatin p.o. Nausea, Vomiting & Diarrhea d/t breakdown of normal GI cells. Metoclopramide (Reglan) Check serum protein level for nutritional status

100 Nursing Intervention - GI
Antiemetics prochlorperazine (Compazine); promethazine (Phenergan) Serum albumin less than 3 g/dL indicates poor nutrition & possible need for support Dehydration, Anorexia, Constipation Cardiac Pulm

101 Physiological Symptoms or Psychological Responses
GI System Physiological Symptoms or Psychological Responses Depression Withdrawal

102 Pain Management Pain - a late symptom of CA Tx: Opioids – MS, hydromorphone (Dilaudid), fentanyl, methadone. Sustained-release MS p.o. – MS Contin or Roxanol SR for terminally ill pts with pain Cocktails

103 Pain Control Causes of pain Bone destruction; obstruction of an organ; compression of peripheral nerves; infiltration or distention of tissue; inflammation or necrosis; psychological causes, such as fear Interventions Assess pain as fifth VS Collaborate with pain management team Administer salicylates, acetaminophen (Tylenol), anti-inflammatories, opioid analgesics orally or parenterally as prescribed Provide nonpharmacological techniques of pain control

104 Relationships of Food & CA
Thought to be carcinogenic: Nitrates in cured & smoked foods High-fat diets Excessive caloric intake Alcohol & cigarettes

105 Relationships of Food & CA
Certain diets seem to have health benefits Diets high in fiber Diets rich in vitamin C Diets high in vitamin A

106 Relationships of Food & CA
Health benefits Phytochemicals - anticarcinogenic. Legumes contain vitamins, minerals, protein, & fiber High intake of soy foods

107 The Effects of CA May cause unexplained wt. loss, weakness, early satiety, & anorexia May lead to loss of muscle tissue, hypoalbuminemia, & anemia Effect of CA on the pt. depends on the location of the tumor

108 Nutritional Care Calorie needs of the pt with CA are greater than before the illness. Pts who can eat normally tolerate the side effects of therapy better. Pts can form aversions to food, making anorexia worse.

109 Nutritional Care Soft diet Low-residue diet High-protein, high-calorie diets and plenty of fluids for pts undergoing radiation or chemotherapy 45 to 50 calories per kg of body weight per day

110 Nutritional Care Carbohydrates & fat needed to provide energy & spare protein for tissue building & the immune system 1.0 to 1.2 g of protein per kg of body wt. a day Malnourished pts may need from 1.3 to 2.0 g of protein per kg of body wt. a day. Vitamins & minerals are essential.

111 Nutritional Care Encourage foods that will ↑ appetite Salad dressings, gravies, sauces, & syrups Several small meals Drugs to control nausea & pain. Nutritional supplements

112 A pt. with CA may feel that comments to encourage eating are depressing reminders of the CA & the situation. How can the health care professional be helpful to the pt?

113 Nutritional Therapy Malnutrition High-calorie foods Nutritional supplements (5% wt loss) Parenteral nutrition

114 Communication & Psychological Support
Most common fears disfigurement, dependency, pain, emaciation, financial depletion, abandonment, & death. Coping factors for fear shock, anger, denial, bargaining, depression, helplessness, hopelessness, rationalization, acceptance, & intellectualization.

115 Coping factors Ability to cope with stressful events in past. Availability of significant others. Ability to express feelings & concerns. Age at the time of dx. Extent of disease.

116 Coping factors cont’d Disruption of body image. Presence of symptoms Past experience with CA Attitude associated with the CA

117 Nursing Interventions
Be available Exhibit a caring attitude Listen actively to fears & concerns Provide relief from distressing symptoms

118 Nursing Interventions cont’d
5. Provide essential info. Regarding CA & CA care 6. Maintain a relationship based on trust & confidence, be open, honest & caring 7. Use touch to exhibit caring

119 Nursing Interventions cont’d
8. Assist in setting realistic, reachable short-term & long- term goals 9. Assist in maintaining usual lifestyle patterns 10. Maintain hope

120 Terminal Prognosis Honesty & openness Spiritual help Social worker assistance

121 Hospice Care Less than 6-Month Prognosis Inpatient Outpatient

122 Nursing Diagnoses Ineffective Protection Imbalanced Nutrition Deficient Self-Care Anticipatory Grieving

123 Nursing Diagnoses Caregiver Role Strain Social Isolation Ineffective Sexuality Pattern Disturbed Body Image

124 Oncological Emergencies
Superior Vena Cava Syndrome Spinal Cord Compression Hypercalcemia Pericardial Effusion/Cardiac Tamponade Disseminated Intravascular Coagulation

125 Oncological Emergencies
- Sepsis, disseminated intravascular coagulation (DIC) Maintain strict aseptic technique; administer antibiotics, anticoagulants, cryoprecipitated clotting factors as prescribed Syndrome of inappropriate antidiuretic hormone (SIADH) Tumors can produce, secrete, stimulate brain to synthesize ADH Initiate fluid restriction, increased sodium intake as prescribed; administer demeclocycline (Declomycin) as prescribed Spinal cord compression Occurs when tumor directly enters spinal cord Assess for back pain, neurological deficits; prepare client for radiation, chemotherapy as prescribed 125

126 Oncological Emergencies (cont’d)
. Hypercalcemia Late manifestation of extensive malignancy, often in clients with bone cancer Monitor serum calcium level; administer oral or parenteral fluids as prescribed; administer medications to lower calcium levels as prescribed Superior vena cava syndrome Occurs when vein compressed, obstructed by tumor growth Prepare client for radiation therapy as prescribed Tumor lysis syndrome Occurs when large numbers of tumor cells are destroyed rapidly, indicating CA tx is effective Encourage oral hydration; administer diuretics as prescribed

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