Oncologic Emergencies

Oncologic Emergencies
Learning Objectives

Discuss the major classifications and sub-classifications of oncologic emergencies

Discuss the treatment and nursing care management for each specific emergency

What is an Oncologic Emergency?

With a greater range of treatments available, many forms of cancer can now be
characterized as chronic or long-term conditions with periods of treatment leading to periods
of remission, sometimes followed by recurrence and further treatment. Occasionally, more
urgent, acute, medical problems occur in patients with cancer and these require timely
diagnosis, intervention and treatment if medium or long-term survival is not to be adversely
affected. Such problems can be described as oncological emergencies.

A clinical condition resulting from a metabolic, neurologic, cardiovascular,

hematologic, and/or infectious change caused by cancer or its treatment that requires
immediate intervention to prevent loss of life or quality of life.

ANTICIPATE potential emergencies & RECOGNIZE them early!

Regular monitoring of lab values every shift by RN.

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Need for RN & AP communication & documentation throughout the shift

updating eachother, sharing gut feelings of observations something just
doesnt seem right

Identification of risk factor(s): Is there a history of MI, multiple surgeries, DVTs,

drug abuse, etc.

Review of admission history if RN has not cared for assigned patient; review,
patient 24flow sheet, & post-pain scores.

Educate patients/families of potential problems and need to notify RN/AP as soon

aspossible.

CLASSIFICATIONS

Cardiovascular System Emergencies

Hematologic Emergencies

Central Nervous System Emergencies

Infectious Emergencies

Metabolic Emergencies

CARDIOVASCULAR SYSTEM

Pericardial Effusion

Cardiac tamponade

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Malignant Pericardial Effusions

Often are undiagnosed in patients with cancer.

Most effusions develop from metastatic lung or breast cancer

Other causes include malignant melanoma, leukemia, lymphoma, radiation

therapy to the chest wall, and chemotherapy agents.

Cardiac Tamponade

Cardiac tamponade: An acute form of a pericardial effusion caused by cancer (most

commonly lung cancer) and/or fluid accumulation around the heart consisting of malignant
cells.

Is the accumulation of fluid in the pericardial space.

fluid compresses the heart

= expansion of the ventricles and cardiac filling during diastole
= ventricular volume and cardiac output
= the heart pump fails and circulatory collapse and failure develops.

With gradual onset, fluid accumulates steadily and the outer layer of the
pericardial space stretches to compensate for the rising pressure. Large amounts
of fluid accumulate before symptoms of heart failure occur. With rapid onset,
pressures rise too quickly for the pericardial space to compensate.

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Most common causes of Cardiac Tamponade

- cancerous tumors
- cancer treatment

Radiation therapy of 4,000 cGy or more to the mediastinal areas has also been
implicated in pericardial fibrosis, pericarditis, and resultant cardiac tamponde.
Untreated pericardial effusion and cardiac tamponade lead to circulatory collapse
and cardiac arrest.

Nursing Care Management

Assess for hypotension, muffled heart sounds, tachycardia, dyspnea, and decreased
level of consciousness.

Monitor vital signs and oxygen saturation frequently

Assess for pulsusparadoxus

Monitor ECG tracings

Assess heart and lung sounds, neck vein filling, LOC, respiratory status and skin
color and temperature

Monitor and record intake and output

Review ABG and electrolyte levels

Elevate head of bed to ease breathing

Minimize patients physical activity; administer supplemental oxygen as prescribed

Provide frequent oral hygiene

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Reposition and encourage the patient to cough and take deep breaths every 2 hoursas
needed, maintain patent IV access, reorient patient and provide supportive measures
and appropriate instruction.

Obtain a chest X-ray and/or echocardiogram and an EKG.

Collaborative Management

Pericardiocentesis(aspiration or withdrawal of the pericardial fluid by a large-bore

needle inserted in the pericardial space)

Windows or openings in the pericardium can be created surgically to drain fluid into
the pleural space

Catheters may also be placed in the pericardial space and sclerosing agents
(tetracycline, talc, bleomycin, 5-fluorouracil or thiotepa) injected to prevent fluid
reaccumulation

Radiation therapy or antineoplastic agents

Superior vena cava Syndrome

Superior vena cava syndrome: Caused by direct obstruction on the wall of the superior
vena cava (SVC) associated with tumor compression.

This may be due to compression of the superior vena cava, caused by primary or
secondary tumours.

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Caused by the gradual compression of the superior vena cava, leading to edema and
retrograde flow.

Lung cancer - most common malignant cause, although lymphoma, metastatic

mediastinaltumors, and indwelling catheters also can cause superior vena cava
syndrome.

SVC Syndrome: Etiology

Malignant tumors are cause of SVC syndrome in 78-85% of cases.

Malignancy
o Lung CA caused by extrinsic compression or intrinsic invasion
Greatest risk is with small cell lung ca (up to 20% will develop SVC
syndrome)
o Lymphoma typically caused by compression by lymph nodes
o Thymoma, primary mediastianal germ cell neoplasms
o Solid tumors with mediastinal nodal metastases
Breast CA is the most common solid tumor.

SVC Syndrome: Management

Historically SVC syndrome was considered a potentially life-threatening emergency

Standard of care was immediate radiotherapy
The emergent approach is not appropriate for most patients
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Exception to the rule

Stridor
-Central airway obstruction or laryngeal edema

True medical emergency

Immediate action needed

-Possible intubation and ICU admission
-Immediate therapy to target obstruction needed

Tumors with good response: Non Hodgkins lymphomas, germ cell neoplasms and
limited-stage small cell cancer (usually responsive to chemo with or without
radiation). Symptoms improve in 1-2 weeks.

Anticoagulation

Intraluminal metal stents

-Used in cases where unable to give chemo or radiation
-Now some data showing that placing a stent better when patient first diagnosed
because
of quicker resolution of symptoms.
-Combination endovascular therapy (thrombolysis, angioplasty and stent placement)

Nursing Care Management

Assess for dyspnea, facial and upper extremity edema, neck vein distention, and
cough.
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Monitor and maintain proper breathing pattern: assess for signs of resp. distress,
maintaining supplemental oxygen.

Advise on the limitation of activities and maintain a high head in Fowlers position.

Monitor neurological functions, in search of cerebral edema signs.

Monitor Vital Signs

Conduct hydric and electrolytic balance.

Avoid invasive or constricting procedures in the affected extremity, such as

peripheral venous access and BP.

For pts that require anticoagulant therapy, establish bleeding precautions and conduct
coagulation exams.

Advise the pt and family of the syndrome and their treatment (Client Education)

Provide emotional support , and

Promote comfort and security by providing a calm and relaxing environment.

Collaborative

Administer medications:
o Corticosteriods, diuretics, anticoagulants

Radiation treatment may also be indicated in an effort to reduce the size of the tumor.

Obtain a chest X-ray and/or CT scan of the chest and abdomen.

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Infectious Emergencies

Neutropenic sepsis/sepsic shock

Sepsis: Caused by decreased tissue perfusion as a result of a severe infection.

Neutropenia:
ANC < 500 or <1000 w/ a predicted nadir of <500 cells
ANC = (WBC) x (% of neutrophils + % of bands)
Nadir usually occurs 5 to 10 days after last chemo dose and usually recovers in 5 days
(certain leukemia/lymphoma regimens cause longer lasting and more profound
neutropenia)

Fever:
Single temp of 38.3oC (101.3oF)
Sustained Temp of 38.0oC (100.4oF) for > 1 hour

Diagnosis

Fever is commonly the only symptom. Common infections present atypically

(asymptomatic UTIs, meningitis w/o nuchal rigidity, bacteremia with only fatigue as
a symptom)

Avoid digital rectal exams/manipulations

Careful oral exam and exam of catheter sites if any

Pan Cultures
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Etiology

BACTERIA:
Until 1980s, GNR (P.aeruginosa) were the most commonly identified pathogens
1995-2000, Gram + organisms = 62-76% of all bloodstream infections
Trend toward Gram + due to introduction of long-term indwelling lines
(Hickmans,Mediports)
FUNGAL:
- Risk increases w/ duration and severity of neutropenia, prolonged antibiotic use, and
number of chemotherapy cycles
-Candida (lines), aspergillus (immunocompromised, skin,sinus) >>>histo, blasto,
coccidio, TB(prolonged steroids, other high risk patients)
High risk patients

Already in-patients when fever and neutropenia develop

Outpatients who need acute hospital care for problems in addition to the fever and
neutropenia

Outpatients with uncontrolled cancer (e.g. acute leukaemia not in remission, those
with tumours progressing during anticancertherapy)

On immunosuppressive agents e.g. cyclosporin A, steroids

Patients with specific foci of infection e.g. intravascular catheter infection, tunnel
infection, new pulmonary infiltrate

Neutropenia likely to last for more than 10 days

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Oncologic Emergencies

Recent fludarabine treatment

Phase I or II clinical trial patients (inform investigator)

Presence of any of the following features;

o abdominal pain, nausea and vomiting, diarrhoea
o neurological or mental changes
o allogeneic BMTs or autologous BMT
o pregnancy
o HIV
o recent treatment with antibiotics (in previous 72 hours)
o renal failure (creatinine clearance <30ml/min)
o hepatic failure
o respiratory insufficiency
o haemodynamic instability
o inability to take oral medications

All febrile patients with neutrophil counts <500/mm3 and those whose counts are
<1000/mm3 but are falling rapidly.
Afebrile patients with neutrophil counts <500/mm3 should also be treated if they
have symptoms compatible with infection.

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Oncologic Emergencies

TREATMENT

Numerous regimens studied:

monotherapy found equivalent to two drug regimens (i.e.: piperacillin/tazobactam,

cefepime, meropenem)

In critically ill, add one aminoglycoside (better G negative coverage)

Addition of Gram (+) as initial empiric coverage

In patients with lines and cathetersin patients without port/catheter/line or mucositis
has no proven clinical benefit instead canVRE

Vancomycin or Linezolid :

Fungal coverage (candida or aspergillusssp.):

o Routinely added after 5-7 days of persistent neutropenic fever w/o clear source
o Post mortem of fatalities after prolonged febrile neutropenia (1966-1975)
o 69% had evidence of systemic fungal disease
o Rx with liposomal amphotericin B (most common),
o No to fluconazole = efficacy

Colony Stimulating Factors (GM-CSF):

o NOT routinely used for neutropenic fever unless the patient had previous bout of
neutropenic fever with prior chemo cycle.
o Not shown to decrease mortality
o Beneficial effects are quite modest
o Used in neutropenic septic shock/severe sepsis (hypotension, organ dysfunction)

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Oncologic Emergencies

o Used in patients whose bone marrow recovery is expected to be especially

prolonged.

Nursing Care Management

Instruct patient and family about s/sx of septicemia, methods for preventing infection
and, actions to take if s/sx of infection occur.

Assess for tachypnea, tachycardia, hypotension, organ dysfunction, and

hyper/hypothermia.

Monitor temp and hemodynamic and respiratory status on a frequent basis in pt with
impending shock.

Monitor ABG values and pulse oximetry to determine tissue oxygenation.

Monitor fluid and electrolytes status by MIO and serum electrolytes.

SepsisNursing Care Management

Carry out neurologic assessment to detect changes in orientation and responsiveness.

Obtain blood, urine and wound cultures, chest X-ray, and CT scan if necessary.

Most of these patients will require intensive care monitoring.

Collaborative

Administer IVF, blood products, vasopressor and inotropic agents as prescibed to

maintain BP and tissue perfusion, as well as broad-spectrum antibiotics which may be
prescribed initially to combat the underlying infection.
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Oncologic Emergencies

Note: Supplemental O2 and mechanical vent are often necessary. Mortality is associated
with causative organism, site of infection, & level/duration of neutropenia).

Central Nervous System

Spinal Cord Compression

Spinal cord compression: Occurs when the spinal cord is compressed directly by the tumor.

Neoplastic epidural spinal cord compression

Defined as thecal sac indentation radiographically (spinal cord or caudaequina)

Thoracic spine: 60%

Lumbar spine: 30%

Cervical spine: 10%

Cord compression is a common complication in oncology patients

(5-10% of all cancer patients: prostate, lung, breast)

is a cause of pain and irreversible loss of neurologic function.

Back pain is the precursor to spinal cord injury in almost all (96%)patients w/ spinal
mets. Pain similar to disc disease: except pain supine, upright

NOT immediately life threatening unless it involves C3 or above

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Epidemiology

Vertebral mets are common than ESCC

Prostate cancer: 90%

Breast Cancer: 74%

Lung Cancer: 45%

Lymphoma: 29%

Renal cell: 29%

Gastro-: 25%

Many cases of unrecognized ESCC

Difficult to define incidence

Autopsy review studies suggest around 5% of cancer patients die with ESCC

Diagnosis

Back pain + known malignancy

= SCC until proven otherwise
=Plain films NOT enough
=Exam has poor accuracy with localizing level
=MRI without contrast is the best test for SCC when suspected
=Can do CT (myelography) if pt cannot tolerate MRI, or not candidate for MRI, or
not available.

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Oncologic Emergencies

TREATMENT
Steroids
Radiation Therapy
Surgery

Treatment is usually with RT. A laminectomy may be an alternative.

Steroids may be given to reduce inflammation and swelling around the spinal
cord. (Note: Corticosteriod, DEXAMETHASONE, can cause changes in
serum glucose. Monitor blood glucose levels)

Important to recognize

Early recognition leads to better outcomes

Efficacy of treatment depends most on patients neurological function at presentation

Median time from symptoms to diagnosis is around 2 months

More than half of patients who present to hospital are non-ambulatory

Best predictor is pre-treatment functional/neurologic status

Rapid onset and quick progression = poor Prognosis
75% of patients treated correctly while still ambulatory, will remain ambulatory
Only 10% of patients presenting with paraplegia will regain ambulatory status

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Nursing Care Management

Assess for back pain, paralysis, and urinary and/or bowel incontinence.

Safe and comfortable movement of the patient, in cases of impaired physical

mobility.

Establishment of bowel training program, if there is a loss of sphincter control.

Considering that it often requires RT, the nurse should be attentive to skin care as
well as N & V.

Provision of nursing emotional support and guidance to decrease anxiety of pt and

family members, making them active agents in their health-disease process.

Patients functional capacity and the high possibility of home care for rehabilitation
must be continuously evaluated.

Collaborative Management

Obtain an MRI of the entire spine or an X-ray if an MRI is contraindicated.

Administer glucocorticoid therapy (Decadron) orally or intravenously to help reduce

edema. Surgery may be a treatment option, but radiation is typically indicated and is
considered emergent.

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Metabolic Emergencies

Obstructive Uropathy

Obstructive Uropathy: Obstructive uropathy occurs when urine cannot drain through a
ureter (a tube that carries urine from the kidneys to the bladder). Urine backs up into the
kidney and causes it to become swollen (hydronephrosis).

- Obstructive uropathy can affect one or both kidneys.

Common causes:

Benign prostatic hyperplasia (enlarged prostate)

Bladder or ureteral cancer

Colon cancer

Cervical cancer

Uterine cancer
Note : Any cancer that spreads

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Manifestations

Mild to severe pain in the middle of the body (flank pain), felt on one or both sides

Fever

Nausea or vomiting

Weight gain or swelling (edema)

May also have problems passing urine

Nursing Care Management

Educate patient and family on the s/sx of obstructive uropathy.

Nurses must be attentive of foleycatheters, because once its obstructed, it has a

significant potential for causing permanent renal injury.

Surgical correction is specific to the type of obstruction and generally consists of

removal of the obstruction, re-implantation of ureters as necessary, and occasionally
creation of a urinary diversion.

Postoperatively, assess urine output for color, clots, clarity, and amount.

Encourage fluids once the pt can tolerate them orally.

Administer analgesics and/antispasmodics as needed for bladder spasms.

Teach patient and family care of draining tubes if they will be discharged with it.

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Oncologic Emergencies

Tumor Lysis Syndrome

Tumor Lysis syndrome: Caused by the lysis of tumor cells, creating metabolic
complications. This most often occurs in the lymphoma and leukemic population.

Tumor Lysis Syndrome: Prevention &Management

The best management is prevention.

FLUIDS and HYDRATION:

Aggressive hydration and diuresis

Improve intravascular volume, renal blood flow, GFR (decrease [solute] in distal
nephron/renal microcirculation)

+/- diuretics (contraindicated in hypovolemia and obstructed uropathy)

TLS Hyperuricemia

Mechanism
Following initial therapy of sensitive tumors gout renal tubular damage and acute
renal failure

Diagnosis
-Monitor serum uric acid levels
-Uric acid precipitate stones radiolucent
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Oncologic Emergencies

Therapy
-Diuresis
-Alkalization
-Dialysis
-Prophylaxis -- Allopurinol 600 mg daily 2 days before treatment and continue for 2
weeks after treatment

Nursing Care Management

Evaluate and stimulate kidney functions:

-

hydration and daily weighing of thepatient.

assess for signs of fluid overload

Assess for signs and symptoms of severe metabolic imbalance: hyperkalemia,

hyperphosphatemia, hyperuricemia, and hypocalcemia.

Obtain complete metabolic panel and urinalysis.

Monitor biochemical parameters related to the syndrome:

-

serum levels of phosphate, K, Uric acid, Caand creatinine, urine PH,

arterial gasometry

Monitor Cardiac and neurological functions

Avoid food rich in K and be mindful of drugs that can cause renal impairment.

Provide emotional support to the patient and family.

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Collaborative Management

Administer medications according to clinical conditions:

-

Allopurinol (hyperuricemia)

Sodium Bicarbonate (Metabolic Acidosis)

Aluminum Hydroxide (Hyperphosphatemia)

Diuretics ( Fluid Overload)

Administer prophylactic Allopurinol for patients with large tumor burden, IV

hydration, and (for patients with renal failure) hemodialysis.

Conduct ECG in patients with hyperkalemia.

Hematologic Emergencies

DIC (disseminated Intravascular Coagulation

DIC: Pathological activation of coagulation and bleeding at the same time in response to
disease. Coagulation and fibrinolysis are dysregulated. This may be caused by endotoxins
released in the blood and cancer.
Also defined as the inappropriate, accelerated, and systemic activation of the coagulation
cascade, resulting in thrombosis and, subsequently, bleeding & hemorrhage.

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Oncologic Emergencies

Manifestations

Uncontrolled bleeding and rapid consumption of clotting factors.

Bleeding from gums/nosebleeds, dyspnea, hemoptysis, tachypnea, lethargy, confusion

Prolonged PT & PTT, platelets, fibrin level, & fibrin split products ( D-dimer
level)

Nursing Care Management

Monitor VS & MIO

Assess for excess bleeding, bruising, and signs of clotting and organ failure. DIC can
be an acute or chronic process.

Assess skin color and temp; lung, heart, and bowel sounds; LOC, headache, visual
disturbances, chest pain, decreased urine output, abdominal tenderness.

Inspect all body orifices for bleeding.

Review lab results.

Minimize physical activity to decrease risk of injury and O2 requirement.

Prevent bleeding; apply pressure to all venipuncture sites and maintain skin integrity
as much as possible.

Assist the patient to turn, cough, and deep breathing exercise on regular schedule

Reorient the pt if needed, maintain safe environment and provide appropriate pt

education and supportive measures.

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Oncologic Emergencies

Collaborative Management

Obtain a coagulation panel, including a DIC profile -- very important.

Administer Heparin. Although controversial, Heparin can interrupt the clotting

cascade and prevent further microemboli -- coagulation is in the name. Platelets and
fresh frozen plasma may also be administered in the case of severe bleeding.

Paraneoplastic Syndrome

- Malignant cells produce enzymes, hormones, and other substances.

SIADH

Cushing Syndrome

Hypoglycemia

Hypercalcemia

SIADH

SIADH: Caused by excessive release of antidiuretic hormone (ADH) from the posterior
pituitary. This may be found in patients with brain tumors and small-cell carcinomas of the
lung. It is also related to some chemotherapy drugs.
-

Occurs when antidiuretic hormone (ADH) is secreted w/o response to

the bodys usual feedback mechanisms, resulting in water
intoxication
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Oncologic Emergencies

The kidneys continue to return water to the body, diluting the Na.

Associated with pancreatic /prostate/brain cancers/Infusions of

Cytoxan, Vincristine, or Cisplatin can cause SIADH.

Nursing Care Management

Nursing Care is directed toward management of fluids and the side effects of
hyponatremia and its treatment.

Assess for hyponatremia and associated symptoms, such as nausea, vomiting,

headache, confusion, cerebral edema, hypertension, urine osmolality, and fluid
overload.

Obtain complete metabolic panel and urinalysis.

Pt must maintain fluid restriction of 500ml to 1L/day so strict monitoring of I & O.

Further assessments and interventions include daily weights, monitoring of blood and
urine chemistry levels;

Frequent review of cardiopulmonary, neuromuscular and renal systems

Placing the patient on seizure precautions.

Teach the patient and family which signs of hyponatremia to report and how to
respond to seizures

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Oncologic Emergencies

Collaborative Management

Fluid Excretion (Diuretics)

IV infusion of hypertonic saline (3% - 5%) if severe, to prevent pulmonary edema;

strict MIO.

Administer medications like Declomycine (Demeclocycline), Lithane (Lithium), and

Urea

Cushing syndrome

Cushing syndrome is caused by constant, high levels of the steroid hormone cortisol.
A tumor on one of the adrenal glands causes about 15% of all cases of Cushing
syndrome. Adrenal tumors release cortisol.

Adrenal tumors may be noncancerous (benign) or cancerous (malignant).

Noncancerous tumors that may cause Cushing syndrome include:

Adrenal adenomas

Micronodular hyperplasia

Cancerous tumors that may cause Cushing syndrome include:

Adrenal carcinomas

Adrenal tumors are rare. In children with high cortisol levels, adrenal tumors are
more common than pituitary tumors or ectopic ACTH secretion. In adults, adrenal
tumors are less likely to be the cause of high cortisol levels. Pituitary tumors

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(Cushing's disease) are more often seen in adults. Adrenal tumors are found in
women more often than in men.

Treatment

Cushing syndrome due to an adrenal tumor is treated with surgery to remove the
tumor and often the entire adrenal gland.

Glucocorticoid replacement treatment is usually needed until the other adrenal gland
recovers from surgery.

If surgery is not possible (such as in cases of adrenal cancer), medicines can be used
to stop the release of cortisol. These include:
-Aminoglutethimide
-Ketoconazole
-Mifepristone
-Mitotane

Radiation therapy usually does not work for cancerous adrenal tumors and is not
appropriate for noncancerous tumors.

Nursing Care Management

Monitor VS, especially BP for HTN

MIO and weight for EDEMA.

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Oncologic Emergencies

Lab values especially the blood glucose for hyperglycemia, serum sodium for
hypernatremia, serum K for hypokalemia, and serum calcium for hypocalcaemia.

Protect from trauma to prevent bruising and fracture.

Collaborative Management

Administer medications

Prepare the client for RT as prescribed

Prepare the client for surgery.

Hypoglycemia

Hypoglycemia can arise in the patient with cancer through several etiologies. Some
tumors are capable of ectopic production of substances that affect glucose
metabolism. Insulin is made in excess by insulinomas and nesidioblastosis.

Mesenchymal tumors like sarcoma, including gastrointestinal stromal tumor and

solitary fibrous tumor, can produce insulin-like growth factors

S/SX both arise from neuroglycopenia and adrenergic counterregulation.

Neurologic manifestations range from confusion and blurred vision to seizures and
coma.

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Oncologic Emergencies

Nursing Care Management

Assess catecholamine response to hypoglycemia such as diaphoresis, palpitations,

and dilation of the pupils.

Observe seizure precautions.

Monitor blood glucose levels.

Notify the physician if severe hypoglycemic reaction occurs.

Collaborative Management

The treatment of cancer-related hypoglycemia can include surgical removal of the

underlying tumor, or chemotherapy and radiation for unresectable tumors.

Interim management may include the administration of glucagon at a dose of 1 mg

iv/im, dextrose infusion, diazoxide (3 mg/kg/day initially), and cessation of
nonselective beta-blockers that blunt adrenergic response to low blood sugar.

Exogenous glucocorticoids and regimented frequent carbohydrate intake have also

been proposed as interventions.

Hypercalcemia : approach to patients

When initially discovering patients with hypercalcemia first have to rule out
malignancy and PTH

Occurs in 10-20% of cancer patients

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Oncologic Emergencies

Most common cancers include lung, breast and hematologic malignancies.

Signs & Symptoms

Acute hypercalcemia:
nausea, vomiting, constipation, polyuria, polydipsia,Nephrogenic DI, muscle
weakness, arrythmias, short QT, AKI.

Chronic hypercalcemia:
kidney stones, bone pain, & psychosis.

Can also decrease consciousness to coma if hypercalcemia is very severe

stones, bones, groans and psychiatric overtones

Treatment

Lower serum calcium concentration

Treat complications if present

Treat underlying disease

Three therapies for inhibition of bone resorption

Calcitonin

Bisphosphonates

Gallium nitrate

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Oncologic Emergencies

Nursing Care Management

Keep patient safe, manage the symptoms of hypercalcemia.

Monitor for side effects of the administered therapies and minimize the risk of
recurrence.

Monitor VS, Fluid status, cardiovascular status, mental status, and neurological
status.

Place the patient in seizure and safety precautions and protect the patient falls and
injury due to high risk of fracture.

Increase the patient physical activity and mobility with ATTENTION TO SAFETY.

Pain management is a priority if patient suffers pain from bony metastases or

fractures.

Due to likelihood of recurrence, to educate the patient and their family on its s/sx is
essential.

Oncologic Emergencies: Urgency Approach

Right Now This Minute

Airway obstruction, neutropenic sepsis, tamponade, cord compression, CNS

metastases with symptoms

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Oncologic Emergencies

Today

coagulopathies, tumor lysis, DIC, leukostasis, TTP, hyperviscosity, severe

thrombocytopenia, sickle cell complications, INR over 9

If Not Today, Tomorrow

SVC syndrome, most hypercalcemia, most CNS mets without edema, INR 5-9
SVC syndrome, most hypercalcemia, most CNS mets without edema, INR 5-9

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