- Information
- AI Chat
Palliative Care Emergencies
Nursing Care- Complex Health Problems II (11-63-375)
University of Windsor
Recommended for you
Preview text
Palliative Care Emergencies
Palliative Care Emergency Definition/Presentation Management (must align with GOC/prognosis) Hypercalcemia (metabolic oncologic emergency) When serum corrected calcium is greater than 2/L Fundamental cause in malignancy is excessive movement of calcium from bones to circulation with impaired renal clearance (osteolytic lesion or paraneoplastic syndrome) Signs and Symptoms (S+S): BONES (boney pain) STONES (kidney stones) MOANS (abdominal pain) GROANS (lethargy, confusion) Treatment goals in PC: early ID can help with symptom management and family education Medical management: correct dehydration, increase renal excretion of calcium with vigorous saline diuresis, inhibit calcium resorption from bone with anti-resorptive agents Treatment of underlying malignancy when appropriate. Febrile Neutropenia When a fever (temperature greater than or equal to 38°C) is present in a patient with neutropenia (neutrophil count of less than 500 neutrophils/mm 3 ) S+S: Temperature is ≥38°C with or without other signs of infection in patients who are actively/recently received chemotherapy Treatment goals in PC: treat infection Encourage patient to present to hospital when febrile neutropenia is discovered for ABX therapy and assessment Spinal Cord Compression (structural oncologic emergency) A malignant process that causes a disruption in neurologic function (tumor and its destructive effects on spinal cord compress neural tissue or interfere with blood supply) S+S follow a progressive pattern: 1) Back pain (95% of time is the presenting symptom) 2) Motor weakness/decreased sensation (uni- or bilateral) 3)Motor loss/sensory loss 4) Autonomic dysfunction (loss of bladder/bowel control) Treatment goals in PC: relief of pain, decompression of neural tissue, preservation of neural function Pain management- opioids; epidural when decompression not reversible Steroids- always start with high level of suspicion of SCC Radiation- if aligned with prognosis and patient’s wishes An increase in pressure within Treatment goals in PC: improve
Increased cranial pressure the cranial vault due to a variety of causes (tumor, tumor edema, hemorrhagic stroke, abscess) S+S: headache, N+V, blood pressure, decreased mental abilities confusion, double vision pupil(s) that don’t respond to changes in light, seizure comfort, preserve cognitive function Pain management- steroids, acetaminophen, opioids Radiation- if related to tumor and aligned with prognosis/GOC Seizure management plan- use preventative meds when possible and have med to manage seizure available Superior Vena Cava Syndrome (SVCS) Top 3 Risk Factors: -smoking hx -primary or metastatic lung mass at mediastinum -presence/hx of a central vascular access device S+S indicative of venous congestion related to a block of the superior vena cava; can be external compression of vessel by tumor or a thrombus in SVC vessel Can have acute or chronic onset; thrombus would be more likely to contribute to an acute onset event RESPIRATORY: dyspnea, tachypnea, orthopnea, non-productive cough, hoarseness, fatigue CARDIOVASCULAR: neck vein distention, BP higher in upper extremities than lower, facial swelling esp. upon rising, periorbital edema, swelling of neck , arms, hands (tight collar, rings, watch), cyanosis of upper torso, collateral circulation with chronic onset ENT- visual changes including blurred or double vision CNS- headache, anxiety, lethargy, lightheadedness Treatment goals in PC: improve comfort, correct reversible causes MED/SURG interventions: For mediastinal mass- radiation, steroid therapy For Lung Ca (primary or metastatic)- chemotherapy (multi-drug is best for SCLCa), steroid therapy For Thrombus- anti-coagulant Nursing Interventions: HOB elevated to 45°, remove tight clothing/jewellery, adequate oxygenation, management of dyspnea and anxiety, ongoing assessment Bowel Obstruction A mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion Presentation will vary based on location of obstruction and if obstruction is complete; can be transient S+S of small bowel obstruction: abdominal pain, abdominal distension, vomiting, no flatus, no bowel sounds S+S of large bowel obstruction: abdominal distention, nausea, vomiting (late), and crampy abdominal pain Treatment goal in PC: improve comfort, restore function if possible given prognosis/GOC Partial obstructions: -gut motility agent, bowel management, manage nausea, pain Compete obstruction: -surgical intervention (venting PEG) -NPO -excellent mouth care -pain management A bone broken, not by trauma Treatment goal in PC: optimize
Palliative Care Emergencies
Course: Nursing Care- Complex Health Problems II (11-63-375)
University: University of Windsor
