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NURS 425 > Exam 3: Hematopoietic Stem Cell Transplantation And Oncologic Emergencies > Flashcards

Exam 3: Hematopoietic Stem Cell Transplantation And Oncologic Emergencies Flashcards

1
Q

Bone marrow transplant and peripheral stem cell transplantation allows for:

A

Safe use of very high doses of chemotherapy agents and/or radiation therapy in patients whose tumors have developed resistance (refractory) or failed to respond to standard doses of chemotherapy and radiation

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2
Q

Hematopoietic Stem Cell Transplantation

A
  • Procedure with many risks, including death
  • Highly toxic
  • Overall cure rates still low but increasing
  • Tumor cells are eradicated and bone marrow is rescued by infusing healthy cells
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3
Q

HSCT can be categorized as

A
  • Allogeneic
  • Syngeneic
  • Autologous
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4
Q

Sources of cells for HSCT include

A
  • Bone marrow
  • Peripheral blood
  • Umbilical cord blood
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5
Q

Autologous Stem Cell Transplant

A
  • Patient receives their own stem cells back following myeloablative (destroying bone marrow) chemotherapy.
  • Enables patient to receive chemotherapy and/or radiation by supporting them with their previously harvested stem cells until their marrow generates blood cells again on its own.
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6
Q

Autologous Transplants are typically used to treat

A

Hematologic malignancies if there is no donor or the patient cannot undergo allogeneic transplantation

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7
Q

HSCT: Stem Cells from Bone Marrow Procedure

A
  • Procedure is performed in OR under general or spinal anesthesia
  • Multiple aspirations are carried out to obtain adequate number of stem cells (Usually from iliac crest or sometimes from sternum)
  • Marrow is processed to remove bone fragments
  • Cells are cryopreserved until infused
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8
Q

HSCT: Stem Cells from Peripheral Blood Procedure

A
  • Outpatient procedure
  • Cell separation equipment sorts stem cells out, and other cells are returned to donor
  • Procedure takes 2 to 4 hours
  • Multiple collections may be needed
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9
Q

HSCT: Stem Cells from Cord Blood

A
  • Umbilical cord blood is rich in hematopoietic stem cells.
  • Umbilical cord blood can be HLA-typed and cryopreserved
  • Disadvantage is that it may have insufficient numbers of stem cells to permit transplant to adults
  • Research is ongoing
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10
Q

Preparative Regimens and Stem Cell Infusion: Conditioning Regimens

A
  • Myeloablative dosages of chemotherapy with or without adjunctive radiation to treat underlying disease
  • Total body irradiation can be used for immunosuppression or to treat disease

*Read notes!

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11
Q

What are complications of HSCT?

A
  1. Bacterial, viral and fungal infections are common. (Prophylactic ABT therapy)
  2. Graft-versus-host disease
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12
Q

Graft-versus-host disease

A

T lymphocytes from donor stem cells recognize recipient as foreign and attacks organs such as the skin, liver and GI tract

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13
Q

What kind of stem cells produce fewer complications?

A
  • Peripheral blood stem cells cause fewer and less severe complications.
  • This is because they are more mature than stem cells from bone marrow.
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14
Q

Complications of Cancer: Oncologic Emergencies

A
  • Life-threatening

- Occur as the result of disease or treatment

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15
Q

Make sure you know Table 15-19 page 263!!!

A

!!!!

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16
Q

Oncologic Emergencies can be

A
  1. Obstructive
  2. Metabolic
  3. Infiltrative
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17
Q

Oncologic Emergencies: Obstructive Emergencies are primarily caused by

A

Primarily caused by tumor obstruction of an organ or blood vessel.

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18
Q

Oncologic Emergencies: Metabolic Emergencies

A
  • Are caused by the production of ectopic hormones directly from the tumor or are secondary to metabolic alterations caused by the tumor or by cancer treatment.
  • Ectopic hormones arise from tissues that do not normally produce these hormones.
  • Cancer cells return to a more embryonic form, thus allowing the cells’ stored potential to become evident.
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19
Q

Metabolic Emergencies include

A
  • SIADH secretion
  • Hypercalcemia
  • Tumor lysis syndrome
  • Septic shock
  • Disseminated intravascular coagulation
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20
Q

Oncologic Emergencies: Infiltrative Emergencies

A

occur when malignant tumors infiltrate major organs or secondary to cancer therapy.

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21
Q

What are the most common infiltrative emergencies?

A
  • Cardiac tamponade

- Carotid artery rupture.

22
Q

Oncologic Emergencies include

A
  • Superior vena cava syndrome
  • Spinal cord compression syndrome
  • Third space syndrome
  • Intestinal obstruction
23
Q

Obstructive Emergencies: Superior Vena Cava Syndrome

A

Obstruction by tumor or thrombosis

24
Q

Signs of Superior Vena Cava Syndrome include

A
  • Facial and periorbital edema
  • Distention of veins of head, neck, and chest
  • Seizures
  • Headache
25
Q

Obstructive Emergencies: Spinal Cord Compression

A

Tumor in the epidural space of spinal cord

26
Q

Signs of Spinal Cord Compression include

A
  • Intense, localized, persistent back pain
  • Motor weakness
  • Sensory paresthesia and loss
  • Change in bladder or bowel function
27
Q

Obstructive Emergencies: What is third space syndrome?

A

-Shifting of fluid from vascular space to interstitial space

28
Q

What are signs of third space syndrome?

A

Signs of hypovolemia including hypotension, tachycardia, low central venous pressure, and ↓ urine output

29
Q

What is the treatment for third space sydnrome?

A

Replacement of:

  • Fluids
  • Electrolytes
  • Plasma Protein
30
Q

Metabolic Emergencies caused by production of ectopic hormones include

A
  • Syndrome of inappropriate antidiuretic hormone (ADH) secretion
  • Hypercalcemia
  • Tumor lysis syndrome
  • Septic shock
  • Disseminated intravascular coagulation (DIC)
31
Q

Oncologic Emergencies: SIADH

A
  • Abnormal or sustained production
  • Cancer cells are able to manufacture, store, and release ADH.
  • Some chemotherapeutic agents stimulate release.
32
Q

How do you treat SIADH?

A
  • Fluid restriction or IV of 3% NaCl in severe cases

- Demeclocycline may be needed for moderate SIADH

33
Q

Oncologic Emergencies: Hypercalcemia

A
  • Parathyroid hormone–like substance secreted from cancer cells in absence of bony metastasis
  • Can be life-threatening
34
Q

Signs of Hypercalcemia include

A
  • Apathy, depression, fatigue, weak muscles

- Electrocardiogram changes, polyuria, nocturia, anorexia, nausea, vomiting

35
Q

Treatment of Hypercalcemia

A
  • Aimed at primary disease
  • Hydration
  • Diuretic administration
  • Bisphosphonate
36
Q

Chronic hypercalcemia can result in

A
  • Nephrocalcinosis

- Irreversible renal failure

37
Q

Tumor lysis syndrome

A
  • Triggered by chemotherapy’s rapid destruction of large numbers of tumor cells:
  • ↑ Serum phosphate causes calcium to go ↓ resulting in hypocalcemia.
  • Can cause biochemical changes resulting in renal failure
  • Can be fatal
38
Q

What are four hallmark signs of tumor lysis syndrome?

A
  • Hyperuricemia
  • Hyperphosphatemia
  • Hyperkalemia
  • Hypocalcemia
39
Q

When does tumor lysis syndrome usually occur?

A
  • Within 24-48 hours after chemotherapy

- May persist for 5-7 days

40
Q

What are early symptoms of tumor lysis syndrome?

A
  • Weakness
  • Muscle cramps
  • Diarrhea
  • Nausea/Vomiting
41
Q

What is the primary goal for treatment of tumor lysis syndrome?

A

Preventing renal failure and severe electrolyte imbalance

42
Q

Tumor lysis syndrome: Primary treatments

A
  • Increase urine production with hydration therapy

- Decrease uric acid concentrations

43
Q

What are other Oncologic emergencies?

A
  • Septic shock

- Disseminated intravascular coagulation

44
Q

Infiltrative Emergencies: Cardiac Tamponade

A

Fluid accumulation in pericardial sac, constriction of pericardium by tumor, or pericarditis

45
Q

What are clinical manifestations of cardiac tamponade?

A
  • Heavy feeling over the chest
  • Shortness of breath
  • Dysphagia
  • Tachycardia
  • Cough, hoarseness, hiccups
  • Extreme anxiety
  • ↓ Level of consciousness
  • Pulsus paradoxus
  • Distant, muted heart sounds
  • Nausea, vomiting, excessive perspiration
46
Q

Cardiac Tamponade: Management is aimed at

A

Decreasing fluid around heart and includes:

  • Surgical establishment of pericardial window
  • Indwelling pericardial catheter
47
Q

Supportive therapy for cardiac tamponade include

A
  • Oxygen therapy
  • Intravenous hydration
  • Vasopressor therapy
48
Q

Infiltrative Emergencies: Carotid Artery Rupture

A

-Invasion of the artery wall by either a tumor or to erosion following surgery or radiation

49
Q

Carotid Artery Rupture: Bleeding

A

Can manifest as minor oozing or spurting of blood in case of a blowout (pressure should be applied in case of a blowout)

50
Q

Management of Carotid Artery Rupture includes

A
  • IV fluids (to stabilize for surgery)
  • Blood administered (to stabilize for surgery)
  • Surgery: involves ligation of carotid artery above and below the rupture site and reduction of local tumor

NURS 425 (19 decks)

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