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Chapter 11

Oncology: Nursing management in cancer care

Table 11-12  Oncological Emergencies: Manifestations and Management (continued) Clinical manifestations and Emergency diagnostic findings Management Nursing

• Identify at-risk patients, including those in whom tumour lysis syndrome may develop up to 1 week after therapy has been completed • Institute essential preventive measures (e.g. fluid hydration, allopurinol) • Assess patient for signs and symptoms of electrolyte imbalances • Assess urine pH to confirm alkalisation • Monitor serum electrolyte and uric acid levels for evidence of fluid volume overload secondary to aggressive hydration • Instruct patients to report symptoms indicating electrolyte disturbances

CLINICAL REASONING EXERCISES 1  You are seeing Mr and Mrs Brown, a married couple, both in the seventh decade of life, in the clinic for blood pressure checks. What questions regarding cancer screening are appropriate for them? How would you respond if your suggestions for cancer screening are met with the answer that they are too old to worry about cancer? What special considerations are there if the woman has a physical dis­ ability that requires her to use a wheelchair? 2  A 54-year-old woman with bone metastases secondary to breast cancer has been admitted to the hospital with a diagnosis of hypercalcaemia. Describe the underlying cause of hypercalcaemia and the medical and nursing management strategies that are anticipated. What patient monitoring would be essential before and after treatment of hypercalcaemia?  ONLINE RESOURCES  A wide range of additional resources to enhance teaching and learning and to facilitate understanding of this chapter may be found online at http://thepoint.lww.com, including videos, animations, journal articles, review questions, quizzes and the e-book. Subscribers may also access Lippincott’s extensive online point-of-care procedure guide LNPS, which provides a wealth of evidence-based, reliable information. REFERENCES AND SELECTED READINGS Books Abraham, J. L. (2005). A doctor’s guide to pain and symptom management in cancer patients (2nd ed.). Boston: Johns Hopkins University Press. American Joint Commission on Cancer (2010). AJCC Staging Manual (7th ed.). Chicago: Springer Science and Business Media Inc. Batchelor, D. (2006). Biological therapy. In Kearney, N. & Richardson, A. (Eds). Nursing patients with cancer , pp. 303–328. Edinburgh: Elsevier Churchill Livingstone. Bruner, D. W., Haas, M. L., & Gosselin-Acomb, T. K. (2006). Radiation oncology nursing practice and education (3rd ed.). Pittsburgh: Oncology Nursing Society. Burcat, S. & McAdams, F. (2007). Hematologic effects of transplantation. In Ezzone, S. & Schmit-Pokorny, K. (Eds). Blood and marrow stem cell transplantation: Principles, practice and nursing insights. Sudbury, MA: Jones and Bartlett. Clancey, J. A. (2006). Syndrome of inappropriate antidiuretic hormone secretion. In Kaplan, M. (Ed.). Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh: Oncology Nursing Society.

Edge, S. E., Byrd, D. R. & Compton, C. A. (Eds). (2010). AJCC cancer staging manual (7th ed.). New York: Springer. Ezzone, S. A. (2006). Disseminated intravascular coagulation. In Kaplan, M. (Ed.). Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh: Oncology Nursing Society. Gobel, B. H. (2006). Tumour lysis syndrome. In Kaplan, M. (Ed.). Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh: Oncology Nursing Society. Gobel, B. H. & Peterson, G. J. (2006). Sepsis and septic shock. In Kaplan, M. (Ed.). Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh: Oncology Nursing Society. Gullatte, M. M. (Ed.). (2007). Clinical guide to antineoplastic therapy: A chemotherapy handbook (2nd ed.). Pittsburgh: Oncology Nursing Society. Hewitt, M., Greenfield, S. & Stovall, E. (Eds). (2006). From cancer patient to cancer survivor. Washington, DC: Institute of Medicine and National Research Council; National Academies Press. Kaplan, M. (2006a). Hypercalcemia of malignancy. In Kaplan, M. (Ed.). Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh: Oncology Nursing Society. Kaplan, M. (2006b). Spinal cord compression. In Kaplan, M. (Ed.). Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh: Oncology Nursing Society. Keller, C. (2007). Bone marrow and stem cell transplant. In Langhorne, M. E. Fulton, J. S. & Otto, S. E. (Eds). Oncology nursing (5th ed.), pp. 388–401. St Louis: Mosby Elsevier. Kuzin, E. (2006). Superior vena cava syndrome. In Kaplan, M. (Ed.). Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh: Oncology Nursing Society. Mumber, M. P. (Ed.). (2006). Integrative oncology principles and practice. London: Taylor & Francis Group. National Health and Medical Research Council (NHMRC) (2009). Cancer: Clinical practice guidelines. Available online via www.nhmrc.gov.au/publications/ subjects/cancer.htm. National Health and Medical Research Council (NHMRC) (2011). An ethical framework for integrating palliative care principles into the management of advanced chronic or terminal conditions . Commonwealth of Australia: Canberra National Heart Foundation of Australia. (2008). Second-hand smoking and your health. Available at: www.heartfoundation.org.au/SiteCollectionDocuments/ A_TC_SecondhandSmoking_ISC_FINAL.pdf. Nussbaum, R. L., McInnes, R. R. & Willard, H. F. (Eds). (2007). Thompson and Thompson genetics in medicine (7th ed.). Philadelphia: W. B. Saunders Company. Perry, M. C. (Ed.). (2007). The chemotherapy source book (4th ed.). Baltimore: Williams & Wilkins. Polovich, M., White, J. M. & Kelleher, L. (2005). Chemotherapy and biotherapy guidelines and recommendations for practice (2nd ed.). Pittsburgh: Oncology Nursing Society. Porth, C. M. & Matfin G. (2009). Pathophysiology: Concepts of altered health states (8th ed.). Philadelphia: Lippincott Williams & Wilkins. Story, K. T. (2006). Cardiac tamponade. In Kaplan, M. (Ed.). Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh: Oncology Nursing Society. Szopa, T. J. (2005). Nursing implications of surgical treatment. In Otano, J. K. & Taoka, K. N. (Eds). Core curriculum for oncology nursing (4th ed.). St Louis: Elsevier Saunders. Wilkes, G. M. & Barton-Burke, M. (2007). 2007 oncology nursing drug handbook. Sudbury, MA: Jones and Bartlett.