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Questions and Answers
Which electrolyte imbalance is primarily associated with muscle cramps and tetany in tumor lysis syndrome?
Which electrolyte imbalance is primarily associated with muscle cramps and tetany in tumor lysis syndrome?
- Hyperkalemia
- Hyperuricemia
- Hyperphosphatemia
- Hypocalcemia (correct)
What is a primary consequence of tumor lysis syndrome?
What is a primary consequence of tumor lysis syndrome?
- Hypoglycemia
- Decreased red blood cell production
- Metabolic derangement (correct)
- Increased white blood cell count
Which is an effective medical management strategy for hyperkalemia in tumor lysis syndrome?
Which is an effective medical management strategy for hyperkalemia in tumor lysis syndrome?
- Oral phosphate binders
- Administration of hypertonic dextrose and regular insulin (correct)
- Administration of potassium supplements
- Increased dietary potassium intake
What is a common gastrointestinal manifestation of tumor lysis syndrome?
What is a common gastrointestinal manifestation of tumor lysis syndrome?
Which of the following treatments aims to alkalinize urine in patients at risk for tumor lysis syndrome?
Which of the following treatments aims to alkalinize urine in patients at risk for tumor lysis syndrome?
Which clinical manifestation is associated with renal impairment in tumor lysis syndrome?
Which clinical manifestation is associated with renal impairment in tumor lysis syndrome?
Which of the following treatments is NOT typically associated with managing tumor lysis syndrome?
Which of the following treatments is NOT typically associated with managing tumor lysis syndrome?
Which intervention is essential for nursing management of patients at risk for tumor lysis syndrome?
Which intervention is essential for nursing management of patients at risk for tumor lysis syndrome?
Which of the following describes a goal of chemotherapy in treating cancer?
Which of the following describes a goal of chemotherapy in treating cancer?
What clinical finding might indicate hyperphosphatemia in a patient with tumor lysis syndrome?
What clinical finding might indicate hyperphosphatemia in a patient with tumor lysis syndrome?
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Study Notes
Pathophysiology of Tumor Lysis Syndrome
- Occurs in patients with bulky, highly proliferative, and chemosensitive tumors undergoing cytotoxic treatment.
- Rapid destruction of cancer cells results in the release of large amounts of intracellular components like potassium, phosphorus, and nucleic acids into the bloodstream.
- Impaired renal excretion leads to a buildup of metabolites, causing metabolic derangements.
- Key metabolic alterations include:
- Hyperuricemia
- Hyperphosphatemia
- Hyperkalemia
- Hypocalcemia
- These alterations can lead to serious health complications affecting multiple systems:
- Neurological issues such as fatigue, seizures, and memory loss.
- Cardiac complications including dysrhythmias and potential cardiac arrest.
- Gastrointestinal symptoms like nausea, anorexia, and diarrhea.
- Renal problems including oliguria and possible renal failure.
Clinical Manifestations
- Neurological: Symptoms include fatigue, weakness, memory impairment, muscle cramps, tetany, paresthesias, and seizures.
- Cardiac: Manifestations include elevated blood pressure, shortened QT intervals, widened QR waves, dysrhythmias, and potential cardiac arrest.
- Gastrointestinal: Symptoms encompass anorexia, nausea, vomiting, abdominal cramps, and diarrhea.
- Renal: Indicators include oliguria, anuria, renal failure, and acidic urine pH.
Diagnostic Evaluation
- Laboratory tests reveal electrolyte imbalances as a critical component of diagnosis for tumor lysis syndrome.
Management
Medical Management
- Diuretic therapy with carbonic anhydrase inhibitors is used to alkalinize urine.
- Administration of hypertonic dextrose and regular insulin facilitates cellular uptake of potassium, thus lowering serum potassium levels.
- Hemodialysis is indicated for persistent electrolyte disturbances unresponsive to medical management.
- Phosphate-binding gels, like aluminum hydroxide, are used to treat hyperphosphatemia.
Nursing Management
- Identify at-risk patients for tumor lysis syndrome.
- Implement preventative measures, including hydration.
- Regular assessment for signs and symptoms of electrolyte imbalances.
- Monitor urine pH to confirm alkalization.
- Continuously track serum electrolyte levels and uric acid, monitoring for signs of fluid overload.
Modalities of Cancer Treatment
- Objectives include destroying malignant cells while sparing healthy tissue, inducing remission, relieving pain, and palliating symptoms.
- Treatment approaches can vary from single therapies to combinatorial methods, including:
- Chemotherapy
- Radiation therapy
- Gene therapy
- Biological therapy
- Stem cell and bone marrow transplantation
- Surgical interventions
Chemotherapy
- Involves systemic administration of chemicals to target and destroy cancer cells or provide palliative symptom relief.
- Directly impacts cancer cellular function, contributing to improved quality of life for patients.
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