DEFINITION
Which statement best defines tumor lysis syndrome?
A. Gradual tumor shrinkage over months
B. Rapid lysis of tumor cells after chemotherapy
C. Chronic bone pain in leukemia
D. Tumor invading the SVC
E. Causes Hyperkalemia and Hyperphosphatemia
F. Mild electrolyte imbalance
B. Rapid lysis of tumor cells after chemotherapy
E. Causes Hyperkalemia and Hyperphosphatemia
TLS causes which electrolyte imbalances? (Select all that apply)
A. Hyperkalemia
B. Hyperphosphatemia
C. Hyperuricemia
D. Hypocalcemia
E. Hypokalemia
F. Hypophosphatemia
A. Hyperkalemia
B. Hyperphosphatemia
C. Hyperuricemia
D. Hypocalcemia
Which diagnostic results confirm TLS?
A. Serum uric acid >8 mg/dL
B. Serum potassium >6.0 mEq/L
C. Calcium 12 mg/dL
D. Phosphate > 4.5 mg/dL
E. Urinalysis with uric acid crystals
F. Blood glucose 90 mg/dL
A. Serum uric acid >8 mg/dL
B. Serum potassium >6.0 mEq/L
D. Phosphate > 4.5 mg/dL
E. Urinalysis with uric acid crystals
Priority nursing actions for TLS include:
A. Increase IV fluids
B. Strict I&O monitoring
C. Restrict fluids
D. Assess cardiac rhythm.
E. Stop all chemo
F. Encourage potassium-rich foods
A. Increase IV fluids
B. Strict I&O monitoring
D. Assess cardiac rhythm
Which medical orders are expected for TLS?
A. Allopurinol
B. Kayexalate for hyperkalemia
C. Loop diuretics
D. Potassium supplements
E. IV calcium gluconate for cardiac symptoms
F. Anticoagulant
A. Allopurinol or rasburicase
B. Kayexalate for hyperkalemia
C. Loop diuretics E. IV calcium gluconate for cardiac symptoms
Which outcomes indicate effective management of TLS?
A. Urine output >100 mL/hr
B. Normalized electrolytes
C. Decreased uric acid
D. Rising creatinine
E. ECG with ventricular tachycardia
F. Confusion
A. Urine output >100 mL/hr
B. Normalized electrolytes
C. Decreased uric acid
Which statement best defines SCC?
A. Neurologic emergency caused by tumor pressing on spinal cord
B. Increased ICP due to metastasis
C. Infection of spinal meninges
D. Rupture of vertebral disc
A. Neurologic emergency caused by tumor pressing on spinal cord
The imbalance in hemostasis causes this in DIC.
What is simultaneous clotting and bleeding?
The reason hypercalcemia causes bone pain.
What are pathologic fractures?
The reason oncology patients are at higher risk for sepsis.
What is immunocompromised/low WBC count and invasive devices?
Severe symptoms of hypersensitivity indicate this.
What is anaphylaxis?
Hyperkalemia causes these side effects.
What are cardiac arrhythmias, muscle cramping weakness, paralysis
Three signs and symptoms of DIC.
What are (any of the following:) change in mental status, petechiae, SOB, diminished breath sounds, irregular heart rate, hypotension, dizziness, bleeding from specific site or any/all orifices
This cancer type has hypercalcemia in nearly 100% of its patients.
What is multiple myeloma?
Four potential signs/symptoms of shock.
What are fever, hypotension, tachycardia, tachypnea, increased WBC, and infection-specific symptoms (cough, wound drainage, abdominal pain, central-line redness, etc.)
These medications are given for a mild hypersensitivity reaction.
What are diphenhydramine (Benadryl) and famotidine (Pepcid)?
The large amounts of uric acid turn into these, potentially leading to acute renal failure.
What are uric crystals?
DIC causes a decrease in these two lab findings.
What are platelets and fibrinogen?
Hypercalcemia will cause this change to the patient's bowel moevements.
What is constipation?
Medical management of sepsis.
What are rapid fluid replacement (30 mL/kg), empiric antibiotics, and vasopressors if severely hypotensive.
This medication is added if the patient is having a moderate hypersensitivity reaction.
What is hydrocortisone?
Four potential treatments for tumor lysis syndrome.
What are high rates of IVF, Rasburicase, a diuretic, and hemodialysis?
These four treatments are used in the treatment of DIC.
What are (any of the following:) identify and treat underlying cause, IVF, blood products, O2, coagulation factors, and heparin?
This is the first step to treating hypercalcemia of malignancy.
The response called overhead if our patient has signs of sepsis.
What is "Rapid Response: Code Sepsis"?
This medication is added if the patient is having a severe hypersensitivity reaction.
What is epinephrine?