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Tumor lysis syndrome (TLS) is a life-threatening disorder that is an oncologic emergency. Risk factors for TLS are well-known, but the current literature shows case descriptions of unexpected acute TLS. Solid tumors and untreated hematologic tumors can lyse under various circumstances in children and adults. International guidelines and recommendations, including the early involvement of the critical care team, have been put forward to help clinicians properly manage the syndrome. Advanced practice nurses may be in the position of triaging and initiating treatment of patients with TLS, and need a thorough understanding of the syndrome and its treatment.

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The practice guidelines aimed to identify appropriate nursing management for the prevention and treatment of tumor lysis syndrome, in line with the current evidence-based medical guidelines. Using a systematic approach, 15 relevant articles were identified for the review. The evaluation of patient risk factors for tumor lysis syndrome and the appropriate medical and nursing assessment were identified. The treatment algorithms for the prevention of tumor lysis syndrome from both the medical and nursing perspectives have been established. In particular, the guidelines highlight the importance of pediatric oncology nurses in contributing to the prevention and management of tumor lysis syndrome.

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The prevention and identification of hyperuricemia are critical components in the management of tumor lysis syndrome (TLS), which is common in acute leukemias, large cell lymphomas, bulky tumors, large tumor burdens, and other cancers with high proliferation rates. Such cancers are very receptive to cytotoxic therapy because of increased mitotic rates. Lysis of their tumor cells results in metabolic abnormalities because of the release of their intracellular products. TLS is an oncologic emergency that could lead to renal failure and death; therefore, early identification of high-risk patients is vital for successful treatment outcomes. Treatment modalities include the use of allopurinol and hydration while implementing evidence-based practices for the prevention of TLS in the outpatient clinical center.

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When caring for a patient with TLS, astute nursing care is required for positive patient outcomes. Assessments and monitoring are required for prompt management of complications and patient safety. Because of the skilled nursing care that Mr. B received, along with supportive medications and hydration, his renal function improved, with increased urine output, normalization of electrolytes, and return of his appetite.

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A patient in our hematology unit who was receiving chemotherapy for lymphoma developed a complication called tumor lysis syndrome. Can you explain what this is?-M.K., GA.

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OBJECTIVES: To provide a general overview of tumor lysis syndrome (TLS) focusing on the incidence, epidemiology, and patient outcomes associated with the syndrome; review the role of the oncology nurse in impacting patient outcomes and identify evolving issues relating to TLS. DATA SOURCES: Primary and tertiary literature related to TLS and clinical practice experience. CONCLUSIONS: Issues related to TLS continue to evolve and the oncology nurse plays a key role in patient management. As with other neoplastic disease-related complications (e.g., pain, nausea/vomiting), knowledge of TLS and attention and intervention, where appropriate, can positively impact patient outcome. IMPLICATIONS FOR NURSING PRACTICE: The oncology nurse plays a critical role in impacting patient outcomes with respect to TLS ranging from collaboration with other disciplines to identifying patients at risk, through assessments, vigilant monitoring, and implementing optimal treatment regimens.

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OBJECTIVES: To provide a review of the pathophysiology and corresponding signs and symptoms of tumor lysis syndrome (TLS); to review clinical and laboratory monitoring parameters. DATA SOURCES: Primary and tertiary literature and clinical experience. CONCLUSIONS: An understanding of the pathophysiology of TLS, meticulous assessment for signs and symptoms and monitoring of laboratory data, as well as early recognition of problems are essential for optimal patient outcomes. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of the pathophysiology of TLS will assist the oncology nurse in better understanding the overall syndrome and allow improved patient care management through close clinical and laboratory monitoring of signs and symptoms, and, ideally, promote a proactive approach to managing TLS.

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Rasburicase is a new treatment for hyperuricemia, a metabolic manifestation of tumor lysis syndrome (TLS). Rasburicase has a unique mechanism of action that allows uric acid byproducts to be easily excreted in the urine. Clinical trials have shown that rasburicase has a rapid onset of action that allows chemotherapy to be delivered on time and prevents hyperuricemia-related complications, including renal compromise. The drug has been used successfully in adults and children. The main side effect of rasburicase is the potential for a hypersensitivity reaction. The drug is contraindicated in patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency because this can precipitate hemolytic anemia. The drug has not been studied in patients with a history of allergies or asthma. Oncology nurses play a major role in the assessment and management of TLS-related complications. They must assess patients for G6PD deficiency and signs and symptoms of hypersensitivity reaction before and during chemotherapy or other therapeutic interventions. Nurses play a direct role in preventing complications related to TLS and contributing to the quality of life in this patient population.

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OBJECTIVES: To review the pathophysiology, clinical manifestations, and management of tumor lysis syndrome. DATA SOURCES: Published articles, case reports, and book chapters on tumor lysis syndrome. CONCLUSIONS: Tumor lysis syndrome is a very serious and sometimes life-threatening complication of cancer treatment. Identification of patients at risk and initiation of preventative interventions are the focus of medical and nursing management. Ongoing monitoring during and following cancer treatment is necessary to promote early response to changes in patient condition and minimize adverse events. IMPLICATIONS FOR NURSING PRACTICE: Early recognition of signs and symptoms and clinical management of tumor lysis syndrome is a challenging responsibility of the oncology nurse.

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OBJECTIVES: To provide a brief overview of the oncologic emergencies most commonly occurring in lymphoma patients. DATA SOURCES: Published articles, research studies, and reference books. CONCLUSIONS: As a result of their malignancy and the treatments they receive, lymphoma patients are at an increased risk for the development of the following oncologic emergencies: superior vena cava syndrome, cardiac tamponade, sepsis, acute tumor lysis syndrome, and increased intracranial pressure. If not recognized and treated quickly, these complications can be deadly. With appropriate medical and nursing management, these emergencies either can be prevented or their complications minimized. IMPLICATIONS FOR NURSING PRACTICE: An awareness of which patients are at risk for these complications and the pathophysiology of each emergency will assist nurses in the implementation of treatment measures.

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Hematologic emergencies in the oncology population may require an admission to the intensive care unit (ICU). Syndrome of inappropriate antidiuretic hormone, hypercalcemia, tumor lysis syndrome, and disseminated intravascular coagulation are diseases defined in this article. These are common conditions in oncology patients that are reduced or prevented with close monitoring and accurate assessments. The purpose of this article is to introduce intensive care nurses to these disease entities so they will have a better understanding of the care involved with an oncology patient in the ICU unit.

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Acute tumor lysis syndrome (TLS) is a metabolic complication that occurs in some patients with cancer and frequently is triggered by chemotherapy. TLS results from a rapid destruction of a large number of tumor cells, which causes several potentially fatal biochemical changes. If not identified and treated quickly, TLS can result in acute renal failure. TLS often is associated with tumors that have high growth fractions. Typically, these tumors are very sensitive to the effects of chemotherapeutic agents. Fortunately, this complication can be prevented with appropriate medical and nursing management of patients at high risk. This article reviews the pathogenesis and medical treatment of TLS and identifies nursing implications for oncology nursing practice.

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Con los avances alcanzados en la terapia de las enfermedades malignas se ha logrado mejorar la calidad de vida e incluso curar muchos niños con neoplasias, pero simultáneamente han aparecido complicaciones que es necesario prevenir y manejar con el fin de mejorar el pronóstico en el paciente con cáncer. El síndrome de lisis tumoral es una entidad que inicialmente se describió en pacientes que luego del inicio de la quimioterapia por enfermedades linfoproliferativas presentaban muerte súbita por hiperkalemia. Posteriormente se encontró que estos pacientes presentaban como complicaciones comunes una alteración caracterizada por la triada metabólica de hiperuricemia, hiperkalemia e hiperfosfatemia, las cuales llevaban a falla renal, y por una hipocalcemia sintomática. El sindrome de lisis tumoral en general ocurre en los primeros 5 días después del inicio de la terapia citotóxica específica en tumores que tienen una alta fracción de crecimiento y en los que el porcentaje de células en fase S de reproducción celular es alto y por lo tanto son muy sensibles a la quimioterapia. Dentro de las patologías con riesgo de este síndrome está el linfoma de Burkitt que tiene una tasa de duplicación celular entre 38 y 116 horas. También las leucemias linfoblásticas en general, particularmente las de células B que tienen una tasa de duplicación 3 veces mayor que las de células PRE-B. Rara vez se presenta en leucemia mieloide crónica y no se encuentra en leucemia mieloide aguda ni en tumores sólidos no linfomatosos.

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