Oncologic emergencies: four situations to recognize
Febrile neutropenia. A single temperature above the threshold in a client whose neutrophils are low is an emergency. The antibiotic is given within the hour, after the blood cultures, and it does not wait for the morning round. There may be no other sign of infection, because the client cannot mount one. Spinal cord compression. New or worsening back pain in someone with a known cancer, especially if it wakes them at night, precedes the neurological signs by days or weeks. Waiting for the weakness or the bladder dysfunction is waiting for a deficit that will not fully recover. Hypercalcemia of malignancy. Confusion, constipation, nausea, thirst, polyuria and weakness. The symptoms are easily attributed to the disease or to the opioids. A calcium level is what settles it. Tumour lysis syndrome. In the first days after treatment of a chemosensitive tumour: potassium, phosphate and uric acid rise, calcium falls, urine output drops. Hourly urine output and serial electrolytes are the surveillance. What these four share is that the client attributes the symptom to the cancer or the treatment, and so does everyone else. Asking directly about back pain, taking a temperature, and looking at the calcium are what interrupt that.