Congress Abstracts 2004

89

NURSING MANAGEMENT OF PATIENTS WITH CARCINOID SYNDROME. Michelle Grover, BSN, RN, OCN^®, Sidney Kimmel Comprehensive Cancer at Johns Hopkins Hospital, Baltimore, MD.

In order to effectively manage patients with carcinoid syndrome, oncology nurses need to understand the precipitating factors and clinical manifestations of this syndrome and emergency management of patients in carcinoid crisis.

Carcinoid tumors are a type of neuroendocrine tumor that produces bioactive amines and peptides such as serotonin, growth hormone, insulin, adrenocorticotropic hormone (ACTH), gastrin, pancreatic peptide, and calcitonin. Secretions of these hormones causes carcinoid syndrome, which occurs in less than 10% of patients with carcinoid tumors. Carcinoid syndrome occurs when high levels of hormones are released into the systemic circulation. The most common manifestations of carcinoid syndrome include flushing, diarrhea, cardiac disease, wheezing, arthralgia, changes in mental status, and skin changes. Carcinoid syndrome is most likely to develop in patients with liver metastases and is due to a high level of serotonin production, which is rapidly secreted into the circulation. Carcinoid crisis is a rare but potentially fatal manifestation of carcinoid syndrome. It has been associated with stress, chemotherapy, anesthesia, and hepatic mass biopsies. Flushing, diarrhea, abdominal pain, hypertension, change in mental status, and severe hypotension can result.

A case scenario approach will be utilized to provide a review of the disease process and pertinent nursing care issues of patients experiencing carcinoid syndrome and crisis.

A multiple-choice post-test will be utilized to assess participants’ ability to identify important aspects of patient care.

As members of the multidisciplinary team, oncology nurses are in the unique position to facilitate early identification of the symptoms of impending crisis. This timely assessment leads to rapid implementation of crucial, life-saving interventions. For this reason, oncology nurses need a working knowledge of carcinoid tumors, syndrome, and crisis. Improved knowledge will lead to enhanced patient education and patient outcomes, and could potentially impact morbidity and mortality.