Prepared by: Jeremiah B.

Eco, RN
 Acquired Immunodeficiency
Syndrome
• disease of the human immune system caused by
the human immunodeficiency virus (HIV)
• now a pandemic
• HIV originated in west-central Africa during the
late nineteenth or early twentieth century
• transmitted through direct contact of a mucous
membrane or the bloodstream with a bodily fluid
containing HIV, such as blood, semen, vaginal
fluid, preseminal fluid, and breast milk
• Women
Men with
with
AIDS:
AIDS:
– Heterosexual
Homo/bisexualscontact
(59%)(52%)
– Injection drug use (44%)
(24%)
– Heterosexual (7%)
• Race:
– Blacks
– Caucasians
– Hispanics
 Signs and Symptoms:
• Gastrointestinal:
Pulmonary:
– Esophagitis
Pneumocystis pneumonia (formerly
– pneumocystis carinii pneumonia)
Chronic diarrhea
– Tuberculosis
• Neurologic
Tumors andand Psychiatric:
Malignancies:
– Encephalitis
– Kaposi's sarcoma (KS)
– Cryptococcal
– meningitis
B cell lymphomas such as Burkitt's lymphoma
– Progressive
– multifocal leukoencephalopathy
Cervical cancer
(PML)
– AIDS dementia complex (ADC)
 Pathophysiology:
• Viruses are intracellular parasites
• HIV – retorvirus (instead of DNA, they
have RNA)
• For HIV to enter, cell membrane of the viral
envelope must be fused with the plasma
membrane of the cell.
• Life cycle of HIV:
– First, the HIV
GP120 and GP41
attach to the
uninfected CD4 cell
surface and fuses.
– Second, viral core
content are emptied
into the host cells
(uncoating)
• 3rd, HIV enzyme
reverse
transcriptase
copies the viral
genetic material
from RNA into
double stranded
DNA
• 4th, double stranded
DNA is spliced into
the cellular DNA
• 5th, using the
integrated DNA
(provirus) as a blue
print, the cell
makes a new viral
proteins and RNA
• 6th, HIV protease
cleaves cleaves the
new protein
• The new protein
join the viral RNA
 Stages of HIV Disease
• Primary
• Based on clinical history, physical
examination, laboratory infection(Acute
and signs and
symptoms. HIV infection)
– From infection to
development of
antibodies to HIV
– Intense viral
replication and
dissemination
– S/sx: none to severe
flu-like symptoms
• HIV Asymptomatic
Symptomatic (Category
(CategoryB)
A)
– CD4+ T lymphocyte = > 200
500 –cells/mm3
499 cells/mm3
– Criteria:
On average,
a. condition
8-10 years
is before
due to HIV
a major
infection
HIV
related
and b. condition
complication
mustdevelops
be complicated by HIV
infection
• AIDS (Category C)
– CD4+ T lymphocyte < 200 cells/mm3
– Once in category C, pt. remains in category C
 Diagnostics:
• EIA (formerly known
• Polymerase chain as ELISA)
reaction – useful tool for
– Can detect viral DNA determining serum
– can be used for antibody concentrations
diagnostic analyses • Western Blot Assay
or DNA sequencing – Used to confirm
of the viral genome seropositivity when EIA
– The high sensitivity is positive
of PCR permits virus
• CD4 test
detection soon after – measure the number of
infection and even T cells containing the
CD4 receptor
before the onset of
 Treatment:
• Treatment decision are based on 3 factors:
– Viral load
– CD4 T cell count
– Clinical condition of the patient
• Highly Active Anti-
Retroviral Therapy
(HAART):
– consist of combinations
consisting of at least three
drugs belonging to at least
two types, or "classes," of
antiretroviral agents
– Typical regimens consist of
two nucleoside reverse
transcriptase inhibitors
(NRTIs) plus either a
protease inhibitor or a non-
nucleoside reverse
transcriptase inhibitor
(NNRTI).
 Nursing Process:
Assessment: • Interventions:
• Nutritional Status – Promoting skin
integrity
• Skin Integrity – Promoting usual
• Respiratory Status bowel habits
• Neurologic Status – Prevent Infection
– Improving activity
• F & E balance tolerance
• Knowledge level – Maintaining thought
process
– Improving airway
– Relieving pain and discomfort
– Improving nutritional status
– Decreasing the sense of isolation
– Coping with grief
• Hypersensitivity ( Allergy)
– are inappropriate response of the immune
system to an allergen (or antigen) which is
sometimes tissue-damaging
• Factors why such response occur
– Responsiveness of the host to the allergen
• Amount of allergen
• Nature of allergen
• Route of entrance of the allergen
• Timing of exposure to the allergen
• Site of the allergen-immune
mediator reaction
• Host threshold of reactivity
 Classification of
Hypersensitivities
• 2 broad categories based on the component
of the immune system:
– Humoral mediated- B cell-mediated
– Cellular mediated – T cell-mediated
 Type I Anaphylaxis
• are exaggerated response directed by
IgE antibodies
– Atopic diseases – has genetic
predisposition to the
production of IgE antibodies in
response to antigen
– Non-atopic disorders:
• Hives/ Urticaria,
Angioedema, & Anaphylaxis
• Pathophysiology:
Allergen when enters the body
catch by the mast cell will
try to neutralize it

Release of histamines, kenins, chemotatic factors

and active product of arachidonic acid
metabolism (prostaglandin)
from mast cells
which affect smooth muscle & mucous gland

Symptoms appear:
1. Respiratory
2. Dermal
3. Abdomen
4. General
 Signs & Symptoms
• Respiratory:
– runny nose (rhinorrhea)
– watery or tearing eyes, burning or
itching eyes
– red eyes, conjunctivitis
– swollen eyes
– itching nose, mouth, throat, skin, or any
other area
– Obstruction eustachian tube
– Sinusitis with head ache
Respiratory…..
wheezing
coughing
difficulty breathing
Stridor
Broncho spasm
Increase perspiration
• Dermal: • General:
– Hives – Fever
– Rashes – Malaise
• Abdominal: – Joint pain
– Hematopoietic
– N/V
suppression
– Cramp – Anaphylaxis
– Diarrhea
 ATOPIC DISEASES
– ALLERGIC RHINITIS

– ATOPIC ECZEMA

– VENOM HYPERSENSITIVITY

– FOOD ALLERGY
ALLERGIC RHINITIS ( hay fever )
> inflammation of the nasal mucosa

CAUSES:
• Simple acute rhinitis
• Seasonal occurrences
CLINICAL MANIFESTATION

• Nasal congestion
• Clear watery nasal discharge
• Intermittent sneezing
• Nasal itching
• Itching of the throat & soft palate
• Headache, pain over the paranasal
sinuses
DIAGNOSTICS

• Nasal smear
• Peripheral blood counts
• Total serum IgE
• ID testing
MEDICAL MANAGEMENT

• Avoidance therapy
• Pharmacologic therapy
> antihistamine, adrenergic
agents, corticosteroids,
immunotherapy
NURSING MANAGEMENT
The patient is usually ADVISE as
follows;
• Eliminate or limit intake of chocolate,
milk & eggs.
• Cover mattress & pillows w/ plastic
• Do not have domestic animals in the
house.
• Use nonallergenic cosmetics
• Avoid use of wool bedding.
FOOD ALLERGY
> IgE-mediated food allergy, a type I
hypersensitivity reaction occurs in 1%
to 7% of the population.

CLINICAL MANIFESTATION
• Urticaria & Atopic dermatitis
• Wheezing, cough
• Laryngeal edema
• GI symptoms
DIAGNOSTICS
• Skin test

MEDICAL MNGT:
• Elimination of the food responsible for
the hypersensitivity.
• Antihistamine, adrenergic,
corticosteroids.
• Cromalyn Na
NURSING MANAGEMENT:

• Focusing on preventing future

exposure to food allergen.
• Carefully assess food prepared by
others.
INJECTED POISON; STINGING
INSECTS
• Extreme sensitivity to the venoms of
the hymenoptera.
• IgE mediated reaction
CLINICAL MANIFESTATION
• Generalized urticaria, itching
• malaise
• Anxiety due to laryngeal edema to
severe bronchospasm, shock &
death.
MANAGEMENT:
• Stinger removal
• Wound care w/ soap and water.
• Ice application
• Antihistamine & analgesics
• Epinephrine, SQ
 ATOPIC DERMATITIS
• Also known as eczema
• Highest in infants and children
• With remission and exacerbation
 Clinical manifestation
• Pruritus
• Hyperirritability of the skin
• Excessive skin dryness
• Pallor (when dented)
• Lesions secondary to scratching
 Nursing Management:
• Wear cotton fabrics
• Use mild detergents
• Avoid allergens
• Use skin moisturizers
• Lifestyle management
 Medical Management
• Antihistamine
• Topical corticosteroids
• Low dose cyclosporine
NON-ATOPIC DISEASES
• Hives/Urticaria

• Angioedema

• Anaphylaxis
 Hive (Urticaria)
• Pruritic lesion w/ color pale pink elevated
edge cause by food/drug allergy
• Prolonged 6 wks (chronic)
• Rash found on mucous membrane, larynx
and GIT
 Angioedema
• form of urticaria but involve subcutaneous
tissue, involved the eyelid, thumb and lip
• Rash is reddish hue, look like a mosquito
bite that may last for 24-36 hrs.
 Clinical manifestations
• Diffuse swelling covering the back
• Skin does not pit on pressure
• Itching and burning sensation
• Swelling for few sec. or slowly for 1-2 hrs.
 Systemic anaphylaxis:
• Initial:
– Edema & itching on the site of
injection, apprehension & sneezing
• Followed by
– edema of the face, hands, & other part
of the body, wheezing respiration,
dyspnea, signs of vascular collapse,
death
 Prevention
• Primary prevention:
– Patient education-
– Awareness of his/her allergen and avoiding
it
– Should be taught on how to use self-
injecting 1:1000 epinephrine HCL (spring
loaded automated syringe like a pen)
– Taught on when to take antihistamines
(Oral or aerosol)
 Precautionary action
• Should the person undergo animal sera,
allergenic extracts, or contrast media
containing iodide injection, the nurse must
have epi at the bedside
• Dipenhydramine (benadryl) or other
antihistamines be ready
 Secondary Prevention

• Identification of High risk- thorough history

taking is important
• Desensitization-immunize
Other factual data on allergy
• Children who have been breastfed are
less likely to have allergies.

• There is also evidence that infants

exposed to certain airborne allergens
(such as dust mites and cat dander) may
be less likely to develop related
allergies.

• Once allergies have developed, treating

the allergies and carefully avoiding
those things that cause reactions can
prevent allergies in the future.
 Diagnosis & Tests
• Skin testing
• the most common method of allergy
testing.
• This may include intradermal, scratch,
patch, or other tests.
• may even be an option for young children
and infants, depending on the
circumstances.
Diagnosis & Tests
• Blood test -- also called RAST
(radioallergosorbent)
• measures the levels of allergy antibody,
IgE, produced when your blood is mixed
with a series of allergens in a laboratory.
• If you are allergic to a substance, the IgE
levels may increase in the blood sample.
• may be used if you have existing skin
problems like eczema, if you're on
medications that are long-acting or you
cannot stop taking, if you have a history
of anaphylaxis, or if you prefer not to
have a skin test.
 Diagnosis & Tests
• "Use" or "elimination" tests
– suspected items are eliminated and/or
introduced while the person is observed
for response to the substance.
– often used to check for food or medication
allergies.
 Diagnosis & Tests
• Eyelid
– Occasionally, the suspected
allergen is dissolved and dropped
onto the lining of the lower eyelid
(conjunctiva) as a means of testing
for allergies.
 Diagnosis & Tests
• Reaction to physical stimuli
– application of heat, cold, or other
stimulation, and then look for an allergic
response.
• Other tests that may reveal
allergies include:
1. Antibody/immunoglobulin
(particularly IgE) levels -- when
these are elevated, it indicates a
"primed" immune system.
2. CBC -- may reveal an increase in
eosinophils.
3. Complement levels -- may be
abnormal.
 Treatment
• The goal is to reduce the symptoms
caused by inflammation of the affected
tissues.
• Of course, the best "treatment" is to
avoidance
 Treatment
• Medications that can be used to
treat allergies include the
following:

Short-acting antihistamines
• relieve mild to moderate symptoms but
can cause drowsiness.
• can blunt learning in children
• Diphenhydramine, loratadine (Claritin)
Longer-acting antihistamines
– cause less drowsiness and can be equally
effective, and usually do not interfere with
learning.
– Fexofenadine (Allegra) and cetirizine
(Zyrtec).
 Treatment
• Nasal corticosteroid sprays
– very effective and safe for people with
symptoms not relieved by antihistamines
alone.
– These prescription medications include
fluticasone (Flonase), mometasone
(Nasonex), and triamcinolone (Nasacort
AQ). .
 Treatment
• Decongestants
– may also be helpful in reducing symptoms
such as nasal congestion.
– should not be used for more than several
days, because they can cause a "rebound"
effect and make the congestion worse.
– Decongestants in pill form do not cause this
effect.
 Treatment
• Allergy shots (immunotherapy)
– occasionally recommended if the allergen
cannot be avoided and symptoms are hard to
control.
• Epinephrine
– for severe reactions (anaphylaxis)
Type II Cytotoxic
• Blood Transfusion Reactions
• Mismatched blood transfusion
reactions
• Cause by the antigen on the surface
of RBC (which are a lot but only two
are significant clinically)
– 2 major system: ABO system & Rh
system
 ABO system

• 4 major blood group:

– A- has antigen A, with anti B antibodies
– B-has antigen B, with ant A antibodies
– O- has no antigen
– AB- Has antigen A and B
• Cell that are not match will coated by
isohemagglutinins resulting to
agglutination and lead to lysis of the
cell
• Safe donor/recipient relationship
O

A B

AB
 Rh system
• Has 27 different antigen but D is significant
clinically
• Rh (+) – would mean (+) antigen D
• Rh (-) – would mean (-) antigen D
• Epidemiology: 85 % of the general
population are Rh (+)
• Rh (-) person if expose to Rh (+) will form
antibodies against antigen D
• Subsequent exposure to Rh (+)
blood the Rh antibodies will binds
with antigen resulting to
breakdown of RBC by
macrophages into the spleen –
conversion of hgb to bilirubin that
causes jaundice
 Rheumatoid arthritis

• chronic systemic inflammatory disease

• destruction of connective tissue and
synovial membrane within the joints
• weakens and leads to dislocation of the
joint and permanent deformity
 Rheumatoid Arthritis

Risk Factors:
• exposure to infectious agents
• fatigue
• stress
 Rheumatoid Arthritis
Signs and Symptoms
• inflammation, tenderness, and stiffness of the
joints
• moderate to severe pain and morning stiffness
lasting longer than 30 minutes
• joint deformities, muscle atrophy, and
decreased range of motion
• spongy, soft feeling in the joints
• low grade fever, fatigue and weakness
Rheumatoid Arthritis
Rheumatoid Arthritis
Rheumatoid Arthritis
 Rheumatoid Arthritis
Signs and Symptoms
• anorexia, weight loss, and anemia
• elevated ESR, and positive RF
• Nonreactive: 0-39 IU/ml
• Weakly reactive: 40-79 IU/ml
• Reactive: greater than 80 IU/ml
• X-ray showing joint deterioration
 Diagnostic tests
• Elevated ESR

• Mild leukocytosis

• Anemia

• Positive RF
 Medication
• Salicylates (acetylsalicylic acid )

• NSAIDs

• Corticosteroids- anti-inflammatory

• Gold salts
 Medications-Gold salts
• slow-acting, anti-inflammatory agents

• Gold sodium thiomalate, Aurothioglucose, Auranofin

• - these drugs cannot repair existing damage, rather

they can only prevent further injury

• - use in the treatment of RA that does not respond to

salicylates or other NSAID therapy
 Gold salts
• Adverse effects: dermatitis of the skin or
of the mucous membranes, proteinuria
and nephrosis
• Gold salts should be avoided in patients
suffering from hepatic or renal disease,
pregnancy.
• Serious Toxicity: Dimercaprol
 Treatment

• Hot and Cold packs to affected joints

• Surgical Procedures: synovectomy,

arthrotomy, arthrodesis, arthroplasty
 Nursing Care Plan
Prevent or correct deformities
• bed rest
• daily ROM exercises
• heat and/or pain medication
• increase oral fluid intake at least 1500
mL to prevent renal calculi
 Nursing Diagnosis
• Pain related to joint destruction
• Impaired physical mobility related to joint
contractures
• Risk for injury related to the inflammatory
process
• Body image disturbance related to joint
deformity
• Self-care deficit related to musculoskeletal
impairment
 Systemic Lupus Erythematosus

• A chronic, inflammatory autoimmune

disorder that may affect many organ
systems including the skin, joints and
internal organs.
• Affects 9 times as many women as men.
• Occur at any age, but appears most often in
people between the ages of 10 and 50
years.
• May also be caused by certain drugs.
• African Americans and Asians are
affected more often than people from other
races.
 Symptoms & Signs
• fever
• fatigue
• general discomfort, uneasiness or ill feeling
(malaise)
• weight loss
• skin rash
– "butterfly" rash
– sunlight aggravates skin rash
 Symptoms & Signs
• sensitivity to sunlight
• joint pain and swelling
• arthritis
• swollen glands
• muscle aches
• nausea and vomiting
• pleuritic chest pain
• seizures
• psychosis
• Additional symptoms that may be associated with
this disease:
1. blood in the urine
2. coughing up blood
3. nosebleed - symptom
4. swallowing difficulty
5. skin color is patchy
6. red spots on skin
7. fingers that change color upon pressure or in the cold
(Raynaud's phenomenon), numbness and tingling
8. mouth sores
9. hair loss
10.abdominal pain
11.visual disturbance
Musculoskeletal

• Almost all people with SLE have joint pain and

most develop arthritis.
• Frequently affected joints are the fingers, hands,
wrists, and knees.
• Death of bone tissue can occur in the hips and
shoulders and is frequently a cause of pain in
those areas.
Skin

• A "butterfly" rash over the cheeks and

bridge of the nose affects about half of those
with SLE.
• The rash is usually worsened by sunlight.
• A more diffuse rash may appear on other body
parts that are exposed to the sun.
• Other skin lesions or nodules can also occur.
Kidney

• Some people with SLE have deposits of

protein within the cells (glomeruli) of the
kidney.
Nervous system

• Mild mental dysfunction is the most common

symptom, but any area of the brain, spinal cord, or
nervous system can be affected.
• Seizures, psychosis, organic brain syndrome, and
headaches are some of the varied nervous system
disorders that can occur.
Blood

• Venous or arterial blood clots can form

• Often platelets are decreased which may cause
bleeding or clotting problems.
• Anemia of chronic disease often develops at
some point in the course SLE.
Heart

• Inflammation of various parts of the heart may

occur as pericarditis, endocarditis, or myocarditis.
• Chest pain and arrhythmias may result from these
conditions.
Lungs
• Pleurisy
• Chest pain and shortness of breath
 Diagnosis & Tests

• The diagnosis of SLE is based upon the presence

of at least four out of eleven typical
characteristics of the disease.
Tests to determine the presence of these disease manifestations may vary
but will include some of the following:

1. Antinuclear antibody (ANA)

2. Characteristic skin rash or lesions
3. Chest X-ray showing pleuritis or pericarditis
4. Listening to the chest with a stethoscope to reveal heart
friction rub or pleural friction rub
5. Urinalysis to show blood, casts, or protein in the urine
6. CBC showing a decrease in some cell types
7. Kidney biopsy
8. Neurological examination
 Treatment

• The disease has multiple manifestations with

variable severity, which determines individual
treatment.
• There is no cure for SLE.
 Treatment

• Mild disease (rash, headaches, fever, arthritis,

pleurisy, pericarditis) requires little therapy.
• Nonsteroidal anti-inflammatory medications
(NSAIDS) are used to treat arthritis and
pleurisy.
 Treatment
• Corticosteroid creams are used to treat
skin rashes.
• Antimalarial drugs (hydroxychloroquine)
and low dose corticosteroids are
sometimes used for skin and arthritis
symptoms.
 Treatment
• Sensitivity to light is treated by protective clothing,
sunglasses and sunscreen.
• Severe or life-threatening manifestations often
requires treatment by both rheumatologists and
specialists in the specific area.
• Corticosteroid therapy or medications to suppress the
immune system may be prescribed to control the
various symptoms of severe disease.
 Treatment

• Some health care professionals use

cytotoxic drugs (drugs that block cell
growth) to treat people who do not have a
good response to corticosteroids or who are
dependent on high doses of corticosteroids.
Cellular Aberrations
 Cancer
• Is a disease process that begins when an
abnormal cell is transformed by the genetic
mutation of the cellular DNA
• Cell proliferate
• Cell have invasive characteristics
• They infiltrate thru the lymphatic circulation
and blood vessel (metastasis)
 Proliferative pattern
• Hyperplasia- increase in the number of cell of a
tissue; most common associated with rapid body
growth
• Metaplasia- conversion of one type of mature cell
into another type of cell
• Dysplasia-bizarre cell growth resulting in cells
that differ in size, shape, or arrangement from
other cells of the same type of tissue
• Anaplasia- cells that lack normal cellular
characteristics and differ in shape and
organization with respect to their cells of
origin usually, anaplastic cells are malignant
• Neoplasia- uncontrolled cell gowth that
follow no physiologic demand
 Characteristics of malignant cells
• Malignant cell
• Has special protein on the membrane that
differentiate benign cell from a malignant
cell of the same tissue – Tumor-specific
antigen (TSA)
 Etiology
• Virus and bacteria – incorporate themselves
in the genetic structure and alter the future
generation of the cell.
• Eg. Epstein-barr virus can cause: Burkitt’s
lymphoma, nasopharyngeal CA, some type
of non-Hodgkin's lymphoma and Hodgkin's
disease
• Physical agents- such as:
• Sunlight or radiation
• Chronic irritation or inflammation
• Tobacco use
• Chemical agents- 75% of cancer are due to this,
such as:
• Tobacco
• Alcohol
• Asbestos
• Uranium
• Viruses
• Genetic and familial factors – abnormal chromosomal
pattern
• Accounts to 5%-10% of cancer are due to this factor
• Eg. Retinoblastoma, nephroblastoma
• Dietary factor- long term ingestion of carcinogen, eg.
Alcohol, salt-cured or smoke meat, food containing nitrates
and nitrites, high calorie intake.
• Counteract by taking proactive substance : high fiber food,
vegetable (cruciferous eg. Cabbage, broccoli, cauliflower;
carotenoids eg. Carrots, tomatoe, spinach, peaches, dark-
green and deep-yellow vegetables)
• Hormonal factor- hormonal imbalances either
endogenous or exogenous source of hormone
• Oral contraceptive and prolong estrogen
replacement therapy can cause hepatocellular,
endometrial and breast cancer however, decreased
the incidence of ovarian and endometrial cancer to
some as well
• Eg. Diethylstilbestrol (DES) causes vaginal
carcinoma
C hange in bowel or bladder habits - colorectal
A sore that does not heal on the skin or in the mouth – skin or oral
U nusual bleeding or discharge - colorectal, prostate, bladder or cervical
T hickening of breast tissue or a new lump - breast or testicular cancer.
I ndigestion or trouble swallowing - mouth, throat, esophagus or stomach.
O bvious changes to moles or warts - skin cancer.
N agging cough or hoarseness - lung or throat cancer.

U nexplained anemia – leukemia

S udden weight loss
 Characteristic of Benign and Malignant
Characteristics Neoplasm
Benign Malignant
Cell Characteristics Well differentiated that Undifferentiated and
resemble normal cell bear little resemblance
to the normal tissue
Mode of growth By expansion and At the periphery & send
usually encapsulated out processes that
infiltrate and destroy
other tissue
Rate of growth low Variable; depends on
the level of
differentiation; more
anaplastic the rapid
growth
Metastasis Does not spread by Gain access to blood
metastasis and lymph channels
 Characteristic of Benign and Malignant
Characteristics Neoplasm
Benign Malignant
General effects Localized effect not Often cause
unless location generalized effect
interfere vital such as anemia,
function eg. BPH weakness, wt. loss
Tissue destruction Does not cause tissue Often cause extensive
damage unless tissue damage
location interfere
blood flow
Ability to cause death Does not cause death Usually cause death
unless location unless growth are
interfere with vital controlled
function
 Carcenogenesis
• MALIGNANT TRANSFORMATION
• 3 process
• Initiation – initiator like chemical, physical,
biologic factor that escape the normal enzymatic
mechanism –alter the genetic structure in the DNA
• Promotion – repeated exposure to promoting
agents causes expression of abnormal or mutant
genetic information
• Progression- exhibit increased malignant behavior
 Staging and grading tumor
• Staging – determines the size of the tumor and
the existence of metastasis
• TNM used to refer to this system
• T- extent of the primary tumor
• N- lymph node involvement
• M – extent of metastasis
• Grading – refers to the classification of tumor
cells, can be obtain thru cytology, biopsy, or
surgical excision
 TNM classification system
• Primary tumor (T)
• TX primary tumor cannot be assessed
• TO no evidence of primary tumor
• Tis carcinoma in situ
• T1,T2,T3,T4 incraseing in size & local
local extent of tumor
 TNM classification system
• Regional Lymph Nodes (N)
• NX regional lymph nodes cannot be
assessed
• NO no regional lymph node metastasis
• N1,N2,N3 increasing involvement of
regional lymph nodes
 TNM classification system
• Distant Metastasis (M)
• MX distant metastasis cannot be assessed
• MO no distant metastasis
• M1 distant metastasis
 Diagnostic Test:
• Tumor marker identification- analysis of
substances found in blood or other body fluids
that are made by the tumor or by the body in
response to tumor.
• Use in Breast, colon, lung, ovarian, testicular,
prostate cancer
• MRI – use magnetic field and radiofrequency
signals to create sectioned images of various
body structures
• Use in neurologic, pelvic, abdominal, thoracic
cancer
MRI
• CT scan – use narrow beam x-ray to scan
successive layers of tissue for cross-
sectional view
• Use in neurologic, pelvic, abdominal,
thoracic cancer
CT Scan
• Flouroscopy – uses x-ray that identify the
contrast in body tissue densities; may
involve the use of contrast media
• Use in skeletal, lung , GIT cancer
                                  

                                             
John Y. Connolly, MD
performing fluoroscopy

Fluoroscopy
• UTZ- use high-frequency sound waves
echoing off body tissue are converted to
electronic images use to assess deep tissues
of the body
• Use in abdominal and pelvic cancers
UTZ
• Endoscopy
• Nuclear medicine imaging
• Positron Emission Tomography (PET scan)
• Radioimmunoconjugates
 Modalities of treatment: cure,
control, & palliative treatment
• Surgery: removal of the entire cancer, ideal
treatment for cancer.
• Reasons for surgery:
• Diagnostic – definitive measure in identifying
cellular characteristics that influence the decision to
treat
• Biopsy – to obtain a tissue sample to determine if
malignant or benign.
– Excisional-use for accessible to tumor like breast, upper
& lower GIT, upper RT. The surgeon can remove the
whole tissue & examine
– Incisional- wedge resection, if the tumor is too
large a part will be taken for examination
– Needle biopsy – use for accessible tumor to get
a sample of a fragment tissue and if the
physician wants a little disturbance on the
tissue to avoid proliferation
• Primary treatment Surgery– goal is to removal
of the entire tumor and any involving
surrounding tissue and regional lymph nodes
• Local excision- when mass is small
• Wide excision-radical or en bloc dissection,
include removal of the primary tumor &
surrounding tissue & lymph nodes
• Salvage surgery – lumpectomy instead of
removal of the entire breast
• Others:
• Electrosurgery- use of electrical current to destroy
tumor cell
• Cryosurgery – use of liquid nitrogen in freezing
tumor cell
• Chemosurgery-layer-by-layer removal of the cancer
tissue by applying topical chemical
• Laser surgery-(Light Amplification by stimulated
emission of radiation) use light vaporize cancer
• Stereotactic radiosurgery (SRS) high-dose radiation
use in brain and neck cancer
• Prophylactic surgery- removal of non vital tissue
that are likely to develop cancer like oophorectomy
in hysterectomy
• Palliative surgery- when cure is not possible, to
relieve ulceration, obstruction, hemorrhage, pain.
Eg. Colostomy for colon cancer, nerve block for
pain in case of bone cancer
• Reconstructive Surgery – following radical
surgery in attempt to improve function or obtain
cosmetic effect.
• Chemotherpy
• Immunotherapy/gene therapy
• Biologic response modifier
Radiation Therapy
• The use of radiation to treat a
medical condition.
• Use ionizing radiation to
interrupt cellular growth
• There are different types of
radiation that can be used but
they are usually either
photons or electrons
• Use for Hodgkin's testicular,
thyroid, head & neck,
cervical CA
 Types

• External- a. Kilovoltage, b. Gamma rays c.

High linear transfer radiation d.
Intraoperative radiation therapy

• Internal or implant or brachytherapy

– Sealed
– Unsealed
 Quick Facts About Radiation
Therapy
1. Radiation treatments are painless.
2. External radiation treatment does not make you
radioactive.
3. You need to allow 30 minutes for each treatment
session
4. Get plenty of rest and to eat a well-balanced diet
5. Skin in the treated area may become sensitive and
easily irritated.
6. Side effects of radiation treatment are usually
temporary and they vary depending on the area of the
body that is being treated.
•  It is common for your skin to become red
during radiation therapy.  This redness is a
temporary side effect of radiation treatment. 
• Changes in your skin usually occur two to
three  weeks into treatment and may last one to
two weeks after last treatment. 
• The amount of skin redness or irritation
depends on the part of the body being treated
and the dose of radiation. 
 Most common types of skin reactions:

1. Erythema
2. Alterations in pigmentation
3. Alopecia
4. Dry desquamation
5. Ulceration
6. Loss of perspiration
7. Changes in superficial blood vessels
8. Edema
9. Scarring
1. Wash the skin gently using only lukewarm
water & pat dry with a clean towel
2. The skin should NOT be rubbed or shaved.
3. Use only mild soaps for cleansing.
4. AVOID skin lotions, creams, powders and
perfumes.
5. DO NOT remove skin markings
 Helpful Hints for Skin Care
• Apply moisturizers to the skin as directed by your
nurse. 
• Do not use moisturizers within two hours before
your radiation treatment. 
• Moisturizers work best when applied just after
bathing , while the skin is still damp. 
• Continue to moisturize your skin for at least a
month after treatments are completed,  and then as
needed.
• Protect the skin in and around the treatment area
from extremely hot or cold temperatures,
especially in the summer and winter. 
• Use soft, lightweight clothing to cover the treated
area.
• If the area being treated is exposed to the sun,
apply sunscreen routinely to the treatment site
whenever you are outdoors for more than 10
minutes during the summer or winter. 

• Do not use heating pad, hot water bottle, or ice

pack on the treatment area, unless instructed by
your doctor.

• Always protect the treated area form chemicals

• Bathe for only a short period of time, just long
enough to cleanse yourself. Soap and water can
cause you skin to become drier.
• Do not use deodorant soaps, which can dry skin.
Use moisturizing soaps (such as unscented Dove)
that do not contain perfume or fragrances.
• Use warm water, rather than hot, to prevent your
skin from becoming dry.
• After bathing, pat the skin dry rather than rubbing
it, especially at the treatment site.
• Eat a balanced diet.
• Drink at least eight glasses of fluids daily unless
your doctor has restricted the amount of fluids you
can drink to another medical condition.
• Check the skin at the treatment site daily. Report
any changes to your nurse or doctor.
• You may take your prescribed pain medication as
directed. If you experience discomfort and have no
pain medication prescribed, you may take an over-
the-counter pain relief medication.
 Alkaline Phosphatase Test-APT
• This test measures the amount of the enzyme
alkaline phosphatase in your blood.
• This enzyme is present in most tissues but is
especially concentrated in the liver and bones
particularly in osteoblasts that reflects
osteoblastic activity
• The amount of alkaline phosphatase in your blood
is measured to help diagnose liver and bone
disease
• What does the test result mean?

• In most labs the normal alkaline

phosphatase range for adults is 39 to 117
units per liter (U/L).
• Increased: liver or bone diseases
• Decreased: anemia or glandular disorder
 Chemotherapeutic drugs
• Alkylating Agents – e.g. Carboplatin,
Cisplatin
• Nitrosureas – e.g. Carmustine, Lomustine
• Antimetabolites – 5-FU, Cytarabine
• Antitumor antibiotics – Doxorubicin
(Adriamycin)
• Mitotic Spindle Poisons – e.g. Vincristine,
Docetaxel
• Hormonal Agents – e.g. Steroids, estrogen,
progesterone
 Nursing Consideration
• C – cbc, platelets monitor
• A – antiemetics before drug
• N – nephrotoxicity-indesirable effect
• C – counseling regarding reproduction
• E – encourage handwashing, avoid crowds
• R – recommend a wig for alopecia
 Nursing Diagnosis
• Pain
• Altered nutrition r/t anorexia, vomiting
• Electrolyte imbalance r/t vomiting,diarrhea
• Impaired tissue integrity r/t stomatitis
• Impaired physical mobility r/t neurologic
impairments
• Knowledge deficit r/t disease process
• Ineffective breathing patterns r/t cough,
shortness of breath
• Sleep pattern disturbance r/t cancer
therapies
• Fatigue
• Body image disturbance
 Testicular Cancer
What is testicular cancer?

 
How is testicular cancer
diagnosed?
How is testicular cancer
treated?
                   

                    

Related Link: http://www.tc-cancer.com/facts.html

 What is testicular cancer?

Risk Factors

• Occurs more frequently in white males

ages 18-40 years old
• History of undescended testicle
• Family history of testicular cancer
How is testicular cancer diagnosed?
• Testicular self-examination (TSE)
• The usual initial finding is a painless lump in or on the
testis, a hardness or enlargement of the testis.
• (+) nodules in the Testicular UTZ

Cancerous lump
STEPS:
1. Stand in front of a mirror.
2. Check for any swelling on the scrotum skin.
3. Examine each testicle with both hands.
4. Place the index and middle fingers under the testicle with the
thumbs placed on top.
5. Roll the testicle gently between the thumbs and fingers.
6. Find the epididymis and differentiate it with cancerous lumps
which are usually found on the sides or on the front of the testicle

• Best performed after a warm bath or shower.

EPIDYDIMIS
 How is testicular cancer treated?

• Surgery - Orchiectomy
 Abnormal production of
WBC by the bone marrow

WBC: 5T-10T

Related link: http://www.cancer.gov/cancerinfo/wyntk/leukemia#2

 NORMAL

This picture shows the darkly-stained lymph cells

(lymphoblasts) seen in Acute Lymphocytic
Leukemia (ALL), the most common type of
childhood leukemia.
BMA
 Cervical Cancer

http://www.yourmedicalsource.com/library/cervicalcancer/CC_whatis.html
1. Age: 50 to 55 years old
2. Infections: HPV, HIV & Chlamydia infections
• Intercourse at an early age
• Having many sexual partners
• Having unprotected sex at any age
3. Smoking
4. Diet: Low in F& V – vitamin A & C deficiency
5. Use of pills
6. Low socioeconomic status
7. Use of Diethylstilbestrol (DES): miscarriage drug
8. Family history of cervical cancer
• abnormal vaginal bleeding or blood
stained vaginal discharge in between
periods
• irregular periods
• bleeding after intercourse
• pain
• increased mucous discharge
• anemia (constant tiredness, shortness of
breath)
• foul smelling vaginal discharge
• Initial diagnostic test for cervical cancer
• A girl or woman should have a Pap smear if she:
1. has reached the age of 18
2. is sexually active
3. has been sexually active

• Some doctors think that a girl or woman doesn't

need to have a Pap smear every year if
1. she's reached the age of 65
2. she's had normal test results for 3 years in a row
• First described by Sir Thomas Hodgkin in 1832
• Incidence: Most commonly seen in young adults
• S/Sx: Usually presents as painless lymphadenopathy
in superficial lymph nodes
• Complications: Splenomegaly occurs in 50% patients
• Dx: Histological examination of involved node
- (+) Reed-Sternberg cells
painless lymphadenopathy
(+) Reed-Sternberg cells
COMMON SITES:
• Cervical nodes
(60-70%)
• Axillary nodes
(10-15%)
• Inguinal nodes
(6-12%)
What are the symptoms of Hodgkin's
disease?

• The first symptom of Hodgkin's disease is usually

painless swelling in the neck, armpits or groin.
• Other symptoms may include any of the following:
1. night sweats or unexplained fever,
2. weight loss and tiredness,
3. cough or breathlessness,
4. persistent itch all over the body.
• Cough
• Shortness of breath
• Wheezing
• Chest pain
• Hemoptysis (bloody,
coughed-up sputum)
• Loss of appetite
• Weight loss
• Pneumonia
(inflammation of the
lungs)
• Dysphagia (most common)
• Pain associated with
swallowing or there may be
no pain at all.
• Regurgitation
• Hematemesis
• Extreme loss of weight.
Diagnostic Tests

• Barium Swallow
• Esophagoscopy/ Biopsy
• CXR
• CT scan
• UTZ
• The best time to do an exam is right after your period,
when breasts are not tender or swollen.
• If you do not have regular periods or sometimes skip a
month, do it on the same day every month.
 Techniques of Palpation

• BSE may begin on either breast BUT it

is usually performed on the left breast
 Peau d’ orange

Dimpling
 Pelvic exenteration
• Pelvic exenteration was first reported by
Brunschwig in 1948 as an especially radical
surgical treatment for advanced and recurrent
cervical cancer.
• It was described as “the most radical surgical
attack so far described for pelvic cancer”
• Pelvic exenteration continues to be the only
curative option in certain patients with centrally
recurrent cervical, vaginal, or vulvar cancers.
 multiple myeloma
• most common primary malignant neoplasm of bone
• 50-70y; M:F 2:1
• symptoms: vague bone pain of progressive severity, fever,
anemic sxs
• complications: pathologic fractures, solitary plasmacytoma:
solitary osseous focus of MM (uncommon)
• x-ray findings:
• loss of bone density - from diffuse marrow involvement
• "punched out" lesions - esp. skull, long bones
• diffuse bone destruction - esp. pelvis, sacrum
• invasion of soft tissues - often paraspinal, extrapleural mass
• osteosclerosis - very rare
• metastatic calcifications - particularly kidneys, occ. lungs