NCMB 312 Finals! (2.0)

TYPHOID FEVER
NCMB 312 FINALS!!!

11/29/21
FINALS !!!!!!!!!!
- Systemic infection
 Cause by
- salmonellae are gram-negative, flagellate ,
motile, nonsporulating facultative
o Mode of transmission
4 SATAGES OF TYPHOID FEVER
- fecal
1. Prodromal stage
- oral route ingestion of contaminated food &
- Microorganism travel in blood stream
water
 S/SX:
o Incubation period Fever Dull head ache
- 1-3 weeks Abdominal pain Nausea
o Source of infection Vomiting Diarrhea
- 5 F’s Constipation
- Feces
2. Fastidial stage
- Finger
- Organism has reached peyer’s patches
- Food
- Flies
- Fomites 3 clinical features of typhoid
- Presence of rose spots ( abdomen and chest
) – only symptom specific to typhoid
( pathognomonic , present in 25 % of cases )
- Blanching in pink macular spots 2-3mm over
trunk
2.ladderlike fever
3.spienomegaly
3. Defervescence stage
a. Intestinal hemorrhages
- melena ,hematochezia
Note: - !!!! avoid dark colored foods
b. Intestinal perforation - Peritonitis
- Peyer’s patches may become necrotic
- Sudden , severe , abdominal pain ,
persistence of fever , rigid abdomen
JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM
NCMB 312 FINALS!!!
- Ceftriaxone , cefixime , ciprofloxacin
Nursing care
1. Maintenance of fluid and electrolyte imbalance

- Proper regulation of IVF
- Adequate fluids
- Assess for the sign of dehydration
2. Maintenance of nutrition
- High calorie , low residue diet
- !! do not give milk which can lead to
= acidity and diarrhea
3. Isolation of patient
4. Lysis/convalescence  CDT IMMUNIZATION
Adults : 0.5 cc Im deltoid
S/SX: will subside
Children <10 years old 0.25cc IM deltiod
- Patient will should be watched because *6months immunity
patinet may developed relapse
Dx. VIVOTIF – in capsule form

a. Blood culture
- 3 doses : 1 hour before meal q other day
- Done during prodromal stage ( 1st week )
- 3 years immunity
b. Widal test
- Antibody test  Protect / purify water supplies
- nd
Becomes positive on the 2 week  Proper excrete disposal
c. Typhidot  Handwashing
- ELISA kit that detects IgM and IgG antibodies .  Proper preparation and handling food
becomes positive after 2-3 days of infection  Avoid eating fresh and uncooked vegetables
d. Stool culture in endemic areas
- Done on the 2nd week  Do not put anything in your mouth
Tx: Treatment
Antibiotic :
 Chloramphenicol
- 100mg/kg in 4 doses for 14 days
(side effect is bone marrow depression)

NCMB 312 FINALS!!!
o Fecal oral route
DYSENTERY
- Intestinal inflammation , primarily of colon

- Can lead to mild  severe stomach cramps
& severe diarrhea w/ mucus or blood in the
feces
- Diarrhea with blood
3 types of dysentery
1. Bacillary dysentery – shigellosis CHOLERA ( EL TOR)

2. Violent dysentery – cholera
3. Amoebic dysentery – amoebiasis
- Infcetious disease = cause severe watery
diarrhea
- Organism survives well at ordinary
temperatures and miltiplies well
temperature 22-40 degree Celcius
- Usually found in brackish water
- Survived longer in refrigerated food
Pathognomonic sign – RICE WATER STOOL
MODE OF TRANSMISSION
NCMB 312 FINALS!!!
Amoebiasis ( stool should be fresh within 30 minutes
to one hour to find trophozoites)
Treatment
Cholera – dark field microscopy of fresh stool
o Rectal Swab – for cholera and shigellosis
Shigellosis:
- Co-trimoxazole
- ciprofloxacin
Cholera:
- Co-trimoxazoleTetracycline
- Ciprofloxacin
Amoeba:
Metronidazole
Preventive Measures
Brand name of metronidazole : fladgyl
 CDT Vaccine (Cholera/Dysentery/Typhoid)

 months immunity – given only on outbreaks.
 Personal hygiene - handwashing
 Environment sanitation – boiling of water,
protect food from flies
Nursing Care:  Control of fever

 Maintenance of fluid and electrolyte balance
AMOEBIC DYSENTERY
 Oral Rehydration Salt (ORS)
 NaCl, Sodium Bicarbonate, Potassium
Chloride, Glucose
 Given in large amounts as tolerated and
the amount of intake and loss should be
recorded
o Acute - can present as diarrhea (watery foul
smelling) with tenesmus, frequent, small and Rehydration with ORS (Brunner)
often blood streaked stools.
o Chronic- can present with gastrointestinal
symptoms plus fatigue, weight loss and occasional  Mild dehydration
fever, hepatomegaly
o Extraintestinal- can occur if the parasite spreads - mild oral mucous membranes and
increased thirst-
Diagnosis - 50ml/kg over a 4-hour interval
to other organs, most commonly the liver where
it causes amoebic liver abscess  Moderate dehydration
Abcess may break through the lungs by coughing - sunken eyes,loss of skin turgor, increased
“anchovy sauce” sputum thirst, dry oral mucous membrane
o Stool Examination - 100ml/kg over a 4-hour interval
NCMB 312 FINALS!!!
 Severe dehydration  Tx rest
- CHO diet
- IVF
Note: Acute no tendency to be chronic)
 NURSING ALERT-Sports drinks do not replace
fluid losses correctly and should not be used.
3 stagesHEP
of Bmanifestations
(serum hepatitis)
1. Pre-icteric
- Fever
- RUQ pain
- Fatigability
- weight loss anorexia
- N/V
HEPATITIS
- headache
2. Icteric
- Inflammation of the liver - Jaundice
Due to : - Itchiness
- alcoholism - pruritis-bile salts in skin
- drug intoxication - tea colored urine
- parasite - stools-clay-colored
- chemical arsenic - hepatomegaly
- microorganism - tender liver
- viral communicable disease 3. Post -Icteric stage
1. Hepatitis A - jaundice subsides
- infectious hepatitis 2. Hepatitis B

-
catarrhal jaundice hepatitis  Syn: Serum Hepatitis, DNA Virus
 Mode of Transmission:  MOT:
-
fecal-oral, oral-anal sex - Percutaneous
 Incubation period:
- sexual contact
-
2-7 weeks
- mother to child (time at the birth)
 Most common
 Population at risk:
 MOT- Fecal oral route, water and food borne
 Contaminated food, water - healthcare workers, blood recipients
 Oral anal contact during sex - drug addicts
 Incubation Period- 15–50 days Average: 30 days
 S/s with or without symptoms
- sex workers
 Incubation period:
- low grade fever
- 6 weeks- 6 months
- nausea
- Fatigue
- (28-160 days)
- hepatomegaly - average- 70-80 days
NCMB 312 FINALS!!!
Note: Has tendency to go chronic, cirrhotic, CA
 HEP B Vaccine for pre –exposure
 POST EXPOSURE PROPHYLAXIS
Hep B immunoglobulin and vaccine ASAP to 72hrs post

Percutaneous, permucosal routes) contaminated blood, exposure.
Semen , vaginal secretions, saliva
o s/s 14 days after sexual exposure to non immune people
who have close contact with Hep B patient
- jaundice
- hepatomegaly (12-14 cm vertically) (needle prick, sexual contact)
- pale stools If mother has Hep B, her newborn should be given Hep
- Lethargy B vaccine and immune.with this treatment, less than
10% of infants become infected with Hep B
- Nausea
- arthralgia
more than 90% develop antibodies and recover
spontaneously in 6 months.
10% of patients progress to a carrier state or develop
chronic hepatitis with persistent HBV infection and
hepatocellular injury.
Medical Mx 3. Hepatitis C
 Tx
- Rest
- Nutrition
- no alcohol
- alpha-interferon as the single modality of Syn: Post-transfusion hepatitis, multiple drug use,
therapy that offers the most promise. A Transmission possible with sex with infected partner;
regimen of 3x weekly for 16 to 24 weeks  MOT:
result in remission
-percutaneous
-antiviral agents-  Population at risk
 lamivudine (Epivir)
- Healthcare workers
 Adefovir (Hepsera), oral nucleoside analogs
- Blood recipients
NCMB 312 FINALS!!!
- Drug addicts E- EAT LOW FAT , HIGH CARB
 Incubation period: P- PERSONAL HYGIENE NO SHARING
- 2 weeks- 6 months-
A- ACTIVITY CONSERVATION- REST
- 15–160 days- Average: 50 days
- Transfer from mother to baby T- TOXIC PRODUCTS AVOIDANCE- ALCOHOL,
ASPIRIN, SEDATIVES, ACETAMINOPHEN
- IV drug use, multiple blood transfusion
I- INDIVIDUAL BATHROOM
NOTE: Tendency to go Chronic > CA!!!
4. Hepatitis D
- IV drug use
 Transmission T- TESTING RESULTS (ALT,AST,.
- parenteral co infects with HVB to replicate BILIRUBIN,AMMONIA)
5. Hepatitis E
- Water borne
I- INTERFERON/ IMMUNIZATION
- Fecal oral
S- SMALL FREQUENT MEALS
- Resemble HVA
- No chronicity
o Dx:
- Liver function Test- determine extent of liver
damage
- ALT/SGPT- Alanine Aminotransferase
- Hepatitis Profile
o Tx:
- Symptomatic and supportive
- Antiviral: lamivudine  OD x 1 yr
- Interferon 3x a week for 6 months
o Nursing Care:
1. CBR
2. Nutrition: inc. CHO in diet
o Preventive:
1. Immunization
2. Universal precaution
H- HAND WASHING
Oncologic nursing
NCMB 312 FINALS!!!
12/6/21 - in HIV – AIDS patient
- the patient is immune compromised
- Study about cancer & cancer patient
o Tumor terminology
TUMOR ( NEPOLASM )
- Mass
Suffix - OMA
NEO – new
PLASM – growth
 Benign
 Malignant - Cancer
o Theories
1. Cellular differentiation theory
- It Arises from the changes that we have , adaptation
or adjustment
- Benign growth patterns
o HYPERTROPHY
 increase in the size of the cell
o HYPERPLASIA
 in the number of cells
o METAPLSIA
 change in one cell type to another cell
type
o DYSPLASIA - Precursor of cancer Carcinogenesis
 Abnormal changes in the cell
o ANAPLASIA
 Loss of cellualr differentation  Initiation
 Exposure to initiating agents
( carcinogens
 Promotion
 Carcinogens cause unregulated
accelerated growth in previously
initiated cells :reversible
 Progression
 Tumor cells acquire malignant
characteristics
RISK FACTORS :
1. Hereditary – oncogenes
2. Obesity age
2. Failure of the immune response theory
3. Smoking
Failure of the immune response theory 4. Alcohol
5. Radiation
o Kaposi’s sarcoma 6. Chemicals
NCMB 312 FINALS!!!
7. Microbes
- HPV, HBV , HCV
- H, pylori
8. Food ( process foods , preservatives , high
fat , low fiber
o Labile cells – rapidly dividing

- Pag mahaba G0 mas mabagal sila mag divide
CHARACTERISTIC OF CANCER CELLS - Pag maiksi yug G0 mabilis sila mag divide
- Cell cycle time
- Altered cell differentiation

- Appearance change
 Cancer cells vary in size and shape Carcinogenic factors
( pleomorphism )
 Abnormal nuclei or multiple nuclei
 Abnormal number of chromosomes  Heredity
( aneuploidy )  Hormonal factors
 Abnormal chromosome arrangement  Bacteria and parasites
 The more undifferentiated , the more  Oncogenic viruses
aggressive a malignant cells  Immune system deficiency
- Altered metabolism  Environmental factors
 Production of surface enzymes that aid  Chemicals
in invasion and metastasis  Radiation
 Higher rate of anearobic glucosis
 Production of abnormal growth factor
ROUTE OF SPREAD
 Inappropriately seceret hormone r - Lymphatics
hormone like subtance resulting in - Blood vessels
paraneplastic syndrome - Direct seedingDirect seeding
- Tumor specific agents MOST COMMON CANCER IN THE PHILLIPINES
 Proteins marking the cancer cells as
- Breast cancer .
“non-self”
- lung cnacer
- Altered cellular function
Normal control mechanism fail to stop
- cervical
proliferation of cancer cells - colorectal
 Loss of contact inhibition - prostate
 METASTASIS- hallmark of cancer - adult leukemia
o TUMOR GROWTH - head &neck
- Cell cycle - thyroid
- note :read other types of cancer sa module !!
- LEVELS OF CARE
Primary level - Prevention
NCMB 312 FINALS!!!
Secondary =0-4 ng/Ml (normal value )
4. Colorectal cancer
 Screening
- (Anal )
 Detection
 Diagnosis
- DRE 50y/o annualy
 treatment - Colonoscopy – 5 years
Tertiary - Palliative treatment 5. Cervical cancer
- Papsmear
Diagnostic TEST  Class 1 -normal
 Class 2 - inflammation
o Prevention , screening and detection
 Class 3 - dysplasia
MEMORIZE !!!!! - Warning singns of cancer .  Class 4 - probably malignat
C - changes in bowel or bladder habbit (bladder cancer )  Class 5 - malaignant
TUMOR MARKERS
A - a sore that does not heal (skin cancer )
a. Prostate specific antigen
U - unusual bledding or discharge b. S-100 – melanoma antigen
( cervical cancer , uterine cancer) c. Thyroglobulin
T- thickening or lump in the breast or else where(bukol) d. CA 15 – 3 / CA 27 – 29 – breast cancer
e. Carcinoembronic antigen ( CEA)/CA 19-9
I – indifestion & difficulty of swallowing colorectal cancer
f. CA 125 – ovarian cancer
Diagnostic IMAGING
O – obvious changes in warts & moles

1. X ray
LEVELS OF CARE 2. Mammography
3. CT scan
N – nagging cough & hoarseness 4. Ultrasound
5. Nuclear medicine
U – unexplained anemia
6. Position emission tomography
S – severe weight loss 7. Lymphoscontigraphy
8. MRI
1. Lung cancer
- CHX
- 40 y/o and above anually
2. Breast cancer STAGING OF CANCER
- Breast self examination (BSE) monthly
After menses
- Process of describing the extent or spread of a
- Clinical breast exam disease from its origin
- <40 y/o – every 3 years
- >40y/o – yearly a. Surgical staging
- Mammography ( pag may mass ) - Utilizes invasive surgical techniquies to actually
3. Prostate cancer visualize structures and assess the extent of the
- DRE ( digital rectal exam ) done to men disease .
40 annually b. Clinical staging
- PSA( prostate espicific antigen )
NCMB 312 FINALS!!!
- Based on professional judgement and measurement Stage 1 - confined to the tissue and small, it has not
of primary tumor’s size , location in the body and spread Stage
evudence of the disease through physical
examination
Stage 2 - with increase growth of cancer, has not
spread Stage
c. pathologic staging
- the pratice of examintion of the tissue of interest Stage 3 - larger and has spread to surrounding tissues
both grossly and mcroscopically to evaluate its and LN Stage
characteristic and make an assessment a to the
Stage 4 - with distant metastasis
GRADING OF CANCER (type of cells / agressiveness
aggreassiveness of the malignant tumor TNM staging
T – tumopr size
N – nodal involvement Grade 1 – well differentiated
M – metastasis Grade 2 – poorly differentitaed

MODALITIES OF TREATMENT Grade 3 – undifferentiated ( very aggressive )
T1 – T4 a. Surgery
- As the branch of medicine that uses maual and
No- no nodal involvement
instrumental to deal w/ the diagnosis and
N1 – w/nodal involement treatment of injury , deformity , & disease
 Prevent a cancer occurenc in the high – risk
Nx – nodal involmenet cannot be assessed
patient
Mo – no mets  Diagnose a primary or metastatic of
malignancy
M1 – w/mets  Provide a primary or secondary treatment of
Mx – mets cannot be assessed an identified malignancy
 Provide a route of administration of theraphy
 To rehanilitate by means of reconstruction
Stage 1 – tumore confined to an area intervention
 To offer palliative care through symtom
Stage 2 – w/ local nodes management in advance cancer .
Stage 3 – 2/ regional nodes b. Chemotherapy
c. Radiation
Stage 4 – w/ distant nodes d. Biotherapy
e. Stem cell therapy
STAGING
Stage 0 - the cancer is where it started ( in -situ ) , it

has not spread
NCMB 312 FINALS!!! CHEMOTHERAPY
NURSES ROLES IN THE CARE OF SURGICAL ONCOLOGY related to new and possibly unidentified needs of
a. To identify risk factors or behaviors that prompt a the cancer patient.
[reventive surgical procedure
b. Nurses must understand the fundamentals of
surgical oncology
c. Plat role during the initial assessment and • is the use of cytotoxic drugs in the treatment of
evaluation of symptoms , testing , and diganosis
cancer.
throughtout the preoperative , intraoperative ,
• Its function is to kill tumor by interfering with
and post operative care or primary or secondary
cellular functions and reproduction
surgical procedure .
d. Nurses must be instrumental in the - Systemic Treatment rather than localized
identification , planning , implementaion , and treatment
evaluation phases of surgcial treament . GOAL
e. To provide a comprehensive plan of care and  CURE- To cure tumor and cancer, to disappear and do
enhance patient outcomes. not re-occur
 CONTROL- To control or to stop the cancer from
growing and spreading.
 PALLIATION- If / when cure and control is no longer
Cell cycle generation possible, its goal is to relieve symptoms caused by
HISTORCAL PERSPECTIVE
 G1 Phase - the phase where RNA and protein cancer.
- Surgery in the mid eighteenth century provided the
synthesis occur.
era of observation and
 S Phasediscovery
- the phase of thewhere
clinicDNA synthesisfeatures
- pathologic occur. of
Factors influencing chemotherapy selection and
 G2 Phase - pre-mitotic
malignant tumors.phase. For further protein administration
-synthesis
Surgeryinispreparation
the oldest cancer intervention, and one
for mitosis  Blood-Brain Barrier
that has offered the
 M Phase- Mitosis and cell division. - inhibit certain substances from entering the brain or
possibility of cure. CNS.
 G0 Phase- resting phase
- Historically, cancer surgery can be traced back over - Intrathecal route (Omaya reservoir / lumbar puncture)
5000 years toTumor treatment of
growth
• Doubling breasttime cancer,
– timealbeit primitive,
required in the
to reach pre -size.
certain
anesthesia era.
• Micrometastasis- the possibility for the tumor to
- In 1809, Ephraim
th th
MacDowell excised a massive
shed cells (7 -10 )
ovarian tumor, which initiated
Gompertzian thefunction
prospect- of a pattern
successfulwhere doubling
cancer time is
surgery.
more- rapid
Elliot, in 1822,
during reported
the early microscopic examination of a
stages.
lymph nodeChemotherapeutic
related to agent Chronotherapy / Circadian Rhythm
breast Ca cases - regular repeated fluctuation in biologic functions during
1. Adjuvant therapy- chemotherapy used in conjunction
- Surgical procedure significantly advanced through the 24 hour period
with another treatment modality and aimed to treat
work of Halted in radical - “diurnal” means events happening in the daytime
micrometastases.
mastectomy; - Circadian Variables
2. -Neoadjuvant chemotherapy-
Billroth in gastrectomy, done to shrink a tumor
laryngectomy - Influence drug absorption, metabolism, distribution
 itPrinciples:
before is removed surgically. and elimination.
- The principles
3. Primary therapy-of surgical oncology,
treatment for patientare based
who havein the
foundations of surgery,
localize cancer, alternative way but less than Cytoprotectants
oncology, nursing, and medicine. - is used to prevent or decrease specific system effects
completely effective treatment.
- Principles create the basic framework, but rapidly related to drug therapies.
4. Induction
advancing chemotherapy
scientific and- primary treatment for (cardiotoxicity,nephrotoxicity)
patients technologic
who have cancer methodsfor may
which no alternative
change the
treatment exist.
identification or ranking of principle  It protects normal tissues from cytotoxic effects
Combination
5. JDM JDM JDM JDM therapy
JDM -JDM combination
JDM JDMof JDM2 orJDM
more JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM JDM
agents / drugs to treat cancer.
6. Myeloablative therapy- dose intensive therapy used
in preparation for peripheral blood stem cell
transplantation.
NCMB 312 FINALS!!!
of drugs or irritation while preserving their anti- - secreted by the endocrine glands
tumor effects Affecting the cell membrane permeability, manipulating
Liposomes hormone levels, tumor growth can be suppressed.
- use to enhance drug delivery to specifically target - not cytotoxic and not curative and
tissue  purpose
- prevent cell division
- prevent further growth of hormone-dependent
tumors.
- anti-androgen, antii-estrogen
Nitrousoureas
- Action is similar to alkylating agents, inhibits
synthesis of DNA & RNA
- Carmustine
Monoclonal antibodies
• Destroys cancer cells and spare normal cells.
- Rituximab, Gentuzumab
Chemotherapy drug classification

Cell Cycle Phase- specific
-
Most effective against actively growing tumors
that have greater proportion of cell cycling.
(the drugs attack the cell).
- Mostly affect the cell in S phase by interfering Drug calculation
DNA & RNA. - The calculation of the Drug Dosage is based on the
o anti-metabolites - interfere or block essential body surface area (BSA) in both adult and children.
enzymes necessary for DNA and RNA synthesis - BSA is calculated in square meter. (m2)
(cyclophosphamide) - Patient’s BSA (m2) x drug dose (mg)
1.73m2
Cell Cycle Phase- Non specific Adult drug dose = 100 mg child bsa= 0.83m2
- Active in all phases of the cycle and maybe Child dose = 0.83m2 x 100 mg =47.97 or 48 mg
effective in large tumors that have few active 1.73m2
cells dividing at the time of administration.
- It has long acting effect on the cells. Resulting o Body surface area
damage or death to the T- cells.
o Alkylating agents – preventing mitosis. Bond to (height (cm) x weight (kg))
nucleic acid that interfere its duplication. BSA (m2) / 3600
- Carboplatin
o Antibiotic (anti-tumor agents) – disrupt DNA
transcription and inhibit DNA and RNA synthesis.
- Dactinomycin
Hormonal Agents
NCMB 312 FINALS!!!
ROUTS OF MEDICATION
ORAL – most convinient
- Need patinet complaince w/ the predescribe schedule
- Plan for drugs w/emetic potential to be taken w/ meals
Subcutaneous and Intramuscular
- Drugs is injected into the muscle SAFE ADMINISTRATION
- Injection site should be rotated for each dose and 1. Chemo drugs are dangerous
log kept on the dose schedule. 2. There should be NO CONTACT w/ it
3. Pregnant should not undergo chemotherapy
IVTRAVENOUS (IV)
- Most common Note : pregenant women cannot take chemotherapy
- Medication is given directly to the vein
- In some drug it is the most feasible according to their
chemical structure Preparing chemotherapy drugs
- It has the faster effect 1. Prepare in well-ventilated area
- Can be perform “Bolus” or “Short or Long term infusion” 2. Wash hands before and after procedure
~ Peripheral venous access 3. Wear gloves at all times
~ Central venous access 4. Wear gown
~ Percutaneous line 5. Wear face shields
~ Peripherally inserted central catheters (PICC) 6. Wrap gauze or alcohol pad around ampules neck
~ Implantable devices (port-a- caths) 7. Label prepared medication
~ Tunneled venous access devices (Hickman 8. Wrap gauze around injection site when
catheter) withdrawing syringe
INTRA ARTERIAL 9. Dispose in a leak and puncture proof container
- Ommaya reservoir or implantable pump 10. Do not eat, chew and smoke when preparing
~ Agents are administered directly into the medications
cerebrospinal fluid. Usually as prophylaxis in
leukemia or lymphoma.
- Catheter placement in artery near the tumor
Intracavitary
- Instill the drug into the bladder through the catheter
or into pleural cavity via chest tube.
Intravesical
- Therapy for bladder cancer, drugs are puut directly
into the bladder through a catheter.
Topical
- Cover surface area w/ a thin film of medication,
instruct the patient to wear loose fitting cotton
clothing, wear gloves and wash hands thoroughly
after the procedure.
- Commonly prepared as ointments and
usually used to treat sun cancers.
NCMB 312 FINALS!!!
for at least 5 minutes.
- Follow agency guidelines regarding follow up
care with a clinical eye exam
Management of chemotherapy spills

1. Should be clean up immediately by properly
protected personnel and must be trained.
2. A spill should be identified w/ warning sign so
that other people will not be contaminated.
1. Procedure for spill on hard surface, linen, COMMON SIDE EFFECT OF CHEMOTHERAPY
personnel or patient. Nausea & vomiting
- Restrict the area of spill - Mos common for the first 24-48 hrs
- Obtain the drug spill kit
- Delayed N&V! week after chmotherapy
- Put on PPE and if powder spill involved
 Cause unknown
use respirator mask
 Activation receptor
- Open waste disposal (double the bag and
 Stimulation of the peripheral autonomic
put a label on it)
and vertibular pathways Serotonin
Management
Spill on linen
1. Oral hygiene
- remove soiled, contaminated linen from the patient. 2. Assess for dehydration ( anti emetic)
- Place the linen in an appropriate, approved, 3. Ice chips
especially marked, impervious laundry bag. 4. Round the clock medication
- should be washed twice and laundry personnel must
wear latex gloves and gown when handling this Alopecia
material - Begins 2-3 weeks
- clean contaminated area with absorbent and - Ends after 3 months / regrowth of the hair may
detergent solution. begin in 8 weeks.
Spill n Personnel or Patient Management
- Wigs for female, cap for male
- immediately remove any contaminated protective
garments or linen. - Pre - emptive hair cut
- wash the affected area of skin with soap and water. Stomatitis
- follow procedure for contaminated linen.
Management
- notify the physician if there is a drug spill oon the
- Inspect mouth routinely
patient.
- Oral care (saline)/ soft bristle toothbrush/ do
- place all contaminated materials in doubled-bag
not use listerine
waste disposal bag.
- Avoid spicy and citrus foods
- discard the waste bags and contents in approved
- Provide ice chips and popsicles
container.
- Soft bland diet
- then wash your hands thoroughly with soap and
- Viscous lidocaine (adult)
water.
contraindicated to child, it reduces gag reflex
Eyes Exposure
- Immediately flood the affected eyes with water
NCMB 312 FINALS!!!
Anorexia Phlebitis (venipuncture) (48 hours
- Makes the food taste metallic (meat) Anaphylaxis
Management - Aminophyline, Dipenhydramine hydrochloride,
- Place patient in comfortable position Dopamine, Epinephrine, Heparin, Hydrocortisone
- Maintain good hygiene - O2 set-up, tubing cannula or mask and airway
- Serve food atractively devices
- Suction equipment
- Provide general comfort
- IV fluids – isotonic solutions
- IV tubings and supplies for venous access
Anemia - - anxiety, hypotension, urticaria, cyanosis,
Management respiratory distress, abdominal cramping, flushed
- Assess skin for pallor appearance and chills.
- Schedule activities w/ rest periods !!!stop the drug infusion
- Administer erythropoietin as ordered = maintain IV line, isotonic saline
- Blood cells – BM supression = Position comfortably to promote perfusion of the
- ¯ RBC – anemia vital organs
- ¯ wbc infection = notify the physician
¯ platelets – bleediong = maintain airway and anticipate the need for
cardiopulmonary resuscitation
- Methrotrexate – inhibit = monitor vs
= administer medication as prescribed
MEDICAL MANAGEMENT
= follow the institution protocol for follow up care
Neutropenia = document
1. Check the
for Phlebitis
incident in
andpatients
Vesicant
medical record.
Management
extravasation (leak of drug into subcutaneous
- Assess sign of infection - Fever
tissue) (pain, necrosis, sloughing of tissues)
- Abnormal lung sound - Cough
2. High calorie and hiigh protein diet
- Practice cleanliness - Handwashing before
3. Encourage hydration
and after procedures
4. Monitor cbc
- No flowers, fish, fruits, vegetables and raw fruits
Oral examination for stomatitis
1. Teratogenic
Thrombocytopenia 2. Hair loss concerns
3. Encourage counseling
Management
4. Report complications
- Assess skin and mouth for sign of bleeding
5. Administer anti emetic drugs
- Check stool and urine for blood
Practice aseptic techniques at all time
- No shaving
- No suppositories and enema Note : !!CBC must be taken before under go
- Gentle oral care chemotherapy
- AVOID SEX ( bleeding )
Dx test (diagnotis test )
Tumor marker identification
Watch out for - Analysis of substances found in the body
Vesicant Etravasation tissues, blood and other body fluids that are
- Leak of chemo drugs to subcutaneous tissue made by tumor.
that causes pain, necrosis and sloughing of - Breast cancer
tissues - Colon cancer
- Lung cancer
Flare - Ovarian cancer
- Localized allergic reaction, without pain and - Prostate cancer
marked with red blotches along the vein line.
NCMB 312 FINALS!!!
- Testicular cancer
Mammography
- for breast cancer
Magnetic Resonance Imaging (MRI)
- Neurologic Cancer
- Pelvic Cancer
- Abdominal Cancer
- Thoracic Cancer
Breast Cancer
Flouroscopy
- Used of x-ray that identify contrast in body
tissue
- Skeletal Cancer
- Lung Cancer
- Gastrointestinal Cancer
Position Emission Tomography
- Lung
- Colon
- Liver
- Pancreatic
- Hodgkin and Non Hoodgkin
- Lymphoma
Endoscopy
- for diagnostic and therapeutic purpose
• Bronchial
• G.I Cancer
1. Encourage counseling
2. Report complications
3. Administer anti emetic drugs
4. Practice aseptic techniques at all time o Metrotrexate
- Can use of rheumathoid ..
NCMB 312 FINALS!!!
NCMB 312 FINALS!!!
NCMB 312 FINALS!!!
RADIATION THERAPHY
- Kill the cancer cells .
o GLUCOCORTICOIDS, ESTROGEN, PROGESTINS

SERM (Selective Estrogen Receptor Modulators )
- TAMOXIFEN. TOREMIFENE
o SERD (Selective Estrogen Down Regulators )
- FULVESTRANT
o AROMATASE INHIBITORS
- LETROZOLE, ANASTROZOLE
- ANTIANDROGENS
- FLUTAMIDE
- GRH ANALOGUE
- NAFARELIN.
- 5 ALPHA REDUCTASE INHIBITORS
- FINASTERIDE
NCMB 312 FINALS!!!
NCMB 312 FINALS!!!
TYPES OF RADIATION THERAPY
o External radiation theraphy

- Pag uuwi si patinet hindi sya radio active
a. ..
b. ..
- Expose of a bim radiation
o Internal
Makinig knanalng sa record bilis ni doc
NCMB 312 FINALS!!!
BONE MARROW & STEM CELL TRANSPLANT » Bone marrow is obtained by performing multiple
puntures with a large-bore needle into the patient's
(hematopoietic stem cell)
posterior and occasionally the anterior iliac crests.
- The soft spongey tissue found in the .
- .. - Less common
- Is a process of replacing disease or damage marrow
w/ normally functioning bine marrow .
- ..
The 2 Main Types of Transplant

Autologous
» Is a transplant in which the patient's own bone

marrow ox stem cells are collected (harvested), placed
in frozen storage (cryopreserved) and reinfused into the
patient after the conditioning regimen.
 The Patient is his own donor. Allogenic a

transplant in which the patient's receives
someone else's bone marrow or stem cells.
Types of Allogenic Transplant
 Syngeneic
- A patient is given stem cells from their twin or
triplet Related
- The donor related to the recipient's, usually a
sibling
 Unrelated
- The donor is no relation to the recipient
Peripheral Blood Stem Cells

» Peripheral Blood ( PBSC)
More Common
» Bone Marrow
- requires growth factors (G-CSF)
» Umbilical Cord
- apheresis procedure
Bone Marrow Harvest - no anesthesia
- stem cells engraft faster
» aspirated from the donor's pelvis. This procedure
occurs in the operating room under patients general - Higher chance of GVHD
anesthesia. Umbilical Cord Blood Stem Cells
NCMB 312 FINALS!!!
- removed from the umbilical cord andplacenta after
the baby no longer needs them
- birth, collected, tissue-typed,processed and stored
frozen
- no access to donor
- unknown genetic disease
- Expensive!
Diseases Treated with Hematopoietic Stem Cell

Malignant:
Acute / Chronic Myelogenous Leukemia(AML)(CML)
Acute Lymphocytic Leukemia(ALL) Juvenile

Myelomonocytic Leukemia(JMML) - Myelodysplastic
syndrome(MDS) » Hodgkin's disease -Non-Hodgkin's
Lymphoma(NHL)
Multiple Myeloma
Renal Cell Carcinoma Neuroblasto ma Testicular Cancer

Ewing's Sarcoma
Bilis nanaman ni doc
NCMB 312 FINALS!!!
BIOTHERAPHY • IFN-a and IFN-B
- are produced by leukocytes and fibroblast
- A treatment with agents derived from
meanwhile IFN-y Is produced by T-
biological responses and sources.
Lymphocytes. • IFN-y is more potent in
- A treatment of disease using substances
activating macrophages.
obtained or derived from living organisms.
Interferons (IFN)
- IN have a wide range of biologic effects
Note : BCG ( can give)
including
- Antiviral
Approaches of Biotherapy
- Antiproliferative
o Active Immunotherapy - giving tumor-
• Immunomodulatory
bearing host agent that are designed to elicit
• Antiviral: Renders uninfected cells resistance to
an immune response to retard or eliminate
attack by the virus.
tumor growth.
• Antiproliferative: Extends all phases of the cell
- Specific - immunization with tumor cell or
cycle and lengthens
tumor cell extracts as antigens or vaccines.
overall cell generation time.
- Non-specific - to boost overall immunity
• Immunomodulatory: Increases the potential of
through adjuvants.
NK cellsN
o Passive Immunotherapy - administration or
transfer of previously sensitized immunologic
reagents or immune reactive cell to a tumor-
bearing host.
o Adoptive Immunotherapy - transfer of
sensitized cells.
Major agents used in Biotherappy

1. Interferons (IFN)
2. Lymphokines-Interleukins (LI-2)
3. Hematopoeitic Growth Factor (HGF)
4. Monoclonal Antibodies (MoAb).
5. Radioimmunotherapy
6. Epidermal Growth Factor Receptor -
Tyrosine Kinase Inhibitor (EGFR-TKI)
7. Angiogenesis Factor
Interferons (IFN)
- Is a family of glycoproteins hormones
possessing pleiotrophic biologic effects.
3 major classes
1. Alpha (IFN-a)
2. Beta (IFN-B)
3. Gamma (IFN-V)

NCMB 312 Finals! (2.0)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

NCMB 312 Finals! (2.0)

Uploaded by

Copyright:

Available Formats

TYPHOID FEVER

NCMB 312 FINALS!!!

1. Maintenance of fluid and electrolyte imbalance

Dx. VIVOTIF – in capsule form

(side effect is bone marrow depression)

o Fecal oral route

- Intestinal inflammation , primarily of colon

1. Bacillary dysentery – shigellosis CHOLERA ( EL TOR)

Pathognomonic sign – RICE WATER STOOL

 CDT Vaccine (Cholera/Dysentery/Typhoid)

Nursing Care:  Control of fever

- infectious hepatitis 2. Hepatitis B

- hepatomegaly - average- 70-80 days

Note: Has tendency to go chronic, cirrhotic, CA

 HEP B Vaccine for pre –exposure

 POST EXPOSURE PROPHYLAXIS

Hep B immunoglobulin and vaccine ASAP to 72hrs post

o Labile cells – rapidly dividing

- Altered cell differentiation

Primary level - Prevention

O – obvious changes in warts & moles

N – nodal involvement Grade 1 – well differentiated

M – metastasis Grade 2 – poorly differentitaed

Stage 0 - the cancer is where it started ( in -situ ) , it

Chemotherapy drug classification

Management of chemotherapy spills

o GLUCOCORTICOIDS, ESTROGEN, PROGESTINS

o External radiation theraphy

Makinig knanalng sa record bilis ni doc

The 2 Main Types of Transplant

» Is a transplant in which the patient's own bone

 The Patient is his own donor. Allogenic a

Types of Allogenic Transplant

Peripheral Blood Stem Cells

Diseases Treated with Hematopoietic Stem Cell

Acute / Chronic Myelogenous Leukemia(AML)(CML)

Acute Lymphocytic Leukemia(ALL) Juvenile

Renal Cell Carcinoma Neuroblasto ma Testicular Cancer

Bilis nanaman ni doc

Major agents used in Biotherappy

You might also like