Cellular Aberration : cancer (neoplastic disorder)

Cell:
● Osteoblast - form bones (1)
● Osteoclast - dissolve bones (multi)
(N) Mitosis - Cell division
(ABn) Metastasis - Spread of cancer cells in the body

Tumors
● Benign - Harmless and slow in growth
● Malignant - Harmful and rapid growth

Biopsy - Confirmatory test

Microscopy - Cytologic study
1. Aspiration - needle
2. Incisional - tissue sample
3. Excisional - whole tumor
Procedure:
● Invasive - explain
● Consent
● Anesthesia
● Sedation

Staging:

Tumor SIZE

T0 No tumor

Tx Cannot be identified

Tis In situ

T1 <2 cm

T2 <5 cm

T3 >5 cm

T4 >5 cm with metastasis

Nodes # of lymph nodes

N0 No LN

Nx Cannot be Identified

N1 </=4

N2 >4

Metastasis (with or without metastasis)

M0 No metastasis

Mx Cannot be Identified

M1 With metastasis
Gastric Cancer
Risk Factors
● Alcohol
● Family history
● Smoking - Polycyclic hydrocarbons
● Highly seasoned food
● Carcinogens:
○ Benzopyrene - overcooked foods
○ Nitrosamines - preservatives
○ Aflatoxin - peanut
An anastomosis is a surgical connection between two structures.
A Billroth I is the creation of an anastomosis between the duodenum and the gastric
remnant (gastroduodenostomy).
A Billroth II operation is constructed by sewing a loop of jejunum to the gastric remnant
(gastrojejunostomy).
Dumping Syndrome:
● Increase Gastric Motility
● Increase peristaltic movement
● Hyperactive bowel sounds
● Tachycardia
● Palpitations
● Diaphoresis
● Diarrhea
Colon Cancer

RISK FACTOR FOR COLON CANCER

Lack of regular physical activity.
A diet low in fruit and vegetables.
A low-fiber and high-fat diet, or a diet high in processed meats.
Overweight and obesity.
Alcohol consumption.
Tobacco use.
Management
WOF: Perforation (peritonitis)
➢ Fever
➢ Abdominal rigidity
➢ Board like abdomen
➢ Dullness - percussion
Chemotherapy
Radiation Therapy
Surgery: Colon Resection
Stoma!
● Red moist (pinkish)
● Petroleum jelly gauze
● AC - Liquid
● TC - Semiformed
● DC - Solid
Bladder Cancer

Risk Factor
● Male
● Older than 65
● Smoking
● Chronic bladder problems
Chemotherapy
● Kills cancer cells
● Lack specificity
● Kills normal cells
● More likely to kill cancer cells
● Attract to rapidly dividing cells
Side effects:
● Nausea and vomiting
● Alopecia
● Immunocompromised - neutropenia
● Diarrhea
● Anemia

Management:
● Nausea and vomiting - anti emetics before N&V
● Diarrhea - IVF - replacement
● Avoid large crowds
● Avoid fiber - diarrhea
● WOF: uric acid - allopurinol
 ● WOF: platelet - 150k to 450k bleeding!
● Alopecia - temporary (several months after) - wig make up - before alopecia
● Phlebitis - inflammation of Blood Vessels - change access
DONTS
-never a pregnant nurse
-goggles, gloves, gowns, mask
-disposal hazardous containers

Radiation Therapy
● High dose radiation - treatment
● Reduce the size of the tumor
● Brachytherapy - internal
● Teletherapy - external
“Tele from a distance”
Side effects:
● Fatigue
● Alopecia
● Skin changes
● Taste alteration
● Sore throat
Testicular Cancer

Pain management:
● Relaxation (deep breathing)
● warm/cold
● Analgesics
Chemotherapy
Radiation Therapy
Surgery: Orchiectomy
(Unilateral/Bilateral)
● Family planning
● Avoid heavy lifting
Prostate Cancer
Cervical Cancer

Management:
● Chemotherapy
● Radiation Therapy
● Surgery: Hysterectomy, TAHBSO

A hysterectomy is a surgical procedure to remove the womb (uterus).

Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) is
removal of the uterus, cervix and both fallopian tubes and ovaries.
Breast Cancer:

Management:
● Position - Semi-fowler’s
● Administer tamoxifen as ordered
● Chemotherapy
● Radiation therapy
Surgery:
● Lumpectomy - removal of lump
● Mastectomy - Lump + BT + nipple + ALN
-Lymphedema/arm edema
-Elevate
Lung Cancer

● Priority - Airway
● Administer bronchodilators
● O2 - 2 to 3 Liters per minute
● High Fowler's to maximize lung compliance
● Chemotherapy / Radiation therapy
● Surgery: Lobectomy/ Pneumonectomy
A lobectomy is a surgical procedure where an entire lobe of your lung is removed
A pneumonectomy is a type of surgery to remove one of your lungs because of cancer,
trauma, or some other condition. You have two lungs: a right lung and a left lung.
Laryngeal Cancer
Blood Cancers:
● Hodgkin's - lymph nodes
● Multiple Myeloma - Cancer of the plasma
● Leukemia - Hematopoietic stem cells
Multiple Myeloma: cancer of the plasma

Leukemia
Hodgkin’s Disease
Increase Intracranial Pressure

CSF- 50% is glucose dipstick- glucose test

CerebroSpinal Fluid Function:

-Cushion
-Shock absorber
-Ventricles (CSF is primarily produced by the choroid plexus of the ventricles)
-Circulating
-Epidural spaces

Enclosed- Monroe Kelly H.

Causes:
● Tumor- space occupying lesion
● Inflammation
● Trauma
● Infection

Values:
Normal= 7-19 mmHg
Inc CSF= 20 mmHg
21 mmHg- NCLEX

newborn= 18 months = hydrocephalus

S/S: Pain, Headaches, Confusion

VS:
Hyper2 brady2 (ej tetrads)
-hypertension
-hyperthermia
-bradycardia
-bradypnea
Decorticate- Non-functional Cortex
Decerebrate- Lesion on Brainstem

Management:
-No other position just SEMI FOWLER’S

Activities to avoid:
Coughing, sneezing, straining, valsalva maneuver, vomiting, shivering
Exercise: exception - PROM

Meds:
Diuretics- osmotics (mannitol)
Pain- morphine sulfate (resp dep) give Alfentanil
Antipyretics - fever
Antiemetics - vomiting
BP - medications (anti-HPN)
Seizure
A seizure is a burst of uncontrolled electrical activity between brain cells (also called
neurons or nerve cells) that causes temporary abnormalities in muscle tone or movements
(stiffness, twitching or limpness), behaviors, sensations or states of awareness.
Medication: Anticonvulsant agents
● Phenobarbital -Phenobarbital is a prescription medicine used to treat and prevent
the symptoms of seizures
● Phenytoin (dilantin) is used to control seizures (convulsions) in the treatment of
epilepsy. It is also used to prevent and treat seizures that occur during brain surgery.
Side Effect:
● Gingival hyperplasia
○ Frequent oral care
○ Soft bristled toothbrush

Stroke - CVA, Brain attack (cerebrovascular accident)

Heart

Layers- epicardium, myocardium, endocardium

PERICARDIUM: Viscera (Inner) and Parietal (Outer)
Pericardial fluid: cushion (15-20ml) increase= Tamponade- mahihirapan ang puso magpump
Systolic murmur- lub pfff dub
Diastolic murmur- lub dub puff
Atrioventricular (AV) valves
-mitral valve (bicuspid valve)
-tricuspid valve
Semilunar (SL) valves
-aortic valve
-pulmonary valve

Right Congestive Heart Failure Left Congestive Heart Failure

DJV (Distended Jugular Vein Crackles

Hepatomegaly Hemoptysis

Splenomegaly Orthopnea

Generalized edema Pulmonary edema

Electrical Conductivity of Heart

Sinoatrial node (SA) =60-100 PACEMAKER
Atrioventricular node (AV)= 40-60
Bundle of HIS= 40-60
Purkinje Fibers= 20-40

Coronary Circulation
RCA - SA node
LAD- anterior
Circumflex- sides

CAD
-Adventitia
-Media
-Intima
-lumen

Fail safety artery

-Collateral circulation (take over if major artery have problem)

Myocardial Infarction

Causes:
-Coronary Artery Disease (CAD)
-Coronary Dissection
-Coronary Spasms

Detection:
1st- inc myoglobin
2-4hrs - troponins - gold standard (T-widely, I-specifics)
4-6hrs - Creatinine Kinase-Myocardium,Brain (CK-MB)
6-8 - ECG abnormalities
12-36 hrs - Inflammation

Inflammation:
-dys/arrhythmias
-pump failure - hypotension (cardio shock)
-pericardial friction rub (WOF) - pericarditis

S/S:
PAIN
-crushing, intense, heavy (elephant), feeling of an impending doom

Angina MI

Mild-moderate pain Severe pain

No Nausea and vomiting With Nausea and vomiting

With triggers Not necessarily

No inc SNR Inc SNR

Nitroglycerin can relieve Not relieve by Nitroglycerin

Nitroglycerin can be given 3 times INTERVAL OF 5 MINUTES

Radiation
-jaw
-left arm
-back

Assess
-type of pain
-radiation of pain
-breath sound
-EKG/ECG -12-leads
Management:
IVF
-fluid replacement
-access
-NGT-Open coronary arteries (subling)
-Morphine-WOF: hypotension, resp depression
-Heparin (anticoagulant) WOF: bleeding
-ABC - Antihypertensive meds
Kidneys pathophysiology
Gastro Urinary Tract
Acute Renal Failure

Diagnostic test:
eGFR measures your kidneys' ability to filter toxins or waste from your blood. A very
low number may indicate kidney failure, which requires dialysis or a kidney transplant.
Hemodialysis is a procedure where a dialysis machine and a special filter called an artificial
kidney, or a dialyzer, are used to clean your blood.

Peritoneal dialysis is ongoing dialysis (daily) that collects waste from the blood by washing
the empty space in the abdomen (peritoneal cavity). It can be done from home.
Chronic Renal Failure

Management:
Diet:
● Low protein
Care:
● Oral - stomatitis
● Skin - frost (itchy prec)- Apply a cold, wet cloth or ice pack to the skin that itches.
● Emotional - chronic
● Fistula - bruit/thrill - N (no BP, no Injections)
Diuretics - loop (1-2) thiazide (3-4-5)

Diagnostic test:
Blood test. The test measures the levels of a waste product called creatinine in your blood.
Urine tests. Analyzing a sample of your urine can reveal abnormalities that point to chronic
kidney failure and help identify the cause of chronic kidney disease.

Treatment:
Perioperative Nursing