ASTHMA
A. Definition
 Asthma is a condition that causes
your airways to narrow and swell,
as well as create excess mucus.
 This can make breathing difficult,
resulting in coughing, whistling
(wheezing) on exhalation, and
shortness of breath.
B. Anatomy
Normal=relax smooth muscles →
dilated lumen → no obstructions
Asthmatic= tightened smooth
muscles→ obstructed airways (excess
mucus)
C. Pathophysiology
Bronchoconstriction airway
inflammation, and mucous impaction
that result ASTHMA
D. Sign and Symptoms
 wheezing, coughing and chest
tightness becoming severe and
constant.
 being too breathless to eat, speak
or sleep.
 breathing faster.
 a fast heartbeat.
 drowsiness, confusion, exhaustion
or dizziness.
 blue lips or fingers.
 fainting.
E. Diagnostic test
 FeNO test - You breathe into a
machine that detects nitric oxide in
your breath, which is a symptom of
pulmonary inflammation.
 Spirometry is a test that involves
blowing into a machine to
determine how quickly you can
exhale and how much air you can
hold in your lungs.
F. Medical management
 Inhaled corticosteroids are still the
most effective anti-inflammatory
drugs for asthma patients.
 Immediate intervention may be
necessary, because continuing and
progressive dyspnea leads to
increased anxiety, aggravating the
situation.
G. Drug study
 Generic Name: Theophylline -
Brand Name: Uniphyl
 Theophylline acts by widening your
lungs' airways. It accomplishes this
by relaxing muscles and lowering
the reaction to chemicals that
constrict your airways. You will be
able to breathe more easily as a
result of this.
 Side effects: headache, trouble
sleeping
 BRONCHODILATOR Albuterol
(Proventil, Ventolin)- to prevent
airway obstruction
H. Nursing Diagnosis
Ineffective airway clearance related to
increased production of mucus and
bronchospasm.
I. Implementation
 Assess airway for patency
 Auscultate lungs for presence of
normal or adventitious breath
sounds ( Decreased or absent
breath sounds, wheezing and
coarse crackles)
 Abnormal Breath Sounds
( Bronchospasm, Expiratory grunt
and wheeze)
 Note for changes in HR, BP, and
temperature.
 Note cough for efficacy and
productivity.
arterial blood gases (ABGs)
 Position the patient upright if
tolerated. Regularly check the
patient’s position to prevent sliding
down in bed
J. Discharge Planning
 A follow-up check up.
 Encourage families to keep an
asthma diary to monitor
Salbutamol use.
 Information regarding smoking
cessation has been provided.
 Beta carotene-rich vegetables, such
as carrots and leafy greens.
 Swimming is one of the most
recommended exercises for people
with asthma
 Walking as a low-intensity activity
 Support Patients Within Their Own
Faith Tradition
 Keep warm and dry also wear
gloves, a scarf and a hat, and carry
an umbrella.
 The ideal room temperature for
asthmatics is between 68 and 71
degrees Fahrenheit (20 and 21.6
degrees Celsius).
EMPHYSEMA
A.Definition
 A lung condition that affects the
alveoli (tiny air sacs).
 The walls of the alveoli are where
oxygen and carbon dioxide are
exchanged in the lungs.
 The alveoli become excessively
expanded in emphysema, causing
damage to their walls and making
breathing difficult.
B. Anatomy
 Group of lung diseases that make it
hard to breathe and get worse over
time.
 Normally, the airways and air sacs
in your lungs are elastic or stretchy.
 When you breathe in, the airways
bring air to the air sacs.
 The air sacs fill up with air, like a
small balloon.
C. Pathophysiology
 The inner walls of the air sacs
(alveoli) in the lungs are damaged,
causing them to rupture.
 This results in a single bigger air
space rather than a series of small
ones, reducing the surface area
available for gas exchange.
 Causes shortness of breath
D. Sign and Symptoms
 Shortness of breath, especially
during light exercise or climbing
steps
 Ongoing feeling of not being able to
get enough air.
 Wheezing
 Long-term cough or “smoker's
cough”
E. Diagnostic test
Chest X-Ray - can assist confirm an
emphysema diagnosis and rule out
other lung diseases.
Arterial Blood Gases Analysis these
blood tests assess how well your lungs
transport oxygen and eliminate carbon
dioxide from your bloodstream.
F. Medical management
For certain individuals with emphysema,
lung transplantation may be a
possibility. Others may benefit from
lung volume reduction surgery, which
involves removing small wedges of
damaged lung tissue.
G. Drug study
Bronchodilator - which are inhaled as
aerosol sprays or taken orally, may help to
reduce emphysema symptoms by relaxing
and opening the air passageways in the
lungs.
Side effects: muscle cramps, a cough,
nausea and vomiting, dry mouth.
H. Nursing Diagnosis
Impaired Gas Exchange related to
alveoli destruction evidenced by
abnormal breathing
I. Implementation
 Assess and check the color of your
skin and mucous membranes on a
regular basis.
 Monitor changes in the level of
consciousness and mental status.
 Monitor O2 saturation and titrate
oxygen to maintain Sp02 between
88% to 92%
 Monitor arterial blood gasses
values as ordered. ( Pa02 usually
decreases, chronic carbon dioxide
retention may have chronically
compensated respiratory acidosis
with a low normal pH and a PaCo2
higher than 50 mm Hg)
 Monitor vital signs and cardiac
rhythm.
J. Discharge Planning
 Follow up check up
 Aerobic exercise can improve your
circulation and help your body use
oxygen more effectively.
 Increase your energy levels so you
can participate in more activities
without getting fatigued or out of
breath.
 Choose whole-grain bread and
pasta, as well as fresh fruits and
vegetables, for complex
carbohydrates.
 Supplemental oxygen
 Side lying position with leg on the
floor bent at knee
 Support Patients Within Their Own
Faith Tradition
CHEST INJURY
A. Definition
 Any injury to the ribs, heart, or
lungs that results from the
inadvertent or deliberate
penetration of a foreign object into
the chest is known as a chest injury
or trauma.
 An unintentional or deliberate
penetration of a foreign item into
the chest might result in a chest
injury.
 Chest injuries are injuries to the
chest wall (the bones, skin, fat and
muscles protecting your lungs,
including your ribs and sternum) or
any of the organs inside the chest.
B. Anatomy
 Trauma to the chest,
 Involves the Heart, lungs, major
vessels, thoracic cage (ribs, thoracic,
vertebrae and sternum)
C. Pathophysiology
 Derangements in the flow of air,
blood, or both in combination
 Sepsis from alimentary tract
contents leakage, such as
esophageal perforations, must also
be examined.
 Chest-wall injuries are prevalent
after blunt trauma.
D. Sign and Symptoms
 Difficulty breathing
 Coughing up blood indicates a chest
injury
 Crunching sounds in the ribs
 Failure of the chest to expand
normally
E. Diagnostic test
Chest x-ray All patients with chest
injuries should have a portable chest
radiograph taken.
A chest radiograph, on the other hand,
has a sensitivity of just 65% for
detecting acute traumatic injuries like
pneumothorax/hemothorax.
F. Medical management
The medical team will assist with
breathing and circulation. It's possible
that you'll be given oxygen and
intravenous fluids, as well as blood
transfusions.
G. Drug study
Artery relaxers such as Nitroglycerin
used to treat episodes of angina (chest
pain) in people who have coronary
artery disease
Side effect: feeling of warmth or heat,
Headache, dizziness,nausea, flushing
H. Nursing Diagnosis
Ineffective Breathing Pattern related to
decreased lung expansion (air/fluid
accumulation) evidenced by changes in
depth/equality of respiration altered
chest excursion
I. Implementation
 Auscultate breath sounds (absent in
a lobe, lung segment, or entire lung
field (unilateral).
 Note chest excursion and position
of the trachea.
 Assist patient with splinting painful
area when coughing, deep
breathing.
 Maintain a position of comfort,
usually with the head of bed
elevated. Turn to the affected side.
Encourage patient to sit up as much
as possible.
 Maintain a calm attitude, assisting
the patient to “take control” by
using slower and deeper respiration.
J. Discharge Planning
 Breathing exercises are the main
type of rehab, but chest-stretching
exercises for broken ribs are
effective as well. Each type should
be done slowly and gently, with a
gradual increase as you heal
 Sleep in a recliner or upright
position
 Keep moving around home, do not
stay in bed or take short walks,
 Do not smoke
PNEUMONIA
A. Definition
Pneumonia is an illness that causes the
air sacs in your lungs to become
inflamed (alveoli). The air sacs may get
clogged with fluid or pus, resulting in
symptoms including coughing, fever,
chills, and difficulty breathing.
B. Anatomy
Lower respi. begins to Trachea
(windpipe, inhaled air into the lungs→
Lobes (upper, mid, lower) → Alveoli (air
sacs, gas exchange)
C. Pathophysiology
 The most common cause of
pneumonia is a breakdown in your
 body's natural defenses, which
allows germs to infiltrate and
flourish in your lungs.
 White blood cells rapidly
accumulate in order to eliminate
the attacking organisms. They,
together with germs and fungi, clog
your lungs' air sacs (alveoli).
Breathing may be difficult.
D. Sign and Symptoms
 Cough, which may produce
greenish, yellow or even bloody
mucus.
 Fever, sweating and shaking chills.
 Shortness of breath.
 Rapid, shallow breathing.
 Sharp or stabbing chest pain that
gets worse when you breathe
deeply or cough.
 Loss of appetite, low energy, and
fatigue.
E. Diagnostic test
 Blood tests- are used to confirm an
infection and to try to figure out
what kind of organism is causing it.
 Chest X- ray- determining the
severity and location of the
infection.
F. Medical management
You may be given intravenous fluids and
antibiotics, as well as oxygen therapy
and maybe other breathing treatments,
if your pneumonia is severe enough to
require hospitalization.
G. Drug study
 Macrolide antibiotics, like
Azithromycin - to treat certain
bacterial infections, such as
bronchitis; pneumonia
 Side Effects: Diarrhea, Nausea.
Abdominal pain, Loose stool,
Cramping.
 bronchodilators, cough
suppressants, mucolytic agents,
and expectorants
H. Nursing Diagnosis
 Ineffective airway clearance
related tracheal bronchial
inflammation, edema formation,
increased sputum production.
 Excessive secretions and
ineffective or nonproductive
coughing are associated with this
diagnosis. Inflammation and
excessive secretions make
maintaining a patent airway
challenging in pneumonia.
I. Implementation
 Examine your breathing rate,
rhythm, and depth, as well as
your chest movement and
auxiliary muscle use.
 Assess cough effectiveness and
productivity
 Auscultate the lungs, noting areas
of reduced or absent airflow as
well as unusual breath sounds
such as crackles and wheezes.
 Observe the sputum color,
viscosity, and odor. Report
changes.
 Elevate the head of the bed,
change position frequently
J. Discharge Planning
 Breathing warm, moist air helps
loosen the sticky mucus that may
make you feel like you are choking.
 Placing a warm, wet washcloth
loosely near your nose and mouth
 Filling a humidifier with warm
water and breathing in the warm
mist
 Keep your head elevated
 Do not smoke. Avoid
secondhand smoke
  Rest as needed. Rest often
throughout the day
ANGINA PECTORIS
A. Definition
 chest pain or discomfort due to
coronary heart disease
 It occurs when the heart muscle
does not receive enough blood.
This occurs when one or more of
the heart's arteries become
restricted or obstructed, a
condition known as ischemia.
B. Anatomy
 Chest pain occurs when the heart
muscle doesn't get as much blood
as it needs.
 This usually happens because one
or more of the heart's arteries is
narrowed or blocked, also
called ischemia
C. Pathophysiology
 Increase workload of heart
 Increase oxygen demand
 Narrowed vessels are unable to
dilate and supply the heart with this
enter blood and oxygen
 More work in less oxygen
D. Sign and Symptoms
 Pain that may also occur in your
upper back, both arms, neck, or ear
lobes
 Chest pain that spreads to your
arms, shoulders, jaw, neck, or back
 Shortness of breath
 Weakness
 Tiredness
E. Diagnostic test
 Electrocardiogram (ECG) - a stress
test that does not include imaging
or blood testing to aid in the
diagnosis of your problem.
 Chest x-ray - to evaluate the lungs,
heart and chest wall and may be
used to help diagnose shortness of
breath, persistent cough, fever,
chest pain or injury
 Coronary CT angiography - to check
for narrowed or blocked arteries in
your heart
 Cardiac MRI - helps your doctor
detect or monitor cardiac disease
F. Medical management
 Relief o acute pain, the major drugs
used to reduce acute pain are
opioid analgesics, nitroglycerin
 Restore coronary blood flow,
administer vasodilators like
propanolol, calcium channel
blockers such as felodipine.
G. Drug study
 Asaphen - prevention of heart
disease.
 Side Effects: nausea, vomiting and
heartburn
 NTG- to dilate the coronary arteries,
reduce the oxygen requirements of
the myocardium, and relieve the
chest pain
 Beta-blockers: (acebutolol (Sectral),
atenolol (Tenormin), nadolol
(Corgard), metoprolol (Lopressor),
propranolol (Inderal))- reducing the
heart’s workload
H. Nursing Diagnosis
 Acute pain related to decreased
myocardial blood flow evidenced
by reports of pain varying in
frequency, duration, and
intensity (especially as condition
worsens).
 Coronary artery disease are
atherosclerosis, coronary heart
disease, hardening of the arteries,
 heart disease, ischemic heart
disease and narrowing of arteries.
I. Implementation
 Instruct patient to
notify nurse immediately when
chest pain occurs.
 Identify precipitating event, if any:
frequency, duration, intensity, and
location of pain.
 Observe for associated symptoms:
dyspnea, nausea and vomiting,
dizziness, palpitations, desire to
micturate
 Elevate head of bed if patient is
short of breath
 Monitor vital signs every 5 min
during initial anginal attack.
J. Discharge Planning
 Maintain quiet, comfortable
environment. Restrict visitors as
necessary.
 Eat less fat and cholesterol
 Eat less salt (sodium)
 Eat more fresh vegetables and
fruits.
 Eat lean proteins, such as fish,
poultry, and legumes (beans and
peas)
Myocardial Infarction
A. Definition
 An extremely dangerous condition
caused by a lack of blood flow to
your heart muscle
 Lack of blood flow can occur
because of many different factors
but is usually related to a blockage
in one or more of your heart's
arteries
B. Anatomy
 Precipitating factor (smoking)
 Spasm/obstruction of coronary
artery
 insufficient blood flow to the
heart muscle
 increase myocardial oxygen
demand
 myocardial necrosis
C. Pathophysiology
 Due to thrombotic occlusion of a
coronary vessel caused by rupture
of a vulnerable plaque
 Ischemia induces profound
metabolic and ionic perturbations
in the affected myocardium and
causes rapid depression of systolic
function
D. Sign and Symptoms
 pressure or tightness in the chest.
 pain in the chest, back, jaw, and
other areas of the upper body that
lasts more than a few minutes or
that goes away and comes back.
 shortness of breath.
 sweating.
 nausea.
 vomiting.
 anxiety.
 feeling like you're going to faint.
E. Diagnostic test
 Electrocardiogram (ECG) - this first
test done to diagnose a heart
attack records electrical signals as
they travel through your heart
 Sticky patches (electrodes) are
attached to your chest and limbs
F. Medical management
 Clopidogrel and ticagrelor, in
conjunction with aspirin (162 to
325 mg per day), are suggested for
 conservative medical therapy of MI
for up to 12 months.
 Early administration of beta
blockers is recommended during
hospitalization after an MI
G. Drug study
 Aspirin - reducing the blood clots
that are blocking a coronary artery
during an acute heart attack.
 Side Effect: Mild headache,
drowsiness
 Morphine sulfate - Pain relief
increases oxygen supply to the
myocardium
H. Nursing Diagnosis
 Risk for Decreased Cardiac Output
 Risk Factor : Changes in rate,
rhythm, electrical conduction
I. Implementation
 BP. Compare both arms and obtain
lying, sitting, and standing
pressures when able.
 Evaluate quality of pulses on both
pulse points.
 Auscultate breath sounds
 Monitor heart rate and rhythm.
Document dysrhythmias via
telemetry.
 Note response to activity and
promote rest appropriately.
J. Discharge Planning
 Avoid heavy lifting. Get some help
with household chores if you can.
 Take 30 to 60 minutes to rest in the
afternoon for first 4 to 6 weeks. Try
to go to bed early and get plenty of
sleep
 Do not drink any alcohol
 Do not let anybody smoke in your
home, since second-hand smoke
can harm you
 Avoid salty food
CHF ( congestive heart failure )
A. Definition
 When the heart muscle does not
pump blood as well as it should,
this condition occurs.
 When this happens, blood can back
up in the lungs and fluid can build
up, causing shortness of breath.
B. Anatomy
 Heart has 4 chambers, has arteries,
vessels, pul. art. veins
 Pumps blood out through systemic
circ.
SVC→RA → tricuspid→ RV→ Pul. art.→
pul. vein → LA → bicuspid → RV→
aorta→ body
C. Pathophysiology
 caused by a variety of abnormalities,
including pressure and volume
overload, loss of muscle, primary
muscle disease or excessive
peripheral demands such as high
output failure
 In the usual form of heart failure,
the heart muscle has reduced
contractility.
 irreversible damage to myocardial
tissues caused by prolonged
ischemia/hypoxia and by
reperfusion-induced injury
D. Sign and Symptoms
 Shortness of breath with activity or
when lying down.
 Fatigue and weakness.
 Swelling in the legs, ankles and feet.
 Rapid or irregular heartbeat.
 Reduced ability to exercise.
 Persistent cough or wheezing with
white or pink blood-tinged mucus.
 Swelling of the belly area (abdomen)
E. Diagnostic test
 Echocardiogram - can be used to
determine ejection fraction, which
indicates how well the heart pumps
and aids in the classification and
management of heart failure.
 Computed tomography (CT) scan
 Electrocardiogram
F. Medical management
 Angiotensin - converting enzyme
(ACE) inhibitors - These drugs relax
blood vessels to lower blood
pressure, improve blood flow and
decrease the strain on the heart.
G. Drug study
 Digoxin - to treat heart failure and
abnormal heart rhythms
(arrhythmias)
 It helps the heart work better and it
helps control your heart rate.
 Side Effects: Feeling confused, dizzy,
Changes in your vision (including
blurred vision and not being able to
look at bright light) and vomiting.
 Beta blockers= to decrease oxygen
consumption by the myocardium;
given to prevent subsequent angina
episodes.
H. Nursing Diagnosis
 Decreased Cardiac Output - The
heart fails to pump enough blood,
making it difficult to circulate the
blood to all parts of the body, thus
may cause altered heart rate and
rhythm, and weakness.
 The blood flow that supplies the
heart is also decreased; therefore
decrease in cardiac output occurs.
I. Implementation
 Auscultate apical pulse, assess
heart rate
 Assess for palpitations or irregular
heartbeat.
 Monitor blood pressure (BP)
 Inspects the skin for pallor or
cyanosis
 Monitor urine output, noting
decreasing output and
concentrated urine.
J. Discharge Planning
 You will need to learn to watch for
changes in your heart rate, pulse,
blood pressure, and weight
 Limit salt in your food
 Stop drinking alcohol
 Quit smoking
 Get enough rest.
IRON DEFICIENCY ANEMIA
A. Definition
 Anemia is a condition in which the
body does not have enough healthy
red blood cells. Red blood cells
provide oxygen to body tissues.
 Iron deficiency anemia occurs when
your body does not have enough
iron. Iron helps make red blood
cells. Iron deficiency anemia is the
most common form of anemia.
B. Anatomy
 Blood makes up about 8% of the
human body weight.
It contains:
 erythrocytes= transporting
oxygen bound to their heme
groups
 leukocytes= Neutrophils,
eosinophils, basophils,
 lymphocytes (B,T), and
monocytes
 thrombocytes (platelets)=
responsible for homeostasis
plasma= water, plasma proteins,
electrolytes
C. Pathophysiology
 Red blood cells (RBCs) are
abnormally small with low levels of
hemoglobin (hgb)
 Despite the cause, IDA occurs when
the body's iron demand exceeds
that of it's supply
D. Sign and Symptoms
 Extreme fatigue
 Weakness.
 Pale skin.
 Chest pain, fast heartbeat or
shortness of breath.
 Headache, dizziness
 Cold hands and feet.
 Inflammation or soreness of your
tongue.
 Brittle nails.
E. Diagnostic test
Complete blood count (CBC) - a blood
test used to evaluate your overall
health and detect a wide range of
disorders, including anemia, infection
and leukemia
F. Medical management
 Iron therapy - Oral ferrous iron
salts are the most cost-effective
and successful treatment for iron
deficiency anemia; ferrous sulfate is
the most often utilized of the
several iron salts available.
 Management of hemorrhage -
Surgical treatment consists of
stopping hemorrhage and
correcting the underlying defect so
that it does not recur; this may
involve surgery for treatment of
either neoplastic or non neoplastic
disease of the gastrointestinal (GI)
tract, the genitourinary (GU) tract,
the uterus, and the lungs.
 Diet. The addition of non heme
iron to national diets has been
initiated in some areas of the
world.
G. Drug study
 Ferrous sulfate - Ferrous sulfate is
the most common treatment for
anemia caused by iron deficiency.
 They should be continued for
around 2 months after the anemia
and its etiologic cause have been
corrected in order to replace iron
stores in the body.
 Side Effects: constipation, contact
irritation, diarrhea, dark stools.
H. Nursing Diagnosis
 Fatigue related to decreased
hemoglobin and diminished
oxygen-carrying capacity of the
blood.
I. Implementation
 Monitor hemoglobin, hematocrit,
RBC count, and reticulocyte
counts.
 Perform sensitivity testing of IM
iron injection to avoid risk
of anaphylaxis.
 Administer IM or IV iron when
oral iron is poorly absorbed.
 Assess the skin for bruises
J. Discharge Planning
 Advise patient to take liquid forms
of iron via a straw and
rinse mouth with water.
 Inform patient that iron salts
change stool to dark green or black.
 Encourage patient to continue iron
therapy for a total therapy time (6
months to a year), even when
fatigue is no longer present.
PERNICIOUS ANEMIA
A. Definition
 An autoimmune condition that
affects your stomach
 means your immune system, the
body's natural defence system that
protects against illness and
infection, attacks your body's
healthy cells
 Vitamin B12 is combined with a
protein called intrinsic factor in
your stomach.
B. Anatomy
 Blood makes up about 8% of the
human body weight.
It contains:
 erythrocytes= transporting
oxygen bound to their heme
groups
 thrombocytes (platelets)=
responsible for homeostasis
 plasma= water, plasma
proteins, electrolytes
 leukocytes= Neutrophils,
eosinophils, basophils,
lymphocytes (B,T), and
monocytes
C. Pathophysiology
 In pernicious anemia vitamin B12 is
unavailable owing to a lack of
intrinsic factors
 substance responsible for intestinal
absorption of the vitamin.
 lack of the gastric protein known as
intrinsic factor, without which
vitamin B12 cannot be absorbed.
D. Sign and Symptoms
 Fatigue
 shortness of breath
 rapid heart rate
 jaundice or pallor
 tingling and numbness of hands
and feet
 loss of appetite
 Diarrhea
 bleeding gums
 impaired sense of smell
E. Diagnostic test
 Serum folate, iron, and iron-
binding capacity tests - can help
show whether you have pernicious
anemia or another type of anemia.
F. Medical management
 Treatment involves a shot of
vitamin B12 once a month.
 People with severely low levels of
B12 may need more shots in the
beginning.
 A certain type of vitamin B12 may
be given through the nose.
 Some people may be adequately
treated by taking large doses of
vitamin B12 supplements by mouth.
G. Drug study
 Vitamin B12 - to make red blood
cells
 Side effects: bleeding, infections,
and problems with your brain or
nerves that may be permanent
H. Nursing Diagnosis
Activity intolerance related to
Imbalance between oxygen supply
and demand evidenced by
Generalized weakness.
I. Implementation
 Check oximetry; inform physician
O2 saturation 92% or less.
 Encourage deep breathing
techniques and administer oxygen
as prescribed.
 Aid in a gradual increase of
activities to tolerance as the
patient’s strength progress.
 Eat more healthy foods
J. Discharge Planning
 Follow your doctor's instructions
about vitamin B12 shots, vitamin
B12 pills, or a vitamin B12 nasal
spray.
 Eat a varied diet. Include foods with
a lot of vitamin B12, such as eggs,
milk, and meat
 Do not drink alcohol while you are
being treated
LIVER CANCER
A. Definition
Cancer that starts in the cells of your
liver is known as liver cancer. The liver is
a large organ that sits in the upper right
part of your abdomen, beneath your
diaphragm and above your stomach.
The liver can develop a variety of
cancers.
B. Anatomy
 Liver is a football-sized organ that
sits in the upper right portion of
your abdomen.
 The liver is divided into sections,
called lobes, and acts as a filter for
blood.
C. Pathophysiology
Chronic exposure of the liver to injury
from viral hepatitis, alcohol abuse or
NASH causes repeated hepatocyte
damage and sets up a vicious cycle of
cell death and regeneration which
eventually results in cirrhosis.
D. Sign and Symptoms
 Losing weight without trying.
 Loss of appetite.
 Upper abdominal pain.
 Nausea and vomiting.
 General weakness and fatigue.
 Abdominal swelling.
 Yellow discoloration of your skin
and the whites of your eyes
(jaundice)
 White, chalky stools.
E. Diagnostic test
 Ultrasound, CT scan and MRI - can
show liver damage
 Biopsy - Removing a tissue sample
from your liver may help diagnose
liver disease and look for signs of
liver damage.
F. Medical management
 Treatment o liver cancer is largely
palliative
 A lobectomy is sometimes done if
the tumor is localized
 Surgery is usually not possible
because of the late detection of the
disease process
 Chemotherapy may be used but
there is usually a poor response
G. Drug study
 Sorafenib (Nexavar) - to treat
kidney, liver cancer It works by
slowing or stopping the growth of
cancer cells.
 Side Effects: Acne, dry skin, nausea,
diarrhea, patchy hair loss/thinning,
loss of appetite, dry mouth,
hoarseness, or tiredness
H. Nursing Diagnosis
Imbalanced Nutrition: Less Than
Body Requirements evidenced by
Weight loss
I. Implementation
 Measure dietary intake by calorie
count.
 Weigh as indicated. Compare
changes in fluid status, recent
weight history, skinfold
measurements.
 Give small, frequent meals.
 Restrict intake of caffeine, gas-
producing or spicy and excessively
hot or cold foods.
J. Discharge Planning
 Limit canned, dried, packaged, and
fast foods
 Don't add salt to your food at the
table.
 Get some physical activity every
day, but do not get too tired.
 Take your medicines exactly as
prescribed
 Get enough sleep and take time to
do things you enjoy
BREAST CANCER
A. Definition
 Breast cancer is a disease in which
cells in the breast grow out of
control.
 Cancer of the tissue containing or
involving the milk glands
(mammary tissue).
 Breast cancer can begin in different
parts of the breast.
B. Anatomy
 Each breast has 15 to 20 sections,
called lobes.
 Each lobe has many smaller
structures called lobules 20-40;
these end in dozens of tiny bulbs
that can produce milk.
 The lobes, lobules, and bulbs are all
linked by thin tubes called ducts
 Ducts lead to the nipple in the
center of a dark area of skin called
the areola.
 Fat fills the spaces between lobules
and ducts
 There are no muscles in the breast,
but muscles lie under each breast
and cover the ribs.
 Each breast also contains blood
vessels and vessels that carry
lymph
 The lymph vessels lead to small
bean-shaped organs called lymph
nodes.
 These lymph nodes are found in
clusters under the arm, above the
collarbone, and in the chest.
C. Pathophysiology
 Develops due to DNA damage and
genetic mutations that can be
influenced by exposure to estrogen.
 Sometimes there will be an
inheritance of DNA defects or pro-
cancerous genes
 Thus the family history of ovarian
or breast cancer increases the risk
for breast cancer development
D. Sign and Symptoms
 Swelling of all or part of a breast
(even if no lump is felt)
 Skin dimpling (sometimes looking
like an orange peel)
 Breast or nipple pain.
 Nipple retraction (turning inward)
 Nipple or breast skin that is red, dry,
flaking, or thickened.
 Nipple discharge (other than breast
milk)
E. Diagnostic test
 Mammogram is an X-ray of the
breast.
 Mammograms are commonly used
to screen for breast cancer
collection under the skin flaps or in
the arm.
 Monitor incision site for restriction
of dressing, impaired sensation, or
color changes of the skin.
 Maintain fluid and electrolyte
balance; administer diuretics and
provide a low-salt diet as
prescribed for severe lymph edema.

F. Medical management J. Discharge Planning

Surgery, chemotherapy, radiation  Sponge bathe until the sutures
therapy, hormone therapy, and drains are removed;
immunotherapy and targeted drug continue with daily lower arm
therapy. ROM exercises

G. Drug study  Avoid caffeinated foods and

 Estrogen receptor (ER) and/or
progesterone receptor = reduce the
chance of recurrence of these
“hormone-positive” cancers by
nearly half. Endocrine therapies
can cause symptoms of menopause
but are generally well tolerated.
 Hormonal agents = to induce
remissions that last for months to
several years.
H. Nursing Diagnosis
Body image disturbance related to
significance of loss of part or all of the
breast
drinks, nicotine, and secondary
smoke
 Avoid heavy lifting of carrying
bags on the affected side
 For follow up- Prepare the
patient and family for a variety
of encounters with healthcare
providers (radiologist, oncologist,
phlebotomist). Try to provide a
continuity between the
providers

I. Implementation
 Fowler’s position, turn from the
back to the unaffected side, with
the affected arm elevated above
the level of the heart to promote
drainage and prevent lymphedema
 Encourage coughing and deep
breathing
 Assess operative site for infection,
swelling, or the presence of fluid