NCMB312

WEEK 13 multiple thin layers of membranes which eject toxins that’s

why it’s harder to kill.
COMMUNICABLE DISEASE IN GI TRACT

PATHOGENESIS
CHOLERA
Vibrio Cholerae Bacteria ● Entry of Vibrio Cholerae. Starts when you ingest
contaminated food via fecal-oral route.
Also known as EI Tor. It is an acute serious illness
● After ingestion, it will start the multiplication of
characterized by sudden onset of acute and profuse
bacterias in the small intestine or choleragen.
colorless diarrhea, vomiting, severe dehydration, muscular
● This toxin binds to the plasma membrane of
cramps, cyanosis, and in severe cases, collapse.
intestinal epithelial cells and releases an
Incubation period might be hours after ingesting
enzymatically active subunit that causes a rise in
contaminated food or 1-3 days.
cyclic adenosine 51-monophosphate (cAMP)
production
Cholera causes disease with a very rapid onset of copious
○ cAMP is a second messenger, or
diarrhea in which up to 1 L of fluid per hour can be lost.
cellular signal occurring within cells,
Loss of fluids and electrolytes may cause hypovolemic
that is important in many biological
shock and may lead to metabolic acidosis and can kill within
processes that includes memory,
hours if left untreated. The period of communicability is
metabolism, gene regulation, and
during the time the stool test is positive of the bacteria
immune function.
until a few days after recovery. Cholera is endemic or
○ Chloride secretion is the major
epidemic in areas with poor sanitation; it occurs sporadically
determinant of mucosal hydration
or as limited outbreaks in developed countries.
throughout the gastrointestinal tract,
that causes water loss, potassium loss,
CAUSATIVE AGENT
and bicarbonate loss.
● VIBRIO CHOLERAE / VIBRIO COMA
● The resulting high intracellular cAMP level causes
○ Comma-shaped or curved
massive secretion of electrolytes and water into
gram-negative bacilli that survives in
the intestinal lumen
24-40 Degree Celsius and longer in
● Water loss (5-10%) causes dehydration
refrigerated food. It produces
○ Excessive thirst
enterotoxin (choleragen). And appears
○ Restlessness
to vibrate while moving.
○ Washerwoman’s hand
○ An enterotoxin is a substance that is
■ The skin becomes wrinkled,
harmful to your digestive system. It
pale, and sodden due to
enters your stomach and intestines if
severe dehydration.
you eat contaminated food or water.
○ Circulatory collapse / shock
○ Choleragen or CTX, Ctx, or Ct, is an
● Potassium loss causes hypokalemia
AB5 multimeric protein compel secreted
● And loss of bicarbonate causes metabolic
by the vibrio cholerae. It is responsible
acidosis and may develop
for the massive, watery diarrhea
○ Kassmaul’s Respiration – rapid and
characteristics of cholera infection.
deep breathing respiration with intervals
of apnea.
MODE OF TRANSMISSION
● Fecal-Oral Transmission
DIAGNOSTIC EVALUATION
○ 5 Fs
● Rectal Swab / Stool examination
○ Feces
● Darkfield or phase microscopy
○ FInger
○ observing classic 'shooting star'
○ Flies
movement of organisms in cholera stool
○ Food
under a dark field microscope.
○ Fomites (clothes, utensils)

CLINICAL MANIFESTATIONS
T/N: Gram-positive bacteria is surrounded with a thick
● Rice Water Stool – pathognomonic sign
peptidoglycan layer that absorbs surroundings materials,
○ Inoffensive, slightly fishy odor
even toxins. That's why they are easier to kill but produce
● Profuse diarrhea with no tenesmus (a constant
slower resistance. While gram-negative bacteria is
feeling that you have to go to the bathroom, but
surrounded by a thin peptidoglycan layer covered by
you can't)
○ Causes fluid loss (1-30 L/day)
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● Poor tissue turgor, sunken eyes, cold skin CAUSATIVE AGENT

● Wrinkled toes and fingers ● SHIGELLA
● Oliguria if not treated early that may also lead to ○ Is a gram-negative, facultative aerobic
anuria (failure of kidneys to produce urine) (can survive in both oxygenated and
deoxygenated environment),
MEDICAL MANAGEMENT non-motile, non-spore forming, and
● Rapid IV infusion (Na, K, C:, HCO3) rod-shaped bacteria.
● ORESOL, Hydrites
○ a drug that works to rehydrate patients, 4 GROUPS OF SHIGELLA
used to replace lost water and ● Shigella Dysenteriae (Group A)
electrolytes ○ Most deadly as they live in human guts.
● Coconut water (rich in potassium) It causes diarrhea (often bloody),
● For pedia, continue breastfeeding abdominal pain, stomach cramps, and
● Antibiotics fever. It can mix into our blood.
○ Tetracycline – 500 mg , 1 tab q6 for Incubation period is 7 hours until 7 days
adult and 125 mg/kg in children q6 for 3 with an average of 3-5 days. Period of
days communicability is during the acute
○ Furazolidone – 100 mg for adult and infection until stool examination with
125 mg/kg for children q6 for 3 days negative results.
○ Chloramphenicol – 500 mg tab for ● Shigella Flexneri (Group B)
adult, and 18 mg/kg for children q6 for ○ Most common in the Philippines
3 days ● Shigella Boydii (Group C)
○ Cotrimoxazole – 8 mg/kg for 3 days ● Shigella Connei (Group D)
● I&O monitoring and Serum Electrolyte monitoring
after administration of IV and/or oral fluid intake DIAGNOSTIC EVALUATION
● Fecalysis
NURSING MANAGEMENT ● Rectal Swab or Culture
● Protect food and water supplies ● Blood Culture
● Proper storage of food ● Methylene Blue Staining – used In microbiology
● Medical asepsis in handling food item for staining acidic animal cell components such as
● Enteric isolation – instruct patient for proper the nucleus, bacteria, and blood tissue
disposal of excreta specimens.
● Monitoring VS and I&O
CLINICAL MANIFESTATIONS
● Fever
BACILLARY DYSENTERY
● Tenesmus, nausea, vomiting, headache
Shigella Bacteria
● Colicky or cramping abdominal pain associated
Also known as Shigellosis / Bloody Flux. An acute with anorexia and body weakness
bacterial infection of the intestine characterized by diarrhea, ● Diarrhea (bloody-mucoid stool)
fever, tenesmus and in severe cases, bloody and mucoid ● Dehydration and rapid weight loss
stool. Shigella species are gram-negative organisms that ● COMPLICATIONS: rectal prolapse, cough, and
invade the lumen of the intestine. Shigella exhibits a high pneumonia.
level of virulence, as infection with very few bacteria can ○ Rectal prolapse may cause bowel
cause disease. Because transmission occurs easily with perforation – results from insult or injury
improper hygiene, it is not surprising that Shigella organisms to the mucosa of the bowel wall caused
disproportionately affect pediatric populations. due to a violation of the closed system.

MODE OF TRANSMISSION MEDICAL MANAGEMENT

● Fecal-Oral Transmission ● IV Solution with normal saline (with electrolytes) to
○ Ingestion of contaminated food and prevent dehydration
water ● Low-residue diet like whole-grain breads and
● Indirect Transmission cereals, nuts, seeds, raw or dried fruits, and
○ Flies vegetables. Avoid milk products.
● Sex ● Anti-diarrheal drugs (contraindicated)
○ Oro-anal contact ● Antibiotics
○ Ciprofloxacin
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○ Ofloxacin ● Trophozoites will then travel going to the hepatic

○ Levofloxacin veins invading the liver and then lungs, then other
○ Azithromycin soft tissues
● ORESOL – HOMEMADE SALT SUGAR
○ GOOD FOR 24 HOURS PUTREFACTION – the decay of organic matter by the
○ 1-8-1 guide action of microorganisms resulting in the production of a
■ 1 teaspoon salt foul smell. It occurs between 10 to 20 days after the death
■ 8 teaspoon sugar of an organism. Putrefaction involves the decomposition of
■ 1 liter water proteins, breakdown of the tissues, and liquefaction of the
organs.

AMOEBIASIS
DIAGNOSTIC EVALUATION
Entamoeba Histolytica
● Stool exam – white or yellow with plenty of
Also known as Amoebic Dysentery. A protozoal infection amoeba
of human beings that initially involves the colon, but may ● Blood exam (leukocytosis) – Elevation of WBC
spread to soft tissues, most commonly the liver and lungs, ● Proctoscopy and sigmoidoscopy
and contiguity or hematogenous or lymphatic dissemination. ○ A proctoscopy (also called rigid
Incubation period is 1 to 4 weeks but may be shorter or sigmoidoscopy) is a procedure to
longer. Period of communicability is the duration of the examine the inside of the rectum and
disease. the anus. It is usually done to look for
tumors, polyps, inflammation, bleeding,
CAUSATIVE AGENT or hemorrhoids.
● ENTAMOEBA HISTOLYTICA ○ A sigmoidoscopy is a diagnostic test
○ Spherical shape with a thin cell used to check the sigmoid colon, which
membrane and a single nucleus with a is the lower part of your colon or large
prominent nuclear border, central intestine.
karyosome, and vacuole and usually 12
to 15 micron. CLINICAL MANIFESTATIONS
○ Lives in warm climates with poor ● Acute Amoebic Dysentery
sanitation. ○ Slight attack of diarrhea with watery and
foul-smelling stool often containing
TWO DEVELOPMENTAL STAGE blood-streaked mucus
● Trophozoites / Vegetative Form ○ Nausea, flatulence, abdominal
○ Invades the tissue or may be found in distension, tenderness in the right iliac
parasitized tissues and liquid colonic region may occur
contents ● Chronic Amoebic Dysentery
● Cyst ○ Attack of dysentery succeeded by
○ Passed out with stool and resistant to constipation
environmental conditions. Considered ○ Enlargement of the liver
as the infective stage. ○ Poor skin turgor over the abdomen
● Extraintestinal Forms
MODE OF TRANSMISSION ○ RUQ pain
● Fecal-Oral Transmission ○ Jaundice
● Humans get this via ingesting the cyst from poor ○ Intermittent fever
sanitation, poor cooked food, vectors like flies ○ Loss if weight and anorexia
○ Abscess may break in the lungs
PATHOGENESIS ● Anchovy-sauce sputum
● Ingestion of cyst that will pass through the
stomach (unharmed and shows no activity in MEDICAL MANAGEMENT
acidic environment) ● Metronidazole (Flagyl) – if amoebiasis is confirmed
● Cyst will mature in large intestine and will become ; 800 mg tab 3x a day for 5 days. TIV.
trophozoites ● Tetracycline
● Trophozoites burrow and continue the lysis of the ● Ampicillin
cells until it gains access in the blood vessels ● Streptomycin
● Replacement of fluids and electrolytes
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NURSING MANAGEMENT ● Small intestinal ulcerations

● Isolation and enteric precaution ● Leak of bowel contents into the abdomen
● Health Teaching ● Microorganisms is absorbed into circulation
○ Drinking water ● Reaches different organs of the body
○ Cover leftover food
○ Hand washing after defecation DIAGNOSTIC EVALUATION
○ Avoid eating ground vegetables ● Typhidot – confirmatory test
● Proper collection of stool specimen ○ Uses blood or stool. If IgG and IgM are
○ Instruct to avoid mixing urine with feces present in the typhoid test, it indicates
○ Select large portions containing blood acute typhoid fever. If IgM only is
and mucus as possible present, it means you have acute
○ Label the specimen properly typhoid fever.
○ Send the specimen immediately ● ELISA
○ Measures the concentration of IgM and
of IgG against S. typhi in serum. This
TYPHOID FEVER
test is an indirect ELISA test, based on
Salmonella Typhosa / Typhi
a method that makes use of a mixture
A bacteria infection transmitted by contaminated water, of OMPs (outer membrane proteins) in
milk, shellfish, and other foods. An infection of the GIT equal proportion serving as antigen,
affecting lymphoid tissues of the small intestines. Peyer's obtained from different strains of S.
Patches are clusters of subepithelial, lymphoid follicles ● Rectal swab
found in the intestine. They are oval or rectangular in shape ● Widal Test
and found on the antimesenteric wall of the intestine. They ○ measures the capacity of antibodies
are more prominent in the ileum and are characterized by against LPS (lipopolysaccharides) and
specialized epithelial cells called M cells. flagella in the serum of individuals with
suspected typhoid fever to agglutinate
Incubation period would be 5 to 40 days. Period of cells of S.
communicability varies. ○ O Ag – somatic body
○ H Ag – flagellar
CAUSATIVE AGENT ○ V Ag – carbohydrate envelop
● SALMONELLA TYPHOSA / TYPHI
○ Pathogenic only to humans. CLINICAL MANIFESTATIONS
Salmonellae are short, Gram-negative, ● Onset State
facultatively anaerobic, rod-shaped ○ headache , chilly sensation, body
bacteria and can grow at 5–45°C. aches, N&V, diarrhea
○ It produces infections ranging from a ○ Symptoms are worst in the 4th and 5th
mild, self-limiting form of gastroenteritis day
to septicaemia and life-threatening ○ Rose spots occur on the 7th to 9th day.
typhoid fever. Rose spots are red macules 2-4
millimeters in diameter occurring in
MODE OF TRANSMISSION patients with enteric fever
● Fecal-Oral Transmission ● Typhoid State
○ 5 Fs ○ Subsultus Tendinum – twitching of the
○ Feces tendons especially at the wrist.
○ FInger ○ Coma Vigil – is a state of coma in which
○ Flies the patient lies unconscious but with
○ Food the eyes open.
○ Fomites (clothes, utensils) ○ Carphologia – describes the actions of
picking or grasping at imaginary
PATHOGENESIS objects, as well as the patient's own
● Ingestion of S. Typhi clothes or bed linens.
● Propagation (breeding) of the microorganism in ○ Delirium – characterized by an
the stomach alteration of attention, consciousness,
● Microorganisms travels to the small intestine and cognition, with a reduced ability to
(peyer’s patches) focus, sustain or shift attention.
● Inflammation of the small intestine linings
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MEDICAL MANAGEMENT ● Bile fails to reach the intestines

● Chloramphenicol ○ Dark urine, pale stools, itchiness
○ Drug of choice.
● Ampicillin DIAGNOSTIC EVALUATION
● Cotrimoxazole ● HAV and HBV complement fixation rate
● ciprofloxacin/ceftriaxone ○ a blood test in which a sample of serum
is exposed to a particular antigen and
NURSING MANAGEMENT complement in order to determine
● Isolation by medical aseptic technique whether or not antibodies to that
● Maintenance of fluid and electrolytes balance particular antigen are present.
● Monitor vital signs ● Serum Glutamic Pyruvic Transaminase (SGPT)
● Prevent injury ○ a blood test performed to measure the
● Mouth care enzyme created in the liver called
● Cooling measures during febrile stage Alanine Transaminase (ALT).
● WOF signs of intestinal bleeding ● Serum Alanine Transaminase (ALT)
● Terminal and concurrent disinfection ○ When liver cells are damaged, they
release ALT into the bloodstream. High
levels of ALT in your blood may be a
HEPATITIS A
sign of a liver injury or disease.
Hepatitis A Virus
● Bile Examination (stool and urine)
Vaccine preventable liver infection, caused by HAV, the ● IgM level
most benign and harmless type of hepatitis. The incubation ○ becomes detectable in the blood by 4
period is estimated to be between 2 and 6 weeks, with a weeks after infection, persisting at
mean of approximately 4 weeks. Hepatitis A, formerly elevated levels for about 2 months
called infectious hepatitis, is caused by an RNA virus of the before declining to undetectable levels
enterovirus family. It is more prevalent in countries with by 6 months
overcrowding and poor sanitation. The virus has been found
in the stool of infected patients before the onset of CLINICAL MANIFESTATIONS
symptoms and during the first few days of illness. ● Many patients are anicteric (without jaundice) and
symptomless
The illness may be prolonged, lasting 4 to 8 weeks. It ● Fatigue, low-grade fever, anorexia, N&V
usually lasts longer and is more severe in those older than ● Pain on the right side of the abdomen beneath the
40 years. Most patients recover from hepatitis A; it rarely lower ribs
progresses to acute liver necrosis or acute hepatic failure ● Pale stools, dark urine, arthralgia (pain in a joint),
resulting in cirrhosis of the liver or death. jaundice, intense itching

MODE OF TRANSMISSION MEDICAL MANAGEMENT

● Fecal-Oral Route ● No specific treatment. Bed rest is important.
○ Ingestion of contaminated water or food ● High carbohydrate, low fat and chon
○ Close contact with an infected person ● Vit. b complex
○ Having oro-anal sex ● Isoprinosine / Methisoprinol – is a stimulator of
○ Sharing of needles immunity via actions like thymic hormones, active
against HSV and HPV.
Kupffer cells are a critical component of the mononuclear ● Belladonna – dysphagia . plant, leaf, or root
phagocytic system and are central to both the hepatic and ● Antiemetics
systemic response to pathogens. Kupffer cells are ● Hepatitis A Vaccine
reemerging as critical mediators of both liver injury and
repair. Red blood cells are broken down by phagocytic NURSING MANAGEMENT
action of Kupffer cells, where the hemoglobin molecule is ● Enteric isolation
split. ● Bed rest
● Observe for melena (blood in the stool)
PATHOGENESIS ● Skin and mouth care
● Ingestion of contaminated food or water ● Limit activity when fatigued
● Reaches the liver ● Plan periods of reset and activity
● Interlobular infiltration ● Gradual resumption of activities
● Necrosis and hyperplasia of Kupffer cells
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some kinds of meningitis, and

COMMUNICABLE DISEASE IN NERVOUS SYSTEM
strychnine poisoning.
○ (+) BRUDZINSKI'S SIGN – When the
MENINGITIS
patient’s neck is flexed (after ruling out
Also known as cerebrospinal fever. It is the inflammation of cervical trauma or injury), flexion of the
the meninges, which cover and protect the brain and spinal knees and hips is produced; when the
cord. Causes may be ingestion of poison or drugs and lower extremity of one side is passively
reaction to a vaccine or a pathogen. The two main types of flexed, a similar movement is seen in
meningitis are bacterial and viral. The average incubation the opposite extremity. Brudzinski sign
period is 4 days but can range between 2 and 10 days. is a more sensitive indicator of
meningeal irritation than Kernig sign.
CAUSATIVE AGENT ○ (+) KERNIG SIGN – When the patient
● Viral Meningitis is lying with the thigh flexed on the
○ Directly invades the meninges abdomen, the leg cannot be completely
○ Immune reaction extended. When the Kernig sign is
○ Less severe bilateral, meningeal irritation is
■ Types are enterovirus, suspected.
arbovirus, and poliovirus
○ Enteroviruses are a group of viruses
that cause a number of infectious
illnesses which are usually mild.
○ Arboviral disease is a general term
used to describe infections caused by a
group of viruses spread to people by
the bite of infected arthropods (insects)
such as mosquitoes and ticks.
○ Poliovirus invades the nervous system
and can cause total paralysis in a matter
of hours.
● Bacterial Meningitis
○ HiB (Haemophilus Influenzae Type B) is
a life-threatening infection that can lead
to serious illness, especially in children.
○ Neisseria Meningitidis
○ Streptococcus Pneumonia
○ Streptococcus Agalactiae
● Fungal Meningitis
● Chemical Meningitis ● Signs of increased ICP (increased intracranial
○ Antibiotics, NSAIDs pressure) – The initial signs of increased ICP
include decreased level of consciousness (LOC)
MODE OF TRANSMISSION and focal motor deficits. If ICP is not controlled,
● During labor and birth the uncus of the temporal lobe may herniate
● Droplet through the tentorium, causing pressure on the
● Respiratory droplet (nasopharyngeal mucosa) brain stem.
● Direct invasion ○ Bulging fontanels in infants
○ Projectile vomiting
CLINICAL MANIFESTATIONS ○ Severe frontal headache
● Fever, severe headache, and stiffness of the neck ○ Blurring of vision
and spine. Exaggerated and symmetrical deep ○ Altered sensorium
tendon reflexes. ● Delirium, deep stupor, coma, photophobia, skin
● Signs of meningeal irritation lesions
○ Nuchal rigidity – neck stiffness ● Acute fulminant infection produces signs of sepsis
○ Opisthotonos – spasm of the muscles ○ An abrupt onset of high fever, extensive
causing backward arching of the head, purpuric lesions, shock and any signs of
neck, and spine, as in severe tetanus, disseminated intravascular coagulation
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DIAGNOSTIC EVALUATION ● Preventing complications associated with

● Patient’s symptoms immobility, such as pressure injury and
● Physical examination pneumonia
● CSF analysis
○ Diagnostic
POLIOMYELITIS
○ Therapeutic
Poliovirus
● CSF Gram Staining
● Smear and blood culture Also known as Infantile Paralysis or Heine-Medin
● Smear from petechiae Disease. An acute infectious disease characterized by
● CT scan/MRI of the head – is used to detect a chances in the CNS which may result in pathologic reflexes,
shift in brain contents muscle spasm, and paresis or paralysis. Maximum
excretion of the virus is seen in 2 to 3 days prior and 1
MEDICAL MANAGEMENT week after appearance of symptoms.
● Antibiotic Therapy
○ IV antibiotics for 2 weeks Came from the greek word polios or grey, denoting the
○ Oral antibiotic afterwards grey matter of the nervous system, and myelosis or marrow,
○ Penicillin G in combination with one denoting the myelin sheath around certain nerve fibers.
of the cephalosporins (e.g., Poliomyelitis is an exclusive human disease transmitted from
ceftriaxone, cefotaxime) is most often a patient or a symptom-free carrier through the fecal-oral
administered intravenously (IV), route. The Communication period may start in 3 days to
emergently with suspected bacterial 3 months.
meningitis
● Dexamethasone has been shown to be beneficial CAUSATIVE AGENT
as adjunct therapy in the treatment of acute ● Polio Virus (Legio Debilitans)
bacterial meningitis and in pneumococcal
meningitis if it is given before or concurrently with THREE STAINS
the first dose of antibiotic and every 6 hours for ● Brunhilde
the next 4 days. ○ Type 1 poliovirus. Named after a female
● Digitalis chimpanzee from which it was first
● Mannitol isolated. Most severe epidemics are
● Anticonvulsants / Sedatives caused by this type of poliovirus.
● Paracetamol Identified in 1939.
● HIB Vaccine ● Lansing
● Anti pneumonia vaccine ○ Identified in 1938 from the brain and
spinal cord of a man that suffered from
NURSING MANAGEMENT polio.
● Assess neurologic condition ● Leon
○ Observe level of consciousness ○ Obtained in 1937 from the brain and
○ WOF signs of increased intracranial spinal cord of a boy named Leon. a
pressure victim of polio during the LA epidemic.
● Monitor fluid balance
● Position the patient MODE OF TRANSMISSION
● WOF deterioration of patient’s condition ● Direct contact (oropharyngeal secretions)
● Maintain adequate nutrition ● Indirect contact – contaminated water, utensils,
● Isolation food, and flies
● Assisting with pain management due to overall
body aches and neck pain PATHOGENESIS
● Assisting with getting rest in a quiet, darkened ● Ingestion of the Polio Virus
room ● Multiplication in the throat and small intestine
● Monitoring of VS ● Invasion of tonsils and lymph nodes (neck and
● Protecting the patient from injury secondary to ileum)
seizure activity or altered LOC ● If Viremia (the presence of viruses in the blood.)
● Monitoring daily body weight; serum electrolytes; halted = no clinical disease
and urine volume, specific gravity, and osmolality, ● If persistent viremia exists, it leads to penetration
especially if syndrome of inappropriate antidiuretic of capillary wall and entry to CNS - high affinity of
hormone (SIADH) is suspected the virus to motor nerve cells - multiplication in
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the cytoplasm and nerve cell death that leads to ○ (+) KERNIG AND BRUDZINSKI NECK
PARALYSIS SIGN
○ Urinary retention, constipation,
DIAGNOSTIC EVALUATION abdominal distension
● Isolation of virus (throat swab) ○ BULBAR POLIO – results from
● Stool culture paralysis of muscle groups innervated
● CSF Culture by the cranial nerves, especially those
of the soft palate and pharynx, which
TYPES OF POLIOMYELITIS may present as dysphagia, nasal
● Abortive - 48% speech, and sometimes dyspnea.
○ Does not invade CNS Attacks CN9 (glossopharyngeal) and
○ Headache and sore throat is present CN10 (vagus)
○ Slight or moderate fever may occur ○ SPINAL PARALYTIC POLIO – happens
○ No evidence of paralysis when polio virus attacks your brain and
○ Patient usually recovers within 72 hours spinal cord. It can paralyze the muscles
● Non-paralytic that allow you to breathe (higher SPP),
○ All signs of abortive type speak, swallow and move your limbs
○ Hamstring muscle spasm (lower SPP)
○ Changes in deep and superficial ○ FLACCID PARALYSIS – the sudden
reflexes onset of muscle weakness or paralysis
○ Inability to place the head between the which has many causes, both infectious
knees and non-infectious, including poliovirus.
○ (+) PANDY’S TEST – is used to detect ○ BULBOSPINAL POLIO – occurs when
an increase of protein in the both the spinal and bulbar neurons are
cerebrospinal fluid (CSF). The normal affected. Generally, the amount of
range of protein in CSF is 0.20 to 0.45 paralysis plateaus after an individual's
g/litre. fever departs, and strength begins to
○ Usually lasts for about a week return within days or weeks.
○ Transient paresis (muscular weakness
caused by nerve damage or disease) MEDICAL MANAGEMENT
may occur ● Analgesics and moist heat application for pain
● Paralytic and leg spasms
○ All signs of abortive and non-paralytic ○ Morphine is contraindicated because of
type danger signs of respiratory depression
○ (+) HOYNE’S SIGN – when shoulders ● Bed rest
are elevated in a supine patient, head ● Paralytic type (PT, braces, corrective shoes)
will lag. requires rehab

NURSING MANAGEMENT
● Carry out enteric isolation
● Observation for signs of paralysis
● WOF signs of fecal impaction
● Repositioning
● Hand hygiene
● Proper disposal of excreta
● Emotional support
● Oral and skin care

PREVENTION
Polio Vaccine
1. Salk Vaccine – the first successful vaccine was
created by US physician Jonas Salk.
a. IPV – Children usually get the
inactivated poliovirus vaccine (IPV) at
○ Paralysis occurs
ages 2 months, 4 months, 6–18 months,
○ Less tendon reflex
and 4–6 years.
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i. Inactivated ○ Characterized by regions of skin that

ii. IM or ID have lost sensation and are surrounded
iii. No VAPP by border of nodules
2. Sabin Vaccine – ○ Non-infectious type
a. OPV – given at 6,10,14 weeks via oral ● Lepromatous
route ○ Progressive / Borderline –
i. Predominant vaccine MULTIBACILLARY ( leprosy, nodules,
ii. Attenuated trivalent vaccine papules, macules and diffuse
(live) infiltrations are bilateral symmetrical and
iii. Risk of VAPP but due to usually numerous and extensive;
immunodeficiency and/or involvement of the nasal mucosa may
susceptibility to illness lead to crusting, obstructed breathing
and epistaxis; ocular involvement leads
T/N: OPV is the most sensitive to heat. Keep it in the freezer to iritis and keratitis.)
(-15 to -25 degree celsius. And advise mother to not ○ Skin cells are infected and disfiguring
breastfeed for 15-30 minutes after administration. nodules form all over the body
○ Infectious type

LEPROSY
CLINICAL MANIFESTATIONS
Mycobacterium Leprae
● Claw Hand – atrophy of the hand muscles due to
Also known as Hansen’s Disease / Hansenosis. It is a nerve damage or disease. Abnormal hand position
chronic systemic infection characterized by progressive due to lower ulnar nerve lesion.
cutaneous lesions. The disease affects the skin, the ○ Type 1 - Complete : when it involves all
peripheral nerves, mucosa of the upper respiratory tract, the digits and therefore results from
and the eyes. Associated with stigma. It was named after both ulnar and median nerve palsy
Gerhard Henrik Armauer Hansen. ○ Type 2 - Incomplete or Partial : where
it involves only ulnar 2 digits and is
CAUSATIVE AGENT referred to as an isolated ulnar nerve
● MYCOBACTERIUM LEPRAE palsy
○ Attacks cutaneous tissue and peripheral
nerves
○ Produces skin lesions, anesthesia,
infection and deformities

MODE OF TRANSMISSION
● Respiratory droplet
● Inoculation through skin break and mucus
membrane (prolonged contact)

PATHOGENESIS
● Entry of mycobacterium leprae
● Attack in peripheral nerves
● Damage to skin’s fine nerves ● Paralysis and peripheral anesthesia
● Anesthesia (numbness), anhidrosis (inability to ● Corneal insensitivity wherein the cornea isn't
sweat), and dryness of skin sensitive when assessed using the cotton tip
applicator
FORMS OF LEPROSY (TYPES DEPENDING ON ● Eyelid paralysis – lagophthalmos (incomplete or
CLINICAL MANIFESTATIONS) defective closure of the eyelids.)
● Tuberculoid ● Skin
○ Neural / Indeterminate – ○ Lepromatous – relating to or denoting
PAUCIBACILLARY (skin lesions are the more severe of the two principal
single or few, sharply demarcated, forms of leprosy, marked by thickening
anaesthesic or hypoaesthesic, and of the skin and nerves, the formation of
bilateral asymmetrical, involvement of lumps on the skin, and often severe loss
peripheral nerves tends to be severe.) of feeling and paralysis leading to
disfigurement.
NCMB312

■ Leonine Facies — displaying

facial features similar to that of a PREVENTION
lion with prominent convexities
● Avoidance of prolonged skin-to-skin contact
and furrowed creases.
● BCG vaccination
■ Loss of eyebrows and eyelashes
(Madarosis) ● Good personal hygiene
○ Tuberculoid ● Adequate nutrition
■ May be purely neural or ● Health Education
simultaneously affect skin
■ Raised , large, erythematous
plaques with clearly defined TETANUS
borders Clostridium Tetani

Also known as Lock Jaw. An infectious bacterial disease

DIAGNOSTIC EVALUATION which produces a potent exotoxin with prominent systemic
● Identification of signs and symptoms neuromuscular effects such as generalized spasmodic
● Slit-skin smear – An incision 3-5 mm long and contractions of the skeletal muscles.
2-3 mm deep is made with a alcohol cleansed,
single-edged razor blade. Smears should be taken Hypertonia is a condition in which there is too much muscle
from the suspects lesions sites like forehead, tone so that arms or legs, for example, are stiff and difficult
earlobes, chin, arms, and buttocks. to move. Muscle tone is regulated by signals that travel from
○ The lesion is cleaned with ether or the brain to the nerves and tell the muscle to contract.
alcohol
○ A fold is gripped firmly between the CAUSATIVE AGENT
thumb and forefinger to render it blood ● CLOSTRIDIUM TETANI
free ○ Anaerobic Gram Positive, drumstick
○ Fluid and pulp from the dermis, appearance, seen commonly in soil with
collected on one side of the blade, are animal feces. Sensitive to heat and
gently smeared onto a glass slide. cannot survive in the presence of
● Blood tests oxygen. The spores, in contrast, are
○ Increased RBC and ESR extremely resistant to heat and the
○ Decreased serum Ca, albumin, and usual antiseptics.
cholesterol ● Releases two types of toxins:
● Lepromin Test – involves injection of an antigen ○ Tetanospasmin : responsible for
just under the skin to determine if your body has a muscle spasm
current or recent leprosy infection. ○ Tetanolysin : responsible for RBC
destruction
MEDICAL MANAGEMENT
● Sulfone Therapy – are bacteriostatic that MODE OF TRANSMISSION
suppress the growth of various pathogenic ● Puncture wound
bacteria ● Umbilical stump
● Rehabilitation, recreational, and occupational ● Cleaning of ears with sharp objects
therapy ● Circumcision
● Multiple drug therapy
○ Multibacillary : Rifampicin, clofazimine
and dapsone. After taking 12 monthly
doses of MDT (considered cured)
○ Paucibacillary : rifampicin and
dapsone. After taking 6 monthly doses
of MDT (considered cured)

NURSING MANAGEMENT
● If admitted in hospital, isolation and medical
asepsis is needed PATHOGENESIS
● Moral support and encouragement ● Entry of C. Tetani in wounds or break in skin
● Full, wholesome, and nutritious diet ● Local multiplication and release of exotoxins
● Attention to personal hygiene ● Toxin absorbed by bloodstream and lymphatics
● Terminal disinfection and into peripheral motor nerves
NCMB312

● Tetanospasmin happens (high affinity to CNS ○ Tracheostomy

tissue and spinal motor ganglia) ○ Fluid and electrolyte
● Inhibition of muscle relaxation
● Hyperexcitability / spasms NURSING MANAGEMENT
● Maintain adequate airway
CLINICAL MANIFESTATION ● Cardiac monitoring
● Neonate ● Maintenance of IV line
○ Feeding and sucking difficulties ● Wound care
○ Cries excessively ● Avoid stimulation
○ An attempt to suck results spasm and ● Prevent contractures and pressure sores
cyanosis ● Monitor VS
○ Tonic or rigid muscular contractions ● Comfort measures
● Older children and adult
○ Localized tetanus (increased tone near
RED TIDE
the wound)
Karenia Brevis
○ Systemic or generalized
■ Hypertonicity (relative excess Also known as Paralytic Shellfish Poisoning (PSP). Red
of the solute) and hyperactive tide is caused by population explosion of toxic, naturally
DTR occuring microscopic phytoplanktons (dinoflagellates). A
■ Trismus ( jaw muscles syndrome of characteristic symptoms predominantly
become so tight that you neurologic which occur within minutes or several hours after
can't open your mouth) ingestion of poisonous shellfish.
■ Risus Sardonicus –
pathognomonic sign. Spasm An algal bloom or algae bloom is a rapid increase or
of the facial muscles that accumulation in the population of algae in freshwater or
appears to produce grinning marine water systems. It is often recognized by the
■ Opisthotonos ( spasm of the discoloration in the water from the algae's pigments.
muscles causing backward
arching of the head, neck, CAUSATIVE AGENTS
and spine, as in severe ● SINGLE-CELLED ORGANISMS OR
tetanus, some kinds of DINOFLAGELLATES
meningitis, and strychnine ○ They can produce, some of which
poisoning ) involve the production of toxins that can
● Common first signs impact human health through
○ Headache, difficulty swallowing, sore respiratory irritation or even the
throat, irritability, tonic spasms, jaw bioaccumulation of lethal
stiffness, fever, restlessness, chills, concentrations in tainted shellfish.
exaggerated reflexes, profuse sweating ○ Explosions are caused by environmental
○ Intact Sensorium – the parts of the brain conditions that promotes growth of
or the mind concerned with the organisms like heavy rainfall that
reception and interpretation of sensory preceded by prolonged summer or low
stimuli. salinity and calm seas
○ Spasms of Facial Muscles : fixed smile ○ Seafoods that are unsafe to eat are:
and elevated eyebrows quahogs, soft-shell clams, oysters,
scallops, and moon snails.
MEDICAL MANAGEMENT ○ Gonyaulax Tamarensis / Gonyaulax
● Specific belongs to the red dinoflagellates group.
○ ATS (tetanus antitoxin), TAT (tetanus It commonly causes red tides due to red
toxoid), TIG (tetanus immunoglobulin) color, the rapid multiplication of
within 72 hours. Gonyaulax leads to red tides. It secretes
○ Tetanus Toxoid – 0.5 ml a poisonous toxin known as "saxitoxin"
○ Penicillin G for infection which causes paralysis in humans and
○ Muscle relaxant also kills marine organisms.
● Non-specific
○ Oxygen CLINICAL MANIFESTATIONS
○ NGT feeding
NCMB312

● Tingling of the lips and tongue that spreads to the

face, neck, fingertips, and toes – initial sign
● Drunken condition – loss of coordination
● Symptoms aggravated by alcohol consumption
● Floating sensation and weakness
● Total muscle paralysis with respiratory paralysis
○ Victims who survive the first 12 hours
have a greater chance of survival

MEDICAL MANAGEMENT
● No definitive medication indicated
● Induced vomiting
● Charcoal Hemoperfusion – a method of
extracorporeal elimination in which blood
circulates through an activated
charcoal-containing cartridge added to the circuit
of a hemodialysis (HD) machine.
● Mannitol is given to enhance elimination of the
absorbed poison.
● Early Stage
○ Alkaline Fluids (NaHCO3)
○ Coconut milk – the shellfish toxins has
reduced patency in alkaline environment
but must be used in the initial stage of
poisoning

NURSING MANAGEMENT
● Health Teaching
○ Shellfish affected by red tide must not
be cooked with vinegar because it
increases the toxin 15 times greater
○ Toxin or red tide is not totally destroyed
by cooking
● Avoid bi-valve mollusks
○ Tahong
○ Talaba
○ Halaan
○ Kabiya
○ Abaniko
○ Tulya

BFAR – The Bureau of Fisheries and Aquatic Resources

(BFAR) will announce if the area is now free of red tide.
NCMB312

WEEK 14 ● Skin Contact (Cutaneous 5-7 days)

○ Edema with pruritus
COMMUNICABLE DISEASE IN CNS
○ Macule/papule. resulting in ulceration
with 1- to 3-mm vesicles
ANTHRAX
○ Painless eschar, which falls off in 1–2
Recognized as the most likely weaponized biologic agent weeks
available (Category A) with high mortality rate and highly ● GI ingestion (1-6 days)
debilitating agent. Biologic weapons are weapons that ○ Fever, nausea and vomiting, abdominal
spread disease among the general population or the military. pain
They can be used for sabotage, such as food or water ○ Bloody diarrhea. If severe diarrhea
contamination with a small target area or may be used by develops, decreased intravascular
global terrorists with intentions to spread fear and disruption volume becomes the major treatment
of daily life. concern. The bacterium targets the
terminal ileum and cecum. Sepsis can
CAUSATIVE AGENT occur
● Bacillus Anthracis ○ Ascites (fluid collects in spaces within
○ Live in the soil in a spore state the abdomen)
○ Sporulates when exposed to air and is ● Inhalation (1-43 days)
ineffective only in the spore form ○ Its symptoms mimic those of the flu,
○ Naturally occurring gram-positive, and usually treatment is sought only
encapsulated rod-shaped bacterium when the 5872 second stage of severe
that lives in the soil in the spore state respiratory distress occurs
throughout the world. The bacterium ○ HALLMARK SIGN: Hemorrhagic
sporulates (i.e., is liberated) when Mediastinitis – after anthrax exposure
exposed to air and is infective only in leads to acute respiratory failure and
the spore form. acute respiratory distress syndrome
○ Deadliest form
MODE OF TRANSMISSION
● Contact with infected animal products such as REMEMBER: These patients require optimization of
raw meat oxygenation, correction of electrolyte imbalances, and
○ Cattle and other herbivores are ventilatory and hemodynamic support. Death results
vaccinated against anthrax to prevent approximately 24 to 36 hours after the onset of severe
transmission through contaminated respiratory distress. The mortality rate approaches 100%.
meat. As an aerosol, anthrax is odorless
and invisible and can travel a great DIAGNOSTIC EVALUATION
distance before disseminating; hence, ● Patient history
the site of release and the site of ● CXR
infection can be miles apart ● CT Scan
● Inhalation of the spores ● Blood Culture
● Incubation Period – 1 to 6 days ● TIssue Culture
● CSF Analysis

PATHOGENESIS MEDICAL MANAGEMENT

● Spores enters through broken skin, eat food with ● Penicillin
spores, or mucous membranes ● Erythromycin
● Germinate in macrophages, replicate in lymph ● Gentamicin
nodes and intracellular space ● Mass casualty and prophylaxis
● Bacteria produce antiphagocytic capsule ○ Doxycycline
● Production of toxins that causes tissue damage ○ Ciprofloxacin
and edema ● If antibiotic treatment begins within 24 hours after
● Anthrax is caused by replicating bacteria that exposure, death can be prevented
release toxin, resulting in hemorrhage, edema,
and necrosis PREVENTION
● Standard precautions
CLINICAL MANIFESTATION ● Clean equipment
3 MAIN METHODS OF INFECTION
NCMB312

● Cremation, recommended because the spores ● Colicky, periumbilical pain aggravated by cold
can survive for decades and represent a threat to stimulation (Nakamura Sign)
morticians and forensic medicine personnel. ● Palpable intestinal obstruction
● Anthrax Vaccine Adsorbed (Biothrax) – six
doses is available MEDICAL MANAGEMENT
● Antihelminthics
○ Albendazole or mebendazole – 15cc
ASCARIASIS
single dose
Most common helminthic infection ( caused by different ○ Piperazine citrate – 75mg OD x 2 doses
species of parasitic worms). Roundworm infection. They use PO
the human body to stay alive, feed and reproduce. ○ Pyrantel Pamoate – 1 mg per kg single
dose
CAUSATIVE AGENT
● Ascaris Lumbricoides NURSING MANAGEMENT
○ Elongated cylindrical worms ● Health education on preventive measure in home
○ Appears creamy and pinkish yellow and in the community
when fresh ● Health teaching on sanitary practices especially
○ A female worm can produce 240,000 when handling food
eggs per day that are discharged into ● Availability of toilet facilities must be ensured
feces ● Proper disposal of diapers should be emphasized

MODE OF TRANSMISSION
PEDICULOSIS
● Direct or indirect contact
Also known as Phthiriasis. Infestation of the hair-covered
PATHOGENESIS parts of the body with the eggs, larvae, or adults of human
● Ingestion of embryonated ova and progression to lice that feeds on human blood and can result in severe
larval stage itching.
● Larval penetration of the intestinal wall
(duodenum) CAUSATIVE AGENTS
● Blood carries the larva into the liver, heart, biliary ● Pediculus Humanus Capitis – head lice
tract, or lungs and then re-ingested ○ An infestation of the scalp by the head
● Adult ascaris stays in the intestinal tract and lays louse. The female louse lays her eggs
eggs that will sooner be excreted in the feces and (nits) close to the scalp. The nits
the cycle is repeated become firmly attached to the hair
shafts with a tenacious substance. The
DIAGNOSTIC EVALUATION young lice hatch in about 6 to 9 days
● Kato-Katz Technique and reach maturity in 7 days.
○ a diagnostic technique for the detection ○ Head lice may be transmitted directly by
of helminth eggs in stool using a light physical contact or indirectly by infested
microscope. This test is based on the combs, brushes, wigs, hats, helmets,
detection of helminth eggs in small and bedding
amounts (41.7 mg) of fresh stool. ● Pediculus Humanus Corporis – body lice
● Abdominal X-ray ○ An infestation of the body by the body
○ Dense shadow of ascaris louse. This is a disease of those who
○ Looks like strands of spaghetti live in close quarters.
● Routine Blood Count ● Phthirus Pubis – pubic lice
○ Eosinophilia ○ It is extremely common. The infestation
is generally localized in the genital
CLINICAL MANIFESTATION region and is transmitted chiefly by
● Periumbilical pain sexual contact
● RUQ pain
● Cough CLINICAL MANIFESTATIONS
● Fever ● Head Lice
● Rales ○ More common in females and children
● Blood-tinged sputum ○ Itching
NCMB312

○ PLICA POLONICA – is an uncommon

condition characterized by diffuse ● Excitement / Neurological Phase
matting of hair ○ Muscle fasciculations, marked
● Body Lice excitations and apprehension
○ Minute red spots ○ Delirium, maniacal behavior, severe
○ Secondary crust and excoriation on the painful spasms of the muscles of the
surrounding skin mouth, pharynx, and larynx
● Pubic Lice ○ Hydrophobia
○ Persistent itching in the pubic region ○ Aeorphobia
(chief symptom) ○ Hyoertyalism or drooling
○ MACULAE CERULEAE – are the blue
spots in the thigh. They are thought to ● Terminal / Paralytic Phase
be secondary to anticoagulant activity ○ Patient becomes quiet and unconscious
of louse saliva. ○ Loss of bowel and urinary control
○ Spasm cease and there is progressive
MEDICAL MANAGEMENT paralysis
● Head Lice ○ Death occurs due to respiratory
○ 1% malathion powder paralysis and circulatory collapse
○ Gamma benzene hexachloride
shampoo DIAGNOSTIC EVALUATION
● Body Lice ● Virus isolation
○ Laundering or boiling the clothing and ● Fluorescent Rabies Antibody
beddings ○ Most definitive diagnosis
○ Good hygiene ○ Unbound antibodies can be washed
● Pubic Lice away and areas where antigen is
○ Kwell or Gamene (lindane) cream present can be visualized as
○ Crotaminon (eurax, geigy) fluorescent-apple-green areas using a
fluorescence microscope.
○ Presence of Negri bodies in the dog’s
RABIES
brain
Also known as Hydrophobia/Lyssa. Acute viral infection ○ Negri bodies in patients are the
communicated to man by saliva of an infected animal. pathognomonic sign
Lyssaviruses are a group of viruses that includes rabies and
bat lyssavirus. MEDICAL MANAGEMENT
● Post-exposure prophylaxis
CAUSATIVE AGENT ○ Thoroughly wash the wounds with soap
● Rhabdovirus and running water
○ Viruses with a distinct “bullet” shape ○ Give tetanus toxoid if needed
with strong affinity to CNS and is ○ Give tetanus antiserum
sensitive to sunlight, UV light, formalin, ○ Anti-rabies vaccines (passive and
ether, mercury, and nitric acid active)
○ Resistant to phenol and common ■ Rabies vaccine – active
antibacterial agents ■ Rabies Ig – passive
○ Observe the health condition of the
MODE OF TRANSMISSION animal. If the animal died, send the
● Inoculation through skin break and mucus head to the laboratory for evaluation
membranes

CLINICAL MANIFESTATION
● Prodromal / Invasion Phase
○ Fever, anorexia, malaise, sore throat,
copious salivation, lacrimation,
irritability, hyperexcitability, mental
depression, melancholia
○ Pain at the original site of bite
○ Mild difficulty in swallowing
NCMB312

infection, especially by S.
mansoni and S. japonicum
○ Only type that is endemic in the
Philippines
○ Oriental Schistosomiasis – asian blood
flukes that infects the liver and small
intestine
● Schistosoma Mansoni
○ Infects the intestine
○ Common in Africa
● Schistosoma Haematobium
○ Infects the urinary tract
○ Found in the Middle East

MODE OF TRANSMISSION
● Contact with contaminated fresh water with snails
infected with schistosomes

VECTOR
● Oncomelania Quadrasi
○ Tiny snail
○ Greenish-brown in color for adult snail
○ Infected with Cercaria (infective stage)
○ Usually found in riverbanks

DIAGNOSTIC EVALUATION
● Fecalysis
● Kato-Katz Technique
NURSING MANAGEMENT ● Liver and rectal biopsy
● Isolate the patient ● ELISA
● Give emotional and spiritual support ● Circumoval Precipitin Test (confirmatory)
● Provide optimum comfort and prevent injury ○ used to detect serum antibodies to
● Provide a darken, quiet environment Schistosoma mansoni, S.
● Wrap the IV fluid haematobium, or both species by using
● Do not bathe the patient eggs of either species of schistosome
● Concurrent and terminal disinfection
CLINICAL MANIFESTATIONS
● Can see s/sx within 12 hours
SCHISTOSOMIASIS ● Pruritic rash (Swimmer’s itch) on the site of
Also known as Bilharziasis / Snail Fever. Was discovered by penetration
Theodore Bilharz, A slowly progressive disease caused by ○ a skin rash caused by an allergic
blood flukes. Common among farmers and their families in reaction to certain microscopic
the rural areas that results in manpower losses and lessened parasites
agricultural productivity. ● Low grade fever, myalgia, and cough
● Abdominal discomfort
High prevalence in Region 5 (Bicol), Region 8 (Samar and ○ Hepatomegaly – enlargement of the
Leyte), and in Davao. liver beyond its normal size
○ Splenomegaly – the enlargement of the
CAUSATIVE AGENT spleen measured by size or weight
● Schistosoma Japonicum ● Bloody-mucoid stools (on and off)
○ Infects the intestine (Katayama Disease) ● Jaundice
■ is a systemic hypersensitivity
reaction that may occur COMPLICATIONS
weeks after the initial ● Liver cirrhosis – common cause of death in
Philippines)
● Cor pulmonale and portal hypertension
NCMB312

● Heart failure Many women with a healthy vaginal ecosystem harbor

● Ascites Candida but are asymptomatic. Although infections can
● Hematemesis – esophageal varices occur at any time, they occur more commonly in pregnancy
● Renal failure or with a systemic condition such as diabetes or human
● Cerebral schistosomiasis immunodeficiency virus (HIV) infection, or when patients are
taking medications such as corticosteroids or oral
MEDICAL MANAGEMENT contraceptive agents.
● Praziquantel for 6 months
○ 1 tablet BID x 3 months CAUSATIVE AGENT
○ Then 1 tab OD for another 3 months ● Candida Albicans
○ Is a naturally occurring fungus that lives
PREVENTION on your body
● Treat snail-breeding sites with molluscicide ○ Causes infection when there is rise in
● Prevent exposure to contaminated water (use of blood glucose
rubber boots) ○ Immunosuppression
● Towel dry, vigorously and completely, the skin ○ Taking immunosuppressive drugs,
surface that are wet with suspected water radiation, exposure, infection of HIV
● Apply 70% alcohol immediately ○ Increase in estrogen level
● Treat the water with chloride ○ Broad spectrum antibiotics are used
● Allow water to stand 48-72 hours before use ○ Systemic inoculation
● Motivation of the public in endemic area to have
annual stool examination DIAGNOSTIC EVALUATION
● Stool culture
NURSING MANAGEMENT ● Gram staining of the skin, vaginal discharge, or
● WOF dehydration scrapings
● Fluid replacement
● Prevent injury CLINICAL MANIFESTATIONS
● Promote comfort ● Scaly skin with erythema and papular rash
● Health teaching ● Nails – red and swollen, separation of pruritic nails
from nail bed
● Cream-colored or bluish-white exudates on the
SEXUALLY TRANSMITTED INFECTIONS
tongue, mouth or oropharynx
Sexually transmitted infections (STIs) are diseases acquired ● Vagina – white or yellowish discharge
through sexual contact with a person who is infected.
Infections caused by organisms not generally considered MEDICAL MANAGEMENT
STIs can also be transmitted during sexual contact—for ● Nystatin
example, G. lamblia, usually associated with contaminated ● Clotrimazole, fluconazole, ketoconazole (Azoles)
water, can be transmitted through sexual exposure. STIs are ● Fluconazole, amphotericin, and echinocandins
sometimes called sexually transmitted diseases (STDs) as (micafungin)
well.
NURSING MANAGEMENT
Infection with one STI suggests the possibility of infection ● Avoid sharing utensils
with other diseases as well. After one STI is identified, ● Meticulous mouth care
diagnostic evaluation for others should be conducted. The ● Proper disposal of oral secretions
possibility of HIV infection should be pursued when an STI is ● Good perineal hygiene
diagnosed. ● Avoid self medications (antibiotics)

CANDIDIASIS CHLAMYDIA
Also known as Moniliasis / Candidiasis. Vulvovaginal Sexually transmitted infection. Most people who are infected
candidiasis is a fungal or yeast infection caused by strains have no symptoms. Contracted during vaginal, anal, oral
of Candida that usually infects the nails (onychomycosis), sex. It can be passed from an infected mother to her baby
the skin (diaper rash), and mucus membranes of the during childbirth.
oropharynx (thrush), vagina (moniliasis), esophagus, and
GIT. CAUSATIVE AGENT
● Chlamydia Trachomatis
NCMB312

○ Can cause conjunctivitis, perihepatitis, ● Universal precautions

pharyngitis, reactive arthritis, and ● Submit for HIV testing
proctitis ● Check newborns for chlamydial infection
● Chlamydia Psittaci
○ Can cause mild illness or pneumonia
HERPES SIMPLEX
(lung infection)
● Chlamydia Pneumoniae Is a viral infection which is categorized based on the
○ Can cause respiratory tract infections, affected part of the body and is related to the viruses that
such as pneumonia cause infectious mononucleosis, chickenpox, and shingles.

MODE OF TRANSMISSION Herpes simplex virus 2 (HSV-2) is a recurrent, lifelong viral

● Vaginal or rectal intercourse infection that causes herpetic lesions (blisters) on the
● Oral-genital contact external genitalia and occasionally the vagina and cervix.
● Children born to mothers with chlamydial infection
CAUSATIVE AGENT
CLINICAL MANIFESTATION ● Herpes Simplex Virus
● Women with cervicitis ○ Type 1 (HSV1) – the one that cause
○ Swelling or inflamed tissue of the end of cold sores, tiny clear fluid filled blisters
the uterus (cervix) ○ Type 2 / genital herpes (HSV2) –
○ Cervical erosions, mucopurulent sexual contact is the primary mode of
discharges, pelvic pain, dyspareunia transmission. Pain, itching, genital
(pain that occurs just before, during or sores, vesicular and pustular lesions
after sex) around genitals
● Women with endometritis / salpingitis
○ inflammation of the fallopian tubes CLINICAL MANIFESTATION
○ Pain and tenderness of the abdomen, ● HSV2
cervix, uterus ○ Flu-like symptoms
● Women with urethral symptoms ○ Swollen lymph nodes in the groin
○ Dysuria, pyuria, urinary frequency ○ Minor rash
● Men with urethritis ○ Painful sores
○ When the tube that carries pee from the ○ Burning sensation on urination
bladder out of the body (urethra) ○ Tiny white blisters
becomes swollen and sore ● Men & women
○ Dysuria, erythema, tender urethral ○ Buttocks, thighs, anus
meatus, pruritus, urethral discharge ○ Mouth & pharynx
● Men with epididymitis ○ Urethra
○ Where a tube (the epididymis) at the ● Women
back of the testicles becomes swollen ○ Vagina, external genitals, cervix
and painful ● Men
○ Painful scrotal swelling, urethral ○ Penis & scrotum
discharge
DIAGNOSTIC EVALUATION
DIAGNOSTIC EVALUATION ● Direct Method
● Swab from the site of infection ○ The sample should be taken from a
● Culture of aspirated secretions vesicular lesion that has been present
● Enzyme Linked Immunosorbent Assay (ELISA) for less than 24 h because once the
○ to detect and measure antibodies, lesion has begun to crust, the test
including: Antibodies against bacterial, sensitivity will decline. Unroofing ,
viral or fungal infections dacron swab.
● Direct fluorescent antibody test ● Tissue culture – best to test with isolation of the
virus. Criterion standard. Within 48 hours.
MEDICAL MANAGEMENT Scraping.
● Oral doxycycline for 7 days ● Immunofluorescence
● Azithromycin for single dose
MEDICAL MANAGEMENT
NURSING MANAGEMENT ● Acyclovir (Zovirax)
NCMB312

● Famciclovir (Famvir) ● Explain the course of the disease

● Valacyclovir (Valtrex) ● All information of the patient is confidential
● Administer ophthalmic prophylaxis for infants
● Report Gonorrhea in children (child abuse
GONORRHEA
authority)
A sexually-transmitted bacterial infection involving the ○ RA 7160
mucus lining of the genitourinary tract, the rectum, and ● Advice to refrain from coitus until treatment is
pharynx. Gonorrhea is a sexually transmitted infection complete
caused by bacteria. It is sometimes known as 'the clap /
gleet'. It can affect the urethra (the tube for urine), cervix
SYPHILIS
(the opening of the uterus at the top of the vagina), anus,
throat or eyes. Gleet is a watery discharge from the urethra Also known as Lues Venereal / Morbus Gallicus. A
caused by gonorrheal infection. chronic, infectious, sexually transmitted disease that usually
begins in the mucous membranes and quickly becomes
CAUSATIVE AGENT systemic. Caused by a spirochete Treponema pallidum
● Neisseria Gonorrhoeae that is acquired through sexual contact. Can be transmitted
○ Kidney-bean shaped , aero diplococci also via placenta.
gram negative bacteria that can be
killed by ordinary disinfectant CAUSATIVE AGENT
● Treponema pallidum
MODE OF TRANSMISSION ○ No other host than man. Appears as
● Direct contact on the infected mucus membrane shiny, twirling thread that can cross the
placenta
DIAGNOSTIC EVALUATION ○ It is rapidly inactivated by mild heat,
● Culture and sensitivity cold, desiccation, and most
● Gram staining disinfectants.

CLINICAL MANIFESTATION MODE OF TRANSMISSION

● Females ● Direct contact on the infected mucus membrane
○ Burning sensation and frequent with discharges
urination ● Placental transmission
○ Yellowish purulent vaginal discharge ● Indirect contact (handling diaper, wet nurse)
○ Endometritis – inflammation of the
lining of the uterus DIAGNOSTIC EVALUATION
○ Salpingitis – inflammation of the ● Dark field illumination test
fallopian tube ● Fluorescent treponemal antibody absorption test
○ Urethritis – urethra becomes swollen ○ Blood is drawn from a vein
and sore (venipuncture), usually from the inside of
○ Cervicitis – inflamed tissue at the end the elbow or the back of the hand. A
of the uterus needle is inserted into the vein, and the
○ May infect the eye of the baby blood is collected in an air-tight vial or a
● Males syringe
○ Dysuria with purulent discharge (gleet) ● VDRL slide test and rapid plasma reagent test –
detects reagin
MEDICAL MANAGEMENT ○ It measures substances (proteins),
● Uncomplicated called antibodies, which your body may
○ Ceftriaxone IM produce if you have been infected with
○ Oral Doxycycline – 100 mg PO BID for 7 the bacteria that cause syphilis.
days ○ After adequate therapy, the test result
● Pregnant is expected to decrease quantitatively
○ Ceftriaxone IM (single dose) – 125 - 250 until it is read as negative, usually about
+ erythromycin for 7 days 2 years after therapy is completed.
● Crede’s prophylaxis for infants ● CSF Analysis
○ Erythromycin eye ointment ● Treponemal tests, such as the fluorescent
treponemal antibody absorption (FTA-ABS) test
NURSING MANAGEMENT and the microhemagglutination test for
NCMB312

Treponema pallidum (MHA-TP), are used to verify MEDICAL MANAGEMENT

that the screening test did not represent a ● Early Syphilis
false-positive result. Positive results usually are ○ Penicillin G benzathine IM
positive for life and therefore are not appropriate ● Non-pregnant allergic to penicillin
to determine therapeutic effectiveness ○ Tetracycline (contraindicated in
pregnancy)
CLINICAL MANIFESTATION
● Primary Syphilis NURSING MANAGEMENT
○ Painless chancre (a painless ulcer, ● Stress the importance of completing the course of
particularly one developing on the treatment
genitals as a result of venereal disease) ● Practice universal precautions
that disappears 3-6 weeks even without ● Secondary Syphilis
treatment ○ Keep the lesions dry
○ Unilateral or bilateral lymphadenopathy ○ Dispose contaminated materials
○ Occurs 2 to 3 weeks after initial ● Cardiovascular Syphilis
inoculation with the organism. Painless ○ Check the signs of decreased cardiac
lesions at the site of infection, called output
chancres, usually resolve spontaneously ○ WOF pulmonary congestion
within 3 to 12 weeks, with or without ● Neurosyphilis
treatment ○ Regularly check for level of
● Secondary Syphilis consciousness
○ Hematogenous spread ○ WOF signs of ataxia
○ Rash involves the trunk, extremities,
palms, and soles of the feet
ACQUIRED IMMUNODEFICIENCY SYNDROME
○ Condylomata lata – refers to a benign
(AIDS)
and painless cutaneous manifestation
of secondary syphilis. Set of clinical manifestations of HIV. Susceptible to many
○ Occurs by hematogenous spread infections. The patient is very infectious, very ill, and is
leading to generalized infection. The prone to opportunistic diseases. Acquire not hereditary or
rash of secondary syphilis occurs from inborn.
1 week to 6 months after the chancre.
Transmission can occur through contact CAUSATIVE AGENT
with these lesions. Generalized signs of ● Human Immunodeficiency Virus (HIV)
infection may include ○ Retrovirus that belongs to genus
lymphadenopathy, arthritis, meningitis, lentivirus
hair loss, fever, malaise, and weight ○ Attacks and slowly destroys the
loss. immune system and is progressive
● Tertiary Syphilis
○ Neurosyphilitic symptoms MODE OF TRANSMISSION
○ Cardiovascular syphilis ● Sexual intercourse
○ Gumma – chronic superficial nodule or ● Perinatal transmission
a deep granulomatous lesion that is ● Infected blood
solitary, asymmetric, painless, and
indurated PATHOGENESIS
○ Is the final stage in the natural history of ● Acute HIV infection occurs 3-8 weeks
the disease. It is estimated that ● Invades immune cells such as lymphocytes,
between 20% and 40% of those macrophages, langerhans cell
infected do not exhibit signs and ● Invades CD4 cells
symptoms in this final stage. Tertiary ○ CD4 cells are a type of white blood cell.
syphilis may present as a slowly They're also called CD4 T lymphocytes
progressive inflammatory disease with or "helper T cells." That's because they
the potential to affect multiple organs. help fight infection by triggering your
The most common manifestations at immune system to destroy viruses,
this level are aortitis and neurosyphilis, bacteria, and other germs that may
as evidenced by dementia, psychosis, make you sick
paresis, stroke, or meningitis
NCMB312

● Acute illness occurs that may change to chronic ● Oral candidiasis

that results to AIDS ● Wasting syndrome (namamayat)
○ Progression to AIDS is the final stage at
which HIV infection progresses to ONCOLOGIC MANIFESTATIONS
full-blown AIDS. At this stage, people ● Kaposi's Syndrome
infected have CD4 counts of less than ○ a disease in which cancer cells are
200 cells/mm3, significantly weakening found in the skin or mucous membranes
the body's immunity and leading to that line the gastrointestinal (GI) tract,
complications and opportunistic from mouth to anus, including the
infectious diseases (Ols). stomach and intestines. These tumors
appear as purple patches or nodules on
CLINICAL MANIFESTATION the skin and/or mucous membranes
● CD4 <200mm3 – AIDS and can spread to lymph nodes and
● Memory loss lungs.
● Altered gait ● B-cell lymphomas
● Sleep disorders
● Chronic diarrhea NEUROLOGIC MANIFESTATIONS
● HIV encephalopathy
STAGES OF S/SX ○ an infection that spreads throughout the
PRIMARY INFECTION CM brain
● Acute HIV infection, earliest stage ● Vascular myelopathy
● Flu-like symptoms ○ characterized by damage to the spinal
● High-level of viral replication cord due to impaired blood supply.
● HIV in the blood is very high
● Lymphadenopathy, rash and muscle ache DIAGNOSTIC EVALUATION
● Western blot analysis – confirmatory test
CLINICAL LATENCY CM ○ Western blot is often used in research to
● Chronic HIV infection separate and identify proteins. In this
● HIV continues to multiply in the blood but in a technique a mixture of proteins is
slow level separated based on molecular weight,
● Usually advances to AIDS in 10 years or longer and thus by type, through gel
electrophoresis. These results are then
AIDS – FINAL STAGE transferred to a membrane producing a
● Final and most severe stage band for each protein.
● Immune system is severely damaged ● ELISA
● Body can no longer fight off opportunistic ● Oraquick HIV test
infections ○ OraQuick In-Home HIV Test is an FDA
● Decreased CD4 count approved over-the-counter HIV test that
allows you to test quickly and easily in
RESPIRATORY MANIFESTATIONS the comfort of your own home. Shows
● Pneumocystis Jirovicci / Jiroveci Pneumonia results in 20 minutes
○ a serious infection caused by the ● Home access HIV-1 test system
fungus Pneumocystis jirovecii. Most
people who get PCP have a medical MEDICAL MANAGEMENT
condition that weakens their immune ● Antiretroviral Drugs
system, like HIV/AIDS, or take ○ Reverse transcriptase inhibitors
medicines (such as corticosteroids) that (zidovudine, lamivudine, stavudine,
lower the body's ability to fight germs zalcitabine, didanosine (ddI), and
and sickness. abacavir)
● Mycobacterium Avium Complex ○ Protease inhibitors (amprenavir,
○ Mycobacterium Avium atazanavir, darunavir)
○ Mycobacterium Intracellulare ○ Increase DC4 count
○ Mycobacterium Scrofulaceum ● 4 C’s of management
● Tuberculosis ○ Counseling
○ Compliance
GI MANIFESTATIONS ○ Contact tracing
NCMB312

○ Condoms maintain for minutes. (100 + 70) ÷ 2 =

85 mm Hg
NURSING MANAGEMENT ○ Reduce and wait 2 minutes.
● Health education ○ Count petechiae below antecubital
● Give correct information fossa. See image at right.
● Impose confidentiality ○ A positive test is 10 or more petechiae
● Avoid judgemental comments per 1 square inch.
● Use positive statements ■ (+) >20 petechiae in a 1 inch 2
● Universal standards ● Hemoconcentration : steady increase or 20%
● PPE increase
● Occult blood testing

DENGUE FEVER
CLINICAL MANIFESTATIONS
Also known as Breakbone Fever / Hemorrhagic Fever / ● Dengue Fever
Dandy Fever / Infectious Thrombocytopenic Purpura. ○ Malaise and anorexia
Acute febrile disease caused by infection with one of the ○ Fever and chills
serotypes of dengue virus that is transmitted by mosquitoes. ○ Severe frontal headache
Benign form of the disease. ○ Ocular pain
○ Myalgia
DENGUE HEMORRHAGIC FEVER ○ Arthralgia
● Severe, sometimes fetal ○ Rashes
● Dengue Hemorrhagic Fever
MODE OF TRANSMISSION ○ Fever, hemorrhage, hepatomegaly,
● Vector-borne hypovolemic shock

CAUSATIVE AGENT TRIAD OF DENGUE

● Flaviviruses 1,2,3,4 (family: togaviridae) ● Fever
● Arbovirus Group B (arthropod-borne) ● Rashes
● Myalgia
VECTOR
● Aedes Egypti / Aegypti PHASES OF ILLNESS
○ Day biting ● Initial Febrile Phase
○ Low flying ○ High fever with headache
○ Stagnant water ○ Convulsions
○ Urban areas ○ (+) tourniquet test
○ Fine dots at the base of the wings and ○ HERMAN’S RASH – islet of white in the
white bands on the legs sea of red
○ These mosquitoes live in tropical, ○ Purpura, epistaxis (nosebleed), gum
subtropical, and temperate climates. bleeding
● Aedes Albopictus ● Circulatory Phase (3rd to 5th day)
○ Lives in rural areas ○ Decrease in temperature
○ A mosquito native to the tropical and ○ Cyanosis, restlessness, cold clammy
subtropical areas of Southeast Asia. skin
○ Profound thrombocytopenia
DIAGNOSTIC EVALUATION ○ GI hemorrhage
● Platelet count : (+) <100,000 mm3 – ○ Shock
confirmatory test
● Rumpel Leede Test (Tourniquet Test / Capillary CLASSIFICATION ACCORDING TO SEVERITY
Fragility Test) ● Grade 1
○ BP cuff inflated ○ Fever and non-specific Sx
■ Adult – 10 to 15 mins ○ Only hemorrhagic symptom is positive
■ Pedia – 6 to 10 mins in tourniquet test
○ Take the patient's blood pressure and ● Grade 2
record it, for example, 100/70. ○ All signs of grade 1
○ Inflate the cuff to a point midway ○ Spontaneous bleeding from nose and
between SBP and DBP and gums and GIT
NCMB312

● Grade 3 ● Stream Seeding

○ All grade 2 symptoms plus circulatory ● Stream Clearing
collapse
○ Cold clammy skin, hypotension, weak
FILARIASIS
pulse
○ Guarded prognosis Also known as Elephantiasis. Parasitic disease caused by
● Grade 4 the microscopic, thread-like African eye worm. A disease
○ All signs of grade 3 plus shock due to caused by a chronic mosquito-borne parasitic infection.
blood loss
○ Death Chronic infection can lead to swelling of the extremities,
○ Critical prognosis hydroceles, and testicular masses. It is the second-largest
cause of permanent deformity and disability behind leprosy
MEDICAL MANAGEMENT worldwide.
● Symptomatic Treatment
○ Analgesic MODE OF TRANSMISSION
○ IV Infusion ● Vector - borne (mosquito)
○ ORESOL (75mL/kg to run for 4-6 hours)
○ Blood transfusion for severe bleeding TYPES
○ Oxygen therapy
Wuchereria Bancrofti
NURSING MANAGEMENT ● Affects the lymph nodes and lymph vessels of the
● Keep the patient in mosquito-free environment legs, arms, vulva, and breasts
● Rest during bleeding episodes
● Monitoring of VS Brugia Malayi
● Epistaxis – elevate patients trunk and apply ice ● Affects the areas below the knees and below the
bag in the bridge of the nose and forehead elbows
● Trendelenburg position
● Isolation not required Brugia Timori
● Rarely affects genitals. Is a filarial
PREVENTION (arthropod-borne) nematode (roundworm) which
● C – chemically treated mosquito nets causes the disease "Timor filariasis", or "Timorian
● L – larvae eating fish, avoid filariasis"
● E – environmental sanitation (4 o’clock habit)
○ The DOH annual campaign called the 4 Loa Loa (Loiasis)
O’clock Habit, appeals to everyone to ● Called the African eye worm by most people.
STOP, LOOK, and LISTEN. STOP Cutaneous filariasis. It is passed on to humans
means dropping everything at 4:00 p.m. through the repeated bites of deer flies (also
to shift focus to mosquito control. known as mango flies or mangrove flies) of the
LOOK means searching for possible genus Chrysops.
mosquito breeding sites like stagnant
water lying in broken pots or CLINICAL MANIFESTATIONS
receptacles. LISTEN means staying ● Lymphatic Filariasis
updated on bulletins or instructions ○ Fever
from local government units or ○ Inguinal or axillary
community heads about the ongoing ○ Lymphedema of extremities and breasts
measures being done and how one can ○ Orchitis, hydrocele
help or participate ● Cutaneous Filariasis (Loiasis)
● A – anti mosquito soap ○ transient localized subcutaneous
● N – natural mosquito repellants (neem tree, swellings (known as Calabar swellings)
eucalyptus, oregano) ○ Migration of the adult worm across the
● HEALTH EDUCATION subconjunctival of the eye.
○ Change the water in flower vases once
a week DIAGNOSTIC EVALUATION
○ Keep the water containers covered ● Circulating Filarial Antigen (CFA)
○ Avoid hanging too many clothes inside
the house
NCMB312

○ Finger-prick blood droplet taken ● Plasmodium Falciparum

anytime of the day. Routinely used to ○ Malignant tertian
diagnose W bancrofti infection. ○ Most serious malaria
● Nocturnal Blood Examination ○ Infects all types of RBCs
○ Blood obtained around 10 pm - 2 am ○ Blackwater fever – include a rapid
where filarial worms are in high pulse, high fever and chills, extreme
concentration prostration, a rapidly developing anemia
○ Fever paroxysms happen q 36-48 hours
MEDICAL MANAGEMENT ○ Incubation period is 12 days ; period of
● Diethylcarbamazine (DEC) communicability if the patient is
○ Hetrazan untreated >1 year
● Ivermectin ● Plasmodium Vivax
● Albendazole ○ Benign tertian
○ These medications are used to eliminate ○ Eastern Asia
the worms especially the adult ones ○ Affects reticulocytes – immature blood
● Surgery – to remove excess tissue cells
● Elevation of the legs ○ Fever paroxysms happen q 48 hours
● Elastic bandages – reduce edema ○ Incubation period is 14 days ; period of
● DEC-fortified salt – to eliminate transmission of communicability is 1 to 2 years
lymphatic filariasis ● Plasmodium Malaria
○ Quartan
NURSING MANAGEMENT ○ West and Central Africa
● Health education and information dissemination ○ Affects senile RBC – 120 days
on the mode of transmission ○ Fever paroxysms happens q 72 hours
● Environmental sanitation ○ Incubation period is 30 days and period
● Destruction of breeding places of communicability is >3 years
● Encourage personal hygiene ● Plasmodium Ovale
● Explain the course of disease ○ Uncommon in the Philippines
○ Ovale Tertian
○ Fever paroxysm happens q 48 hours
MALARIA
○ Affects reticulocytes
Also known as Marsh Fever / Periodic Fever / King of ○ incubation period is 14 days
Tropical Diseases / Ague. An acute and chronic parasitic
disease transmitted by the bite of infected mosquitoes and PATHOGENESIS
is confined mainly to tropical and subtropical areas. ● Anopheles mosquito gets parasite from the blood
of infected person
It is called Marsh Fever when the marshlands of coastal ● Parasites multiply in mosquito (10-14)
southern and eastern England had unusually high levels of ● Parasites migrate in the salivary gland of the
mortality from the sixteenth to the nineteenth century. The mosquito
unhealthiness of the environment aroused frequent ● Mosquito bites a human
comment during this period and it was attributed to an ● Parasite invades RBC, multiply (asexual
endemic disease known as "marsh fever" or "ague". schizogony, and releases merozoites)
● Invasion of another set of RBC , repeat of the
VECTOR cycle
● Female Anopheles Mosquito
○ Bte people and animals, usually late in DIAGNOSTIC EVALUATION
the evening or at night. ● Malarial Smear
○ Like to lay their eggs in marshy areas or ○ Thick – quantifying – measures the
near the banks of shallow creeks and parasite in the RBC
streams. Adult, female mosquitoes lay ○ Thin – identifying – identifies parasites
eggs one at a time directly on water. form and size of the cells
The eggs float on the surface of the ○ Malaria parasites can be identified by
water. Adult, female mosquitoes lay examining under the microscope a drop
50–200 eggs at a time. of the patient's blood, spread out as a
“blood smear” on a microscope slide.
CAUSATIVE AGENT (Protozoa (Plasmodia) Prior to examination, the specimen is
NCMB312

stained (most often with the Giemsa ● Insect repellants

stain) to give the parasites a distinctive ● People in malaria-infested area should not donate
appearance. blood for at least 3 years
● Rapid Diagnostic Test (RDT) ● Blood donors should be properly screened
○ Can be done in the field
○ Gives result within 10-15 minutes
ENCEPHALITIS
○ Detects malarial parasite antigen in the
blood Also known as Brain Fever. Encephalitis is an acute
● Splenic Biopsy inflammatory process of the brain tissue that usually ends
○ A procedure to take a tiny sample up as a complication characterized by various degrees and
(biopsy) of your spleen tissue. It may be manifestations of cerebral dysfunction. Incubation period
done as a fine-needle aspiration biopsy 5-10 days or 4-21 days.
or as a core needle biopsy. The tissue
sample will be checked under a CAUSATIVE AGENTS
microscope for cancer or other ● Viral Encephalitis
problems. ○ Common viruses (herpes simplex)
○ Childhood viruses
CLINICAL MANIFESTATIONS ○ Arboviruses (culex tritaeniorhynchus)
● Cyclic Paroxysms on and off fever ● Bacterial Encephalitis
○ Cold Stage – Chills (2-3 hours) ○ Bacterial meningitis (primary)
○ Hot Stage – Fever >41 degree cel. (3-4 ○ Syphilis (secondary)
hours) ● Protozoal Encephalitis
○ Wet Stage – Profuse sweating (2-4 ○ Malaria
hours) ○ Amoebiasis
● Splenomegaly
● Hepatomegaly CLASSIFICATIONS
● Myalgia Primary Encephalitis
● Western Equine Encephalitis
MEDICAL MANAGEMENT ○ Western equine encephalitis is a
● Antimalarial Drug mosquito-borne viral infection caused
○ Artemether Lumefantrine – DOC by the western equine encephalitis
○ Chloroquine – except plasmodium virus, a member of the Togaviridae
malaria family of viruses.
○ Quinine – WOF muscular twitching, ○ Most of the infections are subclinical,
delirium, confusion presenting as fever, chills, malaise, and
○ Sulfamethoxazole – resistant myalgias, but some can progress to an
plasmodium falciparum acute inflammation of the meninges and
○ Primaquine – for ovale and vivax brain parenchyma.
○ Erythrocyte exchange transfusion ○ Less than 1 year old
● Eastern Equine Encephalitis
NURSING MANAGEMENT ○ is spread to people by the bite of an
● Close monitoring infected mosquito. Only a few cases are
● Monitor I&O reported in the United States each year.
● Febrile stage: tepid sponge bath, alcohol rubs, ice ○ Happens in young children and adult
cap on the head more than 55 y.o
● Chilling stage: external heat and hot drinks ● St. Louise Encephalitis
● Encourage increase in oral fluid intake ○ Spread to people by the bite of an
● Bed and clothing should be kept dry infected mosquito. Most people
● WOF signs of abnormal bleeding infected with SLE virus do not have
● Evaluate degree of anemia symptoms. Those people who do
become ill may experience fever,
PREVENTION headache, nausea, vomiting, and
● All cases should be reported tiredness.
● Destroy breeding places ○ Olfactory tract
● Insecticides at home ● Japanese Encephalitis
● Use of treated mosquito nets
NCMB312

○ Is a flavivirus related to dengue, yellow ● Use of insect repellent

fever and West Nile viruses, and is ● Public education
spread by mosquitoes. Most common
in Asia.
LEPTOSPIROSIS
○ Children <10 y.o
Also known as Weils Disease / Mud fever / Canicola
Secondary Encephalitis Fever / Hemorrhagic Jaundice / Swine Herd Disease. A
● Post-infection Encephalitis worldwide zoonotic disease caused by bacteria called
○ can be triggered by infection in your Leptospira interrogans. Rat is the main host. An
body. This is known as post-infectious occupational disease affecting veterinarians, miners,
autoimmune encephalitis. In many farmers, sewer workers, abattoir workers. First reported by
instances, no definitive trigger for the Adolf Weil.
abnormal immune response is
identified. CAUSATIVE AGENTS
● Post-vaccine Encephalitis ● Spirochete (Leptospira Interrogans)
○ Most patients complained of ○ Infection comes from contaminated
encephalitis after the first dose 1–2 food and water and infected wildlife and
weeks post-vaccination. AstraZeneca domestic animals like rats and dogs
was the most reported vaccine.
MODE OF TRANSMISSION
CLINICAL MANIFESTATIONS ● Ingestion or contact to mucus membrane of
General Manifestations infected urine or carcasses of wild or domestic
● Early signs animal
○ Fever, headache, vomiting, chills, sore
throat, arthralgia, myalgia, abdominal DIAGNOSTIC EVALUATION
pain ● Kidney function test
● Late signs (encephalitic signs) ● ELISA
○ Nuchal rigidity, ataxia, tremors, mental ● Liver function test
confusion, aphasia, hyperexcitability, ● Leptospira antigen-antibody test (LAAT)
convulsions ○ Leptospirosis can be diagnosed on the
Japanese Encephalitis basis of the presence of IgM antibodies
● Flu-like symptoms, stiff neck, confusion, by Pan Bio ELISA, in a single serum
decreased IQ, serious brain damage sample collected during the acute
phase of the illness. A convalescent
DIAGNOSTIC EVALUATION sample taken after two weeks is
● Serologic test – confirmatory required to confirm the results.
● CSF analysis ● Leptospira antibody test (LAT)
● MRI ○ Antibodies can become detectable by
● CT scan the 6th to 10th day of disease and reach
● Electroencephalogram peak levels within three to four weeks.
○ Blood – 1st week
MEDICAL MANAGEMENT ○ CSF – 4 to 10th day
● Treatment is symptomatic and supportive ○ Urine – 10th day
● TSB, paracetamol
● OFI PATHOGENESIS
● Mouth gags and bedrail Entry of leptospira interrogans
● Monitor i&O ● Liver
● Observe for neurologic signs ○ Kupffer cells proliferation
● Corticosteroids ○ Jaundice
● Physical therapy, occupational therapy, speech ○ Elevation of enzymes
therapy, psychotherapy ● Eyes
○ Icteric eye
PREVENTION ○ Conjunctivitis
● Eradicate mosquito vectors ● Kidneys
● Eliminate breeding places ○ Inflammation of nephrons
● Destruction of larvae ○ Tubular necrosis
NCMB312

○ Renal failure migration inside the abdominal cavity

○ Increase BUN and Creatinine before they direct toward the chest
cavity through the diaphragm.
CLINICAL MANIFESTATIONS ● Intermediate Hosts:
● Septic Stage ○ Antemelania Asperata (freshwater snail)
○ Fever (4-7 days) – 1st intermediate host
○ Chills ○ Crabs (small, fresh-water crabs) – 2nd
○ Headache intermediate host
○ Anorexia
○ Abdominal pain DIAGNOSTIC EVALUATION
● Immune or Toxic Stage ● Sputum analysis (eggs in brown spots)
○ Iritis / Uveitis – inflammation of the eye ● Eosinophilia in CSF
(iris)
○ Can be with or without jaundice CLINICAL MANIFESTATIONS
○ Meningeal manifestations ● Cough of long duration
(disorientation, convulsions) ● Hemoptysis
○ Progressive renal failure (oliguria) ● Chest and back pain
○ Shock ● PTB-like symptoms not responding to anti-TB
○ Edema medications
● Convalescence
○ Relapse may occur during the 4th to 5th MEDICAL MANAGEMENT
weeks ● Praziquantel (treatment of choice)
○ Triclabendazole
MEDICAL MANAGEMENT ● Bithionol – alternative drug
● Antibiotics
○ Penicillin NURSING MANAGEMENT
○ Doxycycline ● Health Teaching
● Prophylaxis ○ Disinfection / sanitary disposal of
○ Doxycycline (100 mg q12 for 1 week) excreta
● Peritoneal dialysis ○ Anti-mollusk campaign
● Fluid and electrolytes replacement ○ Avoid eating infected foods
○ Avoid bathing in infected water
NURSING MANAGEMENT
● Isolate the patient
ENVIRONMENTAL HEALTH AND SANITATION
● Darken the patient’s room
● Meticulous skin care A branch of public health that deals with the study of
● Eradicate rats and rodents preventing illnesses by managing the environment and
● Emphasize the use of protective clothing changing people’s behavior to reduce exposure to biological
○ Boots and non-biological agents of disease and injury.
○ Gloves
PD 856 – Sanitation Code of the Philippines (Dec. 23,
1975)
PARAGONIMIASIS
Presidential Decree No. 856 Promulgating the Code on
A chronic parasitic infection which greatly reduces human Sanitation of the Philippines. The objective of this Code on
productivity and quality of life. Frequently encountered in Sanitation is the improvement of the way of the Filipinos by
communities where eating of fresh or inadequately cooked directing public health services towards the protection and
crabs is a practice. Manifestations closely resemble PTB. promotion of the health of the people.

CAUSATIVE AGENT
WATER SUPPLY SANITATION PROGRAM
● Lung Flukes
○ Paragonimus Westermani (common in APPROVED TYPE OF WATER FACILITIES
Asia)
○ Paragonimus Siamensis Level 1 (Point Source)
○ Westermani penetrate the intestinal wall ● Protected well or a developed spring with an
and localize in the peritoneal cavity outlet but without a distribution system.
there appears to be a considerable ● Serves 15-25 households
NCMB312

● Outreach must not be more than 250 meters b. Eat the food immediately
c. Hand washing before and after eating
Level 2 (Communal Faucet System or Stand Posts) 4. Right Storage
● Composed of a reservoir, piped distribution a. Food at room temperature not more
network, and communal faucets, located not more than 2 hours
than 25 meters from the farthest house b. Tightly seal the containers
c. Store in hot conditions (above 60
Level 3 (waterworks System or Individual Household degrees), cold conditions (10 degrees)
Connections) d. Do not overburden the refrigerator
● System with a source, a reservoir, a piped e. Reheat before eating
distributor network and household taps f.
RULE IN FOOD SAFETY: WHEN IN DOUBT, THROW IT
OUT
PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM

APPROVED TYPE OF TOILET FACILITIES

Level 1
● Non-water carriage toilet facility
○ Pit-latrines, reed-odorless earth closet
● Toilet facilities requiring small amount of water
○ Pour flush toilet and aqua privies

Level 2
● On site toilet facilities of the water carriage type
with water-sealed and flush type with septic vault
/ tank disposal facilities

Level 3
● Water carriage types of toilet facilities connected
to septic tanks and/or sewerage system to
treatment plant

FOOD SANITATION PROGRAM

Inspection and approval of all food sources, containers, and

transport vehicles. Health certificate for food handlers
including ambulant food vendors. Training of food handlers.
Conducted by BFAD.

FOUR RIGHTS IN FOOD SAFETY

1. Right Source
a. Buy fresh
b. Look at expiry date
c. Avoid canned foods with dents and
bulges
d. Clean and safe source of water
e. Boil water at least 2 minutes
2. Right Preparation
a. Avoid contact between raw food and
cooked foods
b. Buy pasteurized milk and fruit juice
c. Hand washing
d. Remove food droppings
3. Right Cooking
a. Cook food thoroughly (70 degrees
centigrade)
NCMB312

WEEK 15 ○ Non-invasive
○ Does not metastasize
ONCOLOGY NURSING
● Malignant – an abnormal collection of cells that is
Oncology nurses are registered nurses who take care of cancerous
either cancer patients or those with the potential of ○ Undifferentiated / anaplasia (loss of the
developing cancer. Oncology nurses work with physicians structural and functional differentiation)
and other medical professionals to prevent, diagnose, treat, ○ Erratic and uncontrolled growth
and manage cancer symptoms, as well as provide palliative ○ Expansive and invasive
care. Branch of medicine that deals with the study, ○ Secretes abnormal proteins
detection, treatment, and management of cancer and ■ Cancer cells are capable of
neoplasia. emitting complicated abnormal
glycoproteins as well as
CANCER calcium-histone proteins which
constitute TAP.
The origin of the word cancer is credited to the Greek
○ Metastasizes
physician Hippocrates (460-370 BC), who is considered the
● Borderline – not invasive but also not completely
“Father of Medicine.” Hippocrates used the terms carcinos
benign. Their behavior can also vary based on
and carcinoma to describe non-ulcer forming and
microscopic features, and some are more likely to
ulcer-forming tumors.
recur or spread than others.
○ Low malignant potential or LMP
Is a complex of disease which occurs when normal cells
■ a disease in which abnormal cells
mutate into abnormal cells that take over normal tissue,
form in the tissue covering the
eventually harming and destroying the host. A large group of ovary
disease characterized by: ○ Difficult to detect
● Uncontrolled growth and spread of abnormal cells
● Proliferation CHARACTERISTICS OF NEOPLASIA
● Metastasis Key Areas
ROOT WORDS
Differentiation
NEO NEW A well-differentiated neoplasm is composed of cells that
closely resemble the cell of origin, while poorly
PLASIA GROWTH differentiated/ undifferentiated neoplasms have cells that
are difficult to recognize as to their cell of origin.
PLASM SUBSTANCE
Capsulation
TROPHY SIZE The presence of a capsule around a tumor is known to be
correlated with benign status, and the absence of a capsule
+OMA TUMOR
often has negative implications for patient prognosis.
STASIS LOCATION
Growth Rate
A NONE An aggressive malignant neoplasm doubles in 1 to 3
months, while benign neoplasms double in years.
ANA LACK
Local Invasion
HYPER EXCESSIVE Occurs when tumor cells proliferate, accumulate genetic
alterations, stimulate angiogenesis, and undergo
META CHANGE epithelial-mesenchymal transition (EMT) locally.

DYS BAD, DERANGED

Metastasis
Cancer has spread to a different part of your body part than
CHARACTERISTICS OF NEOPLASIA where it started.
Uncontrolled growth of abnormal cells
● Benign – an abnormal but noncancerous LOSS OF NORMAL GROWTH CONTROL
collection of cells Normal cells divide only when they receive a set of
○ Well-differentiated appropriate signals whereas cancer cells divide themselves
○ Slow growth despite the absence of those signals, and they are resistant
○ Encapsulated to the signals telling them to self-destruct, known as
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apoptosis or programmed cell death. Cancer cells, on the ○ Ectoderm – the outermost germ layer in
other hand, don't follow this cycle. Instead of dying, they animals
multiply out of control and continue to reproduce other ○ Endoderm – the innermost germ layer
abnormal cells. These cells invade body parts, such as the that forms the linings of the respiratory
breast, liver, lungs and pancreas. and gastrointestinal tracts, and their
● Apoptosis is the process of programmed cell associated organs, during embryonic
death. development.
○ Mesoderm – the middle layer of the
GROWTH PATTERNS three germ layers that develops during
● Benign gastrulation in the very early
○ Hypertrophy – the increase in the development of the embryo of most
volume or increase size of cells of an animals.
organ or tissue due to the enlargement
of its component cells BENIGN TUMOR
○ Hyperplasia – increased cell Suffix “OMA” is used.
production or increased number of cells ● Adipose tissue – lipOMA
in a normal tissue or organ. May be a ● Bone – osteOMA
sign of abnormal changes. ● Muscle – myOMA
○ Metaplasia – the replacement of one ● Blood vessels – angiOMA
differentiated somatic cell type with ● Fibrous tissue – fibrOMA
another differentiated somatic cell type
in the same tissue. MALIGNANT TUMOR
○ Dysplasia – an increase in abnormal Named according to the embryonic cell origin
cell growth or development. This is a (Ectodermal, Endodermal, Glandular, Epithelial). Suffix
precancerous state, and it is more “CARCINOMA” is used.
serious than hyperplasia, which is just ● Pancreatic AdenoCARCINOMA
an overgrowth of normal-appearing ● Squamous Cell Carcinoma
cells
■ a pleomorphic tumor would Mesodermal, connective tissue origin. Suffix
be a growth that is composed “SARCOMA” is used.
of different types of tissues ● fibroSARCOMA
● Malignant ● MyoSARCOMA
○ Anaplasia – implies dedifferentiation (or ● AngioSARCOMA
loss of the structural and functional
differentiation) of normal cells during
OMA BUT MALIGNANT Hepatoma, lymphoma,
tumorigenesis.
glioma, melanoma

INVASION AND METASTASIS THREE GERM LAYERS Teratoma

● Cancer cells invade surrounding tissues and
blood vessels NON-NEOPLASTIC BUT Choristoma
● Cancer cells are transported by the circulatory OMA Hamartoma
system to distant sites
● Cancer cells reinvade and grow at new location WHAT CAUSES CANCER?
● Heredity
TUMOR IS NAMED ACCORDING TO: ● UV Radiation
● Parenchyma, organ or cell ● Chemicals
○ Hepatoma – liver ● Viruses
○ Osteoma – bone ● Smoking
○ Myoma – muscle ● Cell Division
● Pattern and structure, either GROSS OR
MICROSCOPIC ETIOLOGY OF CANCER
○ Fluid-filled or cyst ● Viruses / Bacterias
○ Glandular or adeno ● Chemical Carcinogens
○ Finger-like or papillo ● Physical Agents
○ Stalk or polyp ● Hormonal Factors
● Embryonic Origin
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● Genetic Factors
● Dietary
● Immune Disease

POPULATION-BASED STUDIES
1. United Kingdom – Lung Cancer
2. China – Liver Cancer
3. Japan – Stomach Cancer
4. United States – Colon Cancer
5. Canada – Leukemia
6. Brazil – Cervical Cancer

THE CELL CYCLE

3 types of Cells
● Permanent
○ Cells that are unable to replicate in
postnatal life. Nervous cells, also The duration of these cell cycle phases varies considerably
termed neurons, together with skeletal in different kinds of cells. For a typical rapidly proliferating
muscle and cardiac cells, are included human cell with a total cycle time of 24 hours, the G1 phase
in this group, which traditionally might last about 8-10 hours, S phase about 8 hours, G2
identifies the human tissues that are about 4-6 hours, and M about 1 hour.
incapable of spontaneous regeneration.
● Stable / Quiescent
○ Are cells that multiply only when
needed. They spend most of the time in
the quiescent G0 phase of the cell cycle
but can be stimulated to enter the cell
cycle when needed. Examples include
the liver, the proximal tubules of the
kidney and endocrine glands.
● Labile
○ Are cells that continuously multiply and
divide throughout life . Labile cells
replace the cells that are lost from the
body.

CELL CYCLE TIME

The amount of time required for a cell to move from one

mitosis to another mitosis. For example, if mitosis is 30
minutes (0.5 hours) long and the frequency of cells in mitosis THE CELL CYCLE AND THE CHECKPOINTS
is 0.00012, then 0.5 hours is 0.00012 of the length of the cell 1. Cell Growth Checkpoint
cycle. Thus, the cell cycle is 0.5/0.00012 = 4167 hours in a. Occurs towards the end of G1 or
length, on average, which is nearly half a year. Growth Phase 1
b. Checks whether the cell is big enough
Normally, the number of cells produced = the number of and has made the proper proteins for
cells that die. The total number of cells in the body remains the synthesis phase
constant. c. If not, the cell goes through a resting
period (G0) until it is ready to divide
2. DNA Synthesis Checkpoint
a. Occurs during the synthesis phase
b. Checks whether the DNA has been
replicated correctly
c. If so, the cell continues on the mitosis
phase
3. Mitosis Checkpoint
a. Occurs during the mitotic phase
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b. Checks whether the mitosis is complete becomes mutated, it is called a proto-oncogene,

c. If so, the cell divides, and the cycle and it plays a role in regulating a normal cell
repeats division.
● Tumor Suppressor Genes represents the opposite
DOUBLING TIME
side of cell growth control, normally acting to
It is the length of time it takes for a tumor to double its inhibit cell proliferation and tumor development.
volume. The average doubling time is 2 months. Rapidly
growing tumors may double every month and slow growing Failure of the Immune Response Theory
tumors may double every year. ● Advocates that all individuals possess cancer
cells. However, the cancer cells are recognized by
the immune response system. So, the cancer cells
undergo destruction. Failure of the immune
system leads to inability to destroy the cancer
cells.

STAGES OF CANCER CELL GROWTH

1. Initiation – irreversible mutation of a gene that
leads to malignant transformation. Normally, these
alterations are reversed by DNA repair
mechanisms or the changes initiate apoptosis
(programmed cellular death) or cell senescence.
The Gompertz function is a solution of the mathematical 2. Promotion – promoting agents stimulates the
model which describes dynamics of tumor growth. The growth and divisions of a cell. Repeated exposure
Gompertz Model captures how tumor growth rates decrease to promoting agents (co-carcinogens) causes
as the mass of the tumor increases. proliferation and expansion of initiated cells with
increased expression or manifestations of
abnormal genetic information, even after long
latency periods.
3. Transformation – series of changes that lead to
the characteristics of undifferentiated cells.
4. Metastasis – tumor has properties needed to
spread to other organs in the body

Cellular oncogenes are responsible for vital cell functions,

including proliferation and differentiation. Cellular
proto-oncogenes, such as those for the epidermal growth
factor receptor (EGFR), transcription factors such as c-Myc,
or cell signaling proteins such as Kirsten ras (KRAS), act as
CARCINOGENESIS “on switches” for cellular growth. Amplification of
Is the formation of a cancer, whereby normal cells are proto-oncogenes or overexpression of growth factors, such
transformed into cancer cells. The process is characterized as epidermal growth factor (EGF), can lead to uncontrolled
by changes at the cellular, genetic, and epigenetic levels cell proliferation. Mutations that increase the activity of
and abnormal cell division. Agents that initiate or promote oncogenes also deregulate cell proliferation. Genetic
malignant transformation are referred to as carcinogens. A alterations in the gene for KRAS have been associated with
complete carcinogen is an agent that both initiates and pancreatic, lung, and colorectal cancers.
promotes the development of cancer (e.g., cigarette
smoking, asbestos). Just as proto-oncogenes “turn on” cellular growth, cancer
suppressor genes “turn off,” or regulate, unneeded cellular
THEORIES proliferation. When suppressor genes are mutated, resulting
Cellular Transformation and Derangement Theory in loss of function or expression, the cells begin to produce
● Conceptualizes that normal cells may be mutant cell populations that are different from their original
transformed into cancer cells due to exposure to cellular ancestors.
some etiologic agents.
● Oncogenes is a mutated gene that has the FACTORS INFLUENCING CANCER DEVELOPMENT
potential to cause cancer. Before an oncogene ● Genetic predisposition (gender)
● Family history, lifestyle
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● Geographic Distribution inherited or acquired, leading to abnormal cell behavior. The

● Stress initial genetically altered cell forms a clone and begins to
● Obesity proliferate abnormally, evading normal intracellular and
● Urban vs. Rural Residence extracellular growth-regulating processes or signals as well
as the immune system defense mechanisms of the body.
Environmental Agents Genetic mutations may lead to abnormalities in cell
● Chemicals signaling transduction processes (signals from outside and
○ Asbestos, arsenic, benzidine within cells that turn cell activities either on or off) that can in
● Radiation turn lead to cancer development.
○ Ionizing are x ray, gamma rays, cosmic
rays, UV rays (UVA/UVB/UVC) Ultimately cells acquire a variety of capabilities that allow
■ UVA rays have the longest them to invade surrounding tissues or gain access to lymph
wavelengths, followed by UVB, and blood vessels, which carry the cells to other areas of
and UVC rays which have the
the body resulting in metastasis or spread of the cancer.
shortest wavelengths. While UVA
Benign (noncancerous) and malignant (cancerous) cells
and UVB rays are transmitted
through the atmosphere, all UVC differ in many cellular growth characteristics, including the
and some UVB rays are absorbed method and rate of growth, ability to metastasize or spread,
by the Earth's ozone layer. destruction of tissue, and ability to cause death.. The degree
○ Non-ionizing are microwave, radio of anaplasia (a pattern of growth in which cells lack normal
frequency, visible light characteristics and differ in shape and organization with
● Dietary Radiation respect to their cells of origin) is associated with increased
○ Alcohol, fats, nitrite and nitrates malignant potential.
● Viruses, bacteria, parasites
○ DNA viruses
○ RNA viruses
○ H. Pylori
○ Schistosoma Haematobium
○ Opisthorchis Viverrini

7 FUNDAMENTAL CHANGES IN MALIGNANCY

1. Self-sufficiency in Growth Signals

2. Insensitivity to Growth-Inhibitory Signals
a. Tumor suppressor genes (gatekeepers
and caretakers)
i. GK directly inhibit tumor
growth or promote tumor
death
ii. CT are genes responsible for
keeping other genes healthy
3. Evasion of apoptosis HOW CANCER SPREADS?
4. Defects in DNA repair ● Lymphatic
a. A telomere is a region of repetitive DNA ● Hematogenous
sequences at the end of a ● Direct Spread
chromosome. Telomeres protect the
ends of chromosomes from becoming METASTATIC CASCADE
frayed or tangled. Each time a cell ● Clonal expansion, growth, diversification,
divides, the telomeres become slightly angiogenesis
shorter. ● Metastatic subclone
5. Limitless replicative potential ● Adhesion to and invasion of basement membrane
6. Sustained angiogenesis (VEGF) ● Passage through extracellular matrix
7. Ability to invade and metastasize ● Interaction with host lymphoid cells
● Tumor cell embolus
PATHOPHYSIOLOGY OF CANCER ● Adhesion to basement membrane
Cancer is a disease process that begins when a cell is ● Extravasation
transformed by genetic mutations of the cellular
deoxyribonucleic acid (DNA). Genetic mutations may be
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○ the process of tumor cells invading from ● VInca Alkaloids

the interior of a vessel into the organ ○ Stopping the cancer cells from
parenchyma separating
● Metastatic deposit ○ Indication: Leukemia
● Angiogenesis ○ Vincristine (Oncovin), Vinblastine,
● Growth Taxanes (Paclitaxel, Tacetaxel)
○ Adverse Effects : Teratogenic (can
cause abnormalities in fetal
development and causes congenital
disabilities)
○ Not to be given in patients with renal
failure
○ Side Effects : Neurologic
■ Tingling
■ Numbness
■ Constipation
■ Paralytic Ileus
● Alkylating Agents
○ Attacks the DNA to stop the strands to
uncoil and separate (necessary in DNA
replication) so the cells can no longer
GENERAL PROMOTIVE AND PREVENTIVE NURSING
divide
MANAGEMENT
○ Nitrogen Mustard
● Lifestyle modification (stress reduction)
○ Cyclophosphamide, Carboplatin
● Early detection (Screening)
○ Nitrosoureas
● Nutritional management
■ Carmustine
● Screening
■ Comustine
■ Streptozin
GENERAL WARNING SIGNS OF CANCER
○ Busulfan
C – change in bowel or bladder habits
■ WOF : increased uric acid
A – sore that does not heal
○ Cisplatin
U – unusual bleeding or discharges
■ WOF : ototoxic and
T – thickening or lump in the breast or elsewhere
nephrotoxic
I – indigestion or difficulty in swallowing
○ WOF : hemorrhagic cystitis
O – obvious changes in warts or moles
○ Management : Increased OFI, given
N – nagging cough and hoarse voice
with food
U – unexplained anemia
● Anti-Metabolites
S – sudden weight loss
○ Prevents cancer cells from replicating
○ Hydroxyurea, Fluorouracil, Methotrexate
TREATMENT MODALITIES ○ WOF : Increased uric acid,
hepatotoxicity, photosensitivity
CHEMOTHERAPY ○ ANTIDOTE : leucovorin and folinic acid
Destroys normal and abnormal cells. Route is oral and IV. ● Antitumor-Antibiotics
side effects might be phlebitis (an inflammation that causes ○ These drugs cause the strands of
a blood clot to form in a vein, usually in your leg) / genetic material that make up DNA to
extravasation (highly vesicant). Used to reduce the tumor uncoil, thereby preventing the cell from
size before surgery. reproducing
○ Bleomycin, Daunorubicin (Daunomycin)
Adjuvant therapy is any type of therapy that follows the ○ Doxorubicin
primary treatment. So, adjuvant chemotherapy takes place ■ WOF : Red urine, heart failure,
after you've had first-line treatment, such as surgery to dysrhythmias,
remove a cancerous tumor. Adjuvants also help to destroy cardiomyopathy
any tumor cells post-op. ● Hormonal Drugs
○ Antiandrogen. Blocks your body’s
CHEMOTHERAPEUTIC DRUGS natural hormones from reaching any
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remaining cancer cells to stop Teletherapy is the most commonly used in radiation
replication. therapy. It is done external and is used for destruction of
○ Finasteride, Saw Palmetto (saw abnormal cells only. Put markings opposite the tumor
palmetto inhibits the growth of tumor location site. LART or Linear Acceleration Radiation
cells, indicating that it may be helpful in Therapy machine that aims radiation at cancer tumors with
the treatment of prostate cancer) pinpoint accuracy, sparing nearby healthy tissue. It's used
■ WOF : gynecomastia , to deliver several types of external beam radiation therapy,
virilization (females develop including: Image-guided radiation therapy (IGRT).
male traits)
WOF leukopenia, SE are dry or wet desquamation
SIDE EFFECTS OF CHEMOTHERAPY (shedding) of the skin, dry mouth, mouth sore, decreased
Hair taste may occur.
● Temporary Alopecia
● 14 days after chemo Interventions for Teletherapy would include:
● Hair grows for 3-6 months ● Avoid creams, lotions, powder, and oil at the site
● Management ● Wash with mild soap and water then pat dry
○ Mild shampoo ● Do not remove markings unless done with
○ Wide-toothed comb sessions
○ Wigs, hats, turban hats, scarfs ● Avoid sun exposure
● Wear loose clothes
Mucus Membrane ● Avoid belts, buckles, or strap
● Stomatitis ( inflammation and redness of the oral
mucosa ) Brachytherapy radiation is used in continuous contact with
● Dysgeusia ( a foul, salty, rancid, or metallic taste the tumor. The radiation source is within the patient. A type
sensation persists in the mouth ) of internal radiation that uses radiation to destroy cancer
● Xerostomia ( the sensation of oral dryness, which cells and shrink tumors. The radiation often comes in the
can result from diminished saliva production ) form of seeds, ribbons, or wires. These are put into your
● Management body, in or near the cancer.
○ Avoid hot, spicy, citrus, alcoholic
mouthwash TYPES
○ Increase fluids ● Unselead
○ A medicine with radioactive materials is
Stomach Lining injected into a vein or into a body cavity.
● Nausea and vomiting. Antiemetic medications are ○ Given IV, Oral, or IM with radioisotope
given 30 before chemotherapy. ○ Iodine 1-3-1
○ With radiation
Extravasation ○ Results will show within 48 hours
● Stop and notify the physician for the antidote. ● Sealed Implant (Intracavitary Cesium)
○ The type of implant and the method of
Sperm (Aspermia / Sterility) placing it depend on the size and
● Cryopreservation ( the process of collecting, location of the cancer.
freezing and storing sperm ) ○ Left inside the body
○ Usually for cervix
Bone Marrow Depression (Pancytopenia) ○ No radiation in secretions, tears, urine
● Occurs when a person has a decrease in all three and feces
blood cell types
● Infection control and bleeding precaution SAFETY PRINCIPLES FOR RADIATION THERAPY
● Time : 30 mins or <8 hours or once per shift
● Distance : 6 ft away and stand at foot of the bed
RADIATION THERAPY
● Shield : Lead apron
Used to decrease the tumor size. Contraindicated for
pregnancy, immunocompromised, and children below 6 NURSING MANAGEMENT
years old. It has two types: Brachytherapy (internal) and ● Private room with private bathroom (put radiation
Teletherapy. precaution outside)
● RN should never come into contact with more
than 1 client with radiation implant at a time
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● Bed linens are not removed : unless if source is Testicular Examination is a step-by-step guide to
removed examining a patient's testicles and penis for clinical signs,
● RN should wear dosimeter badge such as skin changes, scars, masses, swelling and bruising.
○ for monitoring cumulative radiation dose Done every month with the same day. Done after a warm
due to ionizing radiation bath,
● If dislodged: ● Lift each testicle
○ Wear long lead apron ● Normal : firm, not hard, and smooth
○ Long-handled forceps ● Both hands on testicles and thumb on top
○ Lead container ● Roll testicles between thumb and fingers
○ Call the radiation oncologist
○ Document Digital Rectal Exam is a simple procedure to check the
health of the lower rectum and other internal organs. 40 y.o
and above can do this test.
SCREENING TESTS

Breast Self Examination, or regularly examining your POSITION

breasts on your own, can be an important way to find breast ● Men : bending forward, check prostate gland
cancer early, when it’s more likely to be treated successfully. ● Women : lithotomy, check uterus and
Starts at 20 years (monthly). 5–7 days after menstruation hemorrhoids
when the breast is less tender.
● (+) menopause / irregular – same day monthly Sigmoidoscopy is a procedure that lets your doctor look
● (+) taking pills – before taking 1st pill inside your sigmoid colon by using a flexible tube with a
light on it. It helps check for ulcers, abnormal cells, polyps,
POSITION etc. Can be done to patients that are 50 years old every 3–5
● Standing in front of mirror years.
● Lying with pillow
Tumor Markers is a biomarker found in blood, urine, or
PALPATE body tissues that can be elevated by the presence of one or
● Horizontal more types of cancer.
● Vertical ● PSA or Prostate Specific Antigen
● Circular ○ Is a protein produced by normal, as well
● Pinch the nipple and note for discharge as malignant, cells of the prostate
gland. The PSA test measures the level
Mammography is the process of using low-energy X-rays of PSA in the blood
to examine the human breast for diagnosis and screening. It ○ Prostate CA
can detect breast cancer, microcalcifications, and other ● PAP or Prostate Acid Phosphate
abnormalities. Starts at 40 years old. Uses 2 metal plates ○ Elevated levels of PAP may indicate
that compress the breast (horizontal and oblique). Clinical testicular cancer
Indications are pregnancy and breast implants. ○ Advanced Prostate CA
● ALP or Alkaline Phosphatase
MANAGEMENT ○ An enzyme found in your liver and
● Avoid deodorant or talcum powder bones that can be measured by a blood
● False (+) – presence of calcium crystals test.
○ Metastatic Prostate Ca
Pap Smear is a screening tool for cervical cancer and other ● CA 125 or Cancer Antigen 125
abnormal cells in the cervix. It can detect HPV, a common ○ Measures the amount of a protein in the
STI that increases the risk of cervical cancer. 18 y.o and blood that may indicate ovarian cancer
above or when sexually active people can undergo this test. or other conditions
Done annually. ○ Ovarian Ca
● If (-) for 3 consecutive years, next is done for ● CEA or Carcinoembryonic Antigen
every 3 years. ○ Measures CEA levels and can help
diagnose, monitor and treat cancer,
MANAGEMENT especially colorectal cancer
● Avoid douching (wash out vagina, usually with a ○ Colorectal / Cervical Ca
mixture of water and vinegar) as it may give false ● AFP or Alpha Fetoprotein
negative result ○ Elevated levels of AFP may be
indicative of open neural tube defects
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because the AFP leaks out of the fetal while keeping heart rate and blood pressure steady. The
circulation into the amniotic fluid and SNS is the driving force behind the ‘fight or flight’ response
chromosome abnormalities. and triggers a number of physiological changes that prepare
○ Testicular / Lung Ca the body to confront or flee a perceived threat.
● HCG or Human Chorionic Gonadotropin
Hormone BRAIN ANATOMY AND FUNCTIONS
○ Is most common in seminomatous and Cerebellar Functions
nonseminomatous testicular tumors, ● Motor Functions
ovarian germ cell tumors, the ○ Coordinates voluntary movements:
gestational trophoblastic diseases posture, balance, coordination, and
(GTDs) speech
○ Choriocarcinoma Cerebral Functions
● CA 19-9 or Cancer Antigen 19-9 ● Higher Mental Function (Frontal Lobe)
○ Is a blood test measures the amount of ○ Problem solving, thinking, planning,
a protein in your blood that can indicate judgment, emotional expression,
the presence of pancreatic cancer or creativity, behavioral control
other types of cancer or conditions ● Motor Functions
○ Pancreatic / Bladder Ca ○ Orientation, head and eye movement,
● CA 15-3 or Cancer Antigen 15-3 posture
○ Is a blood test that checks for CA 15-3 ● Broca’s Area (Temporal Lobe)
levels in the blood. CA 15-3 is a protein ○ Control of muscles for speech
that breast cells produce and release production and ability to comprehend
when they have cancer. grammatical structures
○ Breast Ca ● Motor Functions (Sensory Association
● NSE or Neuron Specific Enolase Functions)
○ Is associated with several cancers, but ○ Initiation of voluntary muscles,
it is used most often to monitor movement
treatment in patients with ● Sensory Functions
neuroblastoma or small cell lung cancer ○ Sensation from skin and muscles
○ Neuroblastoma ● Emotional Functions
○ Fight or flight response, pain, hunger
Biopsy is a procedure used to diagnose cancer. It can help ● Visual Functions (Occipital Lobe)
determine if you have cancer or another condition. The most ○ Coordination of the eye movements,
definitive test for cancer. Historogical proof of cancer by perception, image recognition,
tissue accumulated from the patient's body. association, visual memory
● Association Area (Parietal Lobe)
TYPES ○ Short term memory, equilibrium,
● Needle or Aspiration emotion
○ This type of needle biopsy uses a thin,
hollow needle to draw cells from your
body
● Incisional or Wedge Tissue
○ Is a type of biopsy procedure that
involves making a small incision in your
skin to remove a piece of tissue or a
sample of cells from a suspicious area
● Excisional or Entire
○ Is a surgical procedure that removes an
entire tumor or area of abnormal skin
and some of the surrounding skin

CENTRAL NERVOUS SYSTEM CANCER

The PSNS controls the ‘rest and digest’ functions of the Hypothalamus
body and maintains the body’s internal environment. It is
responsible for regulating digestive and sexual function
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The hypothalamus is a small area in the brain that produces TYPES OF NEUROGLIA
hormones that regulate heart rate, body temperature, ● Ependymal Cells CNS
hunger, and the sleep-wake cycle ● Oligodendrocytes
● Astrocytes
Sella Turcica ● Microglia
Is a bony structure at the base of your brain that surrounds ● Satellite Cells PNS
and protects your pituitary gland. The sella turcica is a ● Schwann Cells
saddle-like compartment ● Glial Cells

Sphenoid Sinus SPINAL CORD

Is an air cavity within the body of the sphenoid bone. It is a ● Lamina
midline structure located anterior to the clivus, posterior to ● Pedicle
the superior meatus of the nasal cavity ● Spinal Cord
● Vertebra Body
Posterior Pituitary
Your posterior pituitary's main functions are to store and
BRAIN TUMORS
release the hormones oxytocin and vasopressin (antidiuretic
hormone). Grey Matters Brain Cancer Awareness. A brain tumor is a
growth of cells in the brain or near it. Brain tumors can
Anterior Pituitary happen in the brain tissue.
Is responsible for creating and releasing over six different
hormones that affect many different bodily processes CLASSIFICATION SYSTEM
● Classified by cell origin
Frontal Sinus ● Mitotic activity
The mucosal lining helps to warm and humidify inhaled air ● Microvascular endothelial perfusion
entering from the nasal cavity, whilst its presence as a ● (+) necrosis
hollow space in the frontal bone lightens the mass of the
skull, allowing the muscles that move the head and neck to TUMOR GRADING
work more efficiently. ● GRADE 1 : tissue is benign or slow-growing
● GRADE 2 : tissue is malignant but slow-growing
Nasal Passages ● GRADE 3 : malignant tissue has cells that are
Humidify and warm the inspired air. Also, as the air passes active reproducing abnormal cells
through, the nasal cavity removes minute airborne particles ● GRADE 4 : malignant tissue has cells are
and other debris before the air reaches the lower airways reproducing rapidly and form new vessels

Hard and Soft Palate

The palates play important roles in swallowing, breathing,
and speech. The soft palate is the muscular part at the back
of the roof of the mouth. It sits behind the hard palate, which
is the bony part of the roof of the mouth.

Cranial Meninges
Refers to the section that covers the brain
● Dura Mater
● Arachnoid Mater
● Pia Mater NEUROEPITHELIAL (GLIOMA)

Astrocytoma
NEURONS AND NEUROGLIAL CELLS
Is a growth of cells that starts in the brain or spinal cord. The
● Dendrite
growth, called a tumor, starts in cells called astrocytes.
● Neuron
Astrocytes support and connect nerve cells in the brain and
● Microglia
spinal cord. Astrocytoma symptoms vary based on the
● Astrocytes
tumor's location.
● Axon
● Most common type of glioma. 30%.
● Oligodendrocytes
● Myelin Sheath
Oligodendroglioma
● Synapse
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Is a central nervous system tumor, meaning it affects your ● GRADE 4 or Glioblastoma Multiforne (GBM)
brain (or rarely, your spinal cord). It starts in a type of glial ○ Also referred to as a grade IV
cells, which are your nervous system’s support cells. astrocytoma, is a fast-growing and
Experts consider oligodendroglioma a very treatable tumor, aggressive brain tumor. It invades the
even when cancerous, and the odds of survival are usually nearby brain tissue, but generally does
good. not spread to distant organs. GBMs can
● Accounts 15% of the gliomas. More in men than arise in the brain de novo or evolve from
women. More sensitive to chemotherapy. lower-grade astrocytoma.
○ The average life expectancy after
Oligoastrocytoma (Mixed Glioma) diagnosis is 14 to 16 months,
Tumors that are a mixture of cells that originated from approximately 1% of patients survive at
oligodendrocytes and astrocytes, two types of cells in the least 10 years. Currently, the longest
brain that support and insulate nerve cells. anyone has survived a glioblastoma is
more than 20 years and counting.
Ependeymomas
MENINGEAL TUMOR (MENINGIOMA)
Are glial cell tumors that commonly arise in the lining cells of
the ventricular system, and less commonly outside the A primary central nervous system (CNS) tumor. This means
central nervous system (CNS), or within the brain it begins in the brain or spinal cord. Overall, meningiomas
parenchyma. They are genetically distinct subgroups of are the most common type of primary brain tumor. However,
tumors and affect children more commonly than adults. higher grade meningiomas are very rare. Even if a
● 6% of cancer. Develop in the wall of ventricles. meningioma is benign, if it grows large enough, it can press
Hydrocephalus is the manifestation. on important nerves and structures of your brain, which can
cause harm and even be life-threatening. More common in
Embryonal or Primitive Neuroectodermal Tumors adults and women.
(PNET)
PNETs are commonly found in the brain and rarely, in the
SELLAR TUMOR
brainstem or spinal cord. PNETs is a group of tumors that
form from the ectoderm, the outermost layer of cells of an Sellar masses (SMs) are adenoma bodies that are typically
embryo in early development. They appear similar to located on or around the pituitary gland, specifically near
medulloblastoma and were once considered a single tumor. the sella turcica. 1,2. Sellar masses are known to account
for approximately 10% to 15% of all intracranial neoplasms.
ASTROCYTOMA GRADING
● GRADE 1 or Pilocytic Astrocytoma (JPA) Pituitary Adenoma
○ A brain tumor that originates from Are benign tumors of the pituitary gland. Most are located in
star-shaped cells called astrocytes — a the anterior lobe (front portion) of the gland. About 1 in 10
kind of glial cell, which support and people will develop a pituitary adenoma in their lifetime.
nourish neurons in the brain. An Some pituitary adenomas secrete one or more hormones in
astrocytoma is a type of glioma. excess.
Pilocytic astrocytomas are low-grade ● Flag PT Hormones
gliomas — a family of slow-growing ○ Prolactin
tumors that arise from glial cells. ○ Thyroid-Stimulating Hormone
○ Pilocytic astrocytoma is the most ○ Follicle-Stimulating Hormone
benign and most treatable of the ○ Luteinizing Hormone or LH
gliomas. The cure rate is over 90 ○ Adrenocorticotropic Hormone
percent and is common on pedia. ○ Growth Hormone
● GRADE 2 or Astrocytoma ○ Oxytocin
○ Is also called low-grade astrocytoma or ○ Antidiuretic Hormone
diffuse astrocytoma and is usually an
infiltrating tumor. This tumor grows Distinct manifestations of hypersecretion of hormones from
relatively slowly and usually does not the pituitary gland. For example, with increased ADH, the
have well-defined borders. It occurs patient may experience concentrated and small amounts of
most often in adults between the ages urine.
of 20 and 40.
● GRADE 3 or Anaplastic Astrocytoma Craniopharyngioma
○ Is a fast-growing and rare malignant Are benign tumors that grow near the pituitary gland. They
brain tumor. can develop as solid tumors or cysts (hollow sacs filled with
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fluid). Approximately 10 percent to 15 percent of pituitary ● CEREBELLAR – ataxia, dizziness, gait problems,
tumors are craniopharyngiomas. nystagmus (repetitive and uncoordinated eye
movements)
Craniopharyngioma can happen at any age, but it occurs ● FRONTAL LOBE – personality, emotional, and
most often in children and older adults. Symptoms include behavioral changes
changes in vision over time, fatigue, headaches and ● CEREBELLOPONTINE ANGLE (ACOUSTIC
urinating more often. Children with craniopharyngioma may NEUROMA) – tinnitus, vertigo, deafness, facial
grow slowly and may be smaller than expected. and tongue numbness (5th CN affectation) and
facial paralysis (7th CN affectation)

SCHWANNOMA
GENERAL SIGNS
Is a rare type of tumor that forms in the nervous system. ● Headaches, N&V, memory problems, seizures,
Schwannoma grows from cells called Schwann cells. vision problems, problems associated with
Schwann cells protect and support the nerve cells of the hearing or speech, and problems with balancing
nervous system. Schwannoma tumors are often benign, or walking
which means they are not cancerous. But, in rare cases,
they can become cancerous.
SPINAL CORD TUMORS

Vestibular Schwannoma / Acoustic Neuroma An abnormal mass of tissue within or surrounding the spinal
A vestibular schwannoma (also known as acoustic neuroma, cord and/or spinal column. These cells grow and multiply
acoustic neuroma, or acoustic neurilemoma) is a benign, uncontrollably, seemingly unchecked by the mechanisms
usually slow-growing tumor that develops from the balance that control normal cells. Spinal tumors can be benign
and hearing nerves supplying the inner ear. (non-cancerous) or malignant (cancerous).

Hearing loss in one ear (the ear affected by the tumor) is the Intramedullary
initial symptom in approximately 90 percent of patients. Can arise anywhere in the spinal cord, from the
cervicomedullary junction to the filum terminale. Spinal
SYMPTOMS OF BRAIN TUMOR ependymomas are found most frequently in the cervical
● Vomiting cord, presumably because it contains more neural tissue
● Mood Swings than the thoracic or lumbar segments.
● Cognitive Decline
● Hearing Problems Intradural-Extramedullary
● Headache Are generally benign neoplasms arising in the spinal canal,
● Speech Problems accounting for about two-thirds of primary spinal tumors
● Seizures and 15% of tumors affecting the Central Nervous System

CLINICAL MANIFESTATIONS Extradural

● Increased Intracranial Pressure Form inside the spinal column and may involve the
○ Monro-Kellie Hypothesis – is that the vertebrae, but typically don't affect the spinal cord. They are
sum of volumes of brain, CSF, and often located in the epidural space, which is the area
intracranial blood is constant. An surrounding the outer – dura – membrane that protects the
increase in one should cause a spinal cord.
decrease in one or both of the
remaining two.
● Headache
● Vomiting
● Visual Disturbances
● Localized Symptoms
○ Hemiparesis – one-side muscle
weakness
○ Seizure
○ Mental Status Changes
● MOTOR CORTEX – generalized seizures
● OCCIPITAL LOBE – visual manifestations
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RISK FACTORS THAT CAN CAUSE CNS AND SPINAL dime-sized opening in the skull bone
CORD TUMORS (burr hole), and insertion of a needle to
● Ionising Radiation – potentially harmful or obtain a tissue sample.
beneficial to humans ● Proton Therapy
○ Cosmic wave ○ Delivers less radiation to the brain stem,
○ Gamma ray eyes, and healthy tissue than X-rays,
○ X-rays reducing the likelihood of side effects.
○ Ultraviolet ○ 5 days per week ; 1 = 6000cGy
● Non-Ionising Radiation – generally harmless to ● Craniotomy
humans, but still harmful in large amounts ○ Done for both Dx and Tx
○ Visible light ○ Benign (meningioma, schwannoma) –
○ Infra-red complete tumor resection
○ Microwaves ○ Malignant
○ Radio Frequency ■ Tumor debulking
■ To relieve s/sx and decrease
COMMON SYMPTOMS OF S.C TUMORS ICP to radiation therapy
● Back pain ● Transsphenoidal Surgery
● Unsteady Gait ○ Is a common pituitary tumor removal
● Possible Paralysis process that goes through nasal
passages instead of the skull
DIAGNOSTICS TESTS ○ A hypophysectomy is a surgery done
● Adult to remove the pituitary gland.
○ CT Scan Hypophysectomy is done for a number
○ MRI with contrast of reasons, including: Removal of
○ Biopsy pituitary tumors. Removal of
○ MRS (magnetic spectroscopy) craniopharyngiomas, tumors made of
● Pediatric tissue from around the gland.
○ MRI ■ NC: head of the bed should
■ 30 minutes. They are not be elevated, evaluate VS,
prone to stroke that’s why avoid sneezing, coughing,
they use MRI instead of CT blowing of nose and ADH
Scan. disturbances or polyuria
○ Surgical Biopsy ● Shunt Surgery
○ Lumbar Puncture ○ Done to divert CSF flow and help drain
■ Pedia is prone to meningitis by inserting a hollow tube that is
surgically placed in the brain
○ The incision would be made depending
TREATMENT AND MANAGEMENT on the landmark
● Stereotactic Radiosurgery (SRS)
○ Is a very precise form of therapeutic
radiation that can be used to treat
abnormalities in the brain and spine,
including cancer, epilepsy, trigeminal
neuralgia and arteriovenous
malformations
○ Gamma Knife radiosurgery involves four
phases: placement of the head frame,
imaging of the tumor location,
computerized dose planning, and
radiation delivery. Under some
circumstances, some facilities may use
a plastic head mask instead of the head
frame. ● Endoscopic Third Ventriculostomy (ETV)
● Stereotactic Biopsy ○ A minimally invasive procedure that
○ Minimally invasive and involves a small creates an opening in the floor of the
scalp incision, the creation of a third ventricle in the brain. This allows
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cerebrospinal fluid (CSF) trapped within ○ Lomustine PO HS (take at bedtime)

the brain's ventricles to escape into its q6weeks
normal pathway. Carried out under ● Cisplatin / Carboplatin
general anesthesia. ● Etoposide
● Ifosfamide
SURGICAL CARE ● Nitrosoureas
● Steroids ○ Indicated for <3y.o
○ decrease edema, inflammation, and ○ Placed in the chest wall for easier
pain. access for drug administration
● Antacids
○ lessen any chance that you might inhale CENTRAL LINE ACCESS
some of the acid contents of your ● Groshong Catheter
stomach into your lungs ○ Are extensively used in gynecologic
● Antibiotics oncology patients for administration of
○ Prevent infection chemotherapy, intravenous fluids, and
● Anticonvulsants pain medications. They are easy to
○ Prevent seizures maintain and have a good safety record.
● Verbal and written instructions are important ○ Placed into one of the large central
● Consent veins so the tip lies in the superior vena
● Infection Control cava above the right atrium
● Assessing LOC ■ Negative pressure – opens
● Support valve inward, permitting blood
● Hospital and Community Resources aspiration
■ Positive pressure – opens
Interstitial Brachytherapy valve outward, allowing
A radioactive material is surgically introduced inside the infusion
tumor and is maintained for a variable amount of time. ■ Neutral Pressure – valve
remains closed, reducing risk
Drug-Loaded Nanocarriers (DLNs) of air embolism, blood reflux
A system that loads drugs incorporated into organic or and clotting
inorganic matrices with a size of 10-1000 nm. Through ● Broviac Catheter
active targeting, the surface of the nanocarriers can be ○ Is a special intravenous (IV) line inserted
modified with ligands that interact with the BBB, enhancing under the skin on the chest wall and
their uptake and penetration across the brain endothelium into a large vein that leads to the heart.
by different physiological mechanisms, such as receptor- or It's used in children and teens who
transporter-mediated transcytosis. need IV therapy for a long time.
● Hickman Catheter
RADIATION THERAPY CARE ○ Is a small, soft tube inserted in your
● Can experience hair loss neck or chest with several channels
● Fatigue (called lumens) on the ends. Several
● Change of taste (metallic) inches of the catheter are outside your
● Report if they are experiencing nausea and skin. A Hickman catheter is used for
vomiting taking and giving blood, and giving
medicines that need a larger vein (such
CHEMOTHERAPY as chemotherapy), and other fluids.
● Temozolomide (Methylating Agent – DNA ● Port-A-Cath
damaging agent) ○ Portacaths showing the portal body (A)
○ 5 days in 28 days cycle (lower dosing if and catheter (B) A portacath (port) is an
with RT implanted device that gives access to
○ Blood tests before next dosing once low your veins. This allows you to have
blood count recovers, lower doses will intravenous medication and blood tests
be used taken. The generic name for a portacath
● Nitrosoureas (Alkylating Agent – used to cross is a Totally Implantable Venous Access
the BBB) Device (TIVAD).
○ Carmustine IV q6 for 6 weeks ● Ommaya Reservoir
NCMB312

○ Is a highly effective implant that

provides long-term access to the
cerebrospinal fluid and has simplified
administration of antimicrobials,
antifungals, antineoplastic, and
analgesic medications directly into the
brain.
● Wafer Implants
○ Placed in the space left after surgery to
remove a brain tumor. The implant will
slowly dissolve (2–3 weeks) and release
the medication in your brain. The
number of implants (wafers) placed is
based on the amount of space in the
brain. Usually, up to 8 wafers may be
placed at one time during surgery.

CHEMOTHERAPY CARE
● Anit-emetics
● Steroids PROTECTIVE FACTORS
● Mannitol ● Exercise
● Observe LOC ● Breast Feeding
● Manage side of each medication ● Pregnancy before 30 y.o lowers the risk of breast
cancer

BREAST CANCER
SUMMARY OF RISK FACTORS FOR BREAST CANCER
October is Breast Cancer Awareness Month. The leading ● Age
type of cancer among women. ● History of family cancer prior to diagnosis
● Abortion / abnormality in BRCA1 and 2
BREAST ○ BRCA1 (BReast CAncer gene 1) and
● A gland located at chest wall BRCA2 (BReast CAncer gene 2) are
● 15-20 lobes in radial pattern for milk production genes that produce proteins that help
● Tissue extends to the clavicle, sternum, latissimus repair damaged DNA. Everyone has two
dorsi muscles up to axilla copies of each of these genes—one
● Axillary Nodules = drain lymphatic fluid from the copy inherited from each parent.
breast ● Late menopause
○ Low in the armpit to lateral border of ● Obese
pectoralis minor (level 1) ● Nulliparity
○ Midway behind pectoralis minor (Level ● Early menarche
2)
○ Above the medial border of pectoralis PREVENTION AND EARLY DETECTION: BSE & CBE
minor (Level 3) ● Lumps
● Mammary changes (dimpling, tenderness,
abnormal contours)
● Nipple changes (retraction, lesions) and
discharges
● Other symptoms (size, symmetry, skin
appearance, color, direction of pointing, rashes,
ulceration)
● Patient risk factors

SIGNS AND SYMPTOMS

● Most common: lump or thickening in breast. Often
painless.
● Discharge or bleeding
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● Changes in size or contours of breast beyond its original tumor site. Over time, ILC may become
● Redness or pitting skin over the breast, like the metastatic breast cancer.
skin of an orange
● Change in color or appearance of areola MEDULLARY CARCINOMA
Tumors grow in a capsule inside a duct (<50 y.o)
TYPES OF BREAST CANCER
● NON-INVASIVE MUCINOUS CARCINOMA
○ Lobular – Lobular carcinoma in situ A slow-growing mucin-producing tumor (postmenopausal –
(LCIS) is a type of breast change that is >75y.o)
sometimes seen when a breast biopsy
is done. In LCIS, cells that look like TUBULAR DUCTAL CARCINOMA
cancer cells are growing in the lining of Axillary metastasis is uncommon; good prognosis
the milk-producing glands (lobules) of
the breast, but they don't invade INFLAMMATORY CARCINOMA
through the wall of the lobules. Aggressive or rare type of carcinoma. characterized by
○ Ductal – This means the cells that line unique signs and symptoms – brawny erythema (peau
the ducts have changed to cancer cells 'd'orange) due to blockage of the lymph in the skin
but they have not spread through the
walls of the ducts into the nearby breast
tissue. STAGING OF BREAST CANCER
● INVASIVE The American Joint Committee on Cancer (AJCC) has
○ Lobular designated staging by TNM
○ Ductal ● Tumor size
○ For both L&C, a type of breast cancer ● Lymph node involvement
that starts in the milk ducts of the ● Metastasis
breast and moves into nearby tissue.
● OTHERS STAGE 1
○ Paget’s Disease of Nipple or Areola ● Tumor < 2.0 cm in greatest dimension
■ It causes eczema-like ● No nodal involvement
changes to the skin of the ● No metastasis
nipple and the area of darker
skin surrounding the nipple STAGE 2
(areola). It's usually a sign of ● Tumor >2.0 to <5 cm
breast cancer in the tissue ● Ipsilateral Axillary Lymph Node (n1)
behind the nipple. ● No metastasis
○ Rare Types
○ Inflammatory STAGE 3
○ Men ● Tumor >5 cm (T3)
● Ipsilateral axillary lymph nodes fixed to each other
DUCTAL CARCINOMA IN SITU (DCIS) or other structures (n2)
DCIS is also called intraductal carcinoma or stage 0 breast ● Involvement of ipsilateral internal mammary nodes
cancer. DCIS is a non-invasive or pre-invasive breast (n3)
cancer. This means the cells that line the ducts have ● Inflammatory carcinoma (t4d)
changed to cancer cells but they have not spread through
the walls of the ducts into the nearby breast tissue. STAGE 4
● Any T
INFILTRATING DUCTAL CARCINOMA ● Any N
The cancer has spread to the surrounding tissue. Carcinoma ● Metastasis (m1)
refers to any cancer that begins in the skin or other tissues
that cover internal organs. DIAGNOSTICS
Tumor Markers
INFILTRATING LOBULAR CARCINOMA ● CEA, CA 15-3, CA 27-29
Invasive lobular carcinoma, also known as infiltrating lobular ● HER2/neu or Human Epidermal Growth Factor
carcinoma, begins in the milk-producing glands (lobules) of Receptor 2
the breast. As an invasive type of cancer, ILC has spread ○ This protein promotes the growth of
cancer cells. In about 1 of every 5
NCMB312

breast cancers, the cancer cells have tissue. During the molecular breast
extra copies of the gene that makes the imaging exam, a small amount of
HER2 protein. radioactive tracer is injected into a vein
● ER-PR or Estrogen Receptor / Progesterone in your arm.
Receptor Test ● Scintimammography
○ The results of IHC testing for ER/PR ○ Uses small amounts of radioactive
status are reported as follows: material, a special camera and a
ER/PR-positive: 1% to 100% of tumor computer to help investigate a breast
cells examined have receptors. abnormality.
● Mammography ■ Technetium 99m sestamibi
○ An x-ray imaging method used to (MIBI), also known as 99m
examine the breast for the early Tc-methoxy isobutyl isonitrile,
detection of cancer and other breast is a radiopharmaceutical used
diseases. It is used as both a diagnostic to evaluate pathology within
and screening tool. the cardiac, breast, and
parathyroid tissues.
● Ductography / Galacto
BREAST IMAGING REPORTING AND DATABASE SYSTEM
○ Injection of less than 1 ml of radiopaque
CATEGORY ASSESSMENT FOLLOW-UP material via cannula inserted into a
ductal opening on the areola, followed
0 Need additional Additional by a mammogram
imaging imaging needed ● Needle Biopsy
evaluation before a ○ Lesion is accessed with trocar needle
category can be ○ Stylet is removed from trocar needle
assigned
○ Core biopsy system is placed through
the trocar needle. Multiple passes are
1 Negative Continue regular
screening made with only a single pass through
mammograms the capsule and a single localization.
(for women over ● Sentinel Lymph Node Biopsy
age 40) ○ A surgical procedure used to determine
whether cancer has spread beyond a
2 Benign finding Continue regular primary tumor into your lymphatic
screening
system. It’s used most commonly in
mammograms
(for women over evaluating breast cancer and
age 40) melanoma.

3 Probably Receive a MANAGEMENT

benign 6-month Pre-op Care
follow-up ● Consent
mammogram
● Operative site assessment
● IV line
4 Suspicious May require
● Post-op teachings
abnormality biopsy

5 Highly Requires biopsy Lumpectomy

suggestive of Is a type of breast cancer surgery in which the tumor and a
malignancy / small amount of surrounding tissue called the margin is
cancer removed. The purpose of a lumpectomy is to remove the
cancerous cells.
6 Known Biopsy confirms
Biopsy-proven presence of
Partial Mastectomy
malignant / cancer before
cancer treatment begins Involves the surgical removal of cancerous breast tissue
along with a rim of surrounding healthy tissue that will be
used for further testing.
● Molecular Breast Imaging
○ It uses a radioactive tracer and a special
Lymph Node Dissection
camera to make pictures of the breast
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It is done to remove lymph nodes that have cancer and ● Purposes :

other lymph nodes when there is a very high chance that the ○ Pre-op Stage 3
cancer may spread there. ○ After breast-converesing surgery
○ DCIS
Total (Simple) Mastectomy ○ Radiation boost
Involves removing the entire breast, including the breast ● Neoadjuvant chemotherapy is chemotherapy
tissue, areola and nipple. given to breast cancer patients before surgery
with the goal of reducing tumor size and
Modified Radical Mastectomy improving overall survival by treating undetected
Removes the entire breast — including the breast tissue, micrometastasis as well as improving postsurgical
skin, areola and nipple — and most of the underarm cosmetic results.
(axillary) lymph nodes. ● Adjuvant therapy is any type of therapy that
follows the primary treatment. So, adjuvant
POST-OP CARE chemotherapy takes place after you've had
● Wound care first-line treatment, such as surgery to remove a
● Positioning (lymphedema) cancerous tumor.
● Skin integrity
● Clothing Accelerated-Partial Breast Irradiation
● Arm exercises (lymphedema) Is a localized type of radiation that specifically treats an area
of a breast from which a tumor was removed
POST-OP EXERCISES
To prevent lymphedema MammoSite is a targeted radiation therapy treatment for
● Rope turning breast cancer performed following a lumpectomy. A small,
● Rod or broomstick lifting soft balloon is placed inside the lumpectomy cavity through
● Pulley tugging a small incision in the breast.
● Wall hand climbing
RADIATION THERAPY SIDE EFFECTS
RECONSTRUCTIVE ● Skin discomfort / breakdown
Repairs parts of your body affected by defects you were ● Pain (inflammation of nerves and/or pectoral
born with, defects that have developed because of disease, muscles
or defects caused by an injury. Breast reconstruction is ● Lymphedema aggravation
surgery to recreate breasts after a mastectomy. ● ROM difficulties

Silicone implants have been curated to feel more like the COMMONLY USED DRUGS
actual natural breast, and are soft to touch. Saline implants a. Adjuvant : CAT
on the other hand are usually firmer, but in cases of a i. 3–6 months, based on the tumor, once
rupture, the saline solution can be safely absorbed by the a month
body. ii. Adriamycin, paclitaxel,
cyclophosphamide
The TRAM — or transverse rectus abdominis iii. Doxorubicin is an antibiotic derived
myocutaneous — flap is named for the muscle in the lower from the Streptomyces peucetius
abdomen between the waist and pubic bone. A flap of this bacterium. It has had wide use as a
skin, fat, and all or part of the underlying rectus abdominis chemotherapeutic agent since the
(six-pack) muscle are used to reconstruct the breast in a 1960s. Doxorubicin is part of the
TRAM flap procedure. anthracycline group of
● Donor area (latissimus dorsi muscle) can come chemotherapeutic agents; other
from the back of the patient or buttocks anthracyclines include daunorubicin,
idarubicin, and epirubicin. May give the
RADIATION THERAPY color red urine.
● Primarily for treatment of high risk of local b. Adjuvant : MF/E
recurrence i. Methotrexate, Fluorouracil, Epirubicin
● External Beam RT ii. Interfering with the synthesis of the DNA
○ Uses high doses of radiation to destroy constituents
cancer cells and shrink tumors iii. Hand-foot syndrome (also called
● Target : affected chest wall and regional lymph palmar-plantar erythrodysesthesia) is
nodes a side effect of some chemotherapy
NCMB312

drugs that can cause redness, swelling Estrogen Receptor Downregulators (ERDs)
and blistering on the palms of the hands SERDs fill estrogen receptors to stop this hormone from
and soles of the feet. attaching to cancer cells and helping them grow. These
iv. CEF-120 regimen (repeat every 28 medicines also reduce the number of estrogen receptors
days for 6 cycles): and change the receptors that remain so they don't work as
1. Cyclophosphamide: 75 well.
mg/m2 orally on Days 1 to 14 ● Faslodex, Exemestane
2. Epirubicin: 60 mg/m2 IV on ○ are the only approved SERD. They treat
Days 1 and 8 late-stage, hormone receptor-positive
3. 5-Fluorouracil: 500 mg/m2 IV breast cancers that are also
on Days 1 and 8 HER2-negative. This means the cancer
v. FEC-100 regimen (repeat every 21 cells don't have any or much of a
days for 6 cycles): protein called HER2 on their surface.
1. 5-Fluorouracil: 500 mg/m2 IV HER2 helps to control cell growth.
on Day 1 ○ Depending on which of these medicines
2. Epirubicin: 100 mg/m2 IV on you take, the doses range from 20
Day 1 milligrams (mg) to 60 mg a day.
3. Cyclophosphamide: 500 ○ Faslodex comes in two shots–one into
mg/m2 IV on Day 1 each buttocks. Each injection takes 1–2
minutes. You'll get this treatment three
Hormone Therapy times in the first month, and then once
Selective Estrogen Receptor Modulators a month after that.
Used to treat estrogen receptor positive breast cancer,
reduce the risk of invasive breast cancer following surgery, Luteinizing Hormone-Releasing Hormone (LHRHs)
or reduce the risk of breast cancer in high risk women. A Is a part of a neurological pathway comprising the
medication used to induce ovulation. hypothalamus, the pituitary gland, and gonads. In this
● Tamoxifen pathway, LH release is stimulated by
○ a selective estrogen receptor modulator gonadotropin-releasing hormone (GnRH) and inhibited by
(SERM) medication used to treat breast estrogen in females and testosterone in males.
cancer in men and women and as a ● Zoladex, Lupron
prophylactic agent against breast ○ Shuts down ovaries and stop them from
cancer in women. producing estrogen
○ Usual dose: 20 mg daily, given as a ○ Zoladex implants are used to treat
single dose or in 2 divided doses symptoms of prostate cancer in men.
○ Competes with estrogen The Zoladex implant is used in women
to treat breast cancer or endometriosis
Aromatase Inhibitors ○ Lupron works by lowering the amount
Aromatase inhibitors (AIs) lower estrogen levels by stopping of testosterone in a person’s body,
an enzyme in fat tissue (called aromatase) from changing which helps slow growth of cancer
other hormones into estrogen. (Estrogen can fuel the growth cells.
of breast cancer cells.) These drugs don't stop the ovaries ○ Can cause hypercalcemia
from making estrogen.
● Anastrozole c. Targeted : Trastuzumab (Herceptin)
○ Lowers estrogen levels by stopping an i. (+) lymph node involvement and
enzyme in fat tissue (called aromatase) increased HER2/neu
from changing other hormones into ii. It is a treatment for cancers that have
estrogen large amounts of a protein called human
○ Aromatase turns androgens into small epidermal growth factor receptor 2
amounts of estrogen (HER2) , such as: early breast cancer
○ Adults—1 milligram (mg) once a day. If (the cancer hasn't spread beyond the
you miss a dose of this medicine, take it breast or the lymph nodes in the armpit
as soon as possible. However, if it is on the same side of the body.
almost time for your next dose, skip the iii. Usually once every week or once every
missed dose and go back to your 3 weeks.
regular dosing schedule. Do not double d. For Breast Tumor Metastasis : Doxorubicin
doses. (Adriamycin)
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e. For Breast Tumor Metastasis : Hormonal membranes of organs, particularly those of the
Manipulation lower digestive tract and airways
i. Nolvadex, Megace ● Gel Layer – a sticky mucoid substance which
ii. Slows or stops the growth of contains chemicals, antibodies and immune cells
hormone-sensitive tumors by blocking to destroy any bacteria and viruses
the body's ability to produce hormones ● Sol Layer – the lubricant sol layer enables the gel
or by interfering with effects of mucus present at the tips of the cilia to be
hormones on breast cancer cells. transported by the ciliary beating of the ciliated
cells.
MANAGEMENT ● Cilia – small, slender, hair-like structures present
a. Risk for recurrence on the surface of all mammalian cells
i. P.E Schedule ● Basal Cell – found at the bottom of the epidermis
ii. Mammography q6 months — the outermost layer of skin
iii. At risk of infection at the 10th day ● Mucous Blanket – The nasal and sinus cavities
b. Psychosocial – long term are normally able to clear mucus on their own
i. Psychosocial support thus promotes through a transport system called the mucociliary
the restoration of social cohesion and blanket.
infrastructure. ● Epithelium – a type of body tissue that forms the
covering on all internal and external surfaces of
your body, lines body cavities and hollow organs
LUNG CANCER
and is the major tissue in glands.
November is Lung Cancer Month. Lung cancer is the ● Lamina Propria – loose connective tissue in a
second leading cause of cancer-related deaths worldwide, mucosa. Lamina propria supports the delicate
accounting for the highest mortality rates among both men mucosal epithelium, allows the epithelium to move
and women. freely with respect to deeper structures, and
provides for immune defense
The major passages and structures of the upper ● Cartilaginous Layer – is covered by a layer of
respiratory tract include the nose or nostrils, nasal cavity, dense irregular connective tissue called the
mouth, throat (pharynx), and voice box (larynx). The lower perichondrium (peri = around)
respiratory tract consists of the trachea (windpipe), ● Smooth Muscle – consists of thick and thin
bronchial tubes, and lungs. The bronchial tubes carry air filaments that are not arranged into sarcomeres
into the lungs and branch into smaller and smaller giving it a non-striated pattern
bronchioles. These end in alveoli (air sacs). ● Submucosal Gland – These glands secrete
mucus to facilitate the movement of particles
THE MUCUS BLANKET along the body's various tubes, such as the throat
and intestines
● Parasympathetic Nerve – is responsible for the
body's rest and digestion response when the
body is relaxed, resting, or feeding
● Basement membrane – are thin layers of a
specialized extracellular matrix that form the
supporting structure on which epithelial and
endothelial cells grow, and that surround muscle
and fat cells and the Schwann cells of peripheral
nerves

RISK FACTORS OF LUNG CANCER

● Environmental Factors (smoking)
○ Leading risk of lung cancer . 87% of
lung cancer deaths.
● Genes
● Diet
● Underlying diseases
● Surface Goblet Cells – modified epithelial cells
that secrete mucus on the surface of mucous
SMOKING
● Mortality : 23x for males and 13x for females
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● Development : increases that starts at early age, ENVIRONMENTAL FACTORS

smoked for years, or smoked greater amount of ● Radon is a naturally-occurring radioactive gas
cigarettes that can cause lung cancer. Radon gas is inert,
○ Same number of smoked = F>M colorless and odorless
○ High Radon Levels ● Asbestos is a natural mineral and carcinogen that
causes mesothelioma. Asbestos has also been
T/N : COPD clients are at risk of Lung Cancer even if they’re used in a wide range of manufactured goods,
not smokers because they already have problems in their mostly in building materials.
lungs
GENETICS
WHAT IS CIGARETTE? ● Approximately 8% of lung cancers are inherited or
Is a narrow cylinder containing a combustible material, occur as a result of a genetic predisposition.
typically tobacco, that is rolled into thin paper for smoking. ● Second-hand smoking can cause lung cancer

CIGARETTE ARE COMPOSED OF:

PREVENTION AND SCREENING
● Cadmium – a soft, malleable, bluish white metal
found in zinc ores, and to a much lesser extent, in Best way to prevent smoking is to quit smoking.
the cadmium mineral greenockite
● Butane – a hydrocarbon and a highly flammable, a. Bronchoscopy
colorless, odorless, easily liquefied gas i. Is a technique used to look at your air
● Acetic Acid – ethanoic acid, ethylic acid, vinegar passages with a small camera that is
acid, and methane carboxylic acid located at the end of a flexible tube.
● Methane – a hydrocarbon that is a primary This connects to a video screen for the
component of natural gas doctors to view and take photos of your
● Arsenic – a naturally occurring, semimetallic air passages.
element widely distributed in the Earth's crust ii. Requires consent, patient is on NPO,
● Stearic Acid – one of the most common fatty patient is placed in high-fowler’s
acids position, and administer local
● Nicotine – the chemical in tobacco that keeps anesthesia using a spray targeting the
you smoking throat.
● Toluene – a clear, colorless liquid which b. Chest X-ray
becomes a vapor when exposed to air at room i. A chest X-ray uses radiation to create
temperature an image of your heart, lungs and
● Hexamine – used to treat urinary tract infections bones. A chest X-ray can diagnose
● Ammonia health conditions like pneumonia or
● Paint – volatile organic compounds COPD.
● Carbon Monoxide – a chemical produced from c. Bone Scan
the incomplete burning of natural gas or other i. Evaluated the rate of metabolism
products containing carbo throughout the body. A specialized
● Methanol – a toxic alcohol that is used industrially radiology procedure used to examine
as a solvent, pesticide, and alternative fuel source the various bones of the skeleton. It is
done to identify areas of physical and
DIET chemical changes in bone
● Consuming red meat, processed meat and d. Sputum Smear
alcoholic drinks might increase the risk of lung i. Sputum cytology is a routine
cancer. examination and/or screening method
● Retinoid (B-carotene) for detection of central-type lung
○ Beta-carotene is a pigment found in carcinomas (squamous cell carcinoma
plants that gives them their color. The and small cell carcinoma).
name beta-carotene is derived from the e. Light Induced Fluorescence Endoscopy
Latin name for carrot. i. Used in oncology for improving
○ Use of beta-carotene has been detection of tumors and premalignant
associated with an increased risk of lesions with the use of special dyes and
lung cancer in people who smoke or excitation wavelengths.
who have been exposed to asbestos. f. Mediastinoscopy
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i. Is a procedure used to examine the Adenocarcinoma is a type of cancer that starts in glands
mediastinum. This is the space behind that line the insides of the organs, which is why it can affect
the breastbone (sternum) in the middle different body areas. Adenocarcinoma forms in glandular
of the chest, between the 2 lungs. It epithelial cells, which secrete mucus, digestive juices or
contains: Lymph nodes. The heart and other fluids.
its great vessels.
g. Endobronchial Ultrasound (EBUS) Large Cell Carcinoma (NSCLC)
i. It is a test that can show if: an abnormal Large cell carcinoma is an undifferentiated malignant tumor
looking area is cancer. the size of the that lacks the characteristic cytologic features of squamous
cancer. The cancer has spread into cell carcinoma, adenocarcinoma, and small cell carcinoma.
other lung areas or outside the lung. It is a diagnosis of exclusion.
h. Fluoridex Glucose (FDG-PET Scan)
i. The role of this procedure is to detect Based on Clinical
metabolically active malignant lesions
including lung cancer, colorectal cancer, Small Cell Lung Cancer (SCLC)
lymphoma, melanoma, breast cancer, Accounts for about 10–15% of tumors. Generally, it includes
ovarian cancer, brain cancer and small cell carcinoma and combined small cell carcinoma.
multiple myeloma. SCLC usually begins in the airways of the lung, and quickly
ii. Diagnostics ; Metastasis – ACS spreads to other areas of your body. SCLC is the most
Recommended aggressive form of lung cancer.

LUNG CANCER STAGING

Also known as Oat Cell Carcinoma because the cells look
● Non-Small Cell like oats under the microscope.
○ STAGE 1 – cancer is <5 cm, localized ● Rapid cell growth
and has not spread to lymph nodes ● Rapid spread
○ STAGE 2 – cancer is 5–7 cm, localized, ● Strongly related to cigarette smoking
and has spread to nearby lymph nodes ● Great sensitivity to chemo and radiation
○ STAGE 3 – cancer is >7cm, localized, ● Arise from KULCHITSKY’s cell (central
and has spread to a major structure endobronchial location)
within the chest ○ They reside alongside the epithelium
○ STAGE 4 – cancer is in both lungs or lining the lumen of the digestive tract
has metastasized to another part of the and play a crucial role in gastrointestinal
body regulation, particularly intestinal motility
● Small Cell and secretion.
○ Limited – only in one lung with or
without spread to the lymph nodes in SIGNS AND SYMPTOMS
the mediastinum ● Blood when coughing or spitting
○ Extensive – the cancer spread widely ● Recurring respiratory infections
throughout the lungs, lymph nodes, and ● Enduring cough that is new or different
other parts of the body including the ● Ache or pain in shoulder, back, or chest
bone marrow, brain, and liver ● Trouble breathing (SOB)
● Hoarseness or wheezing
TYPES OF LUNG CANCER
● Exhaustion, weakness, loss of appetite
Based on WHO
Non-Small Cell Lung Cancer (NSCLC)
Small Cell Lung Carcinoma Accounts for the other 85–90% of tumors. Includes
Small cell lung cancer is a disease in which malignant squamous cell carcinoma, large cell carcinoma,
(cancer) cells form in the tissues of the lung. Signs and adenocarcinoma, and bronchoalveolar carcinoma. Further
symptoms of small cell lung cancer include coughing and classification of NSCLC is according to cell type.
shortness of breath.
LUNG CANCER PATHOLOGY
Squamous Cell Carcinoma (NSCLC)
Squamous cell carcinoma of the skin is a type of cancer that
starts as a growth of cells on the skin.

Adenocarcinoma (NSCLC)
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● A wedge resection involves the removal of lung

cancer along with a wedge-shaped section of
tissue surrounding the tumor.
○ Triangle-shaped tissue; target tumors
for patients unable to withstand
extensive procedure.
○ Disadvantage : high risk recurrence
○ Criteria : <3 cm, located at outer third,
no endobronchial extension, (-)
mediastinal / hilar node
○ Video-assisted thoracoscopic
surgery (VATS) is a minimally invasive
surgical technique used to diagnose
and treat problems in the chest.
● Lobectomy is the most common type of lung
resection. In this procedure, one or multiple lobes
are removed from your lungs.
SIGNS AND SYMPTOMS ○ Treatment of choice for Stage 1–3 with
● Asymptomatic thoracotomy (ideal if confined to single
● No sign of productive cough lobe)
● Will be symptomatic once metastasized ● A pneumonectomy is a surgery to remove your
○ Cardiac Tamponade – accumulation of entire lung. Surgery to remove your entire right
fluid in the pericardial sac impairs lung is a right-sided pneumonectomy, and surgery
diastolic filling and reduces cardiac to remove your entire left lung is a left-sided
output pneumonectomy. Pneumonectomy is the most
○ Spinal cord compression extensive type of lung resection (surgery).
○ Superior vena cava syndrome –
compression of the vein Chemoradiation Therapy
○ Swelling of the face and arms and Radiation therapy uses high-energy beams (like x-rays or
shortness of breath proton therapy) to target and kill cancer cells at a specific
tumor site.
COMMON ONCOLOGIC EMERGENCIES ● SCLC
● Spinal Cord Compression ○ Cornerstone of treatment
○ A result of tumor invasion of the ○ First Line of Treatment : Etoposide
vertebrae and collapse of the vertebrae and Cisplatin
on the spinal cord, tumor invasion of the ○ ED – platinum-based
SC with resulting increased pressure on ○ Relapse
the cord ■ <3 months
○ Back pain, motor weakness, decreased ■ > 3 months
sensation, unsteady gait, drop foot ■ Topoisomerases are nuclear
○ Late S/sx are loss of motor strength, enzymes that play essential
loss of sensation, bowel/bladder roles in DNA replication,
dysfunction transcription, chromosome
○ Steroids are used ; IV Decadron in order segregation, and
decrease the inflammation recombination. Depends on
the relapses.
Pericardiocentesis is a procedure done to remove fluid that ● NSCLC
has built up in the sac around the heart (pericardium). It's ○ As adjuvant
done using a needle and small catheter to drain excess fluid. ○ For unresectable tumors
A fibrous sac known as the pericardium surrounds the heart. ○ First Line of Treatment :
Platinum–based (cisplatin, carboplatin,
TREATMENT MODALITIES FOR CANCER
and oxaliplatin)
Dexamethasone ○ Second Line of Treatment : Docetaxel
Provides relief for inflamed areas of the body.
Brachytherapy
Surgery
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Is a type of internal radiation that uses radiation to destroy

cancer cells and shrink tumors.

Stereotactic Body Radiotherapy

Is a type of radiation therapy that uses many beams of
energy. The beams are carefully targeted to focus on
growths of cells, which are called tumors, anywhere in the
body. SBRT is used to treat tumors in the lungs, spine, liver,
neck, lymph nodes or other soft tissues.

NURSING MANAGEMENT
● Monitoring of pain
● Assessing of dyspnea or any respiratory
complications
○ Oxygenation is needed depending on
the patients S/sx
● Closely monitoring of arrhythmias due to vagal
irritation
● Nurses or other health care workers should wear
protective clothings (lead apron)
● Manage the ff side effects
○ Esophagitis – inflammation of
esophagus
○ Pneumonitis – inflammation in your lung
tissues without an infection
○ Radiation myelopathy – is the
development of spinal cord or nerve
injury because of RT.