212 LECTURE / MIDTERMS

Care of Clients w/ Problems in Oxy, F/E, Infectious, Inflammatory &

Immunologic Response, CA (Acute & Chronic)
● PAP TEST (pap smear)
CANCER o Most commonly used for diagnosing
cervical cancer
OUTLINE Additional notes:
- If there is a history or within the family this
I. CERVICAL CANCER should be done – every 6 months
II. LUNG CANCER - If for a routine test or person is sexually
III. COLORECTAL CANCER
IV. OVARIAN CANCER
active – annually
V. LEUKEMIA - For age bracket, it can be from 21 years
old to 65 yrs. Old
- For sexually active person, regardless of
LESSON 4: CELLULAR ABERRATION IN DIFFERENT age, they are required to have PAP smear
SITES - Best time to schedule PAP test – 5 to 7
days after the end of menstrual period
CERVICAL CANCER
Two types: Adenocarcinoma and Squamous cell carcinoma
- Squamous cells carcinoma - develops from ● Colposcopy
o Involves the use of a special binocular
squamous epithelial cells; and is the mostt common
microscope that is called a colposcope and
form of cervical cancer
similar to a pap smear
- Adenocarcinoma - develops from Columnar
Additional notes:
epithelial cells
- Same with pap smear // specimen will be
obtained inside the cervix for tissue
Additional notes:
- It takes decades to
- Adenocarcinoma - before not common; but now it is
common

RISK FACTORS
Precipitating Factors
● Sexual history - women who had sexual intercourse
at an early age (17y.o) women - multiple sexual
partners; Smoking
● HPV - Humanpapilloma virus
● HIV - Human immunodeficiency virsu; damages the
body’s immune system ● Pelvic exam
● Diet - low fruits and vegetables
● Endocervical curettage
● Immunosuppression
o Scraping the mucus membrane of the
endocervical canal (passageway between
Predisposing Factors
cervix and uterus) to obtain a small tissue
● Age (35-55 y.o) sample.
● Race (Black women: African-american) Additional notes:
● Low socioeconomic status - Same with D&C

SIGNS AND SYMPTOMS MANAGEMENT

Initial symptoms includes: 1. HPV vaccine
● Post-coital bleeding Additional notes:
● irregular vaginal bleeding or spotting between o Can prevent most cases of cervical cancer
periods or after menopause if the vaccine is given before the women is
● Malodorous discharge exposed to the virus
o Prevent from:
Late symptoms include: ▪ vaginal or vulvar cancer
● Bleeding becomes more constant and accompanied ▪ genital warts
by pain that radiates to buttocks and legs ▪ anal cancers
● Weight loss ▪ mouth, throat, head and neck
● Anemia cancer in women and men
● Fever o given thrice with a month interval

DIAGNOSIS 2. Cervical Conization

Additional notes:

1
 o conization of cervix ● Identify client's perception of the threat represented
o also known as “CKC” – cold knife cone by the situation - How the patient copes with the
o is a surgical procedure to diagnose and pain
treat cervical dysplasia or very early sign ● Observe behaviors that can point to client's level of
anxiety
of cancer ● Observed for discharges from the vagina and note
o excision of a cone shape portion of the for its odor, color, and amount - Take down objective
cervix to removal a cervical lesion cues from the patient
● Encourage client to express feelings about the
3. Hysterectomy current condition
Additional notes: ● Be available to client for listening
● Help the patient seek information on stage of
o removal of the uterus
cancer, treatment options. - Only the information
given by the doctor
4. Cryosurgery ● Provide comfort measures such as quiet
Additional notes: environment, and calm activities
o cervical cryosurgery ● Administer analgesics as prescribed by the doctor-
o cryo “cold/freezing” Asses first what kind of pain then administer the
o a procedure to freeze and destroy prescribe medication
● Provide adequate fluid intake including high-fiber
abnormal tissue in the cervix foods.
o performed by freezing and destroying the ● Some chemotherapy drugs can cause constipation
abnormal cell ● Encourage client to comply well with treatment
o performed for women with early stages of regimen
cancer ● Explain to them why they have to comply
● Explain the importance of life-long follow up
5. Laser surgery regardless of treatments to determine the response
to treatment and to detect spread of cancer. -
Additional notes: Encourage them to have regular check up
o using a focus laser beam to create heat ● Provide privacy for patient.
o laser beam is directed to the vagina and
burns off abnormal cells from the surface LUNG CANCER
of the cervix Additional notes:
- Lung Cancer, like other cancers, develops when the
6. Radiotherapy normal processes of cell division and the growth are
Additional notes: disrupted, giving way to abnormal uncontrollable
o also known as radiation therapy growth. Among the subtypes of lung types are:
o may be:
▪ brachytherapy: radioactive ● Adenocarcinoma 45-50%
sources are placed into or near - most common type of lung cancer, especially for
the cancer and with drug non-smokers
administered therapy, radioactive - Usually begins at the outer center of the lungs
material is delivered via drug to
localize in the cancer
▪ teletherapy: external beams of
radiation are used to target the
cancer.
7. Chemotherapy

NURSING DIAGNOSIS
● Acute pain related to disease process
● Deficient fluid volume related to excessive bleeding
● Anxiety related to threat of death
● Risk for imbalanced body temperature related to
presence of invading pathogens
● Risk for constipation related to tumor obstruction

NURSING INTERVENTIONS TYPES OF LUNG CANCER

● Assess vital signs, including temperature, pulse, A. Non-small cell Lung Cancer
respiration and blood pressure. - Usual routine to
check, then refer accordingly 1. Squamous cell carcinoma
● Obtain client's assessment of pain to include - starts in the squamous cells which are flat
location, characteristics, onset, duration, frequency, cells that line the
and intensity; use pain scale for evaluating - inside of the airways in the lungs
- often linked to history of smoking
- common in main airway or bronchus

2
 METASTASIS
2. Large cell carcinoma M0 - no distant metz
- it is identified as undifferentiated M1- distant metastasis, such as to scalene or contralateral
- it can appear in any part of the lungs
- tends to grow and spread quickly which hilar lymph nodes, brain, and lungs
can make it harderto treat
DIAGNOSIS
3. Adenocarcinoma
- fairly aggressive ● Fiberoptic Bronchoscopy
- 61% chance of survival ● Low dose helical computed tomography
- 5 years survival ● Endoscopy with esophageal ultrasound
● Mediastinoscopy
B. Small cell carcinomas
- this type of cancer tends to grow and ● Papanicolau test if the sputum
spread faster compared to non-small cell
lung cancer

ETIOLOGY
● Precipitating Factors:
- Carcinogens
- Tobacco smoke
- Secondhand (passive) smoke
- Occupational exposures
- Dietary deficits
- Air pollution
- Ionizing Radiation

● Predisposing Factors:
- Gender
- Genetics
- Race

SIGNS AND SYMPTOMS

● Cough or chronic cough
● Dyspnea NURSING DIAGNOSIS
● Hemoptysis of blood
● Chest or shoulder pain ● Chronic pain r/t pressure of tumor on surrounding
● Fever structures and erosion of tissues
● Chest pain or tightness
● Ineffective airway clearance r/t increase amount of
● Cardiac tamponade
● Weakness secretions
● Anorexia ● Impaired breathing pattern r/t compression of
● Weight loss bronchus
● Risk for infection r/t immunosuppression
TNM CLASSIFICATION OF THE LUNG CANCER
PRIMARY TUMORS ● Fatigue r/t decreased oxygen supply to the body
T0 - no evidence of primary tumor secondary to anemia
TX - tumor can’t be measured
NURSING INTERVENTIONS
Tis - carcinoma in situ
T1 - tumor <3cms w/o invasion Diagnostic Phase:
T2 - tumor >3.0cm in diameter, or a tumor of any size that ● The nurse should explore the client’s chief
invades the visceral pleura complaints such as dyspnea, pain or recurrent
T3 - tumor of any size with direct extension into an adjacent infection
structure, such as chest wall ● The nurse should ask about the presence of risks
T4 - tumor of any size w/ invasion to distal sites like factors including smoking history, exposure to
esophagus or opposite lung occupational respiratory carcinogens or family
history of the disease
LYMPH NODE INVOLVEMENT ● Focus on the client education and provide
N0- no demonstrable metastasis to regional lymph emotional support
N1- metastasis to nodes in the peribronchial and/or ● Incorporate aspects assisting the client to cope with
ipsilateral hilar region anxiety, fear and family responses
N2- ipsilateral mediastinal and/or subcarinal LN
N3- metastasis to contralateral mediastinal or hilar lymph TREATMENT PHASE: CLIENT UNDERGOING THORACIC
nodes, supraclavicular LN SURGERY

1. Monitor for signs of respiratory failure

3
 2. Monitor for signs and symptoms of tension
pneumothorax such as dyspnea, restlessness, Ascending colon Same, fatigue, palpitations,
tachycardia and cyanosis unexplained iron deficiency
3. Observe for subcutaneous emphysema around anemia, melena.
incision and in the chest and neck
4. Monitor for signs and symptoms of pulmonary Transverse/Descending abdominal cramping,
embolus and pulmonary edema diarrhrea, constipation,
5. Assess dressing and incisional area every 4 hours perforation, "apple core"
for any signs of bleeding radiograph results
6. Assess drainage in closed chest drainage system
for signs of bleeding Rectosigmoid hematochezia, narrowing
7. Monitor for signs of thrombophlebitis of the caliber of the stool,
8. Encourage client perform leg exercises. Discourage unexplained anemia,
placing pillows under knees, crossing the legs or abdominal distention,
prolonged sitting feeling of incomplete
9. Administer pain medications as ordered evacuation after a bowel
10. Position client as indicated by phase of recovery movement, alternating
and surgical procedure constipation / diarrhea
a. Non-operative side-lying position may be
used until consciousness is regained DIAGNOSIS
b. Semi-Fowler's position is recommended
once vital signs are stable ● Stool occult blood test
c. Avoid positioning client on operative side. ● DRE
If a wedge resection has been performed ● Barium enema
d. Avoid complete lateral positioning after ● Flexible sigmoidoscopy
pneumonectomy ● Colonoscopy
11. Gently turn the client every 1 to 2 hours unless
contraindicated MEDICAL MANAGEMENT
12. Avoid traction on chest tubes while changing client
position. Check for kinking or compression of tubing ● IV, blood components- bleeding
● Radiation
13. Begin passive ROM exercises of the arm and ● chemotherapy
shoulder on the affected side 4 hours after recovery
from anesthesia DUKE’S CLASSIFICATION/STAGE
Additional notes:
COLORECTAL CANCER
● pathological staging base on resection of the tumor
- Characterized by neoplpasia in the colon, rectum,
or vermiform appendix. and measure the death of invasion through the
mucosa and the bowel wall
INCIDENCE
- The American Cancer Society's estimates for A – Tumor is limited to bowel wall - the cancer is on the
number of colorectal cancer cases in the US for lining of the bowel
2020 are: B – extension of tumor to all layers – cancer has invaded the
104, 610 new cases of colon cancer
muscle
43, 340 new cases of rectal cancer C – metastases of tumor to regional lymph nodes – cancer
has invaded the nearby lymph nodes
ETIOLOGY D – lymph node metastases, ulcerated carcinoma, distant
- Uknown
metastasis – cancer has metastasize
PRECIPITATING:
- Diet MANAGEMENT
- Geographic location 1. Segmental resection with anastomosis
- Socioeconomic factor Additional notes:
- Religion ● removal of tumor and portions of the bowel
- Inflammatory bowel disease in either side of the growth as well as the
- Tabacco use blood vessels and the lymphatic nodes
● Anastomosis - surgical connection
PREDISPOSING:
between two structures
- Age
- Hereditary
2. Abdominoperineal resection with permanent
SIGNS AND SYMPTOMS sigmoid colostomy
Additional notes:
AFFECTED PART CLINICAL ● removal of a tumor and a portion of the
MANIFESTATION sigmoid and all of the rectum and the anal
sphincter
Cecum No noticeable alterations in
bowel habits 3. Temporary colostomy

4
 Additional notes:
● followed by a segmental resection and SOURCES/SITES
anastomosis and subsequent ● Surface (epithelium) of the ovary
reanastomosis of the colostomy; allowing ● Fallopian tube
● Egg cells (germ cell tumor)
initial bowel decompression and bowel
preparation before resection RISK FACTORS
● Older women - the risk of ovarian cancer increases
4. Permanent colostomy as women age, usually diagnosed in older adults
Additional notes: ● Genetics - the risk also increases, minimal
● for palliation of unresectable obstructive percentage as a risk
lesion ● Infertile women - haven’t been pregnant, risk is also
increased
● Endometriosis - is an often painful disorder in which
NURSING DIAGNOSIS tissue similar to the tissue that normally lines the
● Disturbed body image R/T colostomy inside of your uterus — the endometrium — grows
● Anxiety R/T impending surgery outside your uterus
● Knowledge deficit R/T diagnosis, surgical procedure ● Postmenopausal estrogen replacement theory -
● Risk for infection taking hormonal replacement to control the signs
and symptoms of menopause also increases the
OVARIAN CANCER risk of ovarian cancer
● a cancerous growth arising from the ovary
● Etiology: Unknown DIAGNOSIS
- Physical Examination
TYPES - CA 125
1. Epithelial Ovarian Cancer - most common Additional Notes:
● Biomarkers
Subtypes: ● It is not only used for ovarian cancer
● Serous Carcinoma - common type of ● In case of high result, it doesn’t mean that
ovarian cancer accounting to you have ovarian cancer because there
approximately 75 percent of epithelial are other disorders which will result into
ovarian cancer high levels of CA 125
● Mucinous Carcinoma - an invasive type ● There is also ovarian cancer wherein CA
of cancer in which the mucin is the main 125 is not elevated.
component of the mucus that surrounds - Transvaginal Sonography/Sonogram
the cancer cells. Also known as “Coloid Additional Notes:
Carcinoma”- is another term for Mucinous ● ultrasound
Carcinoma of the breast - Surgery to inspect the abdominal cavity, take
biopsies
2. Stromal Tumors - these are rare tumors, usually Additional Notes:
diagnosed at an early stage, rare type of ovarian ● In biopsy, medical professional will take a
cancer accounting to 1 percent of the ovarian sample tissue and send it to the laboratory
cancer. Most often diagnosed in stage 1, making
them very treatable.

3. Germ Cell Tumors - rare type of ovarian cancer,

common among younger age, usually benign but it
can be malignant

SYMPTOMS
- Symptoms are frequently non-specific early on and
may include:
● Bloating/ abdominal distension - “kabag”,
usually manifested by people with PCOS
● Pelvic pain - or “stomach pain”
● Difficulty eating - because of bloating or
abdominal distension, and feeling of
fullness or feeling full more quickly than
usual when eating,
● Urinary frequency, and are easily confused MANAGEMENT
with other illnesses - frequent voiding - Treatment depends on how far the cancer has
● ++ there is also weight gain or increase in spread
belly size - Chemotherapy
- Other symptoms: - Surgery
● Back pain Additional Notes:
● Constipation ● Salpingo-oophorectomy, removal of the
● Urinary urgency ovaries or fallopian tube; one (unilateral) or
● Pelvic pain both (bilateral)
● Vaginal bleeding ● Laparoscopic Surgery - minimally
● Weight loss invasive

5
 - Radiation CLASSIFICATIONS OF LEUKEMIA
1. Acute Lymphocytic
LEUKEMIA ● mostly lymphoblast present in BM; age of
● A group of malignant disorders affecting the blood onset is less than 15 years old
and blood-forming tissues of the bone marrow,
lymph system, and spleen. 2. Acute Myelogenous
● Neoplasm derived from lymphoid or myeloid cells ● mostly myeloblast; age of onset is between
primarily affecting the bone marrow and peripheral 15-39 years old
blood.
3. Chronic Myelogenous
Additional Notes: ● mostly granulocyte present in BM; age of
● Leukemia comes from the Greek word - “Leukos” onset is after 50 years old
which means white, and “Aima” which means
blood 4. Chronic Lymphocytic
● Leukemia ● mostly lymphocytes present in BM; age of
○ Cancer of the blood onset is after 50 years old
○ Cancer of the bone marrow
● It is characterized by abnormal proliferation or
multiplication of white blood cells
● target in the leukemia is the white blood cell
● there is production of immature white blood cells
● affects the bone marrow, that is why we have acute
lymphocytic leukemia and acute myeloid leukemia.
● The type of leukemia which will develop will depend
on where the tumor arise, if it is in lymphoid tissues
or cells or myeloid cells.

CHARACTERISTICS
● Replacement of BM with malignant, immature WBC
● Appearance of abnormal, immature WBCs on
peripheral circulation.
● General infiltration of cell into liver, spleen & LNs
throughout the body.

CLINICAL MANIFESTATION
BONE MARROW ● Anemia
● Flexible tissue found in the hollow interior of bones ● Thrombocytopenia
● Leukopenia
Types of Bone Marrow ● Chloromas
a. Red Marrow ● Gum infiltration
● Consisting mainly of myeloid tissue (RBC, ● Hepatosplenomegaly
platelets, most WBC) ● Bone pain
b. Yellow Marrow ● Anorexia
● Fat cells and some WBC develop in yellow ● Petechiae
marrow
NURSING MANAGEMENT
NORMAL BLOOD CELLS ● If Ineffective Protection/Risk for Infection:
1. WBC – infection 1. Hand washing
● Granulocytes – neutrophil, eosinophil, 2. Protective isolation
basophil 3. Low-bacteria diet
● Agranulocytes – lymphocytes, 4. Hygiene
monocytes, macrophages 5. Antibiotic administration
2. RBC – carry oxygen to tissue 6. Avoid invasive procedures
3. Platelets – help form blood clots
● If Imbalanced nutrition: less than body requirement:
ETIOLOGY (LEUKEMIA) 1. Administer anti-emetics
● Leukemia Virus (HTLV-1) 2. Offer food selections
● E - spraying of pesticides 3. Cold foods, shakes, sandwiches
● Use of Chloramphenicol - bone marrow 4. Small frequent feeding
suppression) 5. Total parenteral nutrition
● Kapamilya (heredity)
● Exposure to benzene ● If Fatigue:
● May Down Syndrome 1. Encourage exercise
● Ionizing Radiation 2. Advocate for pain reduction, minimizing
● Alkylating Agents interruptions, and reducing visitors when
rest is needed.

6
 ● If Risk for Injury: Bleeding ○ local radiation therapy, chemotherapy, or
1. Insitute bleeding precautions combination
2. Bleeding monitoring every 4hours. ● Stages Ill
3. Vital signs ○ chemotherapy alone or a combination of
4. Blood transfusion radiation therapy and chemotherapy.
● Stage IV (extensive disease)
HODGKIN’S LYMPHOMA ○ most often treated with chemotherapy
● Is a type of lymphoma, which is a cancer originating alone.
from white blood cells called lymphocytes. ● Tumor marker = Lactic dehydrogenase
● Characterized by the elderly spread of disease from
one lymph node group to another and by the If no respond to treatment -
development of systemic symptoms with advanced. ● High-dose chemotherapy
● Etiology: Unknown ● Autologous BMT
● The disease occurrence shows two peaks: the first
in young adulthood (age 15-35) and the second in Steps:
those over 55 years old. 1. Collection
2. Processing
RISK FACTORS 3. Cryopreservation
● Sex: Male 4. Chemotherapy
● Ages: 15-40 and over 55 5. Reinfusion
● Family HIstory
● History of infectious mononucleosis or infection with Additional treatments depend on other symptoms. They
Epstein-Barr virus, a causative agent of may include:
mononucleosis ● Transfusion of blood products, such as platelets or
● Weakened immune system, including infection with red blood cells,
HIV or the presence of AIDS ● to fight low platelet counts and anemia
● Prolonged use of human growth hormone ● Antibiotics to fight infection, especially if a fever
● Exposure to exotoxins, such as Agent Orange occurs

MANIFESTATIONS BONE TUMOR

● Fatigue ● a neoplastic growth of tissue in bone. Abnormal
● Fever and chills that come and go growth found in the bone can be either benign
● Itching all over the body that cannot be explained (noncancerous) or malignant (cancerous).
● Loss of appetite
● Soaking night sweats
● Painless swelling of the lymph nodes in the neck,
armpits, or groin (swollen glands)
● Weight loss that cannot be explained

Other symptoms that may occur with this disease:

● Coughing, chest pains, or breathing problems
● Pain or feeling of fullness below the ribs
● Pain in lymph nodes after drinking alcohol
● Skin blushing or flushing

DIAGNOSIS
● Blood chem
● CBC CLASSIFICATION OF BONE CANCER
● Lymph node biopsy 1. Primary tumors - originating from the bone tissue
● BM aspiration & Biopsy a. Benign - non-cancerous; neoplastic,
● CT scan developmental, traumatic, infectious or
● PET scan inflammatory in etiology; “-blastomas,
omas”
A staging evaluation is necessary to determine the treatment ● Eg. osteoma, osteoblastoma
plan.
● Stage I - indicates one lymph node region is b. Malignant - cancerous in nature;
involved (for example, the right neck). “-sarcomas, -carcinomas”
● Stage Il - indicates involvement of two lymph node ● Eg. Osteosarcoma,
areas on the same side of the diaphragm (for chondrosarcoma, Ewing’s
example, both sides of the neck). sarcoma
● Stage Ill - indicates lymph node involvement on
both sides of the diaphragm (for example, groin and 2. Secondary tumors - include metastatic tumors
armpit). which have spread from other organs, such as
● Stage IV - involves the spread of cancer outside the carcinomas of the breast, lungs, and prostate
lymph nodes (for example, to bone marrow, lungs,
or liver). Manifestations:
1. Pain
TREATMENT 2. Pathologic fracture
● Stages I and Il
TREATMENT

7
 1. Chemotherapy
2. Radiation therapy
● Both therapies may be adjunct to one
another “pwede sila isabay”

Medications:
1. Nonhormonal bisphosphonates
● Eg. Zoledronic acid (increase bone
strength)
2. Metastron (strontium-89 chloride)
● IV medication that helps with pain

Surgical treatment:
1. Amputation - removal of affected limb/s
● Translumbar amputation or waist
amputation (hemicorporectomy) - half of
the body is amputated

PROGNOSIS
● Depends on type, tumor, size, and location
● The greater the stage, the harder to treat.

REFERENCES

I. PROF’S PPT AND LECTURE