MICROBIOLOGY : Factors that Can Impair Host

Defense Mechanisms

“ Cancer and Cancer Chemotherapy, Drugs”

Submitted to:

Mr. Benedict Dwight Lepiten

Presented by (Group4):

Econas, Maria Nicole

Genelsa, John Lloyd

Gerasmio, John

Goc-ong, Kirstie

Maglasang, Angela Faye

Tampus, Jinjen
I. Definition of Cancer

Cancer is the third leading cause of morbidity and mortality in the country. According to the University of the
Philippines’s Institute of Human Genetics, four Filipinos die of cancer every hour while 189 of every 100,000 Filipinos are
afflicted with the disease. Cancer is the name given to a collection of related diseases. In all types of cancer, some of the
body’s cells begin to divide without stopping and spread into surrounding tissues. Cancer can start almost anywhere in
the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the
body needs them. When cells grow old or become damaged, they die, and new cells take their place. When cancer
develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells
survive when they should die, and new cells form when they are not needed. These extra cells can divide without
stopping and may form growths called tumors.

II. Cite two types of cancer

II.I Breast Cancer

The Philippine Society of Medical Oncology said that breast cancer is so common in the Philippines that one in

every 13 Filipinas is expected to develop it in her lifetime. Moreover, the Philippines has been identified as among the

having the highest incidence rate of breast cancer in Asia. Breast cancer starts when cells in the breast begin to grow out

of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump.

Symptoms:

 Swelling of all or part of a breast (even if no distinct lump is felt)

 Skin irritation or dimpling (sometimes looking like an orange peel)
 Breast or nipple pain
 Nipple retraction (turning inward)
 Redness, scaliness, or thickening of the nipple or breast skin
 Nipple discharge (other than breast milk)

II.II Lung Cancer

Among men, lung cancer ranks as the number one cause of cancer among Filipino men, the Philippine Cancer
Society, Inc. claims. “Lung cancer is killing more Filipino men than ever before,” the society deplored. Every year almost 2
million people around the world are diagnosed with the disease. “Only about 250,000 of them will remain alive, five
years later,” claimed Dr. Ted Hamilton, medical director of Florida Hospital Central Care in Orlando. Typically, the body

programs cells to die at a certain stage in their life cycle to avoid overgrowth. Cancer overrides this instruction, causing

cells to grow and multiply when they should not. The overgrowth of cells leads to the development of tumors and the
 harmful effects of cancer. In lung cancer, this pattern of cell overgrowth occurs in the lungs, which are vital organs for

breathing and gas exchange.

Symptoms:

 appetite loss

 changes to a person's voice, such as hoarseness

 frequent chest infections, such as bronchitis or pneumonia

 lingering cough that may start to get worse

 shortness of breath

 unexplained headaches

 weight loss

 wheezing

III. Factors that can impair Host Defense Mechanism

III.I Breast Cancer

Lymphocytes, including T cells, T reg cells, and NK cells, and their cytokine release patterns are implicated in both
primary prevention and secondary prevention (ie, relapse or recurrence) of breast cancer.

III.II Lung Cancer

 Adaptive anticancer immunity. The adaptive anticancer immune response is initiated by immature DCs, which
capture and process tumor antigens. DCs subsequently undergo maturation and migrate to tumor-draining lymph nodes,
where they present tumor antigens within MHC molecules to naïve T cells, triggering a protective T-cell response. T-cell
activation requires interaction not only between the antigen-MHC complex on DCs and TCRs but also among an array of
co-stimulatory molecules, including CD80/86 on DCs and the CD28 receptor on T cells. The adaptive anticancer immune
response culminates with the infiltration of activated cytotoxic T cells into the tumor, killing cancer cells. DC, dendritic
cell; MHC, major histocompatibility; TCR, T-cell receptor.

III.III Chemotherapy

Chemotherapy is the cancer treatment most likely to weaken the immune system. Chemotherapy medicines
target rapidly dividing cells, which cancer cells are — but so are many of the normal cells in the blood, bone marrow,
mouth, intestinal tract, nose, nails, vagina, and hair. So chemotherapy affects them, too. Cancer cells are destroyed by
chemotherapy because they can’t repair themselves very well. The healthy cells typically can repair the damage from
chemotherapy once treatment ends. (One notable exception is nerve cells in the hands and/or feet, which can be
permanently damaged by certain chemotherapy medications — a condition known as peripheral neuropathy.)As
chemotherapy medicines damage the bone marrow, the marrow is less able to produce enough red blood cells, white
blood cells, and platelets. Typically, the greatest impact is on white blood cells. When you don’t have enough white blood
cells, your body is more vulnerable to infection.Although most chemotherapy medications can have an impact on the
immune system, how much of an impact depends on many factors, such as:which medicines you’re taking and in what
combination — having two or three at once is more likely to affect the immune system than having onehow much
medicine is given and how often medicine is given (dosing)how long treatment lasts.

IV. Nursing Interventions

IV.I Breast Cancer

Nursing Interventions Rationale

Expect initial shock and disbelief following diagnosis of Few patients are fully prepared for the reality

breast cancer and traumatizing procedures (disfiguring of the changes that can occur.

& surgery).

Assess patient and SO for stage of grief currently being Knowledge about the grieving process

experienced. Explain process as appropriate. reinforces the normality of feelings and

reactions being experienced and can help

patient deal more effectively with them.

Provide open, nonjudgmental environment. Use Promotes and encourages realistic dialogue

therapeutic communication skills of Active-Listening, about feelings and concerns.

acknowledgment, and so on.

Encourage verbalization of thoughts or concerns and Patient may feel supported in expression of

accept expressions of sadness, anger, rejection. feelings by the understanding that deep and

Acknowledge normality of these feelings. often conflicting emotions are normal and

experienced by others in this difficult situation.

Be aware of mood swings, hostility, and other acting- Indicators of ineffective coping and need for

out behavior. Set limits on inappropriate behavior, additional interventions. Preventing destructive

redirect negative thinking. actions enables patient to maintain control and

sense of self-esteem.

Be aware of debilitating depression. Ask patient direct Studies show that many cancer patients are at

questions about state of mind. high risk for suicide. They are especially

vulnerable when recently diagnosed and

discharged from hospital.

Visit frequently and provide physical contact as Helps reduce feelings of isolation and

appropriate, or provide frequent phone support as abandonment.

appropriate for setting. Arrange for care provider and

support person to stay with patient as needed.

Reinforce teaching regarding disease process and Patient and SO benefit from factual

treatments and provide information as appropriate information. Individuals may ask direct

about dying. Be honest; do not give false hope while questions about death, and honest answers

providing emotional support. promote trust and provide reassurance that

correct information will be given.

Review past life experiences, role changes, and coping Opportunity to identify skills that may help

skills. Talk about things that interest the patient. individuals cope with grief of current situation

more effectively.

Note evidence of conflict; expressions of anger; and Interpersonal conflicts or angry behavior may

statements of despair, guilt, hopelessness, “nothing to be patient’s way of expressing and dealing

live for.” with feelings of despair or spiritual distress

and could be indicative of suicidal ideation.

Determine way that patient and SO understand and These factors affect how each individual deals

respond to death such as cultural expectations, learned with the possibility of death and influences

behaviors, experience with death (close family how they may respond and interact.

members, friends), beliefs about life after death, faith

in Higher Power (God).

Identify positive aspects of the situation. Possibility of remission and slow progression of

disease and new therapies can offer hope for

the future.

Discuss ways patient and SO can plan together for the Having a part in problem solving and planning

future. Encourage setting of realistic goals. can provide a sense of control over anticipated

events.

Refer to visiting nurse, home health agency as needed, Provides support in meeting physical and

or hospice program, if appropriate. emotional needs of patient and SO, and can

supplement the care family and friends are

able to give.
IV.II Lung Cancer

Nursing Interventions Rationale

Note respiratory rate, depth, and ease Respirations may be increased as a result of pain or as an initial

of respirations. Observe for use of compensatory mechanism to accommodate for loss of lung

accessory muscles, pursed-lip tissue; however, increased work of breathing and cyanosis may

breathing, changes in skin or mucous indicate increasing oxygen consumption and energy

membrane color, pallor, cyanosis. expenditures and/or reduced respiratory reserve.

Auscultate lungs for air movement and Consolidation and lack of air movement on operative side are

abnormal breath sounds. normal in the pneumonectomy patient; however, the lobectomy

patient should demonstrate normal airflow in remaining lobes.

Investigate restlessness and changes May indicate increased hypoxia or complications such as

in mentation or level of consciousness. mediastinal shift in pneumonectomy patient when accompanied

by tachypnea, tachycardia, and tracheal deviation.

Assess patient response to activity. Increased oxygen consumption demand and stress of surgery

Encourage rest periods and limit can result in increased dyspnea and changes in vital signs with

activities to patient tolerance. activity; however, early mobilization is desired to help prevent

pulmonary complications and to obtain and maintain

respiratory and circulatory efficiency. Adequate rest balanced

with activity can prevent respiratory compromise.

Note development of fever. Fever within the first 24 hr after surgery is frequently due to

atelectasis. Temperature elevation within the 5th to 10th

postoperative day usually indicates a wound or systemic.

Maintain patent airway by positioning, Airway obstruction impedes ventilation, impairing gas
suctioning, use of airway adjuncts. exchange.

Reposition frequently, placing patient Maximizes lung expansion and drainage of secretions.

in sitting positions and supine to side

positions.

Avoid positioning patient with a Research shows that positioning patients following lung surgery

pneumonectomy on the operative side; with their “good lung down” maximizes oxygenation by using

instead, favor the “good lung down” gravity to enhance blood flow to the healthy lung, thus creating

position. the best possible match between ventilation and perfusion.

Encourage and assist with deep- Promotes maximal ventilation and oxygenation and reduces or

breathing exercises and pursed-lip prevents atelectasis.

breathing as appropriate.

Maintain patency of chest drainage Drains fluid from pleural cavity to promote re-expansion of

system for lobectomy, segmental or remaining lung segments.

wedge resection patient.

Note changes in amount or type of Bloody drainage should decrease in amount and change to a

chest tube drainage. more serous composition as recovery progresses. A sudden

increase in amount of bloody drainage or return to frank

bleeding suggests thoracic bleeding or hemothorax; sudden

cessation suggests blockage of tube, requiring further

evaluation and intervention.

Observe presence or degree of Air leaks immediately postoperative are not uncommon,

bubbling in water-seal chamber. especially following lobectomy or segmental resection;

however, this should diminish as healing progresses. Prolonged

or new leaks require evaluation to identify problems in patient

 versus the drainage system.

Administer supplemental oxygen via Maximizes available oxygen, especially while ventilation is

nasal cannula, partial rebreathing reduced because of anesthetic, depression, or pain, and during

mask, or high-humidity face mask, as period of compensatory physiological shift of circulation to

indicated. remaining functional alveolar units.

Assist with and encourage use of Prevents or reduces atelectasis and promotes re-expansion of

incentive spirometer. small airways.

Monitor and graph ABGs, pulse Decreasing Pao2 or increasing Paco2 may indicate need for

oximetry readings. Note hemoglobin ventilatory support. Significant blood loss can result in

(Hb) levels. decreased oxygen-carrying capacity, reducing Pao2.

Online Sources:

https://www.cancercenter.com/what-is-cancer/

https://businessmirror.com.ph/more-filipinos-dying-of-lung-cancer/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618296/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845458/

Books:

Vera, M. RN. 2013. 13 Cancer Nursing Care Plans

Vera, M. RN. 2013. 5 Lung Cancer Nursing Care Plans