Unit 11

DM 1 and 2
Diabetes is a group of metabolic diseases characterized by increased levels of glucose in the blood resulting
from defects in insulin secretion, insulin action, or both.
Type 1 Diabetes is an autoimmune disease, juvenile onset, and insulin dependent (there is a destruction of
pancreatic islets) which the body destroys the pancreas or the islet of Langerhans, which will not produce beta
cells.
Type 2 Diabetes is an adult onset. the main problem is the lifestyle, we have low to normal insulin. It means
they have the capacity to transfer glucose into the cells. It is also known as non-insulin dependent, and it is more
common in obese people, it has also insulin resistance.
Islets of Langerhans
Produces pancreatic hormones
 Alpha
 Beta
 Delta cells
Alpha cells- produces glucagon. Functions: it increases blood sugar by glycogenolysis means the breakdown of
the sugar and put it back to the bloodstream.
Beta cells- Insulin, main function is to lower the blood sugar level. It transports the glucose into the cells.
Delta cells: Somatostatin- it means the check in balance, it is the one that would balance both glucagon and
insulin, if most likely increase, he will try to compensate and bring it down to normal.

Type 1 is autoimmune disease that means that it would destroys our own cells that why we would develop the
different signs and symptoms present in diabetes mellitus. It will also directly destroy our pancreatic islets or
the islets of Langerhans.

Type 2 diabetes, number 1 factors are insulin resistance, means the body or cells will no longer open itself to
receive the glucose from the bloodstream. The body recognize the increase blood sugar as normal. It is because
of always increase of blood sugar level or prolonged blood glucose level in the bloodstream. (lifestyle)
Because of insulin resistance, you have now liver and peripheral tissue and fat tissue resistance, the liver will
now develop decrease sensitivity levels to glucose levels. The liver or pancreas will continue to produce hepatic
glucose production, that would mean further increase of blood glucose levels. Peripheral tissue and fat tissue, it
means that there is inability to uptake the glucose, inability to feed or to eat the glucose and store it into the
cells.
Another causes of type 2 Diabetes, they have limited beta cells response to hyperglycemia, it means when beta
cells expose to high blood glucose level, it will become now less efficient when responding to further glucose
elevation.
Type 2 is not curable, but it can be controlled through desensitization.
3 major metabolic disorder
  Decrease glucose utilization
In order the glucose will ingested into the cells we need insulin. Here we adequate amount of insulin,
blood glucose will now rise. (Elevated blood glucose). The kidney will now involve thru compensation
by excreting the glucose into urine. (polyuria)
 Increase fat mobilization try to compensate with the lose of glucose inside the cells. To use as a form of
energy but the main problem with increase fat metabolism, they will now develop ketosis or there would
be ketones accumulation in the blood. (End stage renal failure). Kidney will compensate to remove the
excess ketones. (hyponatremia) (increased body lipid level) Complications Atherosclerosis
 Increase protein utilization there’s no glucose, the body will try to compensate and will use protein to
form energy.

Common signs and symptoms

- Polyphagia, excessive hunger, or cells starvation.
- Polydipsia, excessive thirst
- Polyuria
- Prolonged wound healing

Possible management
Regular or controlled diet
 Protein 10 to 20 percent
 Carbohydrate 45 to 60 percent
 Fats 20 to 30 percent
Nutritional therapy
Monitoring blood glucose
Exercise
Change of lifestyle
Lifelong insulin therapy
Lower blood sugar levels
Oral medication
OHA- oral hyperglycemic agents

Management
Prevent lipodystrophy (The rotation of injection)
Insulin pen and insulin pump

Diagnosis fasting plasma glucose

DKA/HHNS
DKA and HHS are the most common, and life-threatening acute complications of DIABETES
DIABETEC KETOACIDOSIS
The body needs a cellular fuel. It happens when there is no insulin that will lead to cell starvation, it grows
critical that there’s no fuel inside the cells, cells starvation and increase blood sugar level that will lead now the
conversion of the fats and proteins. The liver will convert the fats into ketones as a source of new energy but
these ketones is not good and it will develop metabolic acidosis to the patient. Its effect is to accelerate or
increase accumulation of ketones inside the body.
S and sx
- Ketosis
- Acidosis
- Ketonuria
- Acetone breath
- Kussmauls respiration

Complications diabetic coma (common in teenager and adults)

Risk factors – Type 1 diabetes patient, missed insulin doses or taking too little insulin.

For rehydration kay

 .9 sodium chloride for no heart problems
 .45 with heart problems
 Circulatory collapse provide blood, albumin, the plasma volume expander

HYPERGLYCEMIA HYPEROSMORALITY NON-KETOTIC SYNDROME

THE BLOOD SUGAR LEVEL REACH THE MAXIMUM LEVEL.
Extreme hyperglycemia, the patient will have 600 to 2000 mg/dl BLOOD SUGAR LEVEL IN THE
BLOODSTREAM.

FOUR major clinical features

 Severe hyperglycemia
 Profound type of dehydration (10 to 15% water loss)
 Mild to no ketonuria (Absence of acidosis)
 Hyperosmolarity

Increase mortality (DKA kay emergency type) because the patient having type 2 diabetes kay older patients.
Complications
  nephropathy, because of continuous GFR
 Neuropathy
 Retinopathy
(THE GLUCOSE IS IN THE BLOODSTREAM AND IT WILL BLOCK ALL THE CAPPILARIES OR THE
BLOOD VESSELS PATHWAY, IT IS DISLODGED AND IT WILL BLOCK THE SUPPLY OF OXYGEN
APIL SA LOWER EXTREMITIES, MAONG NAAY TINGLING SENSATION (POOR WOUND
HEALING))
 CVA
 STROKE
 MI and ANGINA PECTORIS
Both disorders have to do with Adh, either too much Adh, not enough Adh or the organs in your body aren't
responding appropriately to Adh. Adh is released by the posterior pituitary gland in response to low blood
volume in the body, low blood pressure, or to hypernatremia, or increased blood osmolarity. So, if the body
senses any of these things, it will release ADH from the posterior pituitary gland, which will cause the kidneys
to reabsorb more water, which helps to bring up that blood pressure, bring up that blood volume, and dilute the
blood so that the blood osmolarity is back to a normal level.
DI/SIADH
DIABETES INSIPIDUS
Diabetes insipidus (DI) is a disorder of the posterior lobe of the pituitary gland that is characterized by a
deficiency of ADH (vasopressin).
Causes
 Neurogenic or central diabetes insipidus. Damage to the pituitary gland or hypothalamus from surgery, a
tumor, head injury or illness can cause neurogenic diabetes insipidus by affecting the usual production,
storage, and release of ADH.
 Nephrogenic diabetes insipidus. Nephrogenic diabetes insipidus occurs when there's a defect in the
structures in your kidneys that makes your kidneys unable to properly respond to ADH. The defect may
be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium or
antiviral medications also can cause nephrogenic diabetes insipidus.
• Dipsogenic or primary polydipsia – excessive intake of oral water or other fluid it suppresses the release
of ADH causing polyuria.

Main function of ADH: retention of water

S and SX
• Polyuria (5-40L a day)
• Polydipsia
• (hypo tachy tachy – hypotension, tachycardia and tachypnea)
• Urine pH less than 1
Complications – hypovolemic shock

Diagnosis
• Fluid deprivation test (a weight loss of 3 to 5) (if maobserve ang shock (fainting), iistop)
Management
• Fluid replacement
• Supportive therapy
• Synthetic ADH (desmopressin – intranasal or IM)
o Advise the patient to clean or blow the nose first
• Thiazide diuretics (hold the sodium inside the body)
SYNDROME INAPPROPRIATE ANTI-DIURETIC HORMONE (opposite sa DI)
Increase ADH
S and SX
• Oliguria
• Hypervolemia
• Hyper brady brady, hypertension, bradycardia, bradypnea
• Urine Ph above 1.030
• Hyponatremia (delusional hyponatremia)
• No edema (excess water in the circulation, fluid is in the circulation only)
• Weight gain

Complications
• Cerebral edema
• Pulmonary edema
• Heart problem
• Seizures
Diagnosis
• Fluid challenge test (2 to 4L 24 to 48 hours, obtain urine and measure the output)
Management
• Fluid restriction
• Medications - Declomycin
HYPERTHYROIDISM/HYPOTHYROIDISM
Hyperthyroidism
Hyperthyroidism excessive secretion of thyroid hormones by the thyroid gland.
The hypothalamus produces TRH, thyroid releasing hormone which causes the pituitary gland to produce TSH,
thyroid stimulating hormone and that allows for secretion of T3, T4 and calcitonin from the thyroid gland.
 T3 and T4 function –
o metabolism regulations (conversion of food intake into energy)
o Regulations of the heart rate
o Regulate the temperature
o Growth development (nails, hair, skin)
o Regulate stress hormone and moods

 Primary hyperthyroidism - we have an issue with the thyroid gland itself. The most common cause is
Graves’ disease which is an autoimmune issue, but we can also have thyroid nodule. Due the one of
these causes, we have hypersecretion of T3 and T4.
 Secondary hyperthyroidism - this is where we have pituitary disorder such as a tumor, which is causing
excess secretion of TSH. So, with all this extra TSH, the thyroid gland is getting the message to produce
more and more thyroid gland hormones even though it doesn't really need to, but that's the order it's
getting from the pituitary gland.
 Tertiary hyperthyroidism - means we have an issue in the hypothalamus. So due to hypothalamus
dysfunction, the hypothalamus is producing too much TRH, which is causing the production of too
much TSH, which is causing the thyroid gland to go into overdrive, producing all that T3 and T4 even
though it really isn't supposed to just because it's getting that order from above.

S and SX
• Warm (patient having increase metabolism leads to heat intolerance (sensitive to heat) (weight loss,
increase appetite)
• Wet (diaphoresis)
• Wild (increase palpitation, diarrhea, a moist skin)
• Tremors
• Menorrhagia

Complications
• Heart problems
• Thyrotoxicosis
• Osteoporosis
• Thyroid storm would only occur in thyroidectomy
Diagnosis - Radioactive iodine uptake test
Treatment - thyroidectomy

HYPOTHYROIDISM
• results from suboptimal or low levels of thyroid hormone
• Decrease iodine, decrease T3, T4 and calcitonin. (AFFECTS THE CALCIUM HOMEOSTATIS)
Causes
• Autoimmune disease. The most common cause of hypothyroidism is an autoimmune disorder known as
Hashimoto's thyroiditis. Autoimmune disorders occur when your immune system produces antibodies that
attack your own tissues.
• Over-response to hyperthyroidism treatment. People who produce too much thyroid hormone
(hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications. The goal of these
treatments is to get thyroid function back to normal. But sometimes, correcting hyperthyroidism can end up
lowering thyroid hormone production too much, resulting in permanent hypothyroidism.
• Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or halt hormone
production. In that case, you'll need to take thyroid hormone for life.

S and Sx
• cold intolerance
• constipation
• slow heart rate
• weight gain
• anorexia (decrease appetite)
• apathetic face
• dry skin, dry brittle hair
• amenorrhea or oligomenorrhea
Complications:
• Critinism - present in children due to problem like anorexia, the patient will develop stunted growth.
Due to congenital hypothyroidism due to excessive use thyroid hormone or anti thyroid medications of
the mother *(buros). Poor feeding ang bata
• Myxedema coma – adult (medical emergency)
GRAVES DISEASES
Graves’ Disease, an autoimmune disease. Autoimmune antibodies will destroy the body by excessive
production of the thyroid stimulating hormone, they would further provide T3 and T4 inside the body.
The patient will develop
• Exophthalmos (not reversible) because the autoimmune antibodies have the capacity to create
inflammation and irritation on the muscle and tissue inside the body. Specifically, in the tissue of the
eyes.
Irritation leads to bulging of the eyeballs

Diagnosis – check t3 and t4, biopsy, radioactive iodine 123

Management

• PTU “Propylthiouracil” 
• Methimazole
• Monitor agranulocytosis, fever sore throat, drop of CBC and WBC
• Radioactive iodine 131
• SSKI (saturated solutions of potassium iodine) (prevent thyroid storm) (through straw or mix with milk
or juice and further absorption)
• Monitor vital signs
• Management of exophthalmos – (problem with blinking, conjunctivitis) advice for eyedrops, sunglasses,
and eyepatch
• Surgical – thyroidectomy (partial removal leads to thyroid storm)
o Watch out for the complications of bleeding (frequent swallowing)
o Pharyngeal nerve damage
o Tetani (duol ang parathyroid gland], release of calcium in the blood)
o Chvostek signs, trousseau signs (involuntary contractions or twitching of the hands)
MYXEDEMA COMA
life-threatening condition that occurs in patients with hypothyroidism due to severely low thyroid hormones
(untreated or undiagnosed hypothyroidism). (Medical emergency)

Cause – Hashimoto thyroiditis an autoimmune disease.

S and Sx

Patients will have the typical HYPOTHYROIDISM signs and symptoms, BUT they will be more SEVERE….
systems of the body are slowing down to the point of death

 Hypothermia
 Myxedema
 Slow heart rate and low blood pressure
 Respiratory failure
 Hyponatremia
 Hypoglycemia
 Very confused/drowsy…may progress to a coma
Diagnosis – biopsy, T3 and T4, radioactive iodine 123

Medications: Levothyroxine and liothyronine (regulate the metabolism of patient)

Side effects: Cardiac arrhythmias, tachycardia, and chest pain (stop the medications, resume after 2 to 3 weeks
but with a lesser dose)

Management

• Increase fluid intake and fiber intake

• Lifetime medications
LIVER DISORDER
Functions of the Liver
Glucose Metabolism
The liver plays a major role in the metabolism of glucose and the regulation of blood glucose concentration.
After a meal, glucose is taken up from the portal venous blood by the liver and converted into glycogen, which
is stored in the hepatocytes. Subsequently, the glycogen is converted back to glucose (glycogenolysis) and
released as needed into the bloodstream to maintain normal levels of blood glucose. However, this process
provides a limited amount of glucose. Additional glucose can be synthesized by the liver through a process
called gluconeogenesis. For this process, the liver uses amino acids from protein breakdown or lactate produced
by exercising muscles. This process occurs in response to hypoglycemia
Ammonia Conversion
The use of amino acids from protein for gluconeogenesis results in the formation of ammonia as a by-product.
The liver converts this metabolically generated ammonia into urea. Ammonia produced by bacteria in the
intestines is also removed from portal blood for urea synthesis. In this way, the liver converts ammonia, a
potential toxin, into urea, a compound that is excreted in the urine.
Protein Metabolism
The liver also plays an important role in protein metabolism. It synthesizes almost all the plasma proteins
(except gamma-globulin), including albumin, alpha-globulins and beta-globulins, blood clotting factors, specific
transport proteins, and most of the plasma lipoproteins. Vitamin K is required by the liver for synthesis of
prothrombin and some of the other clotting factors. Amino acids are used by the liver for protein synthesis
Fat Metabolism
The liver is also active in fat metabolism. (mutabang sya og galing atong mga fats) Fatty acids can be broken
down for the production of energy and ketone bodies. Ketone bodies are small compounds that can enter the
bloodstream and provide a source of energy for muscles and other tissues. Breakdown of fatty acids into ketone
bodies occurs primarily when the availability of glucose for metabolism is limited, as in starvation or in
uncontrolled diabetes. Fatty acids and their metabolic products are also used for the synthesis of cholesterol,
lecithin, lipoproteins, and other complex lipids.
FAT SOLUBLE VITAMINS (ADEK) DEFICIENCY.

Vitamin and Iron Storage

Vitamins A, B, and D and several of the B-complex vitamins are stored in large amounts in the liver. Certain
substances, such as iron and copper, are also stored in the liver.
Bile Formation
Bile is the digestive juice that is secreted by the liver. It is generally stored in the liver. Bile is mainly performs
two main functions. One is it mainly assists with the fat digestion and secondly it is a main means for the body
to excrete waste products from the blood. If the liver is damaged, it cannot produce bile, so it can’t metabolize
fats.
Complications: ADEK deficiency, bleeding, and prolonged wound healing
Bilirubin Excretion
EXCRETED THROUGH KIDNEYS. BILIBIRUN COMES FROM RBC, RBC COULD BE BREAKDOWN
TO HEME AND GLOBIN.
THE HEME WHEN BREAKDOWN WILL BE NOW UNCONJUGATED BILIRUBIN (ALSO KNOW AS
INDIRECTED TYPE OF BILIRUBIN) CANNOT BE EXCRETED BY THE KIDNEY. (THERES A
DISCOLORATION OF SKIN IF STAYED IN THE BLOODSTREAM) THE LIVER WILL CONVERT THE
UNCONJUGATED BILIRUBIN INTO CONJUGATED BILIRUBIN OR DIRECT TYPE. ONCE
CONVERTED IT WILL NOW EASILY BE EXCRETED BY THE KIDNEY DUE TO HELP OF THE
WATER SOLUTION. (WATER SOLUBLE) MIXED WITH URINE AND FECAL (MAO COLOR
YELLOW). IF LIVER IS DAMAGED, THE CONJUGATED TPE BILIRUBIN COULD NO LONGER BE
EXCRETED BY THE KIDNEYS BECAUSE IT IS NOT AFFECTED BY THE AQEOUS SOLUTION. (AND
COULD STAY IN THE BLOODSTREAM, MAO NAAY JAUNDICE DISCOLORATION OF SKIN AND
SCLERA, CLAY COLORED STOOL AND THE TEA COLORED URINE)
Drug Metabolism
The liver help in breaking down, to absorb drug and excrete the things that we don’t need.

LIVER COMPLICATIONS
PORTAL HYPERTENSION
The blood that supposes to be will go to inside the liver will backflow now into portal vein, spleen or GI
system.
Increase pressure in the portal vein because the liver could no longer accept the blood that supposed to be
deliver back into the heart.
Due to defected liver, portal hypertension will lead to Splenomegaly – the graveyard of RBC
Lead to hemolytic anemia
Sx weakness, fatigue

Management
o Blood transfusion
o Injections
o Assist ADL (take rest)
ESOPHAGEAL VARICES
Due to the back flow of blood to the gastrointestinal system (varicose)
Signs and Sx
o Bleeding, difficulty of swallowing, hematemesis, melena
o Complications (prolonged bleeding)
o Hypovolemic shock
o Decrease level of conscious

Management
 No Valsalva maneuvers
 No strain activities
 Avoid patient to constipation
 No spicy foods
 Avoid anything that will irritate esophageal areas
Medical
 Using of balloon tamponade (four lumen (Minnesota) or three lumen tube ()
 Sclerotherapy (sclerosing agent)
 Variceal banding

SPIDER ANGIOMA (ANOTHER COMPLICATION OF PORTAL HYPERTENSION) because of back flow

itself
HEMORROIDS RUPTURED WILL DEVELOP HEMATOPECIA (BRIGHT RED STOOL)
(hemorrhoidectomy)

ASCITES
Aside from the backflow of blood, there’s a Problem with albumin (helps in protein synthesis, function kay
pushing and pulling)
The fluid will stay in interstitial spaces.
The patient will have: Fluid volume deficit
o Increase Abdominal Gert
o Assess for fluid wave
o Position in semi fowler position to high fowler position

Surgical management
o Paracentesis (upright position and empty the bladder)
 o Shunt (TIPS Trans jugular intrahepatic portosystemic shunt)

HEPATIC ENCEPALOPATHY
Common complications of the liver disorder
Brain dysfunction cause by the accumulation of ammonia in the blood. Due to ammonia itself, it reaches to the
brain that’s why it develops brain dysfunction. The ammonia will now accumulate the brain blood barrier,
destroy the brain tissues.
Sx
o Decrease level of consciousness
o Decreased vison, sensation, hearing
o Loss of voluntary motor movement control
o Flapping of the hands
o Agraphia
o Asterixis

Management
o Laxatives (lactulose)
o Facilitate defecation
o Antibiotics (Neomycin sulfate)
o Advise for dialysis
o Provide Adequate protein
UNIT 13
SYPHILIS
Syphilis is an acute and chronic infectious disease caused by the spirochete Treponema pallidum.
Mode of transmission
Sexual contacts, mother to child during pregnancy, blood transfusion or needle sharing and non-sexual contact
with infected skin lesion.
Stages of Syphilis
In the person who is untreated, the course of syphilis can be divided into three stages: primary, secondary, and
tertiary. These stages reflect the time from infection and the clinical manifestations observed in that period and
are the basis for treatment decisions.
• Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. A painless lesion at the
site of infection is called a chancre. These lesions usually resolve spontaneously within 3 to 12 weeks,
with or without treatment
• Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads
to generalized infection. The rash of secondary syphilis occurs from 1 week to 6 months after the
chancre and involves the trunk and the extremities, including the palms of the hands and the soles of the
feet. Transmission of the organism can occur through contact with these lesions. Generalized signs of
infection may include lymphadenopathy, arthritis, meningitis, hair loss, fever, malaise, and weight loss.
• After the secondary stage, there is a period of latency, when the person who is infected has no signs or
symptoms of syphilis. Latency can be interrupted by a recurrence of secondary syphilis symptoms.
• Tertiary syphilis is the final stage in the natural history of the disease. It is estimated that between 20%
and 40% of those infected do not exhibit signs and symptoms in this final stage. Tertiary syphilis
presents as a slowly progressive inflammatory disease with the potential to affect multiple organs. The
most common manifestations at this level are aortitis and neurosyphilis, as evidenced by dementia,
psychosis, paresis, stroke, or meningitis.
Assessment and Diagnostic Findings
The conclusive diagnosis of syphilis can be made by direct identification of the spirochete obtained from the
chancre lesions of primary syphilis. Serologic tests used in the diagnosis of secondary and tertiary syphilis
require clinical correlation in interpretation. The serologic tests are summarized as follows: Nontreponemal or
reagin tests
Complication

 Small bumps or tumors

 Neurological problems
 Cardiovascular problems
 HIV infection
  Pregnancy and childbirth complications

Medical Management
Treatment of all stages of syphilis is administration of antibiotic medications. Penicillin G benzathine is the
medication of choice for early syphilis or early latent syphilis of less than 1 year’s duration. It is given by
intramuscular injection at a single session. Patients who are allergic to penicillin are usually treated with
doxycycline (Adoxa).
Nursing Management
Syphilis is a reportable communicable disease. In any health care facility, a mechanism must be in place to
ensure that all patients who are diagnosed are reported to the state or local public health department to ensure
community follow up. The public health department is responsible for identification of sexual contacts, contact
notification, and contact screening. Lesions of primary and secondary syphilis may be highly infective. Gloves
are worn when direct contact with lesions is likely, and hand hygiene is performed after gloves are removed.
Isolation in a private room is not required.
TRICHOMONIASIS
Trichomonas vaginalis is responsible for the STI Trichomoniasis, the symptom is mainly occurred in the
women in the vagina. This STI is not caused by a bacterium, but rather a protozoan which is a more advanced
form of microorganism than a bacterium. It is a parasite, and it exists mainly by eating cells. (Eating cells
fragments)
Mode of transmission
Through vaginal sex (can’t survive elsewhere, they can only live within the urogenital tract).
In men, they are asymptomatic carrier
S and Sx
The immune system will recognize the parasite and in response to the trichomonas, white blood cells will be
sent to combat them and try and engulf them and eat them to stop them killing cells in the body and as a result
we will get inflammation.
Urethritis, dysuria, vaginitis, cervicitis, causing dyspareunia (painful sex)
Green discharge, bad smell.

Complications
Preterm labor, Cervical cancer
In men they are asymptomatic, prostate cancer.

Diagnosis
Wet mount (swab of the vaginal tract)
Culture

Management
Antibiotic culture determine sensitivity
Treat sexual partner too.
Use of condoms
BACTERIAL VAGINOSIS
(Most common vaginal infection) Overgrowth of Gardnerella vaginalis
Gardnerella vaginalis is naturally exist in vagina
Causes= change in vaginal environment due to douching, new or multiple sex partners, use of antibiotics (treat
pneumonia) (attack the bacteria that exist in the vagina)
Pathophysiology
Example use of antibiotics leads to the change in vaginal environment and increased Gardnerella vaginalis that
will lead to symptom of copious vaginal discharge (a lot)
Fishy odor
Painful urination
In pregnant women they can deliver there baby early- preterm labor
Diagnosis
Wet mount (swab the vagina)
Treatment
Antibiotic
Prevention
Use of condom
HERPES SIMPLEX (1/2)
The herpes simplex virus, also known as HSV, is an infection that causes herpes. Herpes can appear in various
parts of the body, most commonly on the genitals or mouth. There are two types of the herpes simplex virus:
 HSV-1: primarily causes oral herpes and is generally responsible for cold sores and fever blisters around
the mouth and on the face.
 HSV-2: primarily causes genital herpes and is generally responsible for genital herpes outbreaks.

HSV-1 can be contracted from general interactions such as:

 eating from the same utensils
 sharing lip balm
 kissing
HSV-2 is contracted through forms of sexual contact with a person who has HSV-2. HSV-2 infections are
spread through contact with a herpes sore. In contrast, most people get HSV-1 from a person with an infection
who is asymptomatic or does not have sores.
Risk factor:
 having multiple sex partners
 having sex at a younger age
 being female
 having another sexually transmitted infection (STI)
 having a weakened immune system

Signs and symptoms

 blistering sores (in the mouth or on the genitals)
 pain during urination (genital herpes)
 itching
The patient may also experience symptoms that are similar to the flu. These symptoms can include
 fever
 swollen lymph nodes
 headaches
 tiredness
 lack of appetite

HSV can also spread to the eyes, causing a condition called herpes keratitis. This can cause symptoms such
as eye pain, discharge, and a gritty feeling in the eye.

Diagnostic Procedure
  PCR tests
 Culture test
 Blood test

Management
 Acyclovir
 Famciclovir
 valacyclovir
GENITAL WARTS
One of the most common types of STI. It is caused by human papillomavirus. It affects the moist tissues
of the genital area. They have a small, cauliflower-like appearance. Some strains of genital HPV can cause
genital warts, while others can cause cancer.
Genital warts are spread through a sexual contact it is spread through skin-to-skin contact usually during anal,
oral, or genital sex with an infected partner. Genital warts may appear on the lips, tongue, mouth, or throat of a
person who has had oral sexual contact with an infected partner.

Sx:
- small, flesh-colored swellings in genitalia
- cauliflower-like shape caused by several warts close together
- itching/discomfort
- bleeding during intercourse
Rf:
- unprotected sex
- had another STI
- sexually active at young age
- immunocompromised patients
Dx
- PAP test
- HPV test
Comp:
- cervical cancer
Treatment:
- ointments
- limit your sexual partners
- HPV vaccination (Gardasil 9)
- Cryotherapy
- Surgical excision
- Laser treatments

GRANULOMA INGUINALE
Sexually transmitted disease. Also called as donovanosis is caused by the bacterium klebsiella
granulomatis. It is spread mostly through vaginal or anal intercourse. In rare instances, it can be contracted
through oral sex. It common in people ages 20-40. Males are twice as likely to acquire granuloma inguinale as
women.
The Symptoms and Stages of Granuloma Inguinale
Signs of the condition have a slow onset. It usually takes at least one week to experience symptoms. It can take
up to 12 weeks for symptoms to reach their peak.

The skin lesion progresses through three stages:

Stage One: In the first stage, the small pimple will begin to spread and eat away at the surrounding tissue. As
the tissue begins to wear away, it turns pink or a faint red. The bumps then turn into raised red nodules with a
velvety texture. This happens around the anus and genitals. Although the bumps are painless, they can bleed if
they are injured.

Stage Two: In the second stage of the disease, bacteria begin to erode the skin. Once this occurs, you will
develop shallow ulcers that will spread from the genitals and anus to the thighs and lower abdomen, or inguinal
area. You will notice that the perimeters of the ulcers are lined with granulated tissue. A foul smell may
accompany the ulcers.

Stage Three: When granuloma inguinale advances to the third stage, the ulcers become deep and morph into
scar tissue.

Tests:
- Culture of tissue sample
- Scraping/biopsy of lesions
Comp:
- Genital damage/scarring
- Loss of skin color in genitals
- Permanent genital swelling due to scarring
Treatment:
- Avoid all sexual activities
- Use of condoms
- Antibiotics (Doxycycline)

CANDIDIASIS
It is a fungal infection caused by yeast called CANDIDA. Some species of Candida can cause infection in
people; the most common is Candida albicans. Candida  normally lives on the skin and inside the body, in
places such as the mouth, throat, gut, and vagina, without causing any problems. It usually occurs due to
excessive taking of drugs that can alter the good bacteria/flora in our body. It can only cause infections if it
grows out of control or if it enters deep into the body, like in the bloodstream or internal organs such as kidneys,
heart, or brain).
Sx:
- Vaginal itching/soreness
- Abnormal vaginal discharge
- Mouth sores
- Onychomycosis - a fungal infection of the nails that causes discoloration, thickening, and separation
from the nail bed. 
Rf:
- Antibiotic use
 - Pregnant
- Use of hormonal contraceptives
- Diabetic patient
Comp:
- Skin infections
Test:
- Pelvic exam
- Culture and sensitivity
Treatment:
- Antifungal medications
- Single dose of fluconazole (oral)
- Nystatin (take it 4wks straight)
ONCO DISEASES
DIC/ MULTIPLE MYELOMA
Disseminated intravascular coagulation (DIC) is not an actual disease but a sign of an underlying condition.
DIC may be triggered by sepsis, trauma, cancer, shock, abruptio placentae, toxins, allergic reactions, and other
conditions.
The main problem with DIC is there is an activation of coagulation that result both in bleeding and thrombosis,
the formation of infarction (clots) or occlusion.
DIC is the presence of both thrombin and plasmin (the one that would make the clot and the one that destroys
the clot), common factors that leads to DIC are infection and a very serious trauma. Then the pathway is
activated now. Either the extrinsic or intrinsic pathway (since naa na mactivate na ang 4 stage of clotting)
followed by the activation of thrombin later on the activation of fibrinogen, this fibrin It will deposit now
throughout the micro circulation. (Triggered by the thrombin). Due to platelet aggregation.
The platelet aggregation, it will attract different blood components that will lead to the different clamping itself
(dagkong clot) leads to microthrombi (flowing to the microcirculation) leads to occlusion or to block the blood
flow in another organ.
When there’s an occlusion the common problems are
 Myocardial infarction
 Coronary heart attack
 Angina pectoris
 Tissue necrosis
 Brain damage leads to CVA
 Occlusion will impede the circulation in the lower extremities.
It is caused by excessive clotting that will now lead or activation of fibrinolytic mechanism. (The process that
dissolve the clot.)
The body will try to compensate to dissolve the clot leads to DIC.
Since nay clotting the body will try to compensate by producing the plasmin in order to save the body itself.
There is now bleeding, thrombocytopenia.
DIC more on compensation of the body.

How to prevent DIC

 Focus on the underlying cause
 Provide cryoprecipitate (provide factors or to control body to produce excessive one
 Plasma or blood transfusion.
 Surgeries
 If bleeding happens only, just normal lysis will happen.
General management
  Blood plasma transfusion
 cryoprecipitate.
 Supportive measures
Others
 Medication sa underlying causes
 Case to case basis

 Anticoagulant igive depends on what types of stage

 Nursing inte, monitor the lab results
 And get the proper diagnosis.
MULTIPLE MYELOMA
Myeloma is the second most common hematologic cancer and generally affecting older adult and common in
men.
Multiple myeloma is a malignant disease of the most mature form of B lymphocyte—the plasma cell. Plasma
cells secrete immunoglobulins, which are proteins necessary for antibody production to fight infection or M-
protein. If there’s a problem in plasma cell it will have excessive in immunoglobulins and incongruent it will
also have excessive amount of M-protein. Because it is excessive, the M-protein will now found in urine and
blood chem.
Dx:
 Bence- jones protein collection 24 hours urinalysis (if positive or increase proteins, related for having
have multiple myeloma)
 Beta microglobulin test (best marker for tumor)
 Bone marrow biopsy
 CBC
 MRI
 PET
Pathophysiology
Abnormal proliferation of plasma B cells that would lead now to the infiltration in the bone marrow that would
lead now to more production of abnormal immunoglobulins or the myeloma protein. The myeloma protein will
further accumulate now the bone marrow and will lead to disruption of the cell, differentiation, and further
proliferation. Disruption of the cell lead to
 increase monoclonal protein, when there is increase monoclonal protein means it will lead to hyper
viscosity and renal sufficiency or failure, because the kidney is the one that would always eliminate
excessive thing in our body, and this protein could be detective by our kidney that is excessive, and the
kidneys will eliminate this through urine. Increase monoclonal protein will destroy the kidney or block
the kidneys.
 Immunodeficiency – involvement of the B-lymphocytes that fights for infection (risk for infection)
 Marrow infiltration – would lead to anemia (pancytopenia) and cytokines release, will lead now to bone
disruption (hypercalcemia and bone problems – risk for pathologic fractures, bone pain, CNS
involvement and renal problems and failure)
Treatments for myeloma
 More on hydration (increase water intake)
 Targeted therapy.
 Immunotherapy.
 Chemotherapy.
 INTERFERON
 Corticosteroids.
 Bone marrow transplant.
  Radiation therapy.

Cancer is unknown (idiopathic), familial or hereditary.

BRAIN TUMORS
It is a mass or growth of abnormal cells in your brain. The effects of brain tumors are caused by
inflammation, compression, and infiltration of tissue.

Pathophysiology
There are space occupying lesions (a mass). That would lead to compression to normal tissues and due to the
compression of the normal tissue there 3 problem that would arise.
 The blood flow is altered
 Ischemia is developed since the blood is altered
 There is an edema formation
If the blood flow is altered and ischemia develops, the patient will develop necrosis. Edema because
there is an excess accumulation inside the brain due to the mass itself.
Sign and symptoms are Increase ICP, ICP will lead to herniation of brain or parts. Mostly likely develop
increase ICP (Monroe Kellie hypothesis)
Class:
- Primary brain tumors- originate from cells within the brain.
- Secondary, or metastatic, brain tumors- develop from structures outside the brain and are twice as
common as primary brain tumors.
Common two types of tumors
- Intra axial tumor and extra axial tumor
- Intra arise in the cerebrum cerebellum and the brain stem (3major parts)
- Extra originated from the skull, meninges, and cranial nerves

Signs and symptoms or deficit will depend on kung aha nalocate ang tumor.
General s and sx
- Increase ICP
- Edema
- Altered level of consciousness
- Mental and emotional changes
- Headache Continuous headache, recurrent and Intermittent (pa increase ang pain frequency, severity
and duration) (Roll out)
- Nausea and vomiting because of the irritation (medulla oblongata) Due to severe headache
- Papilo edema main cause kay increases ICP, increase icp will obstruct the venous return and retinal
vein (second cranial nerve compression) manghubag ang mata (roll out)
- Seizures main kay ka the mass Monitor the specific function of patients and anticipate the needs. For
the family member kay ancipatory grieving, acknowledge the reality

Rf:
- Exposure to radiation
- Family history
Complications
- Seizures
- Mental function
- Brain herniation can cause anything from speech issues

Diagnostic Procedure
- Ct scan
- MRI
- EEG
- angiogram,
- lumbar puncture
- biopsy
Management
 Chemo
 Radiation (Targeted type of radiation (external type)
 Biotherapy
 Surgery- craniotomy to decrease or manage the increase ICP
o Craniectomy
o Laser surgery
o Ultrasonic aspiration
o Ventriculostomy

Pre op teaching
What to expect after the surgery?
Check Limp movement and sensation (pre and post)
Mental status Preop teaching
Post op Assess Check for further bleeding, Periorbital edema
Overall Management
 No Valsalva maneuvers
 Elevated bed or head kay semi fowlers to high fowler
 Change the position slowly
 Check if there’s an alignment of head and neck
 Maintain airway
HEAD/NECK CANCER
Head and neck cancer" are the term used to describe a number of different malignant tumors that
develop in or around the throat, larynx, nose, sinuses, and mouth. Most head and neck cancers are squamous
cell carcinomas. This type of cancer begins in the flat squamous cells that make up the thin layer of tissue on the
surface of the structures in the head and neck.
 Very obvious (it could see it directly, the deformities)
(Benign type cancer, pwede sa kilid and could also be related to TB – Fat’s disease)
Center part could be hypothyroidism

Types (depends on where it is located):

- Laryngeal and hypopharyngeal cancer.
- Nasal cavity and paranasal sinus cancer
- Nasopharyngeal cancer
- Oral and oropharyngeal cancer
- Salivary gland cancer
Rf:
- Smoking
- Alcohol
- Prolonged sun exposure
- Exposure to radiation
Sx:
- Swelling or a sore that does not heal; this is the most common symptom
- Mass in the head or neck area, with or without pain
- Persistent sore throat
- Nasal obstruction
- Difficulty breathing
Diagnostic Findings
- Physical examination/blood and urine tests
- Endoscopy
- Biopsy
- Biomarker testing of the tumor
- X-ray
- Ultrasound
- Computed tomography (CT or CAT) scan
- Magnetic resonance imaging (MRI)
- Bone scan
- Positron emission tomography (PET) or PET-CT scan
Tx:
- Chemotherapy
- Immunotherapy
- Laser technology
- Neck dissection
- Surgery (tracheostomy)
RETINOBLASTOMA
It is a disease in which malignant (cancer) cells form in the tissues of the retina. Retinoblastoma may be
in one eye (unilateral) or in both eyes (bilateral). Genetics and it occurs most often in children younger than 3
years.
Classification:
- Intra ocular (inside the retina)
- Extraocular (it would spread outside the retina and the eye)
Sx:
- Cat Eye reflex (hall mark symptoms)
- White pupil (leukocoria)
- Crossed eyes (strabismus)
- Red or inflamed eyes
- Eye pain (because of IOP)

Diagnosis
- MRI
- Eye exam
- RB1 gene test
- CT scan
- Spinal tap
- Bone marrow biopsy

Tx:
- Chemotherapy
- Surgery (inoculation – removal of the entire eye)
NEPHROBLASTOMA
Wilms tumor, or nephroblastoma, is the type of childhood cancer that starts in the kidneys or the
malignant renal tumor. It is the only cancer that is incapsulated that is distinct to other cancer. It is unilateral
which means that they affect only one kidney, only 5-10% of children have bilateral disease.

Sx:
- Nontender mass in the abdominal area (midline near the liver) – hallmark signs
- Fever (rare)
- Hypertension
- anemia
- hematuria
Rf:
- having a family history of Wilms tumor
Dx:
- physical examination
- blood and urine test
- imaging tests
Tx:
- chemotherapy
- nephrectomy
Precaution
- Do not the palpate the mass it’s because if you palpate you would disseminate now the cancer cells
outside the specific areas
BREAST CANCER
Breast cancer is a disease in which cells in the breast grow out of control. Common in women but men
could also acquire breast cancer.
Etiology is idiopathic or always unknown, but age increase the risk of breast cancer. Factors: early
menarche, nulliparity, hormone replace therapy (risk if nay family history, using for more than 10 years),
benign breast disease (except fibroadenoma)
Mostly in obese because of the accumulation fats.

Sx:
- Lump in the upper outer quadrant part (tale of spence)
- Orange pale skin
- Dimpling
- Discharges on nipple unless a lactating mother
- Venous prominence is present
- Nipple retraction (inverted nipple)
- change in the size or the shape of the breast (grabe ka asymmetrical)
Dx: mammogram

the first node of metastasis: sentinel node

Tx:
- Surgery (mastectomy)
- Chemotherapy and radiation (brachial therapy) prevention drugs (comoxiphen – for breast tumors,
given with riloxiphen – prevent the development of endometrial cancer)
- Wall climbing – fingers and hands to prevent lymphoedema
Management:
- Prophylactic mastectomy
o Promote health and promote body image
- Lifestyle changes – decrease the intake of fats
- Health maintenance activities – mammography, Pet emission, MRI, breast self-examination

After mastectomy, elevate the hand (aha dapit ang mastectomy) to prevent swelling and lymph
edema, do exercise if its allowed.

- Health promotion activities

Post op
- Monitor hemovac (because of the drainage will be able to see infection
- Drain 500 ml, - hemorrhage leads to shock
- Post warning signs, monitor the bp, the iv and the drawing blood, initiate exercise to controlled
lymphedema
- Prevention of lymphedema – wall climbing, exercises, semi fowler position and raising the affected
arm, avoid scratches of the specific, prevent insect bites.
- Avoid strong detergent
- Avoid stretches
(Breast augmentation is included in the rehabilitation of the patient.)

LUNG CANCER
Also known as bronchogenic carcinoma. It is a type of cancer that begins in the lungs. It is the leading cause of
cancer deaths worldwide. Cigarettes are the major cause of cancer.

Types:
- Squamous cell carcinoma (good prognosis)
- Adenocarcinoma (good prognosis)
- Oat cell carcinoma
- Undifferentiated CA
Rf:
- Asbestos, Smoking, alcohol
- Emphysema
- Smoke from burn woods
- TB
- Exposure to Radiation
- Air pollution

Sx:
- Coughing (non-productive, hacking, thick purulent and blood thing sputum)
- Wheezing
- Fever
- Tightness in chest
- Chronic upper respiratory tract infections
- Hoarseness of voice
- Hypoxia (02 sat may drop until 75% and below)
- Dysphagia
- Odynophagia Painful chewing

Late symptoms or complications

- Pain when inhaling
- External pain
- Pleural effusion
- Acquired other diseases
- Bronchitis
- Pneumonia
- TB
Dx:
- Imaging tests (x-rays, CT scan)
- Sputum cytology
- Biopsy

Nursing management
- Maintain the patent airway
 - Oxygen and aerosol therapy (Give oxygenation)
- Deep breathing exercise
- Relieve pain
- Protect the patient from infection
- Provide chest tube management
- High protein and high vitamin C
Tx:
- Surgery
o Wedge resection – small section of the lungs that contains tumor
o Lobectomy – entire lobe of one lung
o Pneumonectomy – entire lung
- Radiation therapy
- Chemotherapy
LIVER CANCER
Begins in the cell of the liver. It can be classified in two ways. Primary liver cancer is one that starts in
the tissue of the liver. The most common type of primary liver cancer is called hepatocellular carcinoma.
Secondary liver cancer is cancer that started in some other place in the body and moved to the liver. This type is
also called metastatic liver cancer.
Risk factors:
- Chronic infection with HBV or HCV
- Cirrhosis
- Certain inherited liver disease
- Having diabetes.
- Being obese.
- Nonalcoholic fatty liver disease
- Exposure to aflatoxins
- Excessive alcohol assumption
- Being a man. Men are more likely to get liver cancer than women.
Sx:

- pain on the right side of the abdomen (abdominal swelling)

- Jaundice
- Unexplained weight loss, nausea, or loss of appetite.
- Dark-colored urine.
- White, chalky stools
Diagnosis:
- CT scan, ultrasound
- Angiography
- Blood test

Tx:
- Chemotherapy
- Radiation therapy
- Immunotherapy
- Partial/total hepatectomy
COLORECTAL CANCER
The second most commonly diagnosed cancer and is the most common gastrointestinal malignancy. Colorectal
cancer, which describes co-occurring colon cancer and rectal cancer. It starts in the colon and rectum.
Rf:
- Common in men 50 years old and above
- Increase intake of fats and decrease intake of fiber diet.
- Smoking
- History of polyps
- Personal history of colon cancer
- Family history
- Inflammatory conditions of the bowel
Sx:
- Change in bowel habits, Diarrhea/constipation
- Rectal bleeding
- Unexplained Weight loss
- Iron deficiency
- Palpable mass on the lower right quadrant of the abdomen
Diagnosis
- Abdominal examination
- Colonoscopy
- Endoscopy
- Digital rectal examination
- Fecal occult blood test
- Sigmoidoscopy
- Cryo Embryonic Antigen S
Prevention
- Early detection
Tx:
- Chemotherapy
- Radiation therapy
- Colectomy
- Polypectomy

COLON CANCER
Involvement of the small and the large intestine (colon).
Risk factor:
- ulcerative colitis
- Chron’s diseases
- 50 years old and above
- Diverticulitis
- Polyps
Common types
- Adenocarcinoma
Hallmarks
- Alternating diarrhea and constipation
- Lower abdominal cramps and abdominal distention
- Weakness
- Anorexia
Diagnosis
- Endoscopy
- Colonoscopy
- Digital rectal examination
- Fecal occult blood test
- Sigmoidoscopy
- Cryo Embryonic Antigen S
Prevention
- Early detection
Surgery
- Colonoscopy with polypectomy
- Colostomy
GASTRIC CANCER
Or stomach cancer. It is an abnormal growth of cells that begins in the stomach.
Types.
- Adenocarcinomas (most common type)
- Lymphomas Gastrointestinal stromal tumors, or GISTs
- Hereditary (familial) diffuse gastric cancer
- Carcinoid tumors
Rf:
- Smoking
- Elderly patient
- Increase intake of nitrite
- Gerd
- Obesity
- Family history
- Long-term gastritis

Sx:
- Early satiety (early symptoms, hallmark symptoms)
- Late symptoms
- Everything that goes in will goes out (vomiting)
- Guaiac stool examination (coffee brown stool because of upper GI bleeding)
- Hematemesis
- Melena
- Pain induced by eating
- Dyspepsia

Dx
- Imaging tests (CT scan and X-ray)
- Upper endoscopy
- Colonoscopy
- Digital rectal examination
- Fecal occult blood test
- Sigmoidoscopy
- Cryo Embryonic Antigen S

Management
- Endoscopic mucosal resection
- Gastrectomy
- Chemotherapy
- Radiation therapy

During surgery (NGT)

After removal of NGT- advised drink only clear fluids

DIGESTSIVE CANCER TYPE – dumping syndrome (anything that goes in, automatic gawas sa anus, no
digestion and absorption happened)
To prevent dumping syndrome kay left side or supine position and control the diet by providing low carb, low
fluid in between in meal to prevent further dumping syndrome, low carbohydrates.
COLOSTOMY
It is a surgery that makes a temporary or permanent opening called a stoma. A stoma is a path that goes from
the large intestine to the outside of your abdomen. This helps solid waste and gas exit the body without passing
through the rectum. The waste is collected in a pouch worn on the outside of your body.

Two types of the colostomy.

- The single barrel and (isa lang ka stoma)
- the double barrel. (Two stoma in the wall)
Classification
- temporary (mostly in double barrel colostomy)
o main purpose is to heal the colon
- permanent – damage of the digestive system. The only elimination of waste is only through
permanent colostomy. (Sigmoid colon)

Why is it performed?
A doctor may do a colostomy to bypass or remove part of the lower intestine. This may be because:
- The large intestine is blocked or damaged
- A part of the large intestine is surgically removed
- A ruptured colon causes an abdominal infection

People with certain types of cancer, such as colorectal cancer, may need a colostomy. Sometimes people being
treated for prostate, ovarian, uterine, or cervical cancer need a colostomy. People with Crohn’s disease,
ulcerative colitis, or pre-cancerous colon polyps may also need a colostomy.

Comp:
- Suture line leakage especially in single barrel
- Peritonitis
- Hemorrhage
- Stomal necrosis
- Stenosis – narrowing require another surgery

Client may resume their normal activities (4 to 6 weeks)

Mgmt.:
- Assess skin for sign of irritation or breakdown; apply skin barrier paste.
- The nurse should help the patient to accept the colostomy and teach patient the necessary care and
management.
- The colostomate is started on a light, low-residue diet.
- Patient education and post medication observation are therefore necessary.
- Protect the skin around the stoma (red color).
BLADDER CANCER
Cancer of the urinary bladder. Common urogenital cancer
Bladder tumors usually arise at the base of the bladder and involve the ureteral orifices and bladder neck.
 Common in male but women could acquire bladder CA
 Common in the elderly and it’s strongly associated with smoking.
Rf:
- Age greater than 40
- Chemicals
- Chronic bladder problems.
- Smoking
- Arsenic exposure
Sx:
- Visible, painless hematuria is the most common symptom.
- Dysuria
- Urinary retention
- UTI
- Any alteration in voiding or change in the urine is indicative.
- Pelvic or back pain may occur with metastasis.
- Fistula
- Gross hematuria
Diagnosis
o Ultrasound
o Biopsy
o Cystoscopy
Comp:
- Swelling of the ureters (hydronephrosis)
- Urethral stricture.
Tx:
- Chemotherapy
- Radiation therapy
- Transurethral resection (TUR)
- Cystectomy – replace conduit
PROSTATE CANCER
It is cancer that occurs in the prostate. It is second of the most common types of cancer in men. Some
types of prostate CA grow slowly and may need minimal or no treatment, other types are aggressive and can
spread quickly. Etiology is always unknown.

Rf:
- Lifestyle
- Sexually active in early years (Men)
- Patient exposed to cadmium
- 50 years old and above
- Multiple sexual partners

Sx:
- Enlargement of prostate
- Pain in defecation
- Pain or hesitancy in urine
- Urinary retention
- Hematuria
- Blood in semen
- Benign prostatic hypertrophy
- Elevated prostate specific antigen (n: 2.6 nanogram per mL)
- Pain that mediates from the hips and legs
- Cystitis
Diet: high fat – need for steroid metabolism
Dx:
- Transabdominal
- Transrectal
- PSA test
- Digital rectal examination
Complications:
- Metastasize
- Erectile dysfunction

Management:
Surgery – Radical prostatectomy
- Suprapubic prostatectomy
- Rectupubic prostatectomy
- Perineal prostatectomy
- Transurethral resection of the prostate (TURP) – closed method
- Transurethral electro vaporization- lesser bleeding (200 - 300 watt) catherization, pulverization
- Transurethral ultrasound guided laser induced prostatectomy
- Radiation therapy
- Hormonal strategy
- Chemotherapy
TESTICULAR CANCER
Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin
underneath the penis. The testicles produce male sex hormones and sperm for reproduction. Testicular cancer is
the most common cancer in men aged 15 to 35 years and the second most common cancer in men aged 35 to 39
years.
Types:
- Germinal tumors make up approximately 90% of all cancers of the testis and may be further classified
as
- Nongerminal tumors accounts for less than 10% of the testicular cancers.
- Secondary testicular tumors (lymphoma) metastasize from other organs.
Rf:
- Undescended testicles (cryptorchidism)
- Personal or Family history
- Age between 15 to 35
- Infertility
- HIV infection
Sx:
- Painless Mass or lump or enlargement in either testicle.
- Feeling of heaviness in the scrotum
- A dull ache in the abdomen or groin
- Backache,
- weight loss
Comp:
- Lymphatic Disorders
Prevention: testicle self-examination
Tx:
- Chemotherapy or radiation therapy.
- Surgery
- Orchiectomy and retroperitoneal lymph node dissection (RPLND)
- Surveillance
CERVICAL CANCER
Cervical cancer is a cancer that's found anywhere in the cervix. Nearly all cervical cancers are caused by
an infection from certain types of human papillomavirus (HPV).
Common Types:
- Squamous cell carcinoma – start in the neck of the cervix
Rf:
- Early age of coitus
- Sexually transmitted diseases
- Early childbearing
- Human papillomavirus (HPV)

Cardinal symptoms:
- Abnormal uterine bleeding
- No early symptoms
- Late stages
- Post coital bleeding
Comp:
- Bleeding
- Vaginal stenosis
- Sexual dysfunction following treatment
- Metastatic disease
Tx:
- Pap smear yearly
- Check for dysplasia
- Endometrial biopsy
- Vaccination (Gardasils) 18 years and above
- Cryo surgery
- Radical Hysterectomy
- TAHBSO - total abdominal hysterectomy and bilateral salpingo-oophorectomy
- Chemotherapy
- Radiation therapy (sealed implants)
UTERINE CANCER
Cancer of the uterine endometrium (fundus or corpus), OR sometimes called the ENDOMETRIAL
CANCER.
Endometrial cancer occurs when the cells of the endometrium start to grow too rapidly. The lining of the uterus
may thicken in certain places. These areas of thickness may form a mass of tissue called a tumor.
Types:
- Endometrial Carcinomas
- Uterine sarcomas
Rf:
- Early menarche
- Post-menopausal women
- Obesity
- Lynch syndrome
- Radiation exposure
Sx:
- Abnormal uterine bleeding (most common symptom)
- Vaginal discharge
- Pain with urination and/or sex
- Pelvic pains
Comp:
- Bladder instability following surgery
- vaginal stenosis/atrophy
- Sexual dysfunction following treatment
- Metastatic disease
- Toxicity
Tx:
- Radiation therapy
- Hormone therapy
- Hysterectomy
ENDOMETRIOSIS
Endometrium is the innermost layer of the uterus (womb), and endometriosis is where these endometrial
cells grow outside of the uterus (womb). In endometriosis, displaced endometrial tissue continues to act as it
normally would – it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue
has no way to exit to our body, it becomes trapped.
Types:
- Pelvic
- Ovarian
- Deeply infiltrating endometriosis
Rf:
- Nulliparity
- Menstrual flow obstruction
- Decreased body mass index (BMI)
- Age - peak incidence: 25-29 years old
- History of pelvic infection
- Uterine abnormalities
Sx:
- Dysmenorrhea
- Dysuria/ dyspareunia
- Pelvic pain
- Menorrhagia
Comp:
- Infertility
- Endometrioma - increased rupture / perforation / torsion risk
- Pneumothorax, hemothorax (thoracic endometriosis)
- ovarian cancer
dx:
- pelvic exam
- ultrasound
- laparoscopy
Tx:
- hormone therapy
o hormonal contraceptives
- NSAIDS
- Laser surgery
LEUKEMIA
Liquid type of cancer and no capacity to solidify.
Leukemia always known as cancer of the blood because of its origin itself.
Main problem of leukemia directly on the WBC. (General WBC ang iyang pinaka ig-on).
In leukemia the stem cells now or line of blood will now compose of either there’s no DNA that will lead to
immaturation and could be young cells development and it could be normal blood components.
Later on, on the stage of the leukemia, the immature cells will try to invade other space that will lead to the
decrease of the other blood components because it is a cancer cell. Immature cells – no function, proliferate, it
just there to crowd out and results to blasts crisis development and will diagnosis now as cancer cells and
general progression of leukemia (the cancer of the blood).
Cancer cells have no apoptosis, have no limit of its lifetime (always be there – magkadaghan) it would
accumulate the spaces that supposed to be for other hematopoietic stem cells leads to development of common
signs and symptoms – pancytopenia – Decrease in all three blood cell types but the origin is the WBC.
Signs and symptoms
Decrease WBC - risk for infection
Platelet problem – thrombocytopenia (bleeding and hemorrhage)
Drop RBC – anemia
(Infection ang makamatay sa patient)

Classification:
- By speed of disease development:
» Acute leukemia - very progressive type of immature cells (6 months below)
» Chronic leukemia - slightly delayed progression (gamay ang immature cells) (6 months above)
- By cell type:
» Myeloid leukemia
» Lymphocytic leukemia
- Major types:
» Acute myeloid leukemia – very progressive (Auer rods hallmark signs)
» Acute lymphocytic leukemia – very progressive, common in children
The rest kay common in adult but could also occur in children
» Chronic myeloid leukemia
» Chronic lymphocytic leukemia
Dx:
- Bone marrow biopsy (confirmatory test)
- CBC (possible indicator kay drop of WBC (normal 6000)

Management
For bleeding
- Avoid IM, tourniquet test
WBC
- Handwashing
 - Reverse isolation, aseptic techniques, avoid crowded areas
- No fresh fruit and fresh vegetables.
- Contraindicated for vaccination
Tx:
- Bone marrow transplant
- Chemotherapy
- Radiation therapy
- Targeted type therapy
- Leukapheresis (prevent TLS)

Complications
- Watch for tumor lysis syndrome (when u apply different modalities)
LYMPHOMA
- Cancer originating in the lymphoid or lymphatic system
Common types:
- Primary – originated in thymus and bone marrow
- Secondary – lymph nodes, spleen, tonsils, intestinal lymphoid tissue
Major subdivision of Lymphoma
- Non-Hodgkin’s - Lymphomas that is common usually is in the second type
o Sub-type of Non-Hodgkin’s disease: o BURKITT LYMPHOMA
o Causative agents: It is unknown, but it could always be related to autoimmune disease together
with the AIDS.

- Hodgkin’s disease - Causative Agent: It is always unknown since it is a cancer, but it’s related to
Epstein-Barr Virus.

Generally, they have same manifestation or signs and symptoms, but they also have difference.
Lympoma - higher rate of survival
- solidifying mass

HODGKIN’S DISEASE
It is a nodal type and the spread of the cancer is more on the lymphatic system. The characteristic of
Hodgkin’s disease is that it has Reed-Stenberg cells, the large cells. Hodgkin’s disease is more on
transmission or spread through lymphatic areas. From that one you would know that the lymph nodes that could
be found in your Hodgkin’s disease is unicentric.
 On the clinical manifestation its always start with a single node or it could be a localize types of
nodes. It’s localized type or unicentric, kasagaran makita ang imohang Hodgkin’s disease is on
the cervical area followed by the axillary area and the mediastinal area.
These are the common areas that could be found in Hodgkin’s disease and also it could be found
in other areas. If it is unicentric or localized and it has orderly manners or contiguity of
spreading, it’s starts with your cervical areas. It would follow now on the saphenous node
followed by the axillary nodes and followed by the mesenteric nodes. The Hodgkin’s disease is
from the waist up and its always start on the upper portion. These are the common lymph nodes
that is usually occur, but they could spread throughout the lymphatic system.
Researcher found out that Hodgkin’s disease involves lymphatic system, it’s more on the
lymphatic areas dili siya mutabok or mugawas padulong sa imong blood vessels that’s why
Hodgkin’s is a nodal type.

Signs and symptoms

 B symptoms it is composed on the
o Fever
o Unintentional Weight loss (10% BMI)
o Drenching night sweats
o Fever without chills B
Symptoms are mostly found in the Hodgkin’s disease, it’s 40%. Hodgkin’s disease has good prognosis it’s
because it could easily be detected at early stage and has higher survival rate for cancers it’s because it’s easy to
identify.
NON-HODGKIN’S DISEASE
It is extra nodal types, and it is more on blood vessels. It has the capacity to spread through the blood vessels
that’s why it could be found in other part of the body.
The characteristic of Non-Hodgkin’s disease is it has no Reed-Stenberg cells. It is a multiple type of nodes, it
involves not just only one node but rather other nodes and other part of the lymphoid system. It could be found
anywhere in the body means randomly nimo siya makita.

Non-Hodgkin’s disease usually found in the mesenteric types of nodes, and it is commonly found in the
stomach areas, it could be found most likely in the groins in the lower portion of the body and also it could
found common in the waldeyers lymph nodes.
If you have mesenteric or groin then it could spread directly either in the axillary or in your cervical lymph
nodes. Non-Hodgkin’s disease, a cancer that usually on the waist down, so sa imong pusod padulong ubos, most
likely it’s waist down it’s because the nodes that usually be affected will always start on the mesenteric areas
almost on the center or in the groins, which is in the lower portion of the body before it will go to cervical or
other areas.

Signs and symptoms

 B Symptoms is rarely found in the Non-Hodgkin’s Disease. It has bad prognosis because it has a
low rate of survival and most likely Non-Hodgkin’s disease could be detected on late stages.
Especially, kung grabe na ang sign and symptoms nga nigawas. It’s late stage since random man
siya.

Diagnostic Procedures
 Lymph node biopsy – the confirmatory test, they would remove one part of the lymph nodes and
they would excise it and they would try to see if what is in there.
 CT Scan
 PET scan
 CBC – If its elevated most likely there is an infection in the body and the one that is fighting the
infection is diminishing.

Treatments
 There are no surgeries
 Incision will only be for the main purpose of biopsy of determining what type of lymphoma’s is
there.
 Radiation and chemotherapy – general treatment
 Radiation therapy involves 3 locations:
o Mental field – it encompasses on the upper most field most likely in your submandibular
cervical intra-clavicular axillary and mediastinal.
o Mantle field – mediastinum part
o Para-aortic field – naa sa navel padulong sa imong para-aortic areas
o Pelvic or inverted Y – it could be the lowest field, pelvic or inguinal node and large area of
your bone marrow. So inverted Y siya.
 Bone marrow transplant
THERAPY (ALL 4 MODALITIES)
- CHEMO, RADIATION, BIOTHERAPY, SURGERY (GENERAL CONCEPT)
Surgery- primary treatment for cancer. Excise the tumor or remove the tumor itself.
Radiation therapy – Internal radiation and external radiation. It will kill the tumor through reducing the size. It
will shrink the tumor.
INTERNAL RADIATION – sealed or the unsealed
Sealed, the bracket therapy. Implant the radiation therapy directly to the body that has cancer itself.
(Common in cervical cancer) - radium therapy
o Bed rest
o Patient will no longer radioactive after removal
o Controlled by STD
 Shield (protect self), time (limit the time exposure, maximum of 30 min/shift, visitors 10-
15 mins., Distance (6 feet)
Unsealed – oral. (Radiation therapy drugs). Also infused with iv.
Bad thing: The patient will still be radioactive even for a few days. And its not good for the nurses and
significant others. (exposed)
The secretion is also radioactive.
EXTERNAL RADIATION – the targeted type. Put laser beam directly on the area, where the tumor or
malignant cells are located, then will provide the therapy to decrease the size of the tumor or to kill the
tumor.
You should not remove the marking.
(Hand in hand- radiation therapy, chemotherapy, and surgery.)

 Radiation (UV RAYS) and radiation therapy.

The main differentiation is the so-called therapy itself.
They are now in the controlled type of radiation in which they will only delivers specific types or rates of
radiation that would kill the progressive types of cells, not to destroy further and develop mutation.

Chemotherapy
 Chemotherapeutic drugs – they would have killed all fast-growing cells. they would kill all fast-
growing cells no matter what cells. whether good or bad cells
o Cell cycle specific
o Cell cycle non-specific
 Common side effects- the bone marrow suppression (RBC (anemia problem), WBC drop
(immunosuppression would occur), PLATELETS (thrombocytopenia) (prone to bleeding,
nosebleeds)
o GI- nausea and vomiting (NPO) (antiemetic medications before giving chemo), diarrhea,
clear liquid therapy, potassium and sodium monitoring
o Perineal and anal care
o Hematologic problems – thrombocytopenia and leukopenia
o Integumentary – body image disturbance (alopecia), stomatitis (all inside the mouth)
o Renal system- increase uric acid (give fluids and uric acid medication)
o Reproductive system – infertile
 (ALL THE SIDE EFFECTS KAY MAWALA AFTER 3 TO 6 MONTHS)

BIOTHERAPY or immunotherapy – its main purpose is to give medications or vitamins to boost their immune
system. The main purpose is to boost the immune system. So that immune system will be the one to kill directly
the growth of cancer cells inside the body.

STAGES IN THE TREATMENT OF CANCER CELLS

 INTRODUCTION (INDUCTION) – initial phase in which they will provide high dosage of
chemotherapeutic drugs or high frequency of radiation therapy. The main purpose is to really
remove the tumor as much as possible.
 CONSIDOLATION – the cells that remain during introduction they would kill it. (3 to 6
sessions) (some patient will not survive). The main purpose is to kill the remaining cancer cells
that has been left by the introduction treatment.
 MAINTENANCE – the main goal is to make the patient cancer free, to become on state of
remission. Continuous chemotherapeutic medications but on the lesser type dosage,
 OBSERVATION – the patient will no longer take any medication but rather they will always be
check for reoccurrence of cancer.
BONE MARROW TRANSPLANT/GVHD (ACUTE/CHRONIC)
BONE MARROW TRANSPLANT
It is a procedure that infuses healthy blood-forming stem cells into your body to replace your damaged
bone marrow.
Types:
- Allogeneic stem cell transplant - uses healthy blood stem cells from a donor to replace the damaged
bone marrow. (Match HLA)
- Autologous stem cell transplant - uses healthy blood stem cells from your own body to replace the
damaged bone marrow (own bone marrow)
Why it’s done?
- Replacing the bone marrow damaged by treatment
- Provide new stem cells which can help kill cancer cells directly
Comp:
- Graft-versus-host disease (allogeneic transplant only)
- Stem cell (graft) failure
- Organ damage
- Infections
- Infertility
- New cancers
- Death
Mgmt.:
- Limit salt intake
- Restrict alcohol
- Avoid grapefruit
- Provide emotional support to patient.

GVHD (ACUTE/CHRONIC)
Graft versus host disease (GvHD) is a condition that might occur after an allogeneic transplant. In
GVHD, the donated bone marrow/peripheral blood stem cells view the recipient’s body as foreign, and the
donated cells/bone marrow attack the body or the rejection of the body.
Types:
- Acute GVHD – early. Acute GVHD might occur once the donor’s cells have engrafted in the
transplant recipient. It might develop in your skin, liver/GI tract, and symptoms might appear within
weeks after the transplant.
- Chronic GVHD – delayed type. Chronic GVHD can appear at any time after allogenic transplant. It
might occur in skin, liver, mouth, lungs, GI tract, neuromuscular system, or genitourinary tract.
- (Difference - progression of the time frame)

Rf:
- Patient having a donor mismatch of two to three HLA
- Recipients who have received peripheral blood stem cells
- A female donor who has been pregnant in the past (within 1 year)
- Advanced age of either the donor or recipient (age gap)
- Older transplant recipient
Sx:
- Fever
- Skin rash
- Jaundice
- Nausea and vomiting
- Diarrhea
- Hepatitis

GVHD STAGES

FOUR TYPES OF DELAYED REACTIONS

- Anaphylactic or immediate reactions – common in drugs reactions, allergic reaction, or insect bite
- Cytolytic or cytotoxic – IgG, IgM, blood transfusion,
- Immune complex hypersensitivity – the good poster syndrome (own antibodies)
- Cell mediated late phase or delayed cell hypersensitivity that falls to GVHD – T-cells reaction

Tx:
- Increasing the immunosuppression in the form of oral or IV Steroids medications
- Long-term immunosuppressive drugs