TUMOR

Benign Malignant
 Harmless  Harmful
 Slow growth  Rapid growth
 W/o metastasis  W/ metastasis
 Encapsulated  Unencapsulated
 Non-invasive  Invasive

Pain
1. Compression- nerve
2. Obstruction- organ
3. Destruction- bones

**Bone Ca- most painful cancer

Management:
 Relaxation with guided imagery
 Massage- the area around the tumor, not the tumor itself
 Warm/cold compress- both for pain and inflammation
-can be use foe vasodilation and vasoconstiction

Mild pain Severe pain

Tylenol Codeine
NSAIDs Morphine

TESTICULAR CANCER

Parts:
>shaft
>head
>testicles
>sperm cells
>testosterone
>germinal epithelium

Risk factors:
>age- 15-40 y/o
>undescended testicles- “cryptorchidism”

Manifestation:
>irregularities in TSE- done monthly basis; done after shower (cooling mechanism)
>painless testicular mass
> “heavy pull”
> Late: Pain in bone and back

Management:
>pain management
>chemotherapy
>radiation
>Surgery: Orchiectomy (uni/bilateral)
**avoid lifting heavy objects after the procedure
BIOPSY: CONFIRMATORY TEST FOR ALL CANCERS
 Chemo Radiation
 Antineoplastics  Highly energy waves
 Spreads throughout the body  Localized
>internal- common >internal- brachytherapy
>external- topical administration >external- common
 Hazardous  Hazardous
 3-6 mos- ideal admin.  As needed

***low dose rad- precipitates risk factors

***high dose rad- for treatment

Chemotherapy
-kills cancer cells
-lacks specificity
-more likely to kill cancer cells
- attracted to rapidly dividing cells
SE:
N- Nausea and vomiting
A- Alopecia
O- Neutropenia (<500)
D- Diarrhea
A- Anemia
Nursing considerations
1. Caring
- n/v- antiemetics (before chemo) as ordered
-diarrhea- IVFs
2. Handing
-never a pregnant nurse
-wear standard precautions (mask, goggles, gown, gloves)
- dispose in a hazardous container
3. Education
-avoid large crowds (neutropenia)
-avoid fiber in the diet (diarrhea)
4. Monitoring
-platelets
Normal- 150-450k
Less 50k- tendencies
Less 20k- spontaneous
5. Observation
-alopecia- temporary (several months)
-phlebitis- change access of IV site

Radiation
-reduces size of tumor

SE:
E- Fatigue
A- Alopecia
S-skin changes (darker pigmented)
T-taste alterations- affects taste buds

1. Internal
-brachytherapy
-radiotherapy

- provide private room

2. - caution on door- di papasok basta basta External
- wear lead shield- Lead can repel radiation
-wear a dosimeter film/badge- tells the amount of radiation inside the room
-observe limit exposure to the patient- 30 mins
- 1:1 ratio
- no pregnant nurse- teratogenic effect
- no visitors 16 y/o and below
 - teletherapy
-not a source
- appropriate for a pregnant t woman to visit

-avoid exposure to sunlight

- avoid restrictive clothing
- wash area with lukewarm water
- rinse with hand, not a washcloth
-dry- patting, not a rubbing motion

PROSTATE CANCER (semen)

Risk factors:
> age- more than 50 y/o
>STDs
> heavy metal exposure- occupational hazard (factories)

Manifestation:
>irregularities- DRE (digital rectal exam)
>painless post-coital bleeding
> (+) PSA- prostate- highly suggestive (PSA + DRE)
>Late: Pain in lumbar and leg

Management
>Pain management
>chemotherapy and/ or radiation
>surgery: TURP (Transurethral resection of the prostate)

TURP
>hematuria is normal
>CBI- continuous bladder irrigation
>WOF hyponatremia, cerebral edema
>WOF increased ICP- pressure build up
CUSHING’S TRIAD:
-hypertension
-bradycardia
-bradypnea

CERVICAL CANCER

Risk factors:
> HPV
>multiple sex partners
>early intercourse- <16 y/o
>smoking

Manifestations:
>painless vaginal bleeding
>painless vaginal discharge
>fistula- leakage of feces and urine
>pain in LLP (leg, lumbar, pelvic)

Management:
>chemotherapy
>radiation
>Surgery: Hysterectomy

Increased ICP
 7-11 mmHg- at rest
 8-18 mmHg- exerting effort/ at motion
 20 mmHg- clinically increased ICP
 Monroe- Kelly Hypothesis- skull is enclosed space

Causes:
>tumor (space occupying lesion)
>trauma
>inflammation
>infection

Manifestation:
>pain
>headache
>confusion
>v/s: hyper-brady-brady (cushing’s triad)
Hyper2- brady2- + hyperthermia
>abnormal respiration
>blurring of vision
>vomiting-( area postrema)
>proectile vomiting (severe)
> unequal pupil size (severe)
> (+) babinski reflex
>decorticate
>decerebrate
>seizures

Abnormal respiratory patterns

>cheyne-strokes respiration- normal, rhythmic follwed by periods of apnea
>neurologic hyperventilation- increased rate and depth
>apneustic respiration- pauses in every inspiration and exhalation
>ataxic respiration- totally abnormal rate, rhythm and depth
>cluster respiration- shallow and clumped together

Management:
>positioning- avoid flat on bed
- avoid elevate head with pillows
- avoid twisting
- Avoid upright
- Semi-fowler’s applicable position because of slight compression of the hip
>avoid coughing, sneezing, valsalva maneuver, vomiting, straining, shivering, exercises (only passive
ROM exercise)
>decreased OFI- 1200cc/day

Medication:
>analgeics (alfentanil)
>anti-pyretics
>anti-emetics
>stool softeners
>antihypertensives
>diuretics (osmotic)

Surgery-
>Shunting (infection)
>VP shunt- less invasive
CI: peritonitis
>AV shunt
>craniotomy
…..Tentorium- imaginary line that separates the lower part of cerebellum and upper part of cerebrum
Supratentorial- head elevation, not flat on bed
Infratentorial- flat on bed not elevation of the head
>craniectomy- removal of the cup of the head
>rich kid- bone bank
> sakto- abdomen
> no budget- balik agad (needs corticosteroids aggressively)

SEIZURE/CONVULSIONS/EPILEPSY
 Abnormal electrical conduction in the brain
 Diagnostics:
>EEG- measures electrical conduction in the brain
- no shave hair
-no shampoo- In 1980s it is mandatory
- avoid stimulants- coffee, tea, tobacco
- remain still

Manifestations:
>generalized
1. Grand mal- tonic (spams)-clonic (jerky movement)
2. Petit mal- normal type, (blank staring, drooling of saliva)- 10-20 secs
3. Febrile- accompanied by fever
**manage fever to manage seizures

>partial
1. Jacksonian- jerking from 1 distal extremity to adjacent areas
2. Psychomotor- associated with head trauma

Management:
>priority #1: Airway- suction secretions after seizure
-turn head to side (to localized the saliva in the buccal mucosa)
-tongue blades, padded tongue blades, tongue depressors- oropharyngeal inflammation
>priority 2: safety (onset) - side rails up
(aura)- put the patient on the floor, cradle the head

Medications:
>phenobarbital
>phenytoin (dilantin)
SE:
>gingival hyperplasia
 -frequent oral care
-soft brittle brush

MYASTHENIA GRAVIS

 Decreased acetylcholine- initiates muscle contraction

 Autoimmune
 Descending body weakness

Diagnostics:
>tensilon (Edrophonium)
-drug- short term relief (10-15 mins)

Manifestation:
>weakness and fatigue
>ptosis or weakness of levator pelpabrae- pathognomonic sign
>difficulty breathing, swallowing , chewing and speaking

Management:
1. Airway
>assess chewing
>assess swallowing
***if difficulty occurs, withhold feeding

2. Breathing
>assess breathing
>mechanical ventilator as ordered
3. Promote rest- cluster activities
4. Medications
>neostigmine (Prostigmin)
>pyridostigmine (Mestinon)
>right time, right dose to prevent crisis

PARKINSON’S DISEASE

**substantia nigra
 Decreased dopamine- for fine motors

Causes:
>Kuru virus
>MTPT- methyl-phenyltetra hydroprodin
>alumuminum theory-
>boxer’s Pugilistica
Manifestations:
>tremor’s- initial
>intentional- kung kailan gumalaw
>resting-most common; pill rolling (pathognomonic sign)
>bradykinesia
>shuffling gait
>mask-like face
>Monotonous speech
>handwriting that becomes progressively smaller

Management:
1. Safety
>teach patient regarding finger food
>provide safety along with independence
>lift feet while walking
>use low heeled shoes
>provide high seated chairs
2. Instruct client to use shoes without laces
3. Instruct client to use shirts without buttons

Medications:
>dopaminergics: Levodopa
Carbidopa
Pag pinagsama (cocktail)- SINEMET
>anti-parkinsonian’s: Artane, Cogentin, Akineton
 SPINAL CORD INJURY
*irreversible

2 types:
>Complete transection of the cord
>Incomplete transection of the cord

>Bowel and bladder retention

>tetra/quadri (paralysis below neck- cervical), paraplegia (paralysis below waist- thoracic)

ANTERIOR CORD SYNDROME

>sensory- intact
>motor- loss

POSTERIOR CORD SYNDROME

>sensory- loss
>motor- intact

CENTRAL CORD SYNDROME

>temperature
>pain
>light touch

BROWN SEQUARD
>affected- ipsilateral (loss of both motor and sensory
>unaffected- contralateral (TPL)

Complications:
>spinal shock
-early: 1-2 hrs
- hypotension
-(-) babinski, (+) plantar refelx
- administer IVFs as ordered
-Atropine SO4- to increase blood pressure
>Autonomic dysreflexia/ hyperreflexia
-late onset, several hours
-hypertension
-(+) babinski, (-) plantar
- high fiber diet
-enema as ordered
- intermittent catheterization (2-4 hrs)

STROKE
-decreased TP to the brain
-brain attack (aka CVA)

Causes:
>thrombus
>hypertension
>DM- viscosity of the blood
>transient ischemic attack

Manifestations:
>hypertension
>slow pulses
>cheyne strokes
>aphasia
-CN XII (hypoglossal)
- CN V (trigeminal)- difficulty chewing
-CN VII (facial)- facial asymmetry
-CN IX (Glossopharyngeal)
>L/R hemiphelgia (paralysis)/ hemiparesis (weakness)

Management:
1. Airway
>Upright- feeding- thick liquids to avoid aspiration
>Suction secretions (<10 secs)
>Positioning
-unaffected- 2 hrs
-affected- 20 mins
>Aphasia- speak slowly

Medication:
>aspirin- hypertension
>heparin-existing thrombus
>dissolve- thrombolytics

Physiology:
>cornea- transparent, allows light to enter the eye
>iris- gives color to the eyes; helps pupil constriction
>pupil- constricts and dilates based on illumination
-constriction illumination- constriction
-decreased illumination- dilation
>lens- refraction/accommodation
>vitreous humor- maintaining normal shape of the eyes, jelly-like structure
>aqueous humor- liquid, normal pressure (10-21 mmHg)
>rods- peripheral vision, decreased illumination
>sclera- topmost/ toughest, white
>choroid- second layer, brown, highly vascular
>retina- converts image to nerve impulse

CATARACT
*painless
-opacity of the lens

Types:
>traumatic- injury
>senile- aging
>congenital- born with it
Diagnostics:
>opthalmoscopy- confirmatory; red reflex, absent red reflex
(+)

Manifestations:
Initial:
>blurring of vision
>decreased color perception

Pathognomonic Sign:
>hazy vision
>cloudy vision- pathognomonic

>presence of white in the eye (late)

>painless
>pain and redness- senile

Management:
>no management necessary unless insisted by the patient: ruin ADL, affects work

Surgery:
>intracapsular cataract extraction (ICCE)
>exracapsular cataract extraction (ECCE)
>PHACO emulsification- laser beam to dissolve cataract

Preop- admin Midriatics- to dilate

Post op- Admin miotics- to constrict- (prophylaxis for glaucoma)

>avoid increasing IOP
-coughing, sneezing, straining, vomiting, avoid prone position, lie on non- operative side, heavy
lifting (<10 lbs)

GLAUCOMA
-increased IOP- normal is 10-21 mmHg
Types:
>acute- 50-70 mmHg
>chronic- 30-50 mmHg
>Closed angle- obstruction of outflow
>open angle- overproduction of aqueous humor

Diagnostics: Tonometry

Manifestations:
Initial:
>increased IOP- fullness/discomfort
>decrease accommodation

Pathognomonic Sign:
>loss of peripheral vision
>tunnel vision

Late:
>pain
>Halos around lights
Management:
>avoid increasing IOP
-coughing, sneezing, straining, vomiting, avoid prone position, lie on non- operative side, heavy
lifting (<10 lbs)

Medications:
>miotics
>b-blockers- decrease production of A.H.
**CI: cycloplegics, atropine
**inform client that this is administer forever (entire life of the patient)

Surgery:
>partial iridectomy- outflow of AH
>trabeculectomy- widening of canal of schlemm
>trabeculectomy- removal of obstruction

RETINAL DETACHMENT

-partial loss of vision

-complete loss of vision- 100% detachment

Pathognomonic sign: curtain veil-like

Black spots (floaters)- bleeding

Management:
>avoid rapid eye movement
-no reading
-no watching tv
-glasses during the day
-eye patches during night

Surgery
>cryosurgery- freezing
>laser therapy- inflammation
>scleral buckling

FRACTURES
Causes:
>trauma- falls, accidents, sports
>osteoporosis
>overuse

Manifestation:
>pain
>swelling
>bruising and discoloration
>inability to use injured part
>numbness

Types:
>open- high risk for infection- osteomyelitis
>closed
>complete
>incomplete
>comminuted- more time to heal
>greenstick- common in children
>impacted- 1 bone- drive- another
>compressed- 2 adjacent
>depressed
>transverse
>oblique
>spiral
>pathological- secondary to diseases process

Other common sites:

Management:
“always think that a fracture has occurred”
>assess environment
>assess the ABC
>

Reduction:reduce angle of fracture

2 types:
A. Open- with surgery, invasive, plates and screws
B. Closed- w/o surgery, non-invasive, manual manipulation

Fixation
A. Internal- plates and screws inside the body, high risk for infection, easy mobility
B. External- plates and screws outside the body, lesser risk for infection, prolonged hospitalization

Tractions

>decrease muscle spasm

>immobilization
>important- counter traction
>never remove, adjust
>assess line- no knots
> weights freely hanging

Casting
>wet- 48-72 hrs
>dry- 20-30 mins
_facilitate drying-- blower (coolest)

Petal-rough edges
No objects inside
Elevate- 24-48 hrs
WOF: infection, fever, altered- pain, hot spots, foul smelling (pus)