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312 Care of Clients with Problem in Oxygenation, Fluid & Electrolytes
Finals Reviewer
f PATHOGNOMONIC /
DISEASE CAUSATIVE AGENT INCUBATION PERIOD PERIOD OF COMMUNICABILITY
HALLMARK
Communicable Diseases Affecting the Gastrointestinal System
few hours to 5 days (usually 1 During the time the stool test positive for the organism, and may continue up
Cholera Vibrio cholerae / coma(-) Rice watery stool
to 3 days) to a few days after recovery
Patient is capable of transmitting the microorganism during the acute infection
Shigella Dysenteriae / Flexneri / 7 hours to 7 days with average
Bacillary Dysentery until the fecalysis results confirms (-) negative for the organism. However,
boydii / Connei(-) of 3 to 5 days
patient remains a carrier for a year or two
usually 1 to 4 weeks but may
Amoebiasis Entamoeba histolytica Duration of the illness
be shorter or longer
Varies as long as the patient is excreting microorganism, the individual is
Typhoid Fever Salmonella typhosa / typhi(-) 5 to 40 days Rose Spots
capable of infecting others
2 to 6 weeks after in contact Patient is capable of transmitting the organism a week before and a week after
Hepatitis A Hepatitis A virus (HAV)
with the virus the appearance of the symptoms
PATHOGNOMONIC /
DISEASE CAUSATIVE AGENT DIAGNOSTIC MODE OF TRANSMISSION
HALLMARK
Communicable Diseases (Bacterial Infection) Affecting the Nervous System
Fever, severe headache,
Viral meningitis, Bacterial, Fungal,
Meningitis CSF Analysis During labor, Droplet, Respiratory Droplet, Direct Invasion and stiffness of the neck
Chemical
and spine
Direct contact / indirect contact
Poliomyelitis Polio virus
Airborne respiratory droplet
Leprosy Mycobacterium Leprae
Puncture wound, rugged traumatic wounds, burn injuries, umbilical stump,
Tetanus Clostridium tetani(+) Slit-skin smear Risus sardonicus
cleaning of ears with sharp objects, circumcision, dental extraction, piercing
Ingestion of shellfish
Red Tide Dinoflagellates
Communicable Diseases (Vector Borne) Affecting the Nervous System (CNS)
Anthrax Bacillus anthracis Contact with infected animals / inhalation of spores
Ascariasis Ascaris lumbricoides Kato-Katz Technique Direct / indirect contact

Pediculosis humanus capiti / corporis
Pediculosis Direct contact(?)
Phthirus pubis
Fluorescent rabies antibody Inoculation through skin break, bite of an animal, direct contact with saliva
Rabies Rhabdovirus Negri bodies
(FRA) through human mucosa or fresh skin wound
Schistosoma japonicum / mansoni /
Schistosomiasis Circumoval precipitin test Ingestion / through skin pores / vector
haematobium
PATHOGNOMONIC /
DISEASE CAUSATIVE AGENT DIAGNOSTIC VECTOR DRUG
HALLMARK
Communicable Disease Transmitted by Vectors
Platelet count (+) <100,000
Dengue Fever Flaviviruses / Arborvirus Aedes aegypti / aedes albopictus Symptomatic Treatment Herman’s rash
mm3
Wuchureria bancrofti / brugia malayi /
Filariasis Blood feeding insects (mosquitos) Diethylcarbamazine
brugia timori / loa loa
Plasmodium falciparum / vivax /
Malaria Malarial smear Female Anopheles mosquito Artemether Lumefantrine
malaria / ovale
Viral / bacterial / protozoal / toxins,
Encephalitis Serologic test Symptomatic Treatment
chemical, trauma
Leptospirosis Leptospira interrogans Rats , Dogs Penicillin, Doxycycline
Paragonimiasis Paragonimus westermani / siamense Antemelania asperata / Crabs Praziquantel

PATHOGNOMONIC /
DISEASE CAUSATIVE AGENT DIAGNOSTIC MOT DRUG
HALLMARK
Sexually Transmitted Diseases
Candidiasis Candida albicans
Chlamydia trachomatis / psittaci /
Chlamydia
pneumoniae
HSV1 (Type 1 virus) / Genital Herpes
Herpes Simplex Tissue Culture Sexual Contact Acyclovir, Famciclovir, Valacyclovir
(Type 2 virus)
Gonorrhea Neisseria Gonorrhea(-) Direct contact Ceftriaxone (uncomplicated)
Syphilis Treponema pallidum Direct / placental / indirect contact Penicillin G benzathine

Sexual intercourse / perinatal /
AIDS Human immunodeficiency virus Western blot analysis Antiretroviral drugs
infected blood
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- Excessive thirst - Kussmaul’s

- Restlessness respiration rapid
- Washerwoman’s respiration with
hand wrinkled intervals of apnea
COMMUNICABLE DISEASE AFFECTING THE GI TRACT - Circulatory
- collapse / shock
CHOLERA (Aka El tor) - If treatment is delayed or inadequate, acute renal failure
Aka El tor particular strain of causative agent of Cholera and hypokalemia will become secondary problems
An acute serious illness characterized by sudden onset of acute and - Cause of hypokalemia is due to massive loss of potassium
profuse colorless diarrhea, vomiting, severe dehydration, muscular in stools
cramps, cyanosis, and in severe cases collapse. Massive loss of fluid - Patient may manifest Abdominal distention that could be
and electrolytes leading to hypovolemic shock, metabolic acidosis. attributed to paralytic ileus
Could kill within hours if left untreated Diagnostic Evaluation
Causative Vibrio Cholerae / Vibrio Coma - Rectal swab appropriate diagnostic
Agent - Comma-shaped - Darkfield or phase microscopy
- Survives longer in refrigerated food o Uses a type of microscope that illuminates the
- Produces enterotoxin choleragen specimen causing the microorganism to appear
o promotes secretion of fluid and bright against dark background
electrolytes into the lumen of the - Stool exam
small intestine which is the one Clinical Manifestations
responsible for the massive watery Rice watery Pathognomonic
diarrhea characteristic of cholera stool - Inoffensive, slightly fishy odor
infection - Initially the stools are brown and contains
- Gram-negative (-) cholera is the fecal material that will become pale grey
predominant organism to translucent until it becomes rice water-
- Appears to vibrate when moving hence like
the name vibrio cholerae / coma Profuse With no tenesmus – sensation of defecation
- Can grow well between 22 to 40 °C diarrhea - Causes fluid loss 1 – 30 liters / day – causing
Mode of Fecal-oral Transmission dehydration and electrolyte loss
Transmissio - 5 Fs as the main sources - Acute
n o Feces, Finger, Flies, Food, Fomites Other Clinical Manifestations
Incubation period - Poor tissue turgor
- few hours to 5 days (usually 1 to 3 days) - Sunken eyes into the orbit
Period of communicability - Cold skin
- during the time the stool test positive for - Wrinkled toes and fingers washerwoman’s hand
the organism, and may continue up to a appearance
few days after recovery - Oliguria
Pathogenesis o If the treatment will be given late, irreversible
problems may occur, oliguria leading to anuria
- Diarrhea - death
o When the patient is in deep shock, diarrhea may
stop and death may occur in a short as 4 hours after
onset, but usually occurs on the first or the second
day, this will happen if not properly treated
Medical Management
GOAL OF TREATMENT: Rehydration (priority treatment)
- Fluid loss / diarrhea is attributed to the enterotoxin After rehydration is completed, the volume of fluid and electrolyte
- As the enterotoxin binds with the lining of the intestine must be replaced by careful and accurate I/O measurement, serum
o once the causative agent is ingested it will start to electrolyte monitoring
multiply in the intestinal mucosa and will start to Rapid Infusion of Alkaline solution
produce the enterotoxin (choleragen) intravenous - Contains Na, Cl, HCO3 ions
- Choleragen will enter the mucosal cells of the intestine infusion
and will stimulate and cause the increase of cyclic ORESOL Oral rehydration through oral route
adenosine monophosphate (cAMP)
Coconut water - Rich in potassium
o The reason for the increase of Chloride, associated
Pedia Continue breastfeeding
with water and HCO3 loss
- Unless oral intake is contraindicated
o The toxins will act upon the intact epithelium
Antibiotics Pharmacologic treatment includes prescription of
vasculature of the bowels resulting to the
outpouring of the intestinal fluids antibiotics;
- Fluid loss of 5 – 10% will result in dehydration - Tetracycline
o 500 mg (adults) every 6 hours
Water Loss Potassium Loss HCO3 Loss
o 125 mg/kg body weight for children
Dehydration Hypokalemia Metabolic Acidosis
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every 6 hours for 72 hours - Causing inflammation and ulceration and severe diarrhea
- Furazolidone containing mucus, blood and pus
o 100 mg for adults Diagnostic Evaluation
o 125 mg /kg for children every 6 - Fecalysis
hours for 72 hours o microscopic examination to determine the
- Chloramphenicol presence of blood and mucus
o 500 mg for adults o determine the presence of bacteria
o 18 mg/kg for children every 6 hours - Rectal swab or culture
for 72 hours o Isolation of the organism
- Cotrimoxazole - Blood culture
o 8 mg/kg for 72 hours o Determine the presence of bacteria
Nursing Management - Methylene blue staining
- Medical asepsis in handling food item o Will show sheets of leukocytes suggesting bacterial
o Instruct patient and S/O so protect food from fecal infection
contamination Clinical Manifestations
o Proper storage and preparation of food - Fever especially in Children
- Enteric isolation - Tenesmus, nausea, vomiting, and headache
o Instruct patient and S/O the proper disposal of - Colicky or cramping abdominal pain associated with
excrete anorexia and body weakness
- Monitoring VS - Diarrhea blood-mucoid stool that are watery at first
- Monitoring I/O - Rapid dehydration and weight loss
o Ensure accurate recording to determine the level of - Complication: rectal prolapse particularly in
hydration undernourished children, cough and pneumonia
respiratory complications
BACILLARY DYSENTERY (Aka Shigellosis / Bloody Flux) - If the infectious organism becomes virulent the intestinal
An acute bacterial infection of the intestine characterized by ulceration may lead to perforation and eventually death
diarrhea, fever, tenesmus, and in severe cases bloody and mucoid Medical Management
stool. IV solution - To prevent dehydration
Mode of Fecal-oral route with normal - At home through oral rehydration
Transmission - Indirect transmission flies saline (with therapy
- Ingestion of contaminated food or water electrolytes)
or milk Low residue - Bland diet; bananas, rice, crackers is
- By oro-anal contact recommended
- Fruits and vegetables that grows close to - Avoid milk products
the ground when washed with polluted Anti- Contraindicated
water or soil fertilized with human waste diarrheal - They delay fecal excretion that can lead
Causative - Shigella Dysenteriae Group A drugs to prolonged fever
Agent o Most infectious Antibiotics - Ciprofloxacin
o Lives exclusively in the GI tract of - Ofloxacin
humans - Levofloxacin or azithromycin
- Shigella Flexneri Group B - Ideally no antimicrobial therapy should
o Most common in the Philippines be administered until microbiological
- Shigella boydii Group C microscopy and culture studies have
- Shigella Connei Group D established the specific infection
- Non motile gram (-) organism involved
- Shigella genus ORESOL HMSS (home made salt sugar)
- Can develop resistance to antibiotics - Good for 24 hours
- Rarely invades the bloodstream - 1–8–1
Incubation period o 1 teaspoon salt
- 7 hours to 7 days with average of 3 to 5 o 8 teaspoon sugar
days o 1 liter water
Period of communicability - Can be included in health teaching in
- patient is capable of transmitting the patients who requires oral rehydration
microorganism during the acute infection therapy
until the fecalysis results confirms (-) - As prescribed by the primary care
negative for the organism provider
- However patient remains a carrier for a
year or two
Pathogenesis
- Starts with individual ingests the microorganism
- After its incubation period, the organism will invade the
mucosal lining of the intestines
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- Can be invasive or non-invasive (invasive is shown in the

pathogenesis)
AMOEBIASIS (aka Amoebic Dysentery) - Cyst can survive even in acidic environment
A protozoal infection of human beings that initially involves the Noninvasive pathogenesis
colon, but may spread to soft tissue, most commonly the liver and - Not all mature cysts becomes trophozoites
lungs (extraintestinal amoebiasis), by contiguity or hematogenous - They will just live in the large intestine of the host through
bloodstream or lymphatic dissemination the colon with feces and excreted ready to infect a
- More related to poor sanitation and socioeconomic status susceptible host again
- Can be acute or chronic - Cyst can remain viable and infective in a moist and cool
Causative Etiologic Agent: Entamoeba histolytica environment for at least 12 days and will survive in water
Agent - Prevalent in warm climate and areas with for 30 days
poor sanitation They can be killed by;
Two developmental stage - putrefaction natural decomposition that takes place in the
Trophozoites / Invades the tissue or may be body
vegetative found in parasitized tissues and - desiccation removal of moisture or drying out an
form liquid colonic contents organism
- They multiple and - temperatures below 5 0C and above 40 0C can kill the
encysts the colon pathogenic organism
Cyst Passed out with formed or semi- Diagnostic Evaluation
formed stool and resistant to - Stool exam
environmental conditions o Microscopic identification of cyst and trophozoites
remain viable and infective for in the stool
several days o Common method for diagnosing entamoeba
- Considered the histolytica
infective stage in the o Presence of cyst and pus; color may be white or
lifecycle of the agent yellow with plenty of amoeba
Mode of Fecal-oral route - Blood exam leukocytosis
Transmissio - Source of infection is the human excrete o Determine changes
n - Humans most commonly acquire the o Elevation of WBC may be noted due to
disease by ingesting viable cysts from inflammation process brought about by infection
contaminated water, food, hands, - Proctoscopy and sigmoidoscopy
unhygienic preparation of food can also o Aspirates or biopsy samples
transmit the parasite Clinical Manifestations
- Vectors such as flies, cockroaches, and Acute Slight attack of diarrhea with watery and foul-
rodents Amoebic smelling stool often containing blood-streaked
- Less common MOT is through sexual Dysentery mucus
contact - Nausea, flatulence, abdominal distention,
Incubation period tenderness in the right iliac region over
- usually 1 to 4 weeks but may be shorter or the colon
longer - Alternating period of constipation and
Period of communicability often accompanied by tenesmus
- duration of the illness Chronic Attack of dysentery which lasts for several days
Pathogenesis Amoebic succeeded by constipation
Dysentery - Enlargement of the liver Hepatomegaly
o if the trophozoites reaches the liver
- Poor skin turgor over the abdomen
- There may be tenesmus, anorexia, weight
loss, and weakness
Extra Can occur if the parasite spread to other organs
Intestinal - Most commonly in the liver causing liver
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Forms amoebic diseases - Gram (-) negative motile organism

- RUQ pain that radiates to the shoulder - Can survive for weeks in water or dried
- Tenderness of the liver with pleural sewage
effusion - Pathogenic only to human
- Jaundice rare MOT Fecal-oral transmission
- Intermittent fever - 5 Fs
o Most patient develop the o Feces – the primary sources, finger,
symptoms within 5 months flies, food, fomites
- Loss of weight and anorexia Incubation period
- Abscess may break in the lungs - 5 to 40 days
o Anchovy-sauce sputum Period of communicability
o If the trophozoites reaches the - Varies as long as the patient is excreting
lungs microorganism, the individual is capable of
o If the abscess ruptures it may infecting others
require drainage Pathogenesis
- Diarrhea
- Initially the salmonella typhosa / typhi will be ingested
o Experienced by 30% of cases
- In normal circumstances, person that are healthy, the
- Clients who are older may experience
bacteria will be killed by the gastric juices of the stomach,
weight loss and hepatomegaly
but to people who are susceptible / doesn’t produce
Medical Management enough amounts of gastric juice;
- Metronidazole Flagyl - Bacteria will propagate and travel down to the small
o Antibiotic and antiprotozoal medication intestine
o Commonly prescribed if amoebiasis is confirmed - The infection will affect the Payer’s patches of the small
within a parasitological examination intestine
o 800 mg 3x / day for 5 days - When this happens, this will provoke a massive
o If the patient is admitted normally / usually inflammatory response of the cells lining the small
metronidazole is administered through IV intestine which will cause ulceration and create a hole in
- Tetracycline the small intestine
- Ampicillin - Leading to bowel contents leaking into the abdomen
- Streptomycin - Then the bacteria will be absorbed and travel with the
- Replacement of fluids and electrolytes bloodstream
Nursing Management - And reach the different organs in the bodies
Isolation and enteric (isolation) precaution o Pancreas
Health - Drinking water o Brain
teaching o Boil water for drinking o Re-enter the GI tract through the bile into the large
o Or use purified water intestine ready to be excreted through the feces
- Cover left over food and still an active bacteria ready for another cycle
- Handwashing after defecation Diagnostic Evaluation
o Or before eating Typhidot Confirmatory
- Avoid eating ground vegetables - Uses blood or stool
o Such as lettuce, carrots and the like - Detects the presence of antibodies IgM, and
Proper - Instruct to avoid mixing urine with feces IgG against the antigen typhi
collection of - Select large portions containing blood - Suggested that the blood should be collected
stool and mucus and possible prior to administration of antimicrobials
specimen - Label the specimen properly whenever possible
- Send the specimen immediately ELISA Enzyme-Linked Immunosorbent Assay
- A stool that is not fresh is nearly useless - Determines the presence of antibodies
for examination Rectal - Performed to determine the presence of
- The bacteria in the old stool can multiply, Swab salmonella typhi
the level of bacteria in the specimen Widal Agglutination test for O and H Ag
container will be more than the bacteria in Test - O Ag – somatic body
the digestive system so the result will be - H Ag – flagellar
inaccurate - V Ag – carbohydrate envelop
o another form of antigen found on the
TYPHOID FEVER surface of the bacteria
A bacterial infection transmitted by contaminated water, milk, The salmonella typhi has 2 antigen
shellfish, and other foods O Ag Somatic body or the polysaccharide form
An infection of the GIT affecting lymphoid tissues of the small H Ag Flagellar – has the protein form
intestines Payer’s patches Clinical Manifestations
Causative Salmonella typhosa / typhi Onset - Headache, chilly sensation, body aches
Agent Characteristics State - N/V, diarrhea
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4th and 5th days symptoms are worst appearance of the symptoms
- Dry cough Although is highly contagious Hepatitis A is self-
- Dull frontal headache limiting
- Body malaise Pathogenesis
- Fever reaches until 40 oC - Starts when a person ingests food / water contaminated
7 to 9 days Rose Spots
th th
with the feces of an infected person
- Rose spots will appear on the abdominal wall - The Hepa A virus can reach the liver and can have an
– PATHOGNOMONIC SIGN, interlobular filtration, causing;
- bacterial emboli to the dermis – represents o Necrosis, Hyperplasia of the Kupffer cells of the
the clumping of the bacteria in response to liver
the body’s immune system - Leading to failure of the bile to reach the intestine
on the 2nd week, symptoms are aggravated o Dark urine
- rose spots become more prominent o Pale stool
Typhoid Subsultus tendinum o Itchiness
State - Twitching of the tendon that sets in Diagnostic Evaluation
(especially at the wrist) - HAV and HBV complement fixation frate
Coma vigil o To determine the presence of antigen – specific
- Stares blankly antibodies
Carphologia - Serum glutamic oxaloacetic transaminase (SGOT)
- Mutters / mumbles deliriously - Serum glutamic pyruvic transaminase (SGPT)
- Picks aimlessly at bedclothes in a continuous - Serum alanine transaminase (ALT)
fashion - Bile examination – in the stool and urine
Delirium - IgM level – presence of antibodies
- In severe cases, delirium sets in often ending - Liver function tests
in Death, if not managed properly Clinical Manifestations
- Pain on the right side of the abdomen beneath the lower
ribs abdominal pain
- Pale stools
Medical Management - Dark urine
- Chloramphenicol Drug of Choice - Arthralgia joint pain
- Ampicillin - Jaundice
- Co-trimoxazole - Intense itching due to the bile salts accumulating in the
- Ciprofloxacin(2nd gen) / ceftriaxone (3rd gen) skin
o 2nd generation antibiotic - Most of the symptoms may be relatively mild and
o If patient do not respond to chloramphenicol, 3 rd disappear in the few weeks
and 4th gen drugs are administered (Cefepime) - Hepa A does not lead to chronic Hepatitis or cirrhosis,
Nursing Management however can result to severe illness that can last for
- Isolation by medical aseptic technique several months depending on the patient’s resistance
o Prevent further spread of infection - Fatigue, low grade fever, anorexia, N/V
- Maintenance of fluid and electrolytes balance Medical Management
- Monitor VS - No specific treatment bed rest is essential
- Prevent injury from falls in times of confusion and delirium - High carbohydrate, low fat, low CHON
- Keep the patient warm, if with chills - Vitamin B complex
- Mouth care - Isoprinosine – may enhance the cell mediated immunity
- Cooling measures during febrile stage - Belladonna – plant (leaf and root to make medicine)
- WOF signs of intestinal bleeding - Antiemetics – to control dyspepsia and malaise
- Terminal and concurrent disinfection is recommended - Hepatitis A vaccine – prevent infection, typically given in 2
shots (1st – 1 year old, booster shot – 6 months later)
HEPATITIS A (Aka Infectious Hepatitis) Nursing Management
Vaccine-preventable liver infection, caused by HAV (Hepatitis A - Enteric isolation
Virus) , the most benign, and harmless type of hepatitis - Bed rest during acute or symptomatic phase
MOT Fecal-oral route - Observe for melena
- Ingestion of contaminated water / good - Skin and mouth care
- Close contact with an infected person - Limit activity when fatigued
- Having oro-anal sex - Plan periods of rest and activity
- Sharing of needles between IV route users - Gradual resumption of activities
Incubation period - Mild exercise during recovery
- 2 to 6 weeks after in contact with the virus
Period of communicability
- Patient is capable of transmitting the
organism a week before and a week after the
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- Insects
Poliovirus, mumps virus, varicella
etc.
Bacterial Causes
Meningitis HiB Hemophilus Primary cause of
influenzae Type meningitis in
B children
Neisseria Affects the
meningitis adolescents
Streptococcus In older adults
pneumoniae
Streptococcus Major cause in
agalactiae neonates
- Life threatening in people in
close contact
- Bacterial meningitis is a
medical emergency, early
diagnosis and treatment
should be carried out
Fungal Rare form and occurs in people who
Meningitis have a weakened immune system
Chemical Antibiotics, NSAIDS
Meningitis - Inflammatory reaction to
certain medication and
procedures
- Lumbar puncture procedure
in some cases may cause
aseptic meningitis
MOT - During labor and birth
o group B streptococcus and E.coli
- Droplet
o strep pneumonia, Hemophilus
influenza, Neisseria meningitis
- Respiratory droplet
COMMUNICABLE DISEASE AFFECTING THE NERVOUS SYSTEM o Nasopharyngeal mucosa
- Direct invasion
BACTERIAL INFECTION AFFECTING THE CENTRAL NERVOUS SYSTEM o through otitis media
MENINGITIS (Aka Cerebrospinal Fever) Clinical Manifestation

Inflammation or infection of the meninges that surrounds the brain Fever, severe headache, and stiffness of the neck and spine (Hallmark
and the spinal cord symptoms)
Causes - Ingestion of poison / drugs Exaggerated and symmetrical DTR
- Reaction to a vaccine or a pathogen Signs of - Nuchal rigidity
Etiologic Viral - Directly invades the meninges meningea o Neck stiffness
Agents Meningitis - Immune reaction l irritation - Opisthotonos
(Aseptic o does not directly affect o Patient has an abnormal posture due
Meningitis) the brain but as a result to impaired brain functioning
of a complication - (+) Brudzinski’s sign
o chicken pox etc. o Done by placing the patient flat on
- Less severe bed, PHC attempts to flex the neck,
- Most people recover quickly watch the knees in reaction to the
without treatment maneuver
Types o Positive – pain and flexion of the hips
Entero Generally, affect the GI and knees
viruses tract o Suggests meningeal inflammation
- Enteric – - (+) Kernig sign
intestine o Patient is lying supine, PHC flexes the
- Can also reach patient leg at both hips and knees,
the CNS straightens the knee
Arbo Arthropods born o Pain and increased resistance to
viruses viruses extending the knee
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o Suggests subarachnoid hemorrhage - Patient on the bed, plucking on

or meningeal irritation the bedclothes
Other signs noted during Assessment - Projectile vomiting
- Sinus arrythmia - Seizure
- Irritability - Change in motor function and VS
- Photophobia Monitor fluid - Maintain adequate fluid intake to
- Diplopia balance prevent dehydration
- Other visual problems - WOF fluid overload to due to
Signs of - Bulging fontanels in infants danger of cerebral edema
 ICP - Projectile vomiting, nausea - Measure central venous pressure
o Stomach contents are propelled if there is CVP
several feet away from the patient - Measurement of I/O
- Severe frontal headache Position the patient - To prevent joint stiffness and
- Blurring of vision neckpain
- Altered sensorium - Turn the patient regularly to
Delirium, deep stupor, coma – worsening symptoms avoid pressure sores and
Diagnostic Evaluation respiratory complications such as
- Patient’s symptoms pneumonia
- Physical examination - Assists in ROM
- CSF analysis WOF deterioration of - Signal for impending crisis
o Diagnostic patient’s condition
o Therapeutic Maintain adequate nutrition
 To reduce the ICP Isolation - Is necessary if nasal culture is
 To introduce serum and other medications positive
 To inject anesthetic agent spinal anesthesia
o Secured through Lumbar Puncture / Spinal tap
 Inserting a needle into the spinal canal which
collects the spinal fluid
- CSF gram staining
o To identify the bacterial cause
- Smear and blood culture
- Smear from petechiae
- CT scan / MRI of the head
o To determine areas of inflammation in the brain
- If lumbar puncture is contraindicated (increased ICP)
other diagnostic evaluation may be performed
Medical Management
Antibiotic Therapy IV antibiotic for 2 weeks
Oral antibiotics afterwards
- Ampicillin
- Cephalosporin – ceftriaxone
- Aminoglycosides – gentamycin,
amikacin
Digitalis - To control arrythmias
Mannitol - Diuretics – to decrease the
cerebral edema
Anticonvulsants - To reduce restlessness and
convulsions
Paracetamol - To relieve headache and fever
HiB Vaccine - To prevent meningitis
- For babies
Neisseria meningitis / If the pathogen is, Pneumonia vaccine can
strep pneumoniae be given
Nursing Management
Assess neurologic Observe LOC
Condition Wof signs of  ICP
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Agent - Legio debilitans

- Human are the only known host for the
virus
Three Strains
- Brunhilde
o caused the most severe epidemics
o strain of a poliovirus of a chimpanzee
named Brunhilde
o first to be identified
- Lansing
o Identified from the brain and spinal
cord of a young man who had
suffered to polio in Lansing, Michigan,
US
- Leon
o Obtained in 1937 from the brain and
spinal cord of an 11 year old boy
named Leon, who was a victim during
the Los Angeles epidemic
MOT - Direct contact oropharyngeal secretions
o Fecal oral route
- Indirect contact
o Contaminated water, food, utensils
o Flies on contaminated objects
Period of communicability
- Patient is capable of transmitting
poliomyelitis during the 1 st 3 days to 3
months of illness
- Disease of most contagious during the 1 st 2-3
days of acute illness
Pathogenesis
POLIOMYELITIS (Aka Infantile Paralysis / Hein-Medin Disease)

An acute infectious disease characterized by changes in the CNS
which may result in pathologic reflexes, muscle spasms, and paresis
or paralysis
Acute viral disease the usually affects the children and the young - Virus enters the body through the GI tract
adults, characterized by inflammation of the motor neurons of the - Multiplies in the oropharynx
brain stem and spinal cord, resulting in paralysis and muscular - Virus can survive an acidic environment
atrophy, and sometimes permanent disability - Once it reached the target organ throat and intestine
- Infantile – Infection is chiefly in young children - Virus will invade the destroy the epithelial cells of the
- Polio – gray matter of the nervous system throat and the small intestine
- Myelo – myelin sheath of the nerve fibers - Once the cells are destroyed, the virus spreads to the
- Heine – reported the earliest poliomyelitis regional lymph nodes and the blood causing viremia
- Medin – first to carefully study an epidemic of - Travel through the circulation, may affect several organs
poliomyelitis and drew attention to the epidemic of the body
character of the disease Two things that may happen when the virus is in the blood
Causative Polio virus 1. Virus may not cause a problem, thereby no clinical disease
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2. Virus can cause the diseases by penetrating the blood patient is elevated
vessels walls in supine position
a. and gain entry to the CNS, - Difficulty in speaking and
b. high affinity with the motor nerve cells anterior swallowing
ventral horn cells of the spinal cord – innervation - Weakening of the cranial
of the motor neurons nerves
c. one attached, virus will multiply in the cytoplasm o Glossopharyngeal
and destroy the cells causing nerve cells deaths o Vagus nerve
leading to paralysis - Paralysis of the face,
Diagnostic Evaluation pharyngeal, ocular
- Isolation of virus throat swab muscles
o Should be done early in the course of the disease - Regurgitation of food risk
- Stool culture for aspiration pneumonia
o Done throughout the course of the disease - Less tendon reflex
- CSF culture - (+) Kernig and Brudzinski
o Done throughout the course of the disease neck sign
(Clinical Manifestations based on) - Urinary retention,
Types of Poliomyelitis constipation, abdominal
- Does not invade the CNS distention
o quiet difficult to diagnose - Paralysis that is innervated
o because non-specific symptoms are by the spinal cord motor
present neurons are affected
- Patient usually recovers within 72 hours Higher SPP spinal paralytic
viremia that is halted in the pathophysiology Spinal poliomyelitis
Non-specific symptoms Paralytic - Occurs when the virus
Abortive (Spinal localizes the upper portion
- Headache and sore throat
- Slight or moderate fever Cord) of the spinal cord
- Occasional vomiting - Muscles of respiration are
- Low lumbar pain affected resulting to DOB
- Has no evidence of paralysis Lower SPP
- Non paralytic type - Virus settles in the lower
- 4 – 8% of all polio cases portion of the spinal cord
- Affects the muscles of the
- All signs of abortive type present
lower limbs
- Usually lasts for about a week
- Asymmetry and scattered
Identifying symptoms
placid paralysis on one or
- Hamstring muscle spasm
both lower extremities
- Changes in deep and superficial reflexes
- Pain in the neck, back, arm, legs, and Brainstem and spinal cord
abdomen Bulbospina - Neurons will be affected
- Inability to place the head between the l including the muscles they
knees innervate
- (+) Pandy’s Test
o Elevation of the protein globulin in
Non-
the CSF, associated with the virus
paralytic
invading the CNS
- When the virus reaches the CNS, and still
active, this will provide some damages and
show as some identifying symptoms
- A transient paresis may occur, but still no
evidence of paralysis
o Due to number of nerves involved are
not sufficient enough to cause
paralysis or may result in weakness Medical Management
- Almost 50% get well recover without - Analgesics and moist heat application pains and leg spasms
significant paralysis last for about a week o Morphine is contraindicated danger due to
Paralytic All signs of abortive and non-paralytic type respiratory depression
- Bed rest
According to the location where the virus has
o necessary
settled
- Paralytic type PT, braces, corrective shoes
Bulbar - CN IX, CN X
o May require rehabilitation
Polio - (+) Hoyne’s sign – head lag
o Orthopedic surgery to correct the deformation
(Medullary o Head of the patient
Area) - No cure but can be prevented through immunization
lags, when the
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- Therapists and anti-spasmodic drugs can improve mobility - Ancient history tells, that the disease is a curse from God,
but cannot reverse permanent polio paralysis patients who were treated with terrifying negative stigma
Nursing Management and were considered outcasts from society
- Carry out enteric isolation - To minimize the prejudice of leprosy, instead of calling it
- Observation for signs of paralysis leprosy, it can be called as Hansen’s Disease or Hansenosis
o Other neurologic damage - Named after Dr. Gerhard Hansen, who discovered the
o Perform neurologic assessment at least once a day, causative agent
do not demand vigorous muscular activity Causative Mycobacterium Leprae
- WOF signs of fecal impaction Agent - Attacks cutaneous tissue and peripheral
o Due to dehydration and immobility nerves
o Give sufficient fluids to ensure adequate I/O - Produces skin lesions, anesthesia
- Repositioning hypoesthesia / numbness, infection and
o Prevent occurrence of pressure sores deformities
o Keep the bed dry - Acid fast bacilli
- Hand hygiene Mode of - Airborne Respiratory droplet
o Prevent spread transmission - Inoculation through skin break and
o After every contact with the patient mucus membranes prolonged contact
- Proper disposal of excreta - it is not passed on from a mother to
- Emotional support unborn baby during pregnancy
o Both the patient and family - does not spread through sexual contact
- Oral and skin care Pathogenesis
o Prevent pressure sores - entry of mycobacterium leprae
Prevention - attack on peripheral nereves
- Inactivated - damage to skin’s fine nerves
- IM or ID - anesthesia, anhidrosis, and dryness of skin
- No VAPP vaccine associated paralytic - starts when the causative agent, enters a susceptible host
Salk poliomyelitis - attack the peripheral nerves ulnar, radial, posterior
Vaccin - Developed in 1955, by Dr. Jonas Salk popliteal, anterior tibial, facial nerves
e (IPV) - Contains all 3 types - when the bacilli damages fine nerves causes anesthesia,
- Does not give strong immunity as a live vaccine anhidrosis, dryness of skin
- May need several doses of booster to get - if the organism attacks a large nerve of the trunk, motor
ongoing immunity damage may occur resulting in weakness or pain,
- Predominant vaccine peripheral anesthesia, muscle paralysis, and atrophy may
- Attenuated, trivalent vaccine follow
Sabine - Risk of VAPP but due to immunodeficiency anhidrosis – impaired sweating in one or several areas of the body
Vaccin and / or susceptibility to illness Category According to Form
e - Developed in 1950s by Dr. Albert Sabine Tuberculoid Paucibacillary (WHO Classification)
(OPV) - Live infectious agent is taken, altered or (neural / - Characterized by regions of skin that
weaken, less virulent indeterminate have lost sensation and are surrounded
- Can give long lasting immune response ) by border of nodules skin tends to be
CHN ALERT dry or hypoesthetic
Polio Vaccine (OPV) - Non-infectious type
- Most sensitive to heat - Person are considered to be with high
- Kept in freezer -15 to -25 oC level of immunity
- No breast feeding for 15 – 30 minutes to promote efficient - Nerve involvement is asymmetric
absorption of the drug - Has a low number of bacteria in the skin
lesions
- No evidence of more and advanced
disease in a skin smear
Lepromatous Multibacillary (WHO Classification)
(progressive / - Skin cells are infected, and disfiguring
borderline) nodules form all over the body
- Most Infectious type
- Persons affected are considered to be
LEPROSY (Aka Hansen’s Disease / Hansenosis) with minimal cellular immune response
Chronic systemic infection characterized by progressive cutaneous - Extensive skin involvement
lesions deformities and disabilities - Skin lesions are described as infiltrated
- Associated with stigma or shame, when deformities are nodules plaques
present - Damages to the respiratory tract, eyes,
- Leprosy is not highly contagious, has low infectivity testis, nerves
- Primarily affects the peripheral nerves, skin, upper - Nerve involvement tends to be
respiratory track, eyes, and nasal mucosa symmetric in distribution
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- There are large number of bacteria that - Thickened or enlarged peripheral nerve
Signs for
can be found on the lesions with loss of sensation
diagnosis
Clinical Manifestations - Weakness of the muscles supply by the
for
Neurologic Involvement nerve affected
Hansen’s
- Claw hand atrophy of the hand muscles and foot drop - Presence of acid-fast bacilli in a slit skin-
Disease
o result from uretic pain and rapid peripheral nerve smear
damage Slit-skin smear
- Paralysis and peripheral anesthesia - Confirmatory test
o due to peripheral nerve involvement, loss of - In lepromatous patients, nodules should be biopsied and
sensation, muscle weakness, and paralysis may be nasal mucosa scraped
observed - In tuberculoid patients, the edge of the lesions should be
- Corneal insensitivity biopsied
o Ocular manifestations Blood tests
o Cornea is not being sensitive when assessed with - Increased RBC and ESR
cotton tip application - Decreased Serum Ca, Albumin, and cholesterol
- Eyelid paralysis lagophthalmos Lepromin Test
- Conjunctivitis, photophobia, blindness may also occur - Immunologic test that indicates the resistance of the
Skin host to mycobacterium leprae,
- Leonine facies - Done by and ID injection (on the forearm), of an
- Loss of eyebrows and eyelashes Madarosis inactivated form of mycobacterium leprae
- Can invade tissues in every organ of the body - Useful in determining the type of leprosy
Lesions are multiple, symmetrical, and erythematous, (+) - indicates a cell mediated immunity
sometimes appearing as macules, or papules with positive o such as activation of phagocytes
smooth surfaces. Lesions have poorly defined borders, findings o and the release of cytokines in
has raised and indurated centers nakaangat yung gitna response to the bacillus,
at matigas. Common areas of lesions, which are - this can be observed in the tuberculoid
enlarged includes the face, earlobes, nose, eyebrows, form of leprosy
Lepromatous
and forehead - there is resistance or presence of immunity

- Facial skin becomes thickened and corrugated to fight with the antigen
giving the patient as leonine facies appearance, (-) - can be observed with lepromatous form of
resembling a lion negativ leprosy,
- Nasal collapse may occur secondary to septal e - suggests a lack of resistance to the disease,
perforation findings - can find skin lesions large amount of
- Multiple, symmetrical, erythematous, smooth Hansen’s bacillus,
surfaces - also an indication of worsened prognosis
- Poorly defined borders, raised and indurated - no resistance or immunity noted to fight
centers with the antigen
- Face, earlobes, nose, eyebrows, and forehead
- Nasal collapse secondary to septal perforation
- May be purely neural or simultaneously affect
skin
- Raised, large, erythematous plaques with
clearly defined borders
Initial lesions are often a sharply, demarcated
hypopigmented macules that is ovoid or circular. Macule
are elevated with clear ring or dry scaly center.
Tuberculoid
Common lesion sites include the buttocks, face, and

limbs. The perineum, scalp, and axilla observed with
lesions after assessment.
- If not treated properly, lesions tends to
destroy the normal skin organs such as sweat
glands and hair follicles
- Sharply, demarcated, hypopigmented macules
(ovoid / circular)
- Buttocks, face, and limbs, perineum, scalp,
axilla
- Sweat glands and hair follicles
Diagnostic Evaluation
Identification of S/Sx at utmost importance
Medical Management
WHO: - Definite Loss of sensation in a Pale
Sulfone therapy
Cardinal reddish skin-patch
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- are bacteriostatic
o the drug is capable of inhibiting the growth of TETANUS (Aka Lock Jaw)
bacteria Infectious bacterial disease which produces a potent exotoxin with
- used principally in the treatment of leprosy prominent systemic neuromuscular effects such as generalized
- effectivity may be due to primarily to its anti-inflammatory spasmodic contractions of the skeletal muscles as manifested by
rather than bacterial effect acute onset of hypertonia
- all sulfones are derivatives of dapsone - Increased tightness of muscle tone
o (most widely used brand name) - Reduced capacity of the muscle to stretch due to damage
Rehabilitation, recreational, and occupational therapy of the motor pathways
- Psychosocial issues may be referred to facilities that - Infection leads to painful muscle contraction particularly
performs Rehabilitation, recreational, and occupational the jaw and neck muscles
therapy Causative Clostridium tetani
Multiple drug therapy (MDT) Agent - Anaerobic gram (+) positive motile bacteria
- Early diagnosis and complete treatment with MDT are o Moves and survive w/o O2
they key strategies for reducing the disease burden o Do not require O2 to reproduce
- Based on studies has high cure rate, fewer SE, and - Drumstick appearance
lower relapse rate o When observed under microscope
Rifampicin, clofazimine, and dapsone o Round terminal spore with slender
- Rifampicin 600 mg body
Multibacillary - Clofazimine 50 mg - Nonencapsulated and form spores
(lepromatous) - Dapsone 100 mg - Resistant to heat, desiccation and
After taking 12 monthly doses of MDT disinfectants
considered cured + Laboratory results - Seen commonly in soil with animal feces,
Rifampicin and dapsone saliva, dust
Paucibacillary
After taking 6 monthly doses of MDT - Grow particularly in wounds and dead
(tuberculoid)
considered cured tissues, while multiplying releases two types
- of exotoxins potent and intensely toxic to
Nursing Management humans and other animals
- If admitted in hospital Release of two types of toxins:
o Isolation and medical asepsis Tetanospasmi Responsible for muscle spasm
- Moral support and encouragement n (neurotoxin)
- Full, wholesome, and nutritious diet Tetanolysin Responsible for RBC destruction
- Attention to personal hygiene - By increasing the cell
o Promote self-care even in the presence of the membrane permeability
disease through cell lysis
- Terminal disinfection MOT - Normally through Puncture wound
Prevention o Contaminated by dust, soil, animal
- Avoidance of prolonged skin-to-skin contact excreta containing the clostridium
- BCG vaccination tetani
o Offers protection - Rugged traumatic wounds, and burn injuries
- Good personal hygiene - Umbilical stump
- Adequate nutrition o Can be infected, in babies delivered
o To maintain better health status with faulty cord dressing
- Health education o Born to mothers without tetanus
o Educating in the s/sx of the disease Toxoid immunization
o Educate the patient and SO about the s/sx and Injection of tetanus Toxoid in a pregnant client
mode of transmission - Mother should receive at least 2 -3 tetanus
o Increasing awareness among family members and Toxoid, and 2 – 3 after delivery
community to reduce discrimination to patients - 1st dose – TT1 – administered as early as
with leprosy possible during pregnancy
- TT2 – should be given after 3 weeks
- TT3 – given after 6 months
- TT4 & TT5 – given after 1 year
- Cleaning of ears with sharp objects
o Unrecognized wounds
- Circumcision
- Dental extraction
- Piercing
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- systemic or generalized
o hypertonicity and hyperactive DTR
o trismus – neck and facial muscle
Pathogenesis rigidity
- entry of clostridium tetani in wounds or break in skin o risus sardonicus – PATHOGNOMONIC
o with low oxygen supply Sign – grinning expression
- local multiplication and release of exotoxins o opisthotonos – abnormal posture due
o local infection and tissue necrosis to brain functioning
o tetanospasmin o tachycardia, profuse sweating, low
- toxin absorbed by bloodstream and lymphatics and into grade fever, painful involuntary muscle
peripheral motor nervers contactions
- tetanospasmin (high affinity to CNS tissue and spinal o abdominal rigidity
motor ganglia) o in severe cases, laryngospasm,
- inhibition of muscle relaxation followed by accumulation of
o interfere with the signals to the brain travelling to secretions in the lower airway may
the spinal cord including the nerves that innervates result to respiratory depression due to
the muscles involvement of respiratory muscles
- HYPEREXCITABILITY / SPASMS o intermittent tonic convulsions lasting
Clinical Manifestations to several minutes
- headache Severe tetanus  cyanosis
- jaw stiffness - opisthotonos  death
- neck stiffness - flexion of the arms  fracture of the vertebrae during
- difficult swallowing - extension of the legs severe spasms
- rigidity of abdominal - periods of apnea Medical Management
muscle - rigidity of the Specific - ATS, TAT, TIG tetanus immunoglobulin
- tonic spasms abdominal wall o within 72 hours after puncture wound /
- sweating Late in the disease injury
- fever - autonomic o TIG specially if the patient does not
- spasms of facial dysfunction have previous immunization
muscles - hypertension and - Tetanus toxoid
o fixed smile tachycardia o 0.5 CC through IM should be given in
o elevated - alternating standard or regular schedule
eyebrows hypotension and o Included in DPT given during childhood
- restlessness bradycardia - Pen G Na (Infection)
- chills - resulting to cardiac o Or metronidazole is administered
- exaggerated reflexes arrest o Common antimicrobial drug used to
- intact sensorium decrease the number of clostridium
- sore throat tetani and prevent multiplying
- irritability - Muscle relaxant
- profuse sweating o Used to treat lockjaw and muscle
Neonate - feeding and sucking difficulties first stiffness
manifestations - Thorough cleaning and washing of the
- cry excessively voiceless crying wound / cuts to prevent infection
- an attempt to suck results in spasm and Non- - Oxygen inhalation
cyanosis specific - NGT feeding
- tonic or rigid muscular contractions spasm or - Tracheostomy for emergency airway
convulsion even with slightest stimuli - Fluid and electrolytes
- jaw becomes stiff, baby cannot suck or - If necessary patient should be administered
swallow to the ICU because of reflex spasms
- progressing to placidity, exhaustion, maybe - Maintain a dark and quite environment
even death - Unnecessary procedures and manipulations
Neonatal tetanus are avoided
- born to mothers who have not been Nursing Management
vaccinated during or before pregnancy - Maintain adequate airway in patient with severe muscle
- occurs through infection through an spasms and relaxation
unhealed umbilical stump - Cardiac monitoring to determine appropriate blood flow
o when stump is cut with non-sterile - Maintenance of IV line fluid and electrolyte imbalances
instrument may occur, and used for medication administration
o or faulty cord care - Wound care to prevent infection and administration of
Older - localized tetanus prescribed antibiotics
children o spasms - Avoid stimulation to prevent reflex spasms, warn visitors
and adult o increased muscle tone near the wound not to upset or overstimulate the patient, instruct the
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visitors not to talk loudly, noises, unnecessary movements

- Prevent contractures and pressure sores turning the
patient regularly and assisting in performing range of
motion exercises
- Monitor vital signs and muscle tone
- Comfort measures to the patient
RED TIDE (Aka Paralytic Shellfish Poisoning PSP)

Red tide is caused by population explosion of toxic, naturally
occurring microscopic phytoplanktons dinoflagellates
A syndrome of characteristic symptoms predominantly neurologic
which occur within minutes or several hours after ingestion of
poisonous shellfish, severity depends on the amount of toxins
consumed
A phenomenon caused by numerous algae Algal blooms, the one
who discolor the coastal water, reason for the name Red tide,
depletes the oxygen in the water and releases toxins, that may
cause illness in humans and other animals
Causative Single-celled organism (Dinoflagellates)
Agent - Carries the toxin saxitoxin
- When ingested may cause severe respiratory
depression leading to respiratory arrest
Explosions are caused by environmental conditions
that promotes growth of microorganism:
- Heavy rainfall preceded by prolonged
summer
- Low salinity and calm seas
- Warm coastal surface temperature
Seafoods that are unsafe to eat
- Quahogs - Scallops
- Soft-shell clams - Moon snails
- Oysters
- Lobsters, crabs, and fish do not accumulate
the toxins and are safe to eat
Pathogenesis
- What happens during a red tide, saxitoxin – potent toxin
- After ingestion will immediately affect the nervous system
- Saxitoxin is a sodium channel blocker which exerts its
neurotoxic effects by binding to target receptors
associated with sodium channels
- The binding will block the entry of sodium to the cells
thereby inhibiting the action-potential of the nervous
system
- Paralytic shellfish is fatal in extreme cases, particularly in
immunocompromised individuals and children which are
more susceptible
Clinical Manifestations
- Symptoms occurs within 30 minutes after ingestion
- Tingling of the lips and tongue
o Slight perioral tingling
o That spread to the face, neck, fingertips and toes
o Initial sign
- Drunken condition
o Loss of coordination
o Headache, dizziness and nausea may be mistaken
as if the person is drunk
- Symptoms aggravated by alcohol consumption
- Floating sensation and weakness
o Tingling progresses to numbness, muscle
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weakness, difficulty swallowing, or difficulty in

speaking
- Total muscle paralysis with respiratory paralysis
o Victims who survive the first 12 hours have a greater
chance of survival
o In severe cases, muscular paralysis and breathing
difficulty may occur in 5 – 12 hours due to paralysis
of the diaphragm
 which may require ventilatory support
Medical Management
- No definite medication indicated or antidote
- Induce vomiting COMMUNICABLE DISEASE (VECTOR BORNE) AFFECTING THE NERVOUS
o so that the shellfish in the stomach can be SYSTEM (CNS)
evacuated
o upon evacuation, gastric lavage and gavage may be ANTHRAX
indicated to remove some toxins still present in the Recognized as the most likely weaponized biologic agent available
stomach (Category A) with high mortality rate and highly debilitating agent
- Charcoal hemoperfusion (CHP) Causative Bacillus Anthracis
o Activated charcoal may be indicated to promote Agent - Lives in the soil in a spore state
gastrointestinal decontamination - Sporulates when exposed to air and is only
o Method of extracorporeal elimination, in which infective only in the spore form
blood circulates through an activated charcoal - Gram (+) positive, encapsulated rod
containing cartridge added to the circuit of a - Not contagious, an individual cannot catch it
hemodialysis machine like a cold or flu
o Extracorporeal elimination means removal of toxins MOT - Contact with infected animal products raw
with the use of hemodialysis machine instead of meat
regular dialyzer o Cattle, and other herbivores are
- Early stage vaccinated against anthrax
o Alkaline fluids (NaHCO3) - Inhalation of the spores
 If gastric lavage is performed, used of alkaline o Odorless, invisible
fluids that sodium bicarbonate as the lavage o Can travel in great distance before
irritant dissemination
o Coconut milk Incubation Period
 Shellfish toxins have reduced potency in an - 1 – 6 days
alkaline environment Pathogenesis
Nursing Management - Where in people get infected with anthrax,
Health - Shellfish affected by red tide must not be - Then the spores get into the body
teaching cooked with vinegar - They can be activated; bacteria will multiply and spread
o Increases the toxin by 15 times greater out and produce toxins
- Toxin of red tide is not totally destroyed by - Causing severe illnesses
cooking Clinical Manifestations
- Wait for the Bureau of Fisheries and Aquatic 3 Main Methods of Infection
Resources (BFAR) to lift the red tide Skin - Edema with pruritis
contamination in the area contact / - Macule / papule resulting in ulceration
Avoid bi-valve mollusks Cutaneous - Painless eschar develops and fall off in 1-2
- Tahong - Kabiya infection weeks
- Talaba - Abaniko - Most common infection
- Halaan - Tulya - Least dangerous type
GI - Fever, N/V, abdominal pain
ingestion - Bloody diarrhea due to GI ulceration
o Decreased intravascular volume will
become major treatment concern
o Target organ is the terminal ileum
and cecum
- Ascites
Inhalation - Hemorrhagic mediastinitis hallmark sign
o More than 50% of these patients, as
seen on a CXR,
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o Spores have reach the mediastinal - clean equipment should be performed using standard
lymph nodes and releases the toxin hospital disinfectant
causing edema, and lymph node - cremation is recommended after the patient’s death,
tissue necrosis spores can survive for decades
- Deadliest form - anthrax vaccine adsorbed biothrax protects a person
- Patient who manifests later signs against anthrax, does not contain any anthrax bacteria
o require optimized oxygenation and cannot give people anthrax, but it is not typically
correction of electrolyte imbalances, available to the general public and not yet widely used.
and ventilatory and hemodynamic
support
- Mortality rate of inhalation anthrax
approaches almost 100%
Symptoms mimics those of the flu
Initial signs
- Cough, headache, fever, vomiting, chills,
weakness, mild chest discomfort, dyspnea,
and syncope
Later Signs
- Fever, respiratory disease, stridor, hypoxia,
cyanosis, diaphoresis, hypotension, and ASCARIASIS (Round Worm Infection / Ascaris)
shock - most common helminthic infection
Severe cases - round worm infection
- Progresses to meningitis with sub arachnoid Causative Ascaris lumbricoides (Giant round worm)
hemorrhage, death may result Agent - up to 40 cm elongated cylindrical worms
approximately 24- 36 hours after the onset - appears creamy and pinking yellow when
of severe respiratory distress fresh
Diagnostic Evaluation - a female worm can produce 240,000
- Patient history to determine exposure embryonated eggs per day that are
- CXR if inhalation anthrax is suspected, can confirm if the discharged into feces
patient has mediastinal widening or pleural effusion, to o which are fertilized by nearby male
determine hemorrhagic mediastinitis worm
- CT scan if inhalation anthrax is suspected - largest nematode found in human
- Blood culture, Tissue culture, CSF analysis, skin lesion swab - head is tapered, tail is pointed
respiratory secretions MOT Direct and indirect contact
o measure the antibodies or toxin in the blood - through vehicle transmission
o test directly for bacillus anthracis - when embryonated eggs are ingested
o samples must be taken before patient begins through contaminated fingers, food, drinks
taking antibiotics for treatment Pathogenesis
Medical Management - ingestion of embryonated ova and progression to larval
- Penicillin (Penicillin V) stage
- Erythromycin (Erythrocin) o contaminated water, raw vegetables
- Gentamicin (Garamycin) o night soil – human excreta used as a manure
- Mass casualty and prophylaxis (both 60 days) - larval penetration of the intestinal wall
o Doxycycline – brand name Vibramycin o duodenum part of the GIT
o Ciprofloxacin - blood carries the larva into the liver, heart, biliary tract, or
o Treatment is continued for 60 days lungs and then re-ingested
o Patients who have been directly exposed to o larva is picked up by the lymphatic system /
anthrax but have no s/sx of the disease circulation
- Patients with serious cases will need to be hospitalized o to the stomach, esophagus, upper respiratory tract
and require aggressive treatment such as continuous fluid o after 10 days in the pulmonary capillaries and alveoli
drainage and help breathing through mechanical whey they grow the larva will migrate to the
ventilation bronchioles, bronchi, trachea and epiglottis where
- If someone has symptoms of anthrax, it is important to they are swallowed again
get medical care as quickly as possible, to have the best - adult ascaris stays in the intestine and lay eggs that will
chances of a full recovery soon be excreted in thefeces
- If antibiotic treatment begins within 24 hours, after - CYCLE is repeated
exposure, death can be prevented Diagnostic Evaluation
Prevention Kato-Katz Technique - ova in stool
- standard precautions - Through the use of a
o to protect the caregiver exposed to a patient with microscope
anthrax, patient is not contagious, disease cannot - to demonstrate fertilized /
spread person-to-person unfertilized eggs in the stool
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Abdominal X-ray - Reveals Dense shadow of prescription

Adult Ascaris Piperazine Alternative (75 mg/kg/daily – 2 doses orally)
- Looks like strands of citrate - Recommended for GI or biliary
spaghetti obstructions secondary to ascariasis
Routine Blood Count - Eosinophilia Pyrantel Drug of choice (1mg/kg single dose orally)
- Increase of eosinophils pamoate - for pregnant patients in some cases
Chest X-Ray (CXR) - In some cases, can reveal the - but with prescription from PHC
presence of larvae in the - doses will be different for different
lungs patients
Ultrasound / Citi scan / - To determine the presence of - Use of medication is usually not indicated if the larvae is in
Imaging Studies larvae in other organs the lungs, this will cause respiratory manifestations
- When the larva is killed in the lungs, it may bring the
individual into higher risk of significant Pneumonitis
Mechanism of Action
Albendazole - decreases the ATP production in worms
- energy depletion, immobilization, finally
death in worms
Mebendazole - causes worm death by blocking the
uptake of glucose and other nutrients in
the intestine where worms stay
Piperazine - Causes flaccid paralysis of the worms
citrate
Pyrantel - Depolarizing neuromuscular blocking
Clinical Manifestations pamoate agent, result to spastic paralysis of the
Based on the developmental stage of the causative agent worms
During the larval stage Nursing Management
- Periumbilical Pain - Health education on preventive measure in home and in
- RUQ pain the community
- Cough - Health teaching on sanitary practices especially when
- Fever handling food
- Rales o All fruits and vegetables that are eaten raw must be
- Nasal pruritus thoroughly washed
o If the larvae has reached the nostrils o Effective sewage disposal
- Blood-tinged sputum - Availability of toilet facilities must be ensured
Adult stage - Proper disposal of diapers should be emphasized
- Colicky, periumbilical pain aggerated by cold stimulation - No isolation is needed for the condition
Nakamura sign - Enforcement of preventive measures in each home and in
- Palpable intestinal obstruction the community
o Bolus of entangled worms in the stomach - Combined approaches in
- Severe abdominal pain o Improved sanitation
o Associated with vomiting o Proper disposal
Severe growth of ascariasis o Mass community treatment in areas where
- Worms can come out of the mouth and nose, due to ascariasis is endemic
massive amount in the intestine - Avoid contact with soil that may be contaminated with
- Worms travel to different organs in the body human feces including night soil that is used to fertilized
- Massive growth can block the intestine, leading to poor crops
absorption of the nutrients and decreased tissue - Do not neglect the importance of handwashing and
perfusion in the intestine resulting to tissue necrosis personal hygiene
- Management may include (Common surgical procedures
used to manage bowel obstruction)
o ileostomy,
o enterotomy – PHC milk the intestine to remove the
worms from the large bowel
o resection of the gangrenous bowel – necrotic
intestine is removed
Medical Management
Anthelminthics
Albendazole Drug of choice (15 cc / single dose)
or - stable patients with uncomplicated
mebendazole infections
- not recommended during pregnancy
- maybe in some cases, and with PHC
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o Graying pigmented spots, found in the

surface of the inner thighs, or
abdomen, with varying sizes
Medical Management
Head - Dusting the scalp 1% malathion powder
louse - Gamma benzene hexachloride shampoo
o Thoroughly massaged in the scalp for
4 minutes then rinsed of thoroughly
Body - Laundering or boiling the clothing and
louse beddings
- Good hygiene emphasized
Pubic lice - Kwell or Gamene lindane cream
- Crotaminon Eurax, Geigy
o rubbed on the affected area
o second application is repeated after a
week
PEDICULOSIS (Aka Phthiriasis)

Infestation of the hair-covered parts of body with eggs, larvae or
adults of human lice that feeds on human blood and can result in RABIES (Aka Hydrophobia / Lyssa)
severe itching Acute zoonotic life-threatening viral infection transmitted
Causativ - Pediculosis humanus capiti (Head lice) communicated to man by saliva of an infected animal, it is almost
e Agent - Pediculosis humanus corporis (Body lice) always fatal but a preventable viral disease
- Phthirus pubis (Public lice / crab lice) - 99% of rabies is brought about by dog bites, can affect
both domestic and wild animals
Pathogenesis
- Spread through people through bites or scratches, usually
- Lice feed on human blood, lays their egg / nits on hair and
via saliva
clothing fibers
Causative Rhabdovirus – Lyssavirus (Genus) – Rhabdoviridae
- After it hatches it will release nymphs and must feed
Agent (Family)
within 24 hours otherwise it will die, Nymphs mature in
about 2 weeks. - Bullet-shaped virus
- When a louse bites, it injects a toxin, that produces a mild - With strong affinity to CNS
irritation and a purpuric spot, leaving purple spot in the - Sensitive to sunlight, UV light, ether,
skin, with repeated bites it can cause sensitization to the formalin, mercury, and nitric acid
skin leading to a more serious inflammation - Resistant to phenol, methiolate(?), and
common anti-bacterial agents
MOT - Inoculation through skin break and mucus
Head - More common in females and children
Louse membranes
- Itching – first and predominant symptoms
- Primarily transmitted through the bite of a
- Plica polonica
rabid animal
o Foul smelling head, that consists of
- Infectious material usually saliva comes
mattered hair consists nits, ova, pus,
into direct contact to human mucosa or
crust, and pediculi
fresh skin wounds
When neglected
Pathogenesis
- Varying degrees of irritation, excoriation, and
crusting - When the virus upon inoculation through a skin break and
mucus membranes
Body - Minute red spots, bitten spots swells just like
- It will first invade the peripheral nervous system and then
louse a mosquito bite initial lesion
travels through the neurons until it reaches the CNS
- Secondary crust and excoriation on the
- Wherein it has the highest affinity particularly the brain,
surrounding skin as a result of scratching
multiplying rapidly and lead to inflammation of the brain
Pubic lice - Persistent itching in the pubic region chief - Eventually the virus spread to some vital organs, primarily
/ Crab symptom the salivary glands, eyes, kidneys, reproductive organs,
Lice - Maculae ceruleae and some other important organs
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Clinical Manifestations - Capturing the animal, to which the patient

Prodromal / - Fever, anorexia, malaise, sore throat, is exposed, undergo euthanasia, to test
Invasion copious salivation, lacrimation, irritability, the brain tissue, performed by penetrating
Phase hyperexcitability, mental depression, the skull
melancholia, and marked insomnia Medical Management
o Melancholia – mental condition, Post-exposure prophylaxis (PEP)
manic depressant condition - Thoroughly wash the wounds with soap and running
characterized by extreme water, local treatment of wound ASAP after exposure in a
depression and sometimes nearby facility
associated with hallucination and - Give tetanus Toxoid if needed
delusion - Give tetanus antiserum
- Pain at the original site of bite o infiltrated around the wound or IM after a negative
o Paresthesia / numbness skin test
- Mild difficulty in swallowing - Anti-rabies vaccine passive and active
- Patient may be sensitive to light, sound, o Rabies vaccine – active
and temperature o Rabies immunoglobulin (RIG) – passive
Excitement / - Period of excessive muscle activity, Muscle - Observe the health condition of the animal
Neurologica fasciculations, marked excitation, and o If the animal died, send the head to the laboratory
l Phase apprehension for evaluation of presence of Negri bodies
- Delirium Algorithm of the management of animal bites / rabies exposure
- confusion (Categorized by WHO)
- Maniacal behavior / thought disorder Category I Described as touching or feeding animals / animal
- Severe painful spasms of the muscles of nicks on intact skin. Contact of skin with secretions /
the mouth, pharynx, and larynx excretions of rabid animal or person
o When the patient tries to attempt - PEP is not regarded as exposure,
water or even the sight of water therefore no PEP measures
- Hydrophobia – fear of water, difficulty of Category II Described as nibbling on uncovered skin, minor
swallowing, panic in the presence of scratches or abrasion w/o bleeding
water, cannot quench thirst - PEP - vaccine should be injected ASAP,
- Aerophobia immediate vaccination and local treatment
- Hypertyalism / drooling – foaming of the measures are required
mouth – profuse drooling
Category III Described as single or multiple transdermal bites or
- Violent involuntary contractions of the
scratches, leaks on broken skin, and contamination
diaphragm or accessory muscles of the
of mucus membrane with saliva
respiration which may lead to death
- PEP – immediate vaccination and
- If the patient survives this phase, they will
administration of rabies immunoglobulin is
enter the paralytic phase
necessary, local treatment of wound must
- Objective signs of developing disease of
be done
the CNS
Nursing Management
- Consciousness remains unaffected until
the onset of coma - Isolate the patient
o Provide a darkened and quiet environment. Any
Terminal / - Patient becomes quiet and unconscious
Paralytic stimulus may trigger furious and aggressive
- Loss of bowel and urinary control
Phase episodes
- Spasm ceases and there is progressive
- Give emotional and spiritual support
paralysis
o Remind patient and SO that they are not alone
- Tachycardia, labored respiration may be
o Encourage expression / clarification of needs and
noted
- Death occurs due to respiratory paralysis concerns
and circulatory collapse or heart failure o Explain all activities, procedures, and issues that
involves the patient
o Use non-medical terms and calm slow speech
Virus - From the patient’s saliva or throat
- Provide optimum comfort and prevent injury
Isolation - Determine causative agent
o Client has a tendency to hurt himself or somebody
Fluorescent - Most definitive else
rabies - Presence of Negri bodies in the dog’s - Provide a darken, quiet environment
antibody brain - Wrap the IV fluid
(FRA) - Negrie bodies in patients o Or any contraptions that may be pulled by the
PATHOGNOMONIC – Classic patient during restlessness and aggressive behavior
histopathological feature of rabies - Do not bathe the patient
o Invades the cytoplasm of the nerve o Due to fear of water
cells of humans o Remove sources of running water from the room or
o Confirms the patient is infected within the hearing distance
with rabies - Concurrent and terminal disinfection
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SCHISTOSOMIASIS (Bilharziasis / Snail Fever)

- A slowly progressive diseases caused by blood flukes
- Common among farmers and their families in the rural
areas that results in manpower losses and lessened
agricultural productivity
- High prevalence in Region V Bicol, Region VIII Samar and
Leyte, and in Davao
- Not only a public health concern but also a socioeconomic
problem
- Bilharziasis named after the Theodore Bilharz who first
described the infection in humans.
Causative Parasitic Worm Blood Flukes – Schistosoma (Genus)
Agent Schistosoma - Infects the intestine
japonicum Katayama Disease
o Endemic in
Katayama district
in Hiroshima,
Japan
- Only type that is endemic
in the Philippines
- “Oriental
schistosomiasis”
Schistosoma - Infects that intestine
mansoni - Common in Africa
Schistosoma - Infects that genito-
haematobium urinary tract
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- Found in the middle east - Renal failure

Iraq, Iran - Cerebral schistosomiasis – when the causative agent
MOT - Ingestion Contact with contaminated fresh reaches the brain leading to flaccid paraplegia
water with snails infected with - Genitourinary disease – migration of causative agent to
schistosomes veins around the bladder leading to calcification and
- Through skin pores obstruction of the urinary tract to possible kidney failure
- Through intermediate host or vector Medical Management
Vector - Praziquantel for 6 months
- Tiny snail o Taken with 1 tablet / 2x a day for 3 months
- Adult snail is Greenish- o 1 tablet / a day / 3 months
brown in color Prevention
- Infected with cercaria - Treat snail-breeding sites with molluscicide
(infective stage) - Prevent exposure to contaminated water use of rubber
Oncomelania - Lives along river banks, boots
Quadrasi freshwater streams, - Towel dry, vigorously and completely, the skin surface
creaks, canals, and that are wet with suspected water
swamps - Apply 70% alcohol immediately
- As big as the smallest - Treat the water with chloride
grain of unhusked rice or - Allow water to stand 48 – 72 hours before use
palay - Motivation of the public in the endemic area to have
Diagnostic Evaluation annual stool examination – especially for those with
- Fecalysis livelihood near water
- Kato-Katz technique Nursing Management
- Liver and rectal biopsy - WOF dehydration
o To determine the invasion of parasites in different - Fluid replacement
organs - Prevent injury
- ELISA o If client is experiencing myalgia or severe body
o To determine the presence of antibodies against malaise
the parasites - Promote comfort
- Circumoval precipitin test – CONFIRMATORY o To clients having the long-term effects of the
o Uses the ova of Schistosoma japonicum (antigen), disease
to determine the presence of antibodies against - Health teaching
the Schistosoma japonicum o During home or community visit in areas where
Schistosomiasis is endemic
o Importance of proper sanitation and disposal of
excreta
o Avoidance of contact to contaminated water
o Health education on the disease process, MOT, and
Clinical Manifestations prevention
- Pruritic rash Swimmer’s Itch on the site of penetration
o 12 hours after infection COMMUNICABLE DISEASE TRANSMITTED BY VECTORS
- Low grade fever, myalgia, and cough
o 2 – 10 weeks DENGUE FEVER
- Acute schistosomiasis or Katayama fever occurs as a (Aka Breakbone fever/ Hemorrhagic Fever / Dandy Fever / Infectious
systemic reaction against the microorganism as they pass Thrombocytopenic Purpura)
through the bloodstream through the lungs and onto the Acute febrile diseases caused by infection with one of the serotypes
liver of dengue virus
o Weeks of months after initial infection - Transmitted by mosquito
- Abdominal discomfort - Benign form of the disease
o Hepatomegaly - DENGUE HEMORRHAGIC FEVER
o Splenomegaly - Severe, Sometimes fatal
o Lymphadenopathy - Breakbone – due to severe muscle and joint pains
- Bloody-mucoid stools on and off - Hemorrhagic – bleeding in severe cases
o Dysentery like stools - Dandy – posture and gait of a dandy / fine man
- Jaundice - Similar characteristics of ITP
Complication o Low platelet count
- Liver cirrhosis o Hemorrhagic episodes
- Cor pulmonale and portal hypertension – arterial Causative - Flaviviruses 1,2,3,4 (family – togaviridae)
hypertension Agent - Arbovirus group B
- Heart failure – RV failure due to cor pulmonale o Arthropod born transmission
- Ascites – result of liver cirrhosis Mode of Vector borne
- Hematemesis esophageal varices Transmission
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Finals Reviewer
bite of an infected mosquito as pressure to determine the

Vector capillary fragility
- Day biting - Wait for 2 minutes for any presence of
o 2 hours after sunrise, petechiae
2 hours before sunset - Count below the antecubital fossa
- Low flying Hemo - Steady increase or 20% increase
- Stagnant water Concetration - Check for Hematocrit
o Breed in man-made Occult Blood Determines signs of coagulopathy, possibility of
containers Testing bleeding
- Urban area WOF Pulse Pressure
To be identified – fine dots at the - Observe in assessment
base of the wings and white bands on Pediatric - If its too low, signs of bleeding
Aedes
the legs Patient - Check in BP – difference of systolic to
aegypti
- Female mosquito diastolic
- Vector for chikugunya, - Normal is 30 – 40
yellow fever and zika virus Manifestations (Based on pattern or form)
- Common in tropical nations, Dengue Fever Prodrome of symptoms
changes in temperature and
- Early symptoms may appear
climate
- Malaise and anorexia – up to 12 hours
- Once a female has laid an
- Fever and chills
egg remains viable and will
- Severe frontal headache
hatch when in contact with
- Ocular pain retroorbital pain
water
- Myalgia back pain
- Rural area
- Arthralgia joint pain
Aedes - Secondary vectors
- Rashes more prominent on the
albopictu - Highly adaptive
extremities and trunk
s - High tolerance in cold
Other manifestations
conditions
- Rashes in the face
Dengue Presence of Hemorrhage
Classic picture of Dengue Fever
Hemorrhagic - Fever
- High fever with petechial rash Fever - Hemorrhage
- Thrombocytopenia
- Hepatomegaly
- Relative Leukopenia
- Hypovolemic shock
o Low platelet
Other manifestations
o Low WBC
- (+) torniquet test
Confirmatory result - Presence of petechia
Platelet - Must be obtained in every patient that is - purpura
count (+) suggestive in symptoms of dengue for 3 - Epistaxis
<100,000 or more days of presentation - Hematemesis
mm3 - Other conditions manifest - melena
thrombocytopenia - thrombocytopenia
Rumple leede BP cuff inflated - 20% increased HCT
test - Adult inflate for (10 – 15 mins) If left untreated may lead to dengue shock
(torniquet - Pedia (6 – 10 mins) syndrome
test / - (+) >20 petechiae in a 1 inch 2 (1 square - Diagnosed when the patient exhibits a
capillary inch) weak pulse pressure of less than 20
fragility) o indicates positive for dengue weakpulse
- Screening test - Hypotension
Procedure - Cold clammy
- Occluding (applying pressure) on the - restlessness
veins of the arm to detect the capillary TRIAD OF DENGUE
fragility 1. fever
o Measures to resist on the given Three
2. rashes
pressure manifestation
3. myalgia
- Patients with dengue fever has fragile s common to
If confused with other conditions, doctor is likely
capillaries leading to leakage of RBC in dengue fever
to take blood test
tissue spaces due to pressure
Phases of Illness
- Taking the blood pressure of the patient
Initial Febrile Phase
90/60 = 150/2 = 75 pressure to determine
the capillary fragility - high fever with headache (39 – 40 degrees centigrade)
o Add systolic and diastolic, get the - febrile convulsions
- (+) torniquet test
middle point, use the middle point
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- Maculopapular / petechial rash – starts in distal portion of o Pulse pressure

extremities - Epistaxis
- Herman’s rash o Elevate the patient’s trunk and apply ice bag to the
o Islet of white in the sea of red bridge of the nose and forehead
o Pathognomonic sign o Trunk up
- Purpura, epistaxis, gum bleeding hemorrhagic / bleeding o Head down patungo – to prevent the possibility of
manifestations aspiration
Circulatory Phase - Trendelenburg position
- Occurs on the 3rd to 5th day o Observe for signs of shock
- Decrease in temperature accompanied by circulatory  Slow pulse, cold clammy skin, decrease in
changes pulse pressure
- Cyanosis, restlessness, cold clammy skin o To increase venous return
- Profound thrombocytopenia - Isolation not required
- GI hemorrhage bleeding may become more severe Preventive Measures (CLEAN)
- Shock may also occur due to loss of plasma from the - Chemically treated mosquito nets
intravascular spaces - Larvae eating fish
o Narrow pulse, hypotension can be noted o Goldfish
o If shock is left untreated, coma, metabolic acidosis, o Catfish
and death may occur in 2 days - Environmental sanitation (4 o clock habit)
Classification according to severity o Vector control program of DOH – in outbreak of
Grade I Fever and non specific Sx fever
- Only hemorrhagic symptoms is (+) o Aim is to search and destroy mosquito breeding
torniquet test sites
Grade II All signs of grade 1 is present o Seeks to raise awareness and encourage
- Spontaneous bleeding from nose, gums, community to eradicate the breeding sites of
and GIT mosquito vectors
Grade III o Mosquitos are most active around Dusk (4 o’clock)
All grade II present + circulatory collapse
- Circulatory failure with manifestations of - Anti-mosquito soap
weak pulse, narrow pulse pressure, o Extracts of lanzones peelings
hypotension, cold clammy skin, restlessness - Natural mosquito repellants
- Cold clammy skin and restlessness, o Neem tree
hypotension, weak pulse o Eucalyptus
- Guarded prognosis – VS is unstable and o Oregano
outcome is uncertain - Health education
Grade IV o Change the water in flower vases once a week
All signs of III + profound shock due to blood loss
o Keep the water containers covered
- Undetectable blood pressure
- Death may occur o Avoid hanging too many clothes inside the house
- Critical prognosis – patient has irreversible - Stream seeding
damages o Fishes are propagated in a constructed bio ponds,
released in breeding sites of vector particularly in
Medical Management (Symptomatic treatment and supportive)
malaria endemic areas
- No effective antiviral therapy
o Also implemented for malaria
- Analgesic
- Stream clearing
o Relief of pain
o Assist community in preventing the spread
- IV infusion
o Overhanging vegetations are cut – to expose the
o For initial phase, prevent dehydration, replace
breeding sites to sunlight, making the site
plasma
unsuitable for vector habitation
o Dextrose
o Also for malaria endemic areas
o Normal saline
- ORESOL (75 mg/kg every 4-6 hours)
- Blood transfusion for severe bleeding
- Oxygen therapy for shock FILARIASIS (Aka Elephantiasis)
- Sedatives Parasitic disease caused by microscopic, thread-like African eye
o To allay anxiety and apprehension worm
o If decreased LOC, contraindicated Extremely debilitating stigmatizing disease that affects men,
o Given in early symptoms prodrome women, and children
- Maintenance of patient’s body fluid volume is critical - Adult worms can only live in the human lymphatic system
- Causes extensive disability, gross disfigurement, and
Nursing Management
untold suffering
- Keep the patient in a mosquito-free environment
- Disease is rarely fatal
o To avoid further transmission
- Elephantiasis - arms and legs swell
- Rest during bleeding episodes
Causative Wuchureria bancrofti
- Monitoring of VS
Agent - Affects the lymph vessels of the legs,
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arms, vulva, and breasts - Surgery

- Common in tropics and subtropics o remove excess tissue, relieve massive enlargement
Brugia malayi of the scrotum
- Affects areas below the knees and below - Elevation of the legs
the elbows - Elastic bandages
Brugia timori o Reduce edema, allay discomfort
- Rarely affects genitals - DEC – fortified salt
Loa loa (loiasis) o Considered a safe low-cost effective strategy to
- Cutaneous filariasis eliminate transmission of lymphatic filariasis
Mode of Vector-born o Also used in community setting
Transmissio Blood feeding insect vectors particularly mosquito Nursing Management
n Prevention
Clinical Manifestations - Health education and information dissemination on the
- all cases usually begin with chills between 3 months mode of transmission
- entry will cause blockage of the lymphatics resulting to o Important responsibility of a CH Nurse
inguinal or axillary lymphadenopathy - Environmental sanitation
Lymphatic - fever o Determine breeding places
Filariasis - inguinal or axillary lymphadenopathy - Destruction of breeding places
- lymphedema of extremities and breasts - Encourage personal hygiene
- orchitis, hydrocele - Explain the course of disease
Cutaneous - subcutaneous and conjunctival swelling o MOT, disease being managed
filariasis - others may manifest the presence of
parasites in the conjunctiva
- caused by loa loa
Diagnostic
Circulating CFA
filarial - finger-prick blood droplet taken anytime
antigen of the day
- provide results in few minutes
Nocturnal - Blood obtained around 10 pm to 2 am
blood where filarial worms are in high
examination concentration
Ultrasound - to determine lymphatic filariasis and
of the lymph obstruction
vessels
Tissue - determine cutaneous filariasis
biopsy
Patient - look for patterns of inflammation
History - signs for lymphatic obstruction
o skin changes, discoloration
o leaking of fluid in the skin
Medical
Medications are started in low doses to prevent reaction due to
death of the parasites
- Diethylcarbamazine (DEC) MALARIA
o hetrazan – common brand in community setting (Aka Marsh Fever, Periodic Fever, King of Tropical Diseases, Ague)
- Ivermectin Acute and chronic parasitic disease transmitted by the bite of
- Albendazole infected mosquito and is confined mainly to tropical and
Other Medical Management subtropical areas
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- Marsh fever – endemic in marsh lands in England 16 th to mosquito

19th century - Night biting look for meals at night
- Periodic fever – classic symptoms of on and off fever - Do not bite a person in motion
cyclical fever - Drawn to CO2 and foul-smelling host
- Tropical disease – prevalent in areas with tropical illness, - Assume at 36-degree position
rainfall is conducive for mosquitos to live and breed - Mechanical through bite
- Mosquitos are rampant in stagnant water resources - Parenteral through blood transfusion,
- Causes more disability and heavier burden than other sharing off needles
parasitic disease - Transplacental / congenital malaria rare
Causative Protozoa (Plasmodia) cases
Agent Plasmodium falciparum Pathogenesis
- Responsible for most deaths of Malaria 1. Anopheles mosquito gets parasite from the blood of
- Predominant found in sub-Saharan infected person
countries 2. Parasites multiply in mosquito
o Africa, Papua New Guinea Haiti, 3. Parasites migrate in the salivary gland of the mosquito
eastern Asia – Philippines 4. Mosquito bites a human
- Most serious malaria infection 5. Parasite invades RBC, multiply (asexual schizogony, and
o because of the development of releases merozoites)
high parasitic densities in the RBC 6. Invasion of another set of RBC
(they grow inside the RBC) will lead 7. Repeat of the cycle
to RBC - Parasites enters the mosquito
 hemolysis- agglutinate-micro - Multiplication inside
emboli - 10 – 14 days, sporozoites are release and will travel into
- Malignant tertian fever the salivary gland of the mosquito
- Infects all types of RBCs - Parasite is carried onto the next victim through bite
- Blackwater fever – darkening of the - Parasite invade the RBC, grow and multiply by asexual
urine / mahogany urine – hemoglobinuria schizogony – nuclei division,
o Sign of impending renal failure - Due to number of parasites, RBC will rupture and release
- If untreated merozoites
o may become source of infection - Merozoites will invade more RBC to start another cycle
Plasmodium Vivax - Fever to liver failure, cerebral invasion, lungs
- Benign tertian Diagnostic
- Affects reticulocytes Malarial Film of blood that is placed on a slide, stained,
- South America and Eastern Asia smear examined microscopically
- Non-life threatening - Gold standard in determine the parasites
- Only affects the immature RBC - Taken at the height of fever
- Only led to limited parasitemia – affects - Done with a finger prick
very young and very old - Thick blood smear
Plasmodium Malaria o Detect infection, quantifying –
- Quartan number of parasites in RBC
- Affects senile RBC - Thin blood smear – identify the malaria
- Not common species and recognize form, distinguish
- Less frequently seen, non-life threatening between diff species
Plasmodium Ovale - Also determine the size and shape of RBC
- Ovale tertian Rapid - Can be done in the field
- Affects reticulocytes diagnostic - Gives result within 10 – 15 minutes
- Rarest type, uncommon in the PH test (RDT) - Done to detect malarial parasite antigen
Period of Splenic - Spleen plays important role in the
Causative Agent Incubation Period
Communicability biopsy immune response against malarial
P. falciparum 12 days More than a year infection
P. vivax 14 days 1-2 years - Spleen selectively filter and destroy
P. malaria 30 days More than 3 yrs senescent RBC matatanda
P. ovale 14 days - Destroy infectious microorganism in RBC
Causative Agent Fever Paroxysms that has plasmodium parasite infection
P. falciparum Fever paroxysms happens q 36 – 48 hours - Enlargement of the spleen splenomegaly
P. vivax Fever paroxysms happens q 48 hours o Is one the early constant sign of
P. malaria Fever paroxysms happens q 72 hours malarial infection
P. ovale Fever paroxysm happens q 48 hours o A sign that malarial infection could
Mode of Female Anopheles mosquito (Primary Vector) be prolonged medyo matagal na
Transmissio - Assists in diagnosis malarial infection
- Breeds in clear, flowy, shaded streams
n usually in the mountains
- Brown colored, bigger than ordinary Manifestations
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Cyclic Stages of Cyclic Paroxysms o consider it as medical emergency, requires close

paroxysms 1. Cold Lasts 2 – 3 hours monitoring of VS
(On and off stage Moderate to severe shaking chills Prevention and Control
fever from 2. Hot Lasts for 3 – 4 hours - Report all cases of malaria to agency PIDSR (Philippine
40 to 42 stage Spike up fever >41 oC integrated disease surveillance and disease response)
degrees 3. Wet Lasts for 2 – 4 hours o Mandated by DOH to collect data of a disease in a
centigrade) stage Profuse sweating specific area
Fever starts due to formation of merozoites in the - Destroy breeding places
liver - Insecticides at home
Fever spikes when the merozoites are already in the o Request at LGU
bloodstream / circulation / propagate inside the RBC - Use of treated mosquito nets
and will damage the RBC - Insect repellants
Splenomegaly - Parasites invades the organs - People in malaria-infested area should not donate blood
Hepatomegaly for at least 3 years
Myalgia - Blood donors should be properly screened
Other symptoms
- Stream seeding and clearing
- Malaise, fatigue, anemia, headache
Medical Management
Antimalarial drug
- Artemether lumefantrine – drug of choice
o Effective on all types of parasites
o Taken immediately after food, or milk to increase
absorption
- Chloroquine
o Effective on all species except p.malaria
- Quinine
o And its related agents
o WOF muscular twitching, delirium and confusion, sx
of neurological toxicity
- Sulfamedoxazole
o Resistant plasmodium falciparum
- Primaquine
o Relapses of ovale and vivax
- Erythrocyte exchange transfusion
o For high levels of parasites in the blood
Nursing Management
- Close monitoring
o Assess on admission and daily thereafter for
fatigue, fever, disorientation, and hypotension
(signs of progression of disease)
- Monitor input and output
o Implement strict monitoring of I/O to prevent
pulmonary edema and electrolyte imbalances
- Febrile stage
o Administer antipyretics, TSB, alcohol rubs, ice cap
to reduce temperature
- Chilling stage: external heat and hot drinks
- Encourage increase in OFI
o Fluid loss from dehydration and diaphoresis may
contribute to fever
- Bed and clothing should be kept dry
- WOF signs of abnormal bleeding due to hemolysis
- Evaluate degree of anemia
o by obtaining CBC
- Enforce bedrest during period of acute illness
- Standard precautions
- Protect patient from secondary bacterial infection
- WOF neurologic toxicity from quinine infusion
o Muscular twitching
o Delirium
o Confusion
- If severe malaria
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- Risk of death is greater

in older people
- Spread through bite of
mosquito Culex T.
Encephalitis (Aka Brain Fever) - Potentially severe viral
Is an acute inflammatory infection of the brain usually as a disease
complication to some viral or bacterial diseases characterized by - Source of infection –
various degrees and manifestations of cerebral dysfunction infected hogs and
Causative Viral encephalitis poultry
Agent - Common virus herpes simplex - Capable of transmitting
o Travels through a nerve to the skin the disease for life
Japanese
leading to a cold sore - Usually affects children
o May travel to the brain – damage younger than 10 years
and death old
o Mumps, rubeola, HIV, Epstein-Barr, - Case fatality 30 – 35%
cytomegalovirus - PH – peak season is
- Childhood viruses March to April,
o Chickenpox, measles, rubella September to October –
- Arboviruses rice fields are flooded
o Arthropod borne with water
o Often transmitted by mosquitoes Secondary
by Culex Tritaeniorhynchus - active - Post infection
at day and night o Complication to some disease like
o Wild birds and domestic fowl chicken pox, measles, and mumps
Bacterial encephalitis - Post-vaccine
- Bacterial meningitis (primary) o Commonly associated with anti-
o Directly to the brain rabies vaccine
- Syphilis (secondary) o In rare cases, predisposes some
o Current infectious disease individual
o Secondary encephalitis Manifestations
Protozoal encephalitis General manifestations for all classification include the prodromal
- Caused by protozoans and parasites or early signs within 1 – 4 days
- Toxoplasmosis Prodrome / early signs
- Malaria - Apathy, conjunctivitis, fever, headache, dizziness,
- Amoebiasis vomiting, chills, sore throat, arthralgia, myalgia,
Toxins, chemical, trauma abdominal pain
Classificatio Primary Late signs encephalitic signs
n Direct invasion of the CNS, inflammation of the - Nuchal rigidity, ataxia, tremors, mental confusion,
brain aphasia, hyperexcitability, convulsions
Based on the place the virus was discovered and - Some patients may experience disturbances of
the species of animal that carry the virus swallowing, mastication and movements of the muscles
of the eyes and face
- Found Western US
Japanese encephalitis
- Acute inflammation of
- Within 72 hours
Western the brain parenchyma
o Stiff neck, confusion, neurologic manifestations
Equine and meninges
may occur, progress to drowsiness, seizures,
Encephaliti - Affects all age groups
sometimes coma,
s but mainly occur in
o Decreased IQ, serious brain damage
children less than 1 year
old - Flu-like symptoms – Fever, chills, nausea, and vomiting
- Found in eastern US Diagnostic Evaluation
- Young children, people - Serologic test
older than 55 o Confirmatory test
- More fatal than western o To determine the antibody against the virus
Eastern - CSF Analysis
type
Equine o Obtained through lumbar tap
- Both types (EEE and
Encephaliti - MRI
WEE) could cause
s o Best imaging option for encephalitis
severe symptoms in
infants o Determine the lesions in the brain
- Permanent nerve and - CT scan
brain damage o Determine changes in brain structure
St. Louise - Organism enter through - Electroencephalogram (EEG)
the olfactory tract o To monitor electrical activity of the brain
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o To determine changes in electrical changes

 show sharp waves if client have encephalitis
Medical Management
Treatment is symptomatic and supportive based on presenting
symptoms
- TSB, paracetamol
o If the patient is febrile
- OFI
o With aspiration precaution especially in late signs
- Mouth gags and raise bedrails
o In case of convulsion
o Protect the patient from injury
o To prevent falls
- Monitor I/O
- Observe for neurologic signs
o Swallowing difficulty
o Eye movements
o Myalgia – indication of paralysis muscle weakness
- Corticosteroids
o To reduce brain inflammation
Depending on the type of encephalitis
- Physical therapy
o Improve strength, coordination, balance
- Occupational therapy
o To redevelop everyday skills like talking
- Speech therapy
o Relearn muscle control for talking
- Psychotherapy
o With coping strategies, mood disorders, personality
changes
Preventive measures
- Eradicate mosquito vectors
- Eliminate breeding places
- Destruction of larvae carried out in the community
- Screening of homes
- Use of insect repellent
o Wear long sleeves, shorts, and pants to prevent
accumulating the condition
- Public education
o Important phase of all prevention programs
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LEPTOSPIROSIS
(Aka Weil’s Disease / Mud Fever / Canicola Fever / Hemorrhagic
Jaundice / Swine Herd Disease)
- Starts from the shedding of the organism from the urine
A (most common) worldwide zoonotic (transmitted by animals to
of an infected animal (most important source)
humans) disease caused by bacteria called Leptospira interrogans.
- Contact via infected urine / chanel results in human
(Rat is the main host)
infection
An occupational disease affecting veterinarians, miners, farmers,
o Contaminated water and food
sewer workers, abattoir workers (who works in the
o Animal bedding
slaughterhouse) (water contaminated by animal’s urine)
o Soil and mud
First reported by Adolf Weil, Weil’s disease is the severe form of
- Bacteria are believed to enter the host through the
leptospirosis, characterized by jaundice, hemorrhage, renal failure
following
Mud Fever – disease can be contracted from mud contaminated
o Abrasion of the skin
with bacteria
o Animal and rodent bites
Canicola Fever – causative agent of infection is Leptospira canicola
o Waterlogged skin – skin soaked for too long
which can also be found in dog
o Mucus membrane, Conjunctiva
Swine Herd Disease – bacteria was contracted from swines or pigs
o Placenta during pregnancy
Causative Spirochete (Leptospira interrogans)
- Leptospira interrogans enters the susceptible host, gains
Agent Infection comes from contaminated food and
rapid access to the bloodstream through the lymphatics
water infected wildlife and domestic animals rats,
resulting in leptospiremia
dogs
- Spread to all organs (particularly liver and kidneys)
- Spiral finely coiled thin motile and slow
- When the bacteria is in the kidneys, invading the
growing aerobic bacteria
interstitium renal tubules, tubular lumen, causing
Mode of - Ingestion or contact to mucus membrane interstitial nephritis and tubular necrosis leading to renal
Transmissio - Of infected urine or carcasses of wild or failure
n domestic animal o Revealing elevation in BUN and creatinine levels
- Invasion across mucosal surfaces or non - Liver involvement is marked by necrosis of the liver
intact skin lobules, and Kupffer cells (Kupffer cell proliferation) – are
- Contact with contaminated soil involved in the breakdown of RBC, problem with regard
Diagnostic Evaluation to RBC production
Kidney Result is impaired, indicated by raised plasma o Jaundice occurs as a result of hepatocellular
function test creatinine dysfunction
ELISA o Expect elevation of enzymes with regards to liver
Liver Reveal elevation in aminotransferases, bilirubin, function test
function test alkaline phosphatase, hyperbilirubinemia and - Icteric eye is associated with liver dysfunction
jaundice in cases of icteric leptospirosis - Damage to other organs may also happen such as the
Leptospira ELISA, Leptospira antigen-antibody test (LAAT), lungs, heart, vascular system, and skin
antigen- Leptospira antibody test (LAT) Used to confirm Clinical Manifestations (Depends on the Phase of Infection)
antibody leptospirosis on the basis of determining antibodies Septic Stage Non-specific flu-like symptoms
test (LAAT) present against the bacteria - Fever (4 – 7 days)
Leptospira Blood 1st week - Chills
antibody CSF 4 – 10th day - Headache
test (LAT) Urine 10th day - Muscle pain
Urine is the most reliable body fluid to - Anorexia
study, urine contains leptospires from - Abdominal pain
the onset of clinical symptoms until at - Conjunctivitis also occurs
least the 10th day of infection Immune or Signs and Symptoms depends on the affected
Other body fluids may also contain organism, blood Toxic Stage organs
and CSF may produce (+) cultures on the first 7 – 1o Manifestations
days of symptoms. Ocular Iritis / uveitis
Pathogenesis Chorioretinitis – long term
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complication walking in potential contaminated water or flood

Subconjunctival hemorrhage – water
most common ocular - Eradicate rats and rodents
complication o Control rats by using rat traps or poison
Liver damage Can be with or without jaundice - Emphasize the use of protective clothing (boots and
gloves)
Kidney Reduced UO, Fluid retention, - Drain potentially contaminated water when possible
damage Hematuria, Peripheral edema, - Maintain cleanliness in the house
Progressive renal failure oliguria
Brain Disorientation, delirium,
convulsions
In severe cases, meningitis.
Meningeal manifestations
disorientation, convulsions
Lungs Dyspnea, chest pain, hemoptysis,
respiratory failure
Cardiovascula Dysrhythmias, atrial fibrillation,
r elevated jugular pulsation, heart
blocks or jugular vein pressure,
cardiogenic shock
Severe Lead to coma
symptoms
Shock
Possible recurrence of fever, this may indicate
onset of immune stage
Conva Relapse may occur during the 4th to 5th weeks
lescence
Medical Management
Antibiotics - Penicillin
- Doxycycline
- Given early in the course of the disease
- If allergic, expect prescription of
Erythromycin
- IV antibiotics required for person with
severe symptoms
o IV Penicillin G
o 3rd generation cephalosporin
 Cefotaxime
 Ceftriaxone
Prophylaxis Doxycycline 100 mg every 12 hours for 1 week / as
prescribed by doctors
- Best way to prevent infection is to avoid
exposure, but if working in areas where
leptospirosis is endemic, suggested to
take a prophylaxis
Peritoneal For patients with acute kidney failure
dialysis
Fluid and Given specifically in late signs, blood and fluid
electrolyte volume decreases as the disease progresses
replacement
Multiorgan Supportive therapy and careful management of
failure renal, hepatic, hematologic, CNS complications are
very important
Nursing Management
- Isolate the patient
- Darken the patient’s room
o Eyes is sensitive to light
- Infection control
o Concurrent disinfection of soiled articles
- Meticulous skin care
o To prevent skin breaks and wounds
o Provide health teaching, avoid swimming or
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Pathogenesis (Life Cycle)

Life cycle involves numerous freshwater crustaceans crabs,
crayfish, snails, serves as intermediate hosts. Infection occurs when
these crustaceans are eaten raw, or lightly cooked. Humans are
also involved in the life cycle.
- Larval flukes will develop in the small intestine
- And penetrate the intestinal wall into the peritoneal
cavity,
- They then migrate into the abdominal wall, or liver
(undergo further development),
- Approximately 1 week later, the adults reenter the
abdominal cavity and penetrate the diaphragm to reach
the pleural space and the lungs
- Flukes in the lungs will lay eggs, which may then be
expectorate through sputum, or swallowed and passed
through stool
- If the eggs reached a water source the life cycle restarts
Diagnostics Evaluation
Sputum Eggs in brown spots
analysis
CSF Eosinophilia in CSF
Stool Also useful to diagnosis paragonimiasis in children,
examinatio because they tend to swallow sputum
PARAGONIMIASIS
n
A chronic parasitic infection which greatly reduces human (causing CBC With differential, usually reveals eosinophilia in 10 –
a subacute to chronic inflammatory disease of the lungs)
30% of patients with paragonimiasis
productivity and quality of life
Frequently encountered in communities where eating of fresh or
inadequately cooked crabs is a practice such as in Asian countries
Japan - Cough of long duration
o Begins as dry and progresses into productive cough
Manifestations closely resembles PTB when worms reach the lung,
with blood tinged sputum, late clinical picture is
symptoms may be significant and typically include cough with
similar to chronic bronchitis and bronchiectasis
blood stained sputum, chest pain with dyspnea and fever, pleural
with profuse expectoration, pleuritic chest pain
effusion, and pneumothorax, possible complications.
- Hemoptysis
If the client with PTB, they do not respond to treatment, suspect
- Chest and back pain
Paragonimiasis
- PTB-like symptoms not responding to anti-TB medications
Causative Lung Flukes
Medical Management
Agent Paragonimus Common in Asia
- Praziquantel
westermani “oriental lung fluke”
o Triclabendazole
Adult: reddish brown,
o Treatment of choice
ovoid
o WHO & CDC recommends the drug to treat
Paragonimus siamense Reported for the first
paragonimiasis
time from Haro, Leyte,
o Praziquantel is most commonly used, cure rate 80-
PH
90%
Life cycle involves numerous freshwater
- Bithionol
crustaceans crabs, crayfish, snails, serves as
o Alternative (anthelminthic) drug
intermediate hosts. Infection occurs when these
crustaceans are eaten raw, or lightly cooked. Nursing Management
Humans are also involved in the life cycle. Health Teaching
Larval flukes will develop in the small intestine, and - Disinfection / sanitary disposal of excreta
penetrate the intestinal wall into the peritoneal - Anti-mollusk campaign
cavity, they then migrate into the abdominal wall, or - Avoid eating infected goods
liver (undergo further development), approximately o In endemic areas
1 week later o Also raw pork, contains parasite
Intermediate hosts - Avoid bathing in infected water
Antemelania asperata Fresh water snail
- 1st intermediate
host
Crabs Small, fresh-water crabs
- 2nd
intermediate
host
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abuse through IV, hyperalimentation

Diagnostics Evaluation
- Stool culture
o Candida can grow in the intestine
- Gram staining of the skin, vaginal discharge, or scrapings
o Examined under microscopy for the presence of
growing yeast cells
- Scaly skin, with erythema and popular rash
o If it affects the skin
- Nails – red and swollen, separation of pruritic nails from
nailbed, purulent discharge
- Cream – colored or bluish-white patches and exudates on
the tongue, mouth, or oropharynx
- Vagina – white or yellowish discharge / cheese like /
pruritus and local excoriation, white and gray patches on
the wall with local inflammation
- Women may also experience with genital itching w/ or
w/out discharge
- Men may have an itch as well as rash on the penis
Medical Management (Location and Severity of the Infection)
- Nystatin
o Oral Thrush / Candidiasis
- Clotrimazole, fluconazole, ketoconazole (Azoles)
o Mucus membranes / vagina
- Fluconazole, amphotericin and echinocandins
(micafungin)
o For systemic infection
SEXUALLY TRANSMITTED DISEASE / INFECTIONS (STDs/STIs) Nursing Management
- Avoid sharing utensils
STDs / STIs - Meticulous mouth care after each meal, every 4 hours while
Infections transmission by sexual contact including vaginal, anal or awake, mouth care prevents oral formation of plaques and
oral sex. Some are contracted through non sexual means blood or bacteria, oral catheter (NGT/OGT/Oxygen) may require
blood products. Many STIs can pass from mother to child from additional care
childbirth such as Chlamydia, Gonorrhea, and Syphilis. Challenge - Proper disposal of oral secretions
because of stigma, people are often reluctant to seek - Good perineal hygiene both male and female, if with
assistance .May progress without symptoms vaginal discharge – document the color and amount
- Avoid self-medications (antibiotics)
CANDIDIASIS (Aka Moniliasis / Candidosis)
A fungal infection caused by a yeast (Called Candida) that usually CHLAMYDIA
infects the nails onychomycosis, the skin diaper rash, and mucus - Sexually transmitted infection
membranes of the oropharynx thrush, vagina moniliasis, - Most people who are infected have no symptoms
esophagus, and GIT - Contracted during vaginal, anal, oral sex
Can cause infections if it goes in the blood stream and invade - It can be passed from an infected mother to her baby
internal organs like kidney, heart or brain during childbirth
Causative Candida albicans Causative Genus Chlamydia
Agent - Part of the normal flora of the GIT, mouth, Agents - Chlamydia trachomatis
and skin, in low amounts, harmless and will - Chlamydia psittaci
not cause disease - Chlamydia pneumoniae
- Are opportunistic pathogens Cause conjunctivitis, genital and respiratory
Causes infection when infections
- There is rise in blood glucose for clients w/ Mode of - Vaginal or rectal intercourse
DM Transmission - Oral-genital contact
- Immunosuppression cancer - Children born to mothers with chlamydial
- Taking immunosuppressive drugs, radiation infection may develop conjunctivitis,
exposure, infection of HIV otitis media, and pneumonia during
- Increase in estrogen level pregnant women passage through the birth canal
- Broad spectrum antibiotics are used Clinical Manifestations (Vary According to the Parts Affected)
depresses normal flora, allowing the candida Women with Cervical erosions, Mucopurulent discharge, Pelvic
albicans to proliferate cervicitis pain, Dyspareunia (Painful intercourse)
- Systemic inoculation urinary catheter, drug Women with Pain and tenderness of the abdomen, cervix,
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endometritis uterus, and lymph nodes - Common sexually

/ salphingitis - Pelvic inflammatory disease transmitted virus
- Fever and chills and bleeding after - Virus can lie dormant in the
intercourse patient’s body and can
Women with Dysuria, Pyuria, Urinary frequency reactivate several times a
urethral year
symptoms - More than 80% affected has
Men with Dysuria, Erythema, Tender urethral meatus, manifestations of cervical
urethritis pruritus, urethral discharge and urethral involvement
- Urinary frequency - Person with genital herpes
Men with Painful scrotal swelling, urethral discharge can be contagious even if he
epididymitis - Some patients may have diarrhea, or she does not have visible
tenesmus, pruritus, bloody or sores
mucopurulent discharge Clinical Manifestations
Diagnostic Procedures HSV2
- Swab From The Site Of Infection from part being affected - Flu-like symptoms during initial outbreak
- Culture Of Aspirated Secretions - Swollen lymph nodes in the groin
- Enzyme Linked Immunosorbent Assay (ELISA) - Minor rash or itching
- Direct Fluorescent Antibody Test - Painful sores
Medical Management - Burning sensation on urination
- Tiny white blisters small red bumps may appear a few days
- Doxycycline oral for 7 days
to weeks after infection, when it ruptures may lead to
- Azithromycin as single dose, preferred by the Primary Care
ulceration, lesions make it painful to urinate
Provider
Sores can develop in:
- Untreated Chlamydial infections can lead to epididymitis,
Men & women - Buttocks, thighs, anus
salpingitis, PID pelvic inflammatory disease, eventually
- Mouth & pharynx
sterility
- Urethra
- Some studies show that pregnancies of women infected
with this organism can result in abortion, premature Women Vagina, external genitals, cervix
delivery Men Penis & scrotum
Nursing Management
- Universal precautions
- Submit for HIV testing
- Check newborns for chlamydial infection
HERPES SIMPLEX
Is a viral infection which are categorized based in the affect part of
the body and is related to the virus that causes infectious
mononucleosis, chickenpox and shingles
Diagnostic Procedures
- Oral herpes face or the mouth, result in small blister that
Direct Method - Used to demonstrate the
occur in groups cold sores / fever blisters
presence of HSV in a suspicious
Causative Herpes simplex virus lesion or genital secretion
Agent Types - Unroofing the vesicle, with the
Type 1 virus The one the cause cold sores, tiny, use of sterile needle or scalpel,
(HSV1) clear fluid-filled blisters exposing the inside of the vesicle,
- Affects infant and children a sterile Dacron swab should be
- Sores on the lips, mouth, rotated firmly in the base of the
nose, chin or cheeks, after lesion, allowing epithelial cells to
exposure be collected
- Sore may also develop in - More than one lesion should be
wounds swabbed and taken for sample
- Transmitted by kissing, Tissue Culture - HSV is best confirmed in isolation
sharing utensil, towels
in tissue culture
- Catch from family members
- To determine if it is HSV1 or HSV2
or friends who carry the virus
- Considered as the criterion
- Sores appears 2 to 20 days
standard for diagnosis
after contact with infected
- Treatment modality can provide
person and usually last for 7
positive results within 48 hours
to 10 days
Immunofluorescenc - Direct fluorescent antigen
Type 2 virus Sexual contact is the primary MOT
e - Performed by scraping cells at the
or genital Pain, itching, genital sores, vesicular
base of the ulcerations
herpes and pustular lesion around genitals
- Stained with a direct fluorescent
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antibody outside the body, not transmitted by

- Used to distinguish HSV1 from touching objects like toilet or clothes
HSV2 Mode of Direct contact on the infected mucus membrane
- Procedure can be performed Transmission - Usually as a result of sexual activity,
within 2 to 3 hours genital or anus, and mouth
Medical Management (No cure for Genital Herpes) - Transmitted on newborns through
- Azyclovir (Zovirax) direct contact with contaminated
- Famciclovir (Famvir) vaginal secretions of the mother
- Valacyclovir (Valtrex) Diagnostics Evaluation
- Medications can relieve symptoms - Culture and sensitivity
- Antiviral drugs o To determine the presence, taken from the cervix
- 3 major drugs commonly used in genital herpes, and anal canal of women
prescribed for 7 to 10 days treatment - Gram staining
o Of urethral discharge from men
Clinical Manifestations (based on who is being affected)
Female - Burning sensation and frequent
urination associated with itching at the
perineal area
- Yellowish purulent vaginal discharge
o Assessment will include redness,
swelling of the genitals
- Endometritis, salphingitis, urethritis,
cervicitis
o May occur a few days after
exposure
- Fever, nausea and vomiting, abdominal
pain or tenderness
o Signs of pelvic infection
o Symptoms of endometritis,
salphingitis, or pelvic peritonitis
o There is already uterine invasion
o Manifestations can lead to
infertility
- Vaginal bleeding
o May occur after vaginal
intercourse
- May infect the eye of the baby during
the passage
Males - Dysuria with purulent discharge (gleet)
o From the urethra
GONORRHEA (Also known as Clap / Gleet)
o May occur 2 to 7 days after
A sexually transmitted bacterial infection involving the mucus lining
exposure
of the genitourinary tract, cervix, the rectum, and pharynx, eye or
- Rectal infections
conjunctivae
o Common among homosexuals
In women the cervix is the most common site of gonorrhea which
- Urethritis
may result in endocervicitis and urethritis which can be complicated
o Could cause strictures, prevent
by pelvic inflammatory disease (PID). In men, gonorrhea causes
passage of urine
anterior urethritis
- Prostatitis
Clap because of those soldiers who were infected, sometimes said o May also complain of pelvic pain
that soldiers had the collapse, shortened and transformed into Clap
and fever as sign of this
Gleet in veterinary pathology is an inflammation of the nasal manifestations
passages of a horse, producing a thick discharge and gonorrhea is - Eye manifestations
characterized by thick discharged thus the name o Pain, photophobia, sensitivity to
Causative Neisseria Gonorrhea light, affected eye has pus-like
Agent - Kidney-bean shaped discharges
- Aerobic Diplococci gram negative (-) - Joints, rectum affectations
- Can be killed by ordinary disinfectant o Usually painful if the patient is
- Fragile and does not long outside the moving around
body o Pain is accompanied by swelling,
- Readily killed by drying, sunlight, UV redness, and warmth
light, ordinary disinfectant o Itchiness around the rectum,
- Cannot live for more than a few seconds discharge and sometimes blood is
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present in the stools, mistaken - Can cross the placenta

for internal hemorrhage - Cannot withstand drying but can tolerate
Medical Management considerable temperature changes
Uncomplicate Ceftriaxone IM - The organism has been found alive in
d Oral doxycycline drinking glass ½ hour after the glass has
- 100 mg per Orem 2x a day for 7 days been rinsed with cold water
- or as recommended by the Primary care Mode of - Direct contact on the infected mucus
provider Transmission membrane with discharges
Pregnant Ceftriaxone IM (125 mg single dose) + - Placental transmission
Erythromycin (500 mg taken orally) for 7 days - Indirect contact (handling diaper, wet
Crede’s Erythromycin Eye ointment nurse)
prophylaxis - Immediately after birth - Blood containing the organism
for infants - To prevent ophthalmia neonatorum Diagnostics Evaluation
Nursing Management - Dark field illumination test
- Explain the course of the disease o To identify microscopy of spirochete in chancres
o Patient to know about the disease and how it can lesions
be managed o Most effective if moist lesions are present
- All information of the patient is confidential - Fluorescent treponemal antibody absorption test
- Administer ophthalmic prophylaxis for infants o Uses exudates from lesions
o 1% silver nitrate o Detects the antibody against treponema pallidum
o Erythromycin eye ointment - VDRL slide test and rapid plasma reagent test (Venereal
- Report Gonorrhea in children (Child Abuse Authority) Disease Research Laboratory)
o Executive order No. 53 for child protection o detect REAGIN – antibody that is released by the
o Intended to protect children from abuse body against the spirochete
- Advice to refrain from coitus until treatment is complete o may assist in determining the pathogen
o Until they recover from the disease - CSF Analysis
o Reveal elevated WBC
o Presence of antibody
o Protein is elevated, suggesting antigen spirochete
in the CSF, in severe cases
(Based on Different Stages; reflect the time of Infection)
Primary Presence of lesions
Syphilis - Painless chancre that disappears 3 – 6
weeks even without treatment; false
conclusion that the disease has already
cured
o Occurs on the genitals, around the
anus, or inside the rectum, can also
be found in or around the mouth
o Firm, round and painless but not
always
o Start as macules then erode,
associated with either unilateral or
SYPHILIS bilateral lymphadenopathy
(Aka Lues Venereal / Morbus Galicus) - Unilateral or bilateral lymphadenopathy
A chronic, infectious, sexually transmitted disease that usually - Highly contagious during this stage, but
begins in the mucous membranes and quickly becomes systemic easily cured with antibiotics
- Caused by a spirochete that is acquired through sexual Secondary Hematogenous spread
contact Syphilis - From the original chancre which may lead
- Can be transmitted also via placenta of a mother with to generalized infection
syphilis - Once there is a development of
- Illness is simple to cure, if not properly managed can mucocutaneous lesions and generalized
cause damage lymphadenopathy, it will signify the onset
- Lues Venereal – latin word; venereal flag; venereal means of secondary syphilis
sexual desire / intercourse - Rash involves the trunk, extremities,
- Morbus galicus – the French disease; was spread by palms, and soles of the feet
returning French troops from war o Macular/papular/pustular/nodular
Causative Treponema pallidum - spirochete o Lesions can be found in warm,
Agent - No other host than man moist areas of the body perineum,
- Appears as shiny, twirling thread vulva, scrotum
- Wavelike corkscrew motion Lesions in the areas are large enough to erode,
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produce highly contaminated pink or grayish white AIDS

lesions known as condylomata lata - Set of clinical manifestations of HIV
- Condylomata lata - Susceptible to many infections
Mild symptoms may also occurs - Patient is
- Headache, anorexia, malaise, slight fever o Very infectious
- Nails becomes brittle o Very ill
Tertiary Associated with severe medical problems o Prone to aggressive kinds of opportunistic diseases
Syphilis - Presents a slowly progression - Acquired not hereditary or inborn
inflammatory disease with the potential o Except in cases of congenital HIV
to affect multiple organs o However, not every child to a mother with HIV may
- Stage is considered destructive but not acquire the virus
infectious Causative Human immunodeficiency virus (HIV)
- Neurosyphiltic symptoms Agent - Retrovirus that belongs to genus
o Headache, N/V, nuchal rigidity, Lentivirus
changes in mental status, o Lenti (latin) – slow
psychological and personality o The time between the infection
abnormality, speech defects, and appearance of symptoms
ataxia, paresthesia, bladder tend to be much longer
disturbances, impotence o Allowing the pathogens to be
- Cardiovascular syphilis transmitted to other hosts
o Aortitis, aortic regurgitation, - Attacks and slowly destroys the
saccular aneurysm, coronary artery immune system leading to
stenosis immunodeficiency
- Gumma - Progressive
o Chronic superficial nodule or a Mode of - Sexual intercourse
deep granulomatous lesion that is Transmission - Perinatal transmission
solitary, asymmetric, painless, and o Pregnant women to a fetus
indurated o Pregnancy, childbirth,
o Lesions obstruct the blood supply, breastfeeding
may result to necrosis of the o Greater risk of transmission
affected areas when the mother has advanced
o Commonly develop on the skin, AIDS
bones, mouth, larynx, liver, and - Infected blood
stomach o Blood transfusion
Medical Management o Sharing infected syringes,
Early Syphilis Penicillin G benzathine IM needles among IV drug uses
- Interferes with the growth of the o Organ donation
spirochete o Accidental exposure to blood
Non- Tetracycline (contraindicated in pregnancy) and blood products in hospital or
pregnant - Oral tetracycline clinic
allergic to - Or doxycycline Pathogenesis
penicillin - 15 days for early syphilis or 30 days for - Acute HIV infection occurs 3 – 8 weeks
late infection - Invades immune cells such as lymphocytes, macrophages,
- Patients receiving treatment must abstain Langerhans cells, neurons within the CNS
from sexual contact until syphilis is - Invades CD4 cells attach to protein molecule CD4, found in
completely healed surface of CD4 cells
o Inserts the genetic material into the cells nucleus
taking over the cell to replicate itself
Nursing Management o Eventually the CD4 cell dies
- Stress the importance of completing the course of o Virus continues to invade more CD4 cells
treatment o CD4 cells – subset or part of lymphocyte, primary
- Practice universal precaution targets of HIV
Secondary - Keep the lesions dry - Acute illness
syphilis - Dispose contaminated materials o Symptoms may occur within months or years
Cardio - Check for signs of decreased CO o Fever, rashes, joint, muscle pain
vascular o Deceased UO, Hypoxia, Decreased - Chronic illness
Syphilis sensorium o Occurs when opportunistic infections infect the
- WOF pulmonary congestion individual
Neurosyphili - Regularly check for LOC - AIDS
s o Mood and coherence o Severe clinical manifestations such as Kaposi’s
- WOF signs of ataxia sarcoma or Cryptococcal meningitis
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- CD4 <200/mm3 – diagnosed with AIDS May also occur late in the HIV infection
- Memory loss Compromised immune system can no
Tuberculosis
- Altered gait longer respond to the TB antigen
- Sleep disorders May be disseminated to
- Chronic diarrhea – GI symptoms extrapulmonary sites (outside the
- Healthy adult generally have a CD4 count of 500 to lungs) such as the brain, bone,
1500 /mm3 of blood pericardium, stomach, and
- Person may remain asymptomatic and may feel and peritoneum
appear healthy for year even when affected with HIV GI Fungal infection, creamy white patches
Oral candidiasis
- Immune system is already impaired, individual may exhibit manifestations in the oral cavity,
neurological symptoms If left untreated, will affect the
Stages of HIV infection esophagus, Patient experiences
Primary Acute HIV infection / syndrome difficult and painful swallowing,
Infection - Earliest stage retrosternal pain
- Flu-like symptoms Occurs when the patient goes into
syndrom
Wasting
o Fever, headache, rash hypermetabolic state. Excessive
e
- High-level of viral replication calories are burned and lean body
o Virus attacks and destroys mass is loss
infection fighting CD4 cells Diarrhea, GI malabsorption, anorexia
- HIV in the blood is very high Oncologic Most common HIV related malignancy
o Greatly affects the risk of HIV manifestations Associated with a low CD4 count.
sarcoma
Kaposi’s
transmission Brownish pink cutaneous lesion which
- Lymphadenopathy, rash & muscle ache can appear anywhere in the body and
o In about 3 weeks may be raised on just flat on the skin
o Symptoms may resolve in 3 to 4 Second malignancy associated with
weeks because of the immune
lymphomas
AIDS
system begins to gain control
B-cell
Develops outside the lymph nodes and
over the virus spread out to the brain bone marrow
Clinical Latency Chronic HIV infection and to the GIT tract
/ - HIV continues to multiply Neurologic Memory deficit, difficulty in
Asymptomatic - Usually advances to AIDS in 10 years of Manifestations
encephalopathy
concentrating, slowed psychomotor
HIV infection longer progressed to delayed verbal
HIV
o In some people, AIDS may responses, hallucination, spastic para-

advance faster paresis, seizures, blank-stare, mutism,
- Infected may not have any HIV related death can follow anytime
symptoms but still can spread HIV to Degenerative disorder that affects the
others
myelopat
Vascular
general and posterior column of the

Acquired Final and most severe
hy
spinal cord, resulting in spastic para-

Immune - Immune system is severely damaged paresis, ataxia, and incontinence
Deficiency - Body can no longer fight off
Diagnostic Procedures
Syndrome opportunistic infections
(AIDS) - Decreased CD4 count - Western blot analysis
- People are diagnosed with AIDS is CD4 o Confirmatory diagnostic test
count is less than 200/mm3 o Used to detect HIV antibodies
o Determine specific protein from a protein sample
- Enzyme linked immunosorbent Assay (ELISA)
- Oraquick HIV test
o Oral swab test that provides results in 20 minutes
- Home access HIV-1 test system
o Finger prick test result is available after 24 hours
Manifestations also vary according to body part being affected:

Respiratory Pneumocytis jirovicci pneumonia (most common)
Manifestations - Mycobacterium avium
Mycobacterium
avium complex
- Mycobacterium intracellulari
- Mycobacterium scrofulaceum
(MAC)
Medical Management
Acid-fast bacilli, usually infects the
respiratory system, but can also affect Antiretroviral - Increases CD4 count more than 200 /
the GIT, lymph node and bone marrow drugs mm3 of blood
- Medications that are used to treat HIV
but not to cure
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- Inhibits the reproduction of HIV A branch of public health that deals with the study of preventing
Reverse Reverse transcriptase is needed illnesses by managing the environment and changing people’s
transcriptas to copy the information for virus behavior to reduce exposure to biological and non-biological
e inhibitors to replicate agents of disease and injury
Protease Inhibits the enzyme protease, “External factors that affects human beings from the air we
inhibitors protease needed to the assembly breathe, food, water. And a much wider impact of human made
of the viral particles hazards on the world around us” Chartered institute of
4 C’s of Counselling education with regards to facts environmental health
management about HIV/AIDS, how to avoid Major Environmental Health and Sanitation Program
contracting the disease PD 856 – Sanitation Code of the Philippines
Compliance ensuring the client receives the - Promulgated by late president Ferdinand Marcos
correct information and council - Signed on December 23, 1975
to enforce treatment and Presidential Decree No. 853 Series of 1975 “The Sanitation Code of
prevention successfully the Philippines”
Contact tracing and providing treatment Water Supply Sanitation Program
tracing on partners Approved type of water facilities:
Condoms provision of condoms and Level I (Point - Protected well or a developed spring
instructions on the use Source) with an outlet but without a distribution
Nursing Management system
- Health education - Serves 15 – 25 households
o Instruct about the MOT, transmission, medical - Outreach must not be more than 250
management, manage the disease process meters from the farthest user
- Give correct information - Indicated for rural areas
- Impose confidentiality Level II System with a source, a reservoir, a piped
- Avoid judgmental comments (Waterworks distributor network and household taps
- Use positive statements System or
- Universal standards Individual
o Thorough medical handwashing after every contact Household
with the patient Connections
o After removing the gown and gloves Approved type of toilet facilities:
o Before leaving the room of the person suspected Level I Non-water carriage toilet facility
with AIDS - Pit latrines, reed odorless earth closet
- PPE Toilet facilities requiring small amount of water
o Universal barrier - Pour flush toilet and aqua privies
o Cap, mask, glove, face shield, goggles, disposable Level II On site toilet facilities of the water carriage type
gowns with water-sealed and flush type with septic
vault / tank disposal facilities
Level III Water carriage types of toilet facilities connected
to septic tanks and or sewerage system to
treatment plants
Food Sanitation Program
- Inspection and approval of all food sources, containers,
and transport vehicles
- Health certificate for food handlers including ambulant
food vendors
- Training of food handlers
- Rule in Food Safety “When in doubt, throw it out”
Four Rights in Right - Buy fresh
Food Safety Source - Look at expiry dates
- Avoid canned foods with
dents and bulges
- Clean and safe source of
water
- Boil water at least 2
minutes
Right - Avoid contact between
Preparatio raw food and cooked
n foods
- Buy pasteurized milk and
ENVIRONMENTAL HEALTH AND SANITATION
fruit juice
- Hand washing
ENVIRONMENTAL HEALTH
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- Remove food droppings

Right - Cook food thoroughly 70
Cooking degrees centigrade
- Eat the food immediately ONCOLOGY NURSING
- Hand washing before and
after eating CANCER
Right - Food at room Cancer is credited to the Greek physician Hippocrates, the father of
Storage temperature not more medicine.
than 2 hours Cancre = crab or crab like, cancer is characterized by finger-like
- Tightly seal the spreading projections into surrounding tissues similar to a crab.
containers Occurs through mutation in specific genes.
- Store in hot conditions Is a complex of diseases which occurs when normal cells mutate
avoid 60 centigrade, cold into abnormal cells that take over normal tissue, eventually harming
conditions 10 degree and destroying the host
centigrade A large group of diseases characterized by:
- Do not overburden the - Uncontrolled growth and spread of abnormal cells
refrigerator - Proliferation
- Reheat food before - Metastasis = spread from one organ to another that is not
eating directly connected
ONCOLOGY
Branch of medicine that deals with the study, detection, treatment
and management of cancer and neoplasia
Branch of medicine that deals with the prevention and diagnosis of
cancer, field/study of tumors and neoplasms
Root Words
Neo New A- None
Plasia Growth Ana- Lack
Plasm Substance Hyper- Excessive
Trophy Size Meta- Change
+Oma Tumor Dys- Bad, deranged
Statis location
Characteristic of Neoplasia
Uncontrolled 1. Benign
growth of 2. Malignant
abnormal 3. Borderline
cells
Key areas Differentiate benign to malignant
1. Differentiation
a. Well differentiated neoplasms =
similar to the normal cells, but
not normal cell itself, with
changes
b. Undifferentiated neoplasms =
new growth is totally different
from the normal cells
2. Capsulation = refers to if a cell is enclosed
in a capsule or not
3. Growth rate = refers to if a cell grows
slow or fast and uncontrolled
4. Local invasion = if a cell invades a local
area and surrounding tissues
5. Metastasis = cell has the capacity to
distant body organ
Benign - Well differentiated
- Slow growth
- Encapsulated = enclosed in a capsule
- Non-invasive = because it is encapsulated
- Does NOT metastasize
Example is a fibroid
Malignant - Undifferentiated / anaplasia
o Anaplasia – hallmark of malignant
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neoplasms, presence of non- shape, in the organization of cells, may

functional cells precede to becoming cancerous, highly
- Erratic and uncontrolled growth pleomorphic = changes in size, shape, will
- Expansive and invasive lead to changes of the function of the cell
- Secretes abnormal proteins = when a itself
cancer begins to mutate, creating Malignant Anaplasia
abnormal protein, provides different - Hallmark of malignant neoplasms
information, multiply uncontrollably, - Harmful to the client
more cancerous Invasion and Invasion
- METASTASIZES Metastasis - Direct migration and penetration of
Borderline cancerous cells into neighboring tissues
Metastasis
- Ability of cancer cells to penetrate into
lymphatic and blood vessels, circulate
into the bloodstream, invade normal
tissues elsewhere in the body
Neoplasm Nomenclature
- Low malignant potential neoplasms (tumor is named according to:)
- Difficult to detect, until they are advanced Parenchyma, - Hepatoma – liver
in size or stage organ or cell - Osteoma – bone
Loss of - Myoma – muscle
Normal Pattern and - Fluid-filled - cyst
Growth structure, - Glandular – adeno
Control either GROSS - Finger-like – papillo
or - Stalk - polyp
MICROSCOPI
C
Embryonic - Ectoderm – gives rise to the nervous
origin system, skin and other tissues
- Endoderm – GIT, lungs, pancreas
- Mesoderm - muscle cells, connective
tissues
Benign Suffix- “OMA” is used
- Cancer arises from a loss of normal Tumors - Adipose tissue – LipOMA
growth control - Bone – osteOMA
- Cell proliferation = increase in number is - Muscle – myOMA
regulated - Blood vessels – angiOMA
- In cancer, balance is disrupted, can result - Fibrous tissue – fibrOMA
from loss of ability to undergo apoptosis Malignant Named according to embryonic cell origin
– mechanism by which cells normally self- Tumor Ectodermal, endodermal, glandular, epithelial
destruct - Use the suffix- “CARCINOMA”
- Uncontrolled growth = neoplasms o Pancreatic AdenoCARCINOMA
- Cell division = process is an inherent o Squamous Cell CARCINOMA
adaptive mechanism in replacing body Mesodermal, connective tissue origin
cells that needs to die or replaced - Use the suffix-“SARCOMA”
Growth Patterns o FibroSARCOMA
Benign - Hypertrophy – increase in cell size, non o MyoSARCOMA
pathological or pathological o AngioSARCOMA
- Hyperplasia – increase in number of cells, PASAWAY “OMA” but malignant
caused by response to specific stimulus - Hepatoma – liver cells
- Metaplasia – when a cell type is converted - Lymphoma – lymphatic system
into another cell type, most commonly - Glioma – glial cells
seen in squamous cell (soft), can be - Melanoma – skin cancer
reversible if the stimulus is temporary. THREE germ layers
Squamous metaplasia – if the stimulus is - Teratoma – involves 2 or more of the
persistent. germ layer, testicular teratoma
o Bronchial cells – chemicals from the Non-neoplastic but “OMA”
smoke can alter the lining of the - Choristoma – excess of tissue in an
cells from smooth to rigid, may abnormal tissue, pancreatic tissue in the
progress to dysplasia duodenum
- Dysplasia – abnormal changes in the size, - Hamartoma – excess of normal tissue
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What Causes Cancer?
Etiology of Cancer
- Viruses / bacterias – gastric helicobacterpylori
- Chemical carcinogens – heavy smokers, artificial
sweeteners
- Physical agents – exposure to radiation, irritants, sunlight
- Hormonal factors – oral contraceptives, estrogen
- Genetic factors – history of colon cancer, pre-menopausal
breast CA
- Dietary – alcoholic
- Immune disease - AIDS
Population-based studies
Cancer arise with different frequencies in different areas of the
world
- UK – lung cancer
- China – liver cancer
- Australia – skin cancer
- Japan – stomach cancer
- US – colon cancer
- Canada – leukemia
- Brazil – cervical cancer
- In Ph, malignant neoplasms 3rd predominant, males – lungs
and prostate CA, females – breast CA
The Cell Cycle
(3 Types of Cells)
Permanent Who go out of the cell cycle, does not undergo
mitosis, once they reach maturity
- Neurons and cardiac muscle
Stable Quiescent
- Dormant type of cells
- Multiply only when needed
- Regrow unless injured or traumatized
- Spend most of the time in the quiescent
phase (dormant)
- Can be stimulated to enter the cell cycle
when needed
- Liver and kidney
Labile - Continuous divides and replaces cells with
limited lifespan
- Skin, endometrium, blood cells
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Failure of the
immune
response
theory
Stages of Cancer Cell Growth
Initiation Irreversible mutation of a gene that leads to
malignant transformation
Promotion Promoting agent stimulates the growth and
division of a cell
Transformatio Series of changes that lead to the characteristics
n of undifferentiated cell
Metastasis Tumor has properties needed to spread to other
organs in the body
Factors Influencing Cancer Development
Host
Environmental Chemicals
Agents Radiation Ionizing
- X-ray, gamma rays,
cosmic rays
- UV rays (UVA, UVB, UVC)
Non-ionizing
Dietary - Alcohol
Substance - Fats
s - Nitrate and nitrates
Viruses, - DNA viruses
bacteria, - RNA viruses
parasites - H. pylori
- Schistosoma hematobium
- Opisthorchis viverrrini
Cell Cycle Amount of time required for a cell to move from
7 Fundamental Changes in Malignancy
Time one mitosis to another mitosis
1. Self sufficiency in growth signals
- From one mitosis to another mitosis
2. Insensitivity to growth-inhibitory signals
Doubling Is the length of time it takes for a tumor to double
 Tumor suppressor genes
Time its volume
 Gate keepers
- Important parameter to check how to
 Care takers
cancer cell duplicate
3. Evasion of apoptosis
- Average doubling time – approximately 2
4. Defects in DNA repair
months
5. Limitless replication potential
- Testicular doubles every month
6. Sustained angiogenesis (VEGF)
- Prostate tumor – doubles every year
7. Ability to invade and metastasize
Tumor Tumor growth scaled by Gompertzian Tumor
MOLECULAR BASIS OF CANCER
Growth Growth
Manifestation will occur after 10 years

Cancer cells rapidly growths
ONCOLOGY NURSING
Carcinogenesis How Cancer Spreads?
Theories 1. Lymphatic
Cellular - Oncogenes 2. Hematogenous
Transformatio - Tumor suppressor genes 3. Direct Spread
n & Metastatic Cascade
Derangement
theory
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Chemotherapy
- Destroys normal and abnormal cells
- Route: Oral and IV (common)
- SE: phlebitis / extravasation (highly vesicant)
Chemotherapeutic Drugs
- Vinca alkaloids
- Alkylating agents
- Antimetabolite
- Antitumor-antibiotics
- Hormonal drugs
Treatment Modalities
Vinca Indication: Leukemia
Alkaloids - Vincristine (oncovin)
- Taxanes
o Paclitaxel
o Tacetaxel
AE: teratogenic
CI: Renal failure
SE: Neurologic
- Tingling
- Numbness
- Constipation
- Paralytic ileus
Alkylating Nitrogen Mustard (Cyclophosphamide)
Agents WOF: hemorrhagic cystitis
Mngt:
- Clonal expansion, growth, diversification, angiogenesis - Increase OFI
- Metastatic subclone - Given with food
- Adhesion to and invasion of basement membrane Nitrosureas
- Passage through extracellular matrix - Carmustine
- Intravasation - Comustine
- Interaction with host lymphoid cells - Streptozin
- Tumor cell embolus Alkylating Like
- Adhesion to basement membrane - Busulfam
- Extravasation o WOF: increased uric acid
- Metastatic deposit - Carboplatin
- Angiogenesis - Cisplatin
- Growth o WOF: ototoxic and nephrotoxic
General Promotive and Preventing Nursing Management Anti- Hydroxyurea
1. Lifestyle modification (Stress reduction) metabolites Fluorouracil
2. Early detection (Screening) Methotrexate
3. Nutritional management WOF:
4. Screening - Increased uric acid
General Warning Signs of Cancer - Hepatotoxicity
C Change in bowel / bladder habits - Photosensitivity
A Sore that does not heal - Antidote: Leucovorin or folinic acid
U Unusual bleeding or discharges Antitumor- Bleomycin
T Thickening or lump in the breast or elsewhere Antibiotics Daunorubicin – daunomycin
I Indigestion or difficulty in swallowing Doxorubicin
O Obvious change in warts or moles WOF:
N Nagging cough and hoarseness - Cardiotoxic (heart failure)
U Unexplained anemia - Dysrhythmias
S Sudden weight loss - Cardiomyopathy
Hormonal Antiandrogen
Drugs - Finasteride
- Saw palmetto
o WOF:
 Gynecomastia
 Virilization
Side-effects of Chemotherapy
ONCOLOGY NURSING TREATMENT MODALITIES Hair - Temporary ALOPECIA
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- 14 days after chemo Sealed Intracavitary Cesium)

- Hair grow 3 – 6 months implant - Left inside the body
o Management - Usually for cervix
 Mild shampoo - No radiation in secretions,
 Wide-tooth comb tears, urine, and feces
 Wigs, hats, turban hats, Safety Time 30 mins or <8hrs or once per shift
scarfs Principles Distance 6 ft away and stand at the foot of the
Mucus - Stomatitis bed
Membrane - Dysgeusia Shield Lead apron
- Xerostomia Nursing Management
o Management - Room
 Avoid hot, spicy, citrus, o Private room with private bathroom (put radiation
alcoholic mouthwash precaution outside)
 Increase fluids - Rn should never come into contact with more than 1 client
Stomach Management with radiation implant at a time
Lining - Antiemetic 30 minutes before chemo - Bed linens are not removed: unless if source is removed
Extravasation Management - RN should wear dosimeter badge
- Stop and notify the physician  If dislodged
ANTIDOTE - Wear long lead apron
Sperm Management - Long-handed forceps
(Aspermia / - Cryopreservation - Lead container
Sterility) - Call the radiation oncologist
Bone Marrow Management - document
Depression - Infection control
(Pancytopenia - Bleeding precaution SCREENING TESTS
) Breast Self Starts at 20 years (monthly)
Radiation Therapy Examination TIME:
- Decreases tumor size - NORMAL: 5 – 7 days after menstruation
- CI: pregnancy, immunocompromised, children <6 yo (breast is less tender)
o Types - (+) menopause / irregular
 Brachytherapy (internal) o Same day monthly
 Teletherapy - (+) taking pills
Teletherapy - External o Before taking 1st pill
- Destruction of abnormal cells only POSITION:
- Done in the radiation room - Standing in front of mirror
- Radiation remains in the room - Lying with pillow
- LART (Linear acceleration radiation PALPATE:
therapy) - Horizontal
- Put markings opposite the tumor - Vertical
location site - Circular
- WOF: leukopenia - Pinch the nipple (note for discharge)
- SE: dry or wet desquamation of the skin Mammograph - Starts at 40 years old
- Head: dry mouth, mouth sore, y - Uses 2 metal plates that compress that
decreased taste breast (horizontally and oblique)
Intervention - CI: pregnancy and breast implants
- Avoid creams, lotions, powder, and oil - Management:
at the site o Avoid deodorant or talcum
- Wash with mild soap and water and pat powder
dry o False (+) – presence of calcium
- Do not remove markings unless done crystals
with sessions Pap Smear - 18 y/o and above or when sexually
- Avoid sun exposure active
- Wear loose clothes - ANNUALLY
- Avoid belts, buckles, or strap o If (-) for 3 consecutive years, next
Brachytherapy - Radiation in continuous contact with is done every 3 years
tumor - MNGT:
- Radiation source is within the patient o Avoid douching (may give false
Types negative result)
Unsealed - Given IV/Oral/IM Testicular - Same day each month
- Iodine 131 Exam - After warm bath
- With radiation o Lift each testicle
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o Normal: firm, not hard, and

smooth
o Both hands on testicles and
thumb on top
o Roll testicles between thumb and
fingers
Digital Rectal - 40 y/o and above
Exam (DRE) - MEN: bending forward
o Check prostate gland
- WOMEN: lithotomy
o Check uterus and hemorrhoids
Sigmoidoscopy 50 y/o (every 3 – 5 years)
Tumor PSA (Prostate Specific Prostate cancer
Markers Antigen)
PAP (Prostate Acid Advanced prostate
Phosphatase) Cancer
ALP (Alkaline Metastatic prostate
Phosphatase) cancer
CA 125 (Cancer Antigen Ovarian cancer
125)
CEA (Carcinoembryonic Colorectal / cervical
Antigen)
AFP (Alpha Testicular / lung cancer
Fetoprotein)
HCG (Human Chorionic Choriocarcinoma
Gonadotropin
Hormone)
CA 19-9 (Cancer Pancreatic / bladder
Antigen 19-9) cancer
CA 15-3 (Cancer Antigen Breast cancer
15-3)
NSE (Neurospecific Neuroblastoma
Enolase)
Biopsy Definitive test for cancer
- Histological proof of cancer
Types
- Needle (aspiration)
- Incisional (wedge tissue)
- Excisional (entire)
CNS CANCER
(Brain and Spinal Cord Tumors)
ANATOMY
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BRAIN TUMORS
Classification - Classified by cell of origin
System - Mitotic activity
- Microvascular endothelial perfusion
- (+) necrosis
Tumor I Tissue is benign (slow-growing)
Grading II Tissue is malignant (slow-growing)
III Malignant tissue has cells are actively
reproducing abnormal cells
IV Malignant tissue has cells are reproducing
rapidly & form new vessels
Tumors
1. Neuroepithelial (Glioma)
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A. Astrocytoma a / Acoustic
B. Oligodendroglioma Neuroma
C. Oligoastrocytoma (Mixed Glioma)
D. Ependymomas
E. Embryonal (PNET) SYMPTOMS OF BRAIN TUMORS
Astrocytoma I Pilocytic Astrocytoma (JPA)
Grading II Astrocytoma
III Anaplastic Astrocytoma
IV Glioblastoma Multiforme (GBM)
2. Meningeal Tumor (Meningioma)
- Increased intracranial pressure
o Monro-kellie hypothesis
1. Intraventricular 6. Foramen magnum - Headache
2. Parasagittal 7. Convexity - Vomiting
3. Falcine 8. Olfactory groove - Visual disturbances
4. Suprasellar 9. cerebellar - Localized symptoms
5. Clivus o Hemiparesis
3. Sellar Tumors o Seizures
A.Pituitary o Mental status changes
Adenoma Motor Cortex Generalized seizures
Occipital Lobe Visual manifestations
Cerebellar Ataxia, dizziness, gait problems, nystagmus
Frontal Lobe Personality, emotional, and behavioral changes
Cerebellopontine - Tinnitus, vertigo, deafness
Angle (Acoustic - Facial and tongue numbness (5th
B.Cranio Neuroma) cranial nerve affectation)
pharyngiom - Facial paralysis (7th cranial nerve
a affectation)
General Signs
- Headaches
- Nausea and vomiting
- Memory problems
- Seizures
- Vision problems
4. Schwannoma - Problems associated with hearing or speech
- Problems with balancing or walking
SPINAL CORD TUMORS
Type of Tumors - Intramedullary

- Intradural-extramedullary
- extradural
Vestibular - Puts pressure on the facial nerve

Schwannom - Location: Cerebello-pontine angle
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o Tumor debulking
o To relieve s/sx & decrease
Increased ICP prior to Radiation
Therapy
Transsphenoidal
Surgery
Transsphenoidal Indicated for Pituitary Tumors

Hypophysectom - Hypophysectomy – removal of
Risk Factors Ionizing - Cosmic y pituitary gland (also leads to
Radiation - Gamma infertility)
- X-Ray Nursing Interventions
- Ultraviolet (UV) H Head of bed should be elevated
Non- - Visible light E Evaluate VS, LOC, NVS
ionizing - Infra-red A Avoid sneezing, coughing, blowing of
Radiation - Microwaves nose
- Radio frequency aD ADH disturbances - polyuria
Other Risk h
Factors Shunt Surgery - Done to divert CSF flow
Endoscopic Third
Ventriculostomy
(ETV)
Common Symptoms of Spinal Cord Tumors

- Back pain
- Unsteady gait
- Possible paralysis
Diagnostic Tests
Adult 1. CT scan
2. MRI with contrast
3. Biopsy SURGICAL CARE
**MRS (Magnetic resonance spectroscopy) Steroids
Pediatric  MRI Antacids
 Surgical biopsy
Antibiotics
 Lumbar puncture
Anti
Treatment & Management
convulsants
(For ADULT and PEDIATRIC Patients)
- Verbal and written instructions
Stereotactic
- Consent
Radiosurgery
- Infection control
(SRS)
- LOC
Stereotactic
- Support
Biopsy
- Hospital and community resources
Proton Therapy
Interstitial A radioactive material is surgically introduced
Craniotomy - Done for both Dx & Tx Brachytherap inside the tumour and is maintained for a variable
- Benign (meningioma, schwannoma) y amount of time
o Complete tumor resection
- Malignant
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Drug-loaded
Nanocarriers
(DLNs)
Radiation Therapy Care

- REPORT: nausea and vomiting
Chemotherapy
Temozolomide (methylating agent – DNA-damaging agents)
- 5 days in 28d cycle (lower if w/ RT) Protective 1. Exercise
- Blood tests before next dosing, once low blood count Factors 2. Breast feeding
recovers, lower doses will be used
3. Pregnancy before 30 y/o
Nitrosureas
Summary of A History of ALONE
- Carmustine IV q6-6weeks, Iomustine PO HS q6wks
Risk Factors - Age
- Cisplatin, carboplatin
of Breast - History of family Ca, prior Dx
- Etoposide
Cancer - Abortion / abnormality in BRCA1 and 2
- Ifosfamide
- Late menopause
- Nitrosureas
- Obese
- Indicated for <3y/0
- Nulliparity
- Placed in the chest well for easier access for drug
- Early menarche
administration
Prevention & Early Detection: BSE & CBE
General line access:
- Groshong catheter LMNOP - Lumps
- Broviac catheter - Mammary changes dimpling, tenderness,
- Hickman catheter abnormal contours
- Port-A-Cath - Nipple changes retraction, lesions and
Minimizing heparin use with the three-way Groshong valve discharges
- Other symptoms size, symmetry, skin
Negative Opens valve inward, permitting blood
appearance, color, direction of pointing,
pressure aspiration
rashes, ulceration
Positive Opens valve outward, allowing infusion
- Patient risk factors
pressure
Signs and Symptoms
Neutral Valve remains closed, reducing risk of air
pressure embolism, blood reflux, and clotting - Lump or thickening in breast. Often painless
- Most Common
Chemotherapy Care
- Discharge or bleeding
- Anti-emetics
- Change in size or contours of breast
- Steroids
- Change in color or appearance of areola
- Mannitol
- Redness or pitting of skin over the breast, like the skin of
- LOC an orange
- Manage side effects of each medication
Types of Breast Cancer
BREAST CANCER
BREAST CANCER
- The leading type of cancer among women
- October is breast cancer awareness month
Breast - A gland located at chest wall
- 15 – 20 lobes in radial pattern (milk
producing)
- Tissue extends to the clavicle, sternum,
latissimus dorsi muscles up to the axilla
Axillary - Drain lymphatic fluid from the breast
nodes - Low in the armpit to lateral border of
pectoralis minor (level 1) Non-invasive In Situ
- Midway behind pectoralis minor (level II) - Lobular
- Above the medial border of pectoralis - ductal
minor (level III) Invasive - lobular
- ductal
Others - Paget’s disease of nipple / areola
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- Inflammatory
- Rare types
- Men
Ductal -
Carcinoma in
situ (DCIS)
Infiltrating - Ductal cancer cells breaking through the
Ductal wall
Carcinoma - The cancer has spread to the surrounding
tissues
- Carcinoma refers to any cancer that
begins in the skin or other tissues that
cover internal organs Diagnostics
Infiltrating - Lobular cancer cells breaking through the Prevention & Early Detection: Molecular Breast Imaging
Lobular wall Tc-99m scintimammography or breast specific gamma
Carcinoma (Technetium- imaging
(ILC) 99m)
Medullary Tumors grow in a capsule inside a duct (<50YO) sestamibi
Carcinoma - Ductography / Injection of less than 1 mL of radiopaque material
Mucinous A slow-growing mucin-producing tumor (post Galactrograph via cannula inserted into a ductal opening on the
Carcinoma menopausal - >75YO) y areola, followed by a mammogram
- Needle Biopsy Steps
Tubular Axillary metastases is uncommon; good prognosis A. Lesion is accessed with trocar needle
Ductal - B. Stylet is removed from trocar needle
Carcinoma C. Core biopsy system is placed through
Inflammator Aggressive / rare type: the trocar needle. Multiple passes are
y Carcinoma - characterized by unique s.sx made with only a single pass through
- brawny erythema (peau ‘d orange) d/t the capsule and a single localization
blockage of the lymph in the skin Sentinel - A surgical procedure used to determine
Paget’s Characterized by scaly, erythematous, pruritic Lymph Node whether cancer has spread beyond a
disease lesion of the nipple Biopsy primary tumor into your lymphatic
system.
Staging of Breast Cancer - It’s used most commonly in evaluating
breast cancer and melanoma
- the American Joint Committee on Cancer (AJCC) has
designated staging by TNM Management
- T = tumor size Pre-operative Care
- N = lymph node involvement 1. Consent
- M = metastasis 2. Operative site
Stage I - Tumor ≤ 2.0 cm in greatest dimension 3. IV line
- No nodal involvement (No) 4. Post-operative teachings
- No metastases (Mo) Post Operative Care
1. Wound care
Stage II - Tumor > 2.0 ≤ 5 cm or
2. Positioning (lymphedema)
- Ipsilateral axillary lymph node (N1)
3. Skin integrity
- No metastasis (Mo)
4. Clothing
Stage III - Tumor > 5 cm (T3) 5. Arm exercises (lymphedema)
- Or ipsilateral axillar lymph nodes fixed
Post-operative Exercises
to each other or other structures (N2)
1. Rope turning
- Involvement of ipsilateral internal
2. Rod or broomstick
mammary nodes (N3)
3. Pulley tugging
- Inflammatory carcinoma (T4d)
4. Wall hand climbing
Stage IV Metastatic Breast Cancer
Breast Conserving Surgery
- Any T
Lumpectomy
- Any N
- Metastasis (M1) Partial
Mastectomy
Diagnostics
Total (Simple)
1. CEA, CA 15-3, CA 27-29
Mastectomy
2. HER2 / neu
Modified
- Human epidermal growth factor receptor 2
Radical
3. ER-PR test
Mastectomy
- Estrogen receptor / Progesterone receptor rest
4. Mammography
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RECONSTRUCTIVE
Definition LUNG CANCER

Definition
Anatomy Review
Radiation Therapy
- Primarily for treatment of high risk of local recurrence
- External beam radiation therapy
- Target: affected chest wall & regional lymph nodes
Purposes 1. Pre-operative (Stage III)
2. After breast-conserving surgery
3. DCIS
4. Radiation boost
Accelerated Is a localized type of radiation therapy that
-partial specifically treats an area of a breast which a tumor
Breast was removed.
Irradiation
Radiation - Skin discomfort / breakdown
Therapy - Pain (inflammation of nerves & / or
Side Effects pectoral muscles)
- Lymphedema aggravation
- ROM difficulties
Chemotherapy
Commonly Used Drugs
A.Adjuvant CAT
- Cyclophosphamide
- Adriamycin
- Paclitaxel
MF/E
- Methotrexate
- Fluorouracil
- Epirubicin
B.Hormone - Selective estrogen receptor modulators
Therapy (SERMs): Tamoxifen
- Competes with estrogen
- Aromatase inhibitors: Anastrozole
- Lower estrogen levels by stopping an
enzyme in fat tissue (called
aromatase) from changing other
hormones into estrogen
- *aromatase – turns androgens into
small amount of estrogen
- Estrogen Receptor Downregulators (ERDs):
Faslodex, Exemestane
- Luteinizing Hormone-Releasing Hormone
(LHRHs): Zoladex, Lupron
- Shuts down ovaries and stop them
from producing estrogen
C.Targeted Trastuzumab (Herceptin)
- (+) lymph node involvement & increased
HER2 / neu
For Breast Tumor Metastasis Risk Factor
- Doxorubicin (Adriamycin) Smoking - Active and passive (environmental
- Hormonal manipulation Nolvadex, Megace, Apo-Megestrol tobacco smoke
Chemotherapy Care - 87% of lung cancer deaths
A. Risk fo recurrence Active
1. P.E Schedule 1. Mortality = 23x for males (13x for
2. Mammography females)
B. Psychosocial – long term 2. Development = increases; start at
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early age, smoked for # year, smoked bronchoalveolar carcinoma.

greater # cigarettes - Further classification of NSCLC is according to cell type
- Same # smoked = F>M SCLC
COPD Oat Meal Carcinoma
Vape e-cigarette - Rapid cell growth
Diet - Retinoid (b-carotene) for smokers - Rapid spread
Environmental 1. Radon - Strongly related to cigarette smoking
Factors 2. Asbestos - Great sensitivity to chemo and radiation
- Arise from KULCHITSKY’S cell (central endobronchial
Genetics
location)
Prevention & Screening
Staging of - Limited disease within a tolerable
Small Cell radiation field
Diagnostic Tests Lung Cancer - Extensive disease distance metastases
1. Bronchoscopy SCLC: Stage (VALG – veterans administration lung
2. Chest x-ray cancer group)
Bronchoscopy - TNM rarely used as patient have locally
Chest X-ray advanced or systemic metastasis at the
Sputum Smear time of Dx
Bone Scan SCLC: - Brain
Flexible Extensive - Bone marrow
Fiberoptic Stage - Liver
Bronchoscopy SCLC: S/sx - Blood when coughing or spitting
Diagnostics: Invasive - Recurring respiratory infections
Light-induced - Invasive diagnostics - Enduring cough that is new or different
Fluorescence - Ache or pain in shoulder, back, or chest
Endoscopy - Trouble breathing (SOB)
(LIFE) - Hoarseness or wheezing
Mediastinoscop - Exhaustion, weakness, loss of appetite
y (dysphagia)
Endobronchial NSCLC
Ultrasound
(EBUS)
Diagnostics: Metastasis
FDG – PET Scan Fluorodeoxyglucose
- ACS recommended
LUNG CANCER STAGING
TYPES 1. Small cell lung carcinoma

(WHO) 2. Squamous cell carcinoma
3. Adenocarcinoma
4. Large cell carcinoma
Classification
Small Cell Lung Cancer
- Accounts for about 10 – 15% of tumors
- Generally, includes small cell carcinoma and combined Types - Squamous cell carcinoma
small cell carcinoma - Adenocarcinoma
Non-small cell lung cancer - Large cell carcinoma
- Accounts for other 85-90% of tumors Stages I 3 – 5 cm w/o LN OR in bronchus OR partial
- Include squamous cell carcinoma (more centrally located), lung collapse
large cell carcinoma, adenocarcinoma and II 3 – 4 cm / 5 – 7 cm, 1 or more tumor in 1 lung,
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LN may or may not be involved Lobectom To remove a tumor from one lobe of the lung
II Any size w/ LN OR grown in a major chest y - Tx of choice for st- I-III w/ thoracotomy
I structure (heart, trachea, esophagus) (ideal if confined to a single lobe
mediastinal LN or opposite side - Lobe + LN
I In both lung OR metastatic / malignant pleural Pneumo Removal of the entire lung
V or pericardial effusion (advanced) nectomy - Whole lung for centralized tumors
S/Sx Asymptomatic VATS Video Assisted Thoracic Surgery
Common Oncologic Emergencies Surgical Treatment (Nursing Management
SCC Spinal Cord Compression - Pain
A result of tumor invasion of the vertebrae and - Dyspnea
collapse of the vertebrae on the spinal cord, tumor - Arrhythmias – due to vagal irritation
invasion of the spinal canal with resulting  Chemoradiation Therapy
pressure on the cord, or primary tumors of the SCLC Cornerstone of treatment
spinal cord - LD – etoposide and cisplatin
Initial signs and symptoms - ED – platinum-based
Late signs and symptoms - Relapse:
- Loss of motor strength - <3 months
- Loss of sensation - >3 months
- Bowel / bladder dysfunction NSCLC - As adjuvant
Cardiac - For unresectable tumors
Tamponade - Platinum-based cisplatin, carboplatin and
oxaliplatin – 1st line
TREATMENT MODALITIES - Docetaxel – 2nd line
Radiation - Commonly used External
Therapy - As a neo-adjuvant therapy to shrink the Beam
tumor prior a surgery Radiation
- Complementary medication such as steroid Brachy
or dexamethasone is given to decrease the therapy
inflammation caused by the tumor Chemoradiation Therapy
Surgery - Preferred for non-small cell lung carcinoma (Nursing Management)
- Limited to stage I or sometimes stage II only - Manage the ff side effects:
- Treatment of choice for cancer that does - Esophagitis
not spread beyond the lung - Pneumonitis
- Removal does that always result in a cure - Radiation myelopathy
- Surgery may not be possible if the client has
existing serious condition such as heart
disease – would limit the client’s ability to
survive the operation
- Often less performed with small cell lung
carcinoma – less likely to be localized to one
area that can be removed
Surgical Procedure
(Depends upon the size and location of the tumor)
Surgery for lung cancer is a major surgical procedure that requires
hospitalization; as nurses consider all responsibilities securing the
consent, IV insertion, pre-op teaching, advising the client to have NPO
(8 – 12 hours), follow-up care (weeks to months), during the
procedure (general anesthesia)
Following the procedure patient may experience, DOB, SOB, Pain
and weakness
- Pneumonectomy & lobectomy = anticipate the patient is
with closed tube thoracostomy
Nursing considerations in CPT, proper positioning (reduces chances
of atelectasis), complications (bleeding, infections, atelectasis)
Wedge To remove a portion of one lobe only
Resection - Triangle-shaped tissue; targets tumor for
patient unable to w/stand extensive
procedure
- Disadvantage: high risk recurrence
- Criteria: <3cm, located at outer third, no
endobronchial extension, (-) mediastinal /
hilar node
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GERD / Barrett’s
Esophagus
Diet
Stomach Obesity
GERD
Diet (malabsorption)
Exposure to
chemicals
Family History
Liver Chronic liver injury
Age
CANCERS OF THE GASTROINTESTINAL TRACT Gender (M>F)
(UPPER GASTROINTESTINAL TRACT CANCERS) Aflatoxin B
Family History
REVIEW OF ANATOMY & PHYSIOLOGY Pancreas Age
Gender
Smoking
Diabetes Mellitus
Family History
Screening / Diagnostic Tests (Radiology Studies)
Barium Pre-test: NPO post-midnight
Swallow Post-test: laxative: instruct that stools will turn white,
monitor for obstruction
EGD Esophagogastroduodenoscopy
Visualization of the upper GIT by endoscope
Pre-test:
- ensure consent
- NPO 8 hours
- Pre-medications like atropine and
anxiolytics
Intra-test
- Position: left lateral to facilitate salivary
drainage and easy access
Post-test
- NPO until the gag reflex return
- Sims position until the client awakens
- Monitor for signs of perforation bleeding,
pain, unusual difficulty swallowing, elevated
temp
- Maintain bedrest for the sedated client until
alert
- Lozenges, saline gargles or oral analgesics
can relieve minor sore throat, after the gag
reflex returns
ERCP Endoscopic Retrograde Cholangio-Pancreatography
Biopsy
Cancer Staging
Risk Factors
Esophagus Age
Smoking
Obesity
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Stent
Endoscopic
Mucosal
Resection
Bilroth
Hepatectomy
Cryosurgery
Whipple
Procedure
Radiation Therapy
Radiation
Therapy
Brachytherap
y
SIRT Selective Internal Radiation Therapy
Nursing Care
Chemotherapy
Esophagus - 5-FU
- Cisplatin
Stomach - F.A.M. or E.C.F
- 5-FU
- Cisplatin
- Adriamycin
- Mytomycin-C
- Epirubicin
Liver - 5-FU
Esophagea - Early stages usually do not produce physical - Mytomycin-C
l Cancer symptoms - Cisplatin
- Once cancer has advanced, most common - Doxorubicin
signs and symptoms are: Pancreas - 5-FU based regimen
- Coughing or hoarseness
Chemo
- Weight loss
embolization
- Painful or difficulty swallowing
Percutaneous
- Regurgitation or undigested food
Infusion
Stomach - Dyspepsia (50%))
Nursing Management
Caner - Anorexia
- Nausea & vomiting
- Weight loss
- Bone marrow suppression
- Epigastric discomfort
- Fatigue
- N&V
- Diarrhea
- Early satiety
- Alopecia
- Hematemesis
- Orange urine
Liver - Weakness - Renal toxicity and hepatoxicity
Cancer - Losing appetite
- Nausea
COLORECTAL CANCER
- Jaundice
- White stools
- Upper abdominal pain COLORECTAL CANCER
March is Colon Cancer Awareness Month
Pancreatic - Jaundice
Cancer - Back pain Anatomy Review
- Dark urine & light stool
- Unintended weight loss
- Upper abdominal pain
- Nausea
- Pain after eating
SURGICAL MANAGEMENT
Esopha
gectomy
Esophageal
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too.
Other Risk Factors
- Previous colon cancer or polyps
- History of IBD (inflammatory bowel disease)
- Diet; high fat, high protein, LOW fiber
You are at risk if:
- Diet high in red meat and low fiber
- Relatives with colon cancer and polyps
- Overweight
- Smoking
- Above 50 years of age
Assessment
- Change in bowel habits
- Blood in stool
- Tenesmus
- Black tarry stools
- Loose, frothy stools
- Flat, ribbon-shaped
- Mahogany-colored
Flat, ribbon shaped stool is consistent with a tumor, which alters
the shape of the left colon and prevents formation and passage of
normally formed stools
Black, tarry stools are indicative of blood from the upper GI tract,
which has been in the GI tract long enough to be completely
digested
Loose, frothy stool is indicative of steatorrhea or fat in the stool.
Large amounts of fat are expelled in the stool as a result of a
variety of malabsorption syndromes
Mahogany colored stool is a symptom of right sided cancer of the
colon. It results from the mixing of blood from the tumor with the
stool and its exposure to digestive tract secretions as it progresses
through the remaining colon
- Unexplained anemia
- Easy fatiguability
- Loss of appetite
Prevention - High fat, high protein diet especially red
meat increases the risk
- High fiber diet decreases the risk
Screening, Detection, Diagnosis: FOBT
-
Fecal occult Prevent / avoid prior the test
blood test - Red meat
(FOBT) aka - Raw vegetables radish, turnips, melon,
Guaiac Test horse radish
or - Medication
Hemooccult - Aspirin
blood test - Iron
- Anticoagulants
Test should be delayed
- (+) menstruation and 3 days afterwards
- (+) bleeding hemorrhoids
Preparation
- Foods and vitamins avoided 3 days
Risk Factors before
Increasing Proctoscopy
Age Barium
Family The most common syndromes linked with Enema Double contract barium enema
History colorectal cancers are Lynch syndrome (hereditary - Apple core = stenosing
non-polyposis colorectal cancer, or HNPCC) and F.Sig and F. Sig
familial adenomatous polyposis (FAP), but other Colonoscopy Colonoscopy
rare syndromes can increase colorectal cancer risk, Other Tests Laboratory
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- CEA skin
- CA 19-9 Characteristics of stool according to anatomic site
- CBC Ileostomy - liquid stool
To check for possible metastasis - constant drainage
- Chest x-ray - cannot be regulated
- Abdominal CT scan - (+) digestive enzymes damaging the
- Liver function tests (AST/ALT) skin
Staging (TNM) - Odor is MINIMAL (fewel bacteria)
Ascending - Liquid stool
colostomy - Other attributes same with ileostomy
- Odor is a problem requiring control
Transverse - MUSHY drainage
Colostomy - Malodorous
- Usually no control
Descending - Increasingly solid fecal drainage
Colostomy
Sigmoidostom - Feces is normal and has formed
y consistency
- Frequency can be REGULATED
Changing Assessment
Complication - Obstruction a bowel Stoma Color
s - Hemorrhage diversion - Red / pinkish and slightly moist
- Peritonitis ostomy Danger!
- sepsis appliance - very pale, dark colored, dusky, bluish,
Systemic Treat the whole body purplish
Therapies - impaired circulation
Local Treat the primary site of the cancer only - NOTIFY the surgeon STAT!
therapies SIZE and SHAPE
Surgery - Slightly protruding from the abdomen
Endoscopic - New stoma: swelling is normal (2-3-6 weeks)
Polypectomy Danger!
Laparoscopic - Failure of swelling to cease may indicate a
Colectomy problem
Colon Anastomosis Stomal Bleeding
Resection: Abdominoperineal Resection (APR) - Slight bleeding when touched: NORMAL
Colostomy Danger!
Pre-operative - bowel preparation - Other bleeding should be reported
Care - diet Periostomal Skin Status
- post-operative health teachings and - Transient redness after removal of
stoma & colostomy care appliance: NORMAL
- enema Danger!
- abdominal PE (NGT to prevent - Redness and irritation should be noted
distention) - Burning sensation under the skin may mean
- monitor urine output and fluid & skin breakdown
electrolytes When to change the appliance:
- antibiotics 1 days prior to surgery Avoid times
Post- - monitor for complications - Close to meals
Operative - return of peristalsis - Immediately after meals
Care - wound (splinting) - After taking meds that stimulate bowel
- skin and stoma care movements
- early ambulation Position
- nutritional health teaching - Sitting, lying, standing
- Lying and standing: facilitates smoother
pouch application
COLOSTOMY CARE
Remove the skin barrier
- closed end pouch
- From the top working downward holding
- drainable with tail clip
the skin taut
- drainable pouch with dipless closure
Clean and dry the stoma
- urostomy pouch
- Use warm water
OSTOMY MANAGEMENT - Mild soap (optional)
Ostomy - Pat dry
- an opening for the GIT, GUT, respiratory tract onto the When to drain the pouch
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- 1/3 to ½ full
- Before sexual intercourse
What to avoid
- Gas-forming
- Apple, broccoli, cabbage, eggplant, melon,
milk, onions
Ostomy Amount
Irrigation - 500 – 1000 mL (lukewarm NSS)
- 300 – 500 mL (tap water)
Frequency
- Once a day
(+) cramping
- Temporarily STOP
Causes of cramps:
- Too fast
- Cold solution
- Introduction of air
RADIATION THERAPY
- Used alone or in combination with chemotherapy
- Neoadjuvant or adjuvant purpose
Radiation External Beam Radiatherapy (EBRT)
Therapy Brachytherapy I-192
Method Bachytherapy Y90
Radiation EBRT Health Teaching (ostomy client – additional
Therapy care)
Methods - Frequency & length
- Skin markings & skin care
- Possible side effects
CHEMOTHERAPY
- Adjuvant: FOLXFOX-4
- Every 2 weeks for 6 months
- Central venous catheter
- 5-FU and leucovorin
- Immunotherapy: Bavacizumab, cetuximab, panitumumab
The
Folfox
Regimen Two main Glandular
types Squamous
Risk HPV
Factors - Having sex at an early age
- Having many sexual partners
- Having a partner who has many sex partners
- Having sex with uncircumcised males
Smoking
- Immunosuppression
Metastasi - Chlamydia infection
- Folfox regimen
s - Diet
- FOLFIRI (leucovorin calcium (calcium
- Oral contraceptives
folinate), 5-fluorouracilm and irinotecan)
- Caplri (Xeliri) capecitabine, irinotecan Intrauterine Device
- IFL (Irinotecan, 5-FU, Leucovorin) - Multiple pregnancies
- Young age at primi
- Poverty
CERVICAL CANCER
- DES
- Family history
Cervical Cancer
Prevention - Regular pap test
Cervical Cancer Awareness Month - January
- Pelvic exam
- Condoms & HPV
- No smoking
- Vaccines
- Gardasil human papillomavirus vaccine types
6,11,16,18
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- At what age given: before they become

sexually active
- Cervarix human papillomavirus bivalent
(types 16 and 18) vaccine, recombinant
- Cervarix – stimulate immunity against
HPVs 16 and 18, thereby conferring
protection against cervical cancer. In
contrast with Gardasil, Cervarix does
not promote immunity against genital
warts
Guidelines for Ealy Detection
- PAP Test + HPV (25-65)
- 25 in cervical cancer
- Women underwent total hysterectomy: should stop
screening
- High risk of cervical cancer: need to be screened more
often and follow the recommendations of their doctors
- Women who have been vaccinated against HPV should still
follow these guidelines
The HPV
Accurate - Not on menstrual period DNA Test
Pap Test - No douche
- No sexual intercourse
2 Types of Pap Smear
1. Conventional cytology
- Pap test results
2. Liquid-based cytology
Signs & Symptoms of Cervical Cancer
- Early or pre-cancers = no symptoms
- Abnormal vaginal bleeding
- Menopausal bleeding
- Spotting between periods longer or heavier than usual
- Bleeding after douching or after pelvic exam may also
occur
- Vaginal discharges
- dyspareunia
Assessmen - medical history & physical exam
t - colposcopy
- cervical biopsies
- LEEP (loop electrosurgical procedure)
- CONE biopsy
- Endo-cervical curettage
- Cold knife biopsy
LEEP & - No intercourse
Cone - Rest for 24 hours
- Vaginal pack should be in place
Bethesda - Negative for intraepithelial lesion or Imaging Studies
system malignancy - Barium XR studies
- Epithelial cell abnormalities - CT guided needle biopsy
Results - IV urography
- Unsatisfactory
- PET
- Atypical cells of uncertain significance
- MRI
- Benign
- CT scan
- Low-grade changes
- High-grade changes
- Squamous cell carcinoma or
adenocarcinoma
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2. CBR
3. Give enema before procedure
4. FC-UB
5. Have long forceps and lead container at bedside
6. DIET: low fiber
Anti-cancer - Cisplatin
Drugs - Paclitaxel
- 5-FU
- Topotecan
- Ifosfamide
- Menopausal women – use black cohosh
- Not for 1st trimester of pregnancy
- Post 13 weeks gestation (fetal risks)
Sugery
- Recurrent / metastasis = cisplatin
- Cryosurgery
Chemo - Concurrent chemoradiation
- Laser Surgery
radiation - Cisplatin, 5FU
- Conization
- Hysterectomy
- Robotic-assisted CANCERS OF THE BLOOD
- Abdominal
- Laparoscopic ANATOMY AND PHYSIOLOGY: BONE MARROW
- Vaginal
- Radical hysterectomy
- Trachelectomy
- Pelvic exenteration
- Pelvic lymph node dissection
Radiation Therapy
- External beam
- Cisplatin
- 6 – 7 weeks
Brachytherapy
- Tandem & ovoid
- High dose
- Low dose
Internal radiation devices
- Procedure can be perofed in hospital and the patient stays
over night using cesium isotope applicator or the
procedure can be done as an outpatient with a faster
technique (called high dose rate or HDR) using iridium
isotope source (iridium 192 with half life of 74 days)
Side Effects - Anemia
- Leukopenia LYMPHATIC SYSTEM
- Tiredness Transport lymph, a fluid containing infection-fighting white blood
- Nausea and vomiting cells, throughout the body
- Upset stomach Spleen
- Loose bowels 1. Fights invading germs in the blood (the spleen contains
- Feeling sunburned infection-fighting white blood cells)
Nursing Management: Radioisotope Implant 2. Controls the level of blood cells (white blood cells, red
1. Patient’s back is turned towards door blood cells, and platelets)
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3. Filters the blood and removes any old or damage red - CNS prophylaxis (adults) intrathecally
blood cells. Post- - Consolidation – increase drug doses
TYPES OF BLOOD CANCER Remission used in induction (1-2months); HSCT
1. Leukemia suggested
2. Lymphoma - Maintenance – decrease doses (2-3
3. Myeloma years) with methotrexate and 6-MP (6-
MERCAPTOPURINE); CNS prophylaxis
ACUTE LEUKEMIA continued
Rise in the number of white blood cells in your body that don’t Refractory - Newer or more intensive doses of
work right chemo drugs may be tried
Acute - Also called lymphocytic leukemia and - HSCT
Lymphoblasti acute lymphoid leukemia Relapse - Brain or spinal fluid
c Anemia - Affects the blood cells and immune - Nelarabine for T-Cell
(ALL) system - MoAbs (Monoclonal Antibody) for B-Cell
- Common among children 2-4 y/o and Chimeric antigen receptor (CAR) T-
- Classification: b-cell 75%; T-cell 25% cell therapy (Kymriah)
Acute Myeloid - Also called acute myelocytic leukemia - HSCT
Leukemia and acute myelogenous leukemia Terms
(AML) - Common among adults Monoclonal antibodies are man-made proteins that act like human
**Type of treatment to receive, and treatment outcome depend on the antibodies in the immune system. There are 4 different ways they
ALL subtype and individual risk factors can be made and are named based on what they are made of.
Risk Factors Murine there are made from mouse proteins and the names of the
- Radiation - Age treatment end in -omab
- Infections - Infection – EBV, HIV Chimeric these proteins are a combination of part mouse and part
- Chemical exposure - Chemicals – benzenes human and the names of the treatments end in -ximab
- Previous and pesticides Humanized these are made from small parts of mouse proteins
chemotherapy - Genetics: trisomy 8 & attached to human proteins and the names of the treatment end in
- Genetic conditions 21 (AML) -zumab
- Race - Race: Whites > Asians Human these are fully human proteins and the names of the
- Smoking treatments end in -umab
Acute Leukemia: Signs and Symptoms Management: Chemotherapy (AML)
AML Induction Pediatrics
- (+) concomitant infections - 7 + 3 regimen (BMA on the 14th day)
- (+) chloromas (extramedullary) - 7+3 = cytarabine continuously for 7
- Bone pain – less seen days, along with short infusions of
- Bleeding episodes anthracycline on each of the first 3
- Appears more ill than all kids days
Leukemia - Fludarabine or etoposide (for patients
- Swollen lymph nodes with poor cardiac function)
- Fever Adults
- Night sweat - Aggressive & short-course 6 months
- Nose bleeds - Ara-C Cytarabine
- Severe infection Post- - Consolidation – HiDAC – High Dose Ara-C
Diagnostic Exams Remission (for younger patients), Daunorubicin,
Blood Tests etoposide, mitoxanthrone for older;
- CBC HSCT
- Peripheral Blood Smear = (+) Auer Rods for AML Management
Bone Marrow Aspiration & Biopsy (Bone Cellularity) Anemia Blood Transfusion
- Cytogenic analysis (Fish, RT-PCR) Treatment - Controls the symptoms of anemia like
- Bone marrow aspiration and biopsy; after a small area of Procedure uncontrolled bleeding
skin is numbed, a bone marrow needle is inserted into the Stem cell transplant
patient’s hip bone. - Rebuilds bone marrow using stem cells
- Samples of blood, bone, and bone marrow are removed from a donor
for examination under a microscope. Immunosuppressant
CSF - Involves drugs to alter / suppress the
- immune system
Management: Chemotherapy (ALL) Nursing Interventions
Induction - Vincristine, doxorubicin, prednisone - Avoid infections to prevent neutropenia
(dexamethasone) - Avoid crowded areas
- T-cell = cytarabine - Wash your hands regularly
- B-cell = cytarabine + methotrexate - Wear shoes
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- Use gloves
- Iron Rich Food
LYMPHOMA
CHRONIC LEUKEMIA
CLL CML
- B-Cell CLL - >95% of - Gets worse slowly
people with CLL have - Philadelphia
B-cell type Chromosome (Ph
- T-cell prolymphocytic chromosome = BCR-
leukemia ABL)
- Leukemia cells from - The prognosis and
these 2 types look treatment options
alike, but lab tests can depend on age, phase
tell the difference of CML, amount of
between them blasts in the blood or
(proteins ZAP-70 and bone marrow, size of
CD38) the spleen at
diagnosis, patient’s
general health
Chronic Leukemia Signs and Symptoms
- Generalized lymphadenopathy
- Anemia, neutropenia, thrombocytopenia
CML: Phases and Manifestations
Chronic Phase In chronic phase CML, fewer than 10% of the cells
in the blood and bone marrow are blast cells; LUQ
pain splenomegaly
Accelerated In accelerated phase CML, 10-19% of the cells in the
Phase blood and bone marrow are blast cells; fever of Risk Factors
unknown origin, night sweats, lymphadenopathy, - Family history
decreased appetite (weight loss) - Infections EHV,HIV
Blastic Phase - In blastic phase CML, 20% or more of the - Autoimmune disorders RA,SLE,etc
cells in the blood or bone marrow are - Chemical pesticides
blast cells; resembles AML/ALL but - Diet
patient does not respond to treatment - smoking
- Tiredness, fever, and an enlarged spleen
occur during this phase = blast crisis
- Chronic myelogenous leukemia can relapse (return) after
it has been treated
- in relapsed CML, the number of blast cells increases after
remission
Management
CLL
Commonly used
1. targeted therapy – bruton’s tyrosine kinase (BTK)
inhibitors & PI3K inhibitors
2. chemotherapy – F.C.R. (Fludarabine + Cyclophosphamide
+ Ritubximab)
3. immunotherapy – monoclonal antibodies
4. EBRT
5. HSTC
CML
Commonly-used
1. Targeted therapy – tyrosine kinase inhibitors (TKIs)
2. Chemotherapy – hydroxyurea
3. Immunotherapy – interferons
4. High-dose chemotherapy with HSTC
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Lymph Node
Biopsy
X-ray
(fluoroscopy of
the lymphatic
vessels Indications
- neoplastic disorders
- hematologic malignancies and solid tumors
- non-neoplastic disorders
- aplastic anemia, autoimmune disease, inborn errors
of metabolism, Parkinson’s, etc.
Types of Stem Cell Transplant
Management - allogeneic family / unrelated donor
- autologous self-donation
- syngeneic identical twins
Complications to successful hematopoietic stem cell transplantion
(HSCT)
- high treatment related mortality
- infection
- grraft versus host disease (GVHD)
- lack of suitable donor
GVHD
- immune-mediated donor’s lymhoid and recipeitns
immmunity
ABVP Doxorubicin + bleomycin + vinblastine + dacarbazine - incidence – 1-2%
BEACOP Bleomycin, etoposide, doxorubicin, cyclophosphamide, - mortality 75%
P vincristine, procarbazine, prednisone 1. acute - <3MOS
2. chronic - >3MOS
CHOP Cyclophosphamide, doxorubicin, vincristine,
prednisone
CVP Cyclophosphamide, vincristine, and prednisone
Special Treatment Considerations
Stem Cell Therapy
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312 Care of Clients with Problem in Oxygenation, Fluid & Electrolytes

Ascariasis Ascaris lumbricoides Kato-Katz Technique Direct / indirect contact

Paragonimiasis Paragonimus westermani / siamense Antemelania asperata / Crabs Praziquantel

Syphilis Treponema pallidum Direct / placental / indirect contact Penicillin G benzathine

- Excessive thirst - Kussmaul’s

- Can be invasive or non-invasive (invasive is shown in the

Forms amoebic diseases - Gram (-) negative motile organism

MENINGITIS (Aka Cerebrospinal Fever) Clinical Manifestation

o Suggests subarachnoid hemorrhage - Patient on the bed, plucking on

Agent - Legio debilitans

POLIOMYELITIS (Aka Infantile Paralysis / Hein-Medin Disease)

and forehead - there is resistance or presence of immunity

Common lesion sites include the buttocks, face, and

visitors not to talk loudly, noises, unnecessary movements

RED TIDE (Aka Paralytic Shellfish Poisoning PSP)

weakness, difficulty swallowing, or difficulty in

Abdominal X-ray - Reveals Dense shadow of prescription

o Graying pigmented spots, found in the

PEDICULOSIS (Aka Phthiriasis)

Clinical Manifestations - Capturing the animal, to which the patient

SCHISTOSOMIASIS (Bilharziasis / Snail Fever)

- Found in the middle east - Renal failure

bite of an infected mosquito as pressure to determine the

- Maculopapular / petechial rash – starts in distal portion of o Pulse pressure

arms, vulva, and breasts - Surgery

- Marsh fever – endemic in marsh lands in England 16 th to mosquito

Cyclic Stages of Cyclic Paroxysms o consider it as medical emergency, requires close

- Risk of death is greater

o To determine changes in electrical changes

complication walking in potential contaminated water or flood

Pathogenesis (Life Cycle)

abuse through IV, hyperalimentation

endometritis uterus, and lymph nodes - Common sexually

antibody outside the body, not transmitted by

present in the stools, mistaken - Can cross the placenta

produce highly contaminated pink or grayish white AIDS

o In some people, AIDS may responses, hallucination, spastic para-

general and posterior column of the

spinal cord, resulting in spastic para-

Manifestations also vary according to body part being affected:

- Remove food droppings

neoplasms, presence of non- shape, in the organization of cells, may

What Causes Cancer?

Manifestation will occur after 10 years

- 14 days after chemo Sealed Intracavitary Cesium)

o Normal: firm, not hard, and

SPINAL CORD TUMORS

Type of Tumors - Intramedullary

Vestibular - Puts pressure on the facial nerve

Transsphenoidal Indicated for Pituitary Tumors

Common Symptoms of Spinal Cord Tumors

Radiation Therapy Care

Definition LUNG CANCER

early age, smoked for # year, smoked bronchoalveolar carcinoma.

LUNG CANCER STAGING

TYPES 1. Small cell lung carcinoma

- At what age given: before they become

Special Treatment Considerations

Stem Cell Therapy

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