Seminar in Nursing
Lecture
[TRANS] CANCER: LUNG, CERVICAL, BREAST & COLORECTAL
LUNG CANCER
DATA & STATISTICS
• Lung cancer is cancer that starts in the lungs.
• Lung cancer is the main cause of mortality from
cancer worldwide.
• Persons who smoke are at the highest risk of
developing lung cancer, but it can also occur in
people who have never smoked.
• According to WRCF (2020), Lung cancer is the
2nd most common cancer worldwide.
• There were more than 2.2 million new cases of
lung cancer in 2020.
• In the Philippines, there were a total of 19,180
new cases of lung cancer last year. This
represented 12.5% of the 153,751 new cases of
cancer that were diagnosed nationwide last year
in both men and women of all ages.
• Overall, the chance that a man will develop lung
cancer in his lifetime is about 1 in 16; for a
woman, the risk is about 1 in 17. These numbers
include both people who smoke and those who
don't smoke.
DEFINITION
• Lung carcinoma starts in the lungs and may
spread or metastasize to lymph nodes or other
organs in the body, including the brain.
• Cancer from other organs may also spread to
the lungs causing lung cancer.
• The most common cancer-related mortality
worldwide is lung carcinoma.
• In 85% of cases, smoking cigarettes is a cause.
Cough, chest pain or discomfort, weight loss,
and, less frequently, hemoptysis are symptoms;
• There are four types of lung carcinoma:
1) Lung nodules
2) Non-small cell lung cancer
3) Small cell lung cancer, and
4) Mesothelioma
• The two major types of lung cancer:
1) Non-small cell lung cancer (NSCLC)
o The most prevalent type of lung cancer is
non-small cell lung cancer.
o Cancer cells start growing in the lung
tissues when you sufferfrom this disease.
o When compared to small cell lung cancer,
non-small cell lung cancer grows more
slowly, but by the time it is discovered, it
has frequently spread to other parts of the
body.
o Early diagnosis and treatment are so
crucial.
Karis’ notes (BSN4K) Love yourself !
SEM 101
2 ) S mall cell lung cancer (SCLC)
o The most aggressive.
o The bronchi, or breathing tubes, in the
middle of the chest are where it typically
begins.
o Despite being tiny, cancer cells proliferate
quickly and form large tumors.
• These types of lung cancer grow adversely and
are treated differently. Non-small-cell lung
cancer is more common than small-cell lung
cancer (American Cancer Society, Inc., 2023).
ANATOMY AND PHYSIOLOGY
LUNGS
• The lungs and respiratory system take air from the
atmosphere and transfer oxygen to the
bloodstream.
• It then circulates to the rest of the body. The lungs
are two sponge-like organs in the chest.
• The right lung has three (3) sections called lobes.
• In contrast, the left lung has two lobes. Because
the heart occupies more space on the left side, so
the left lung is smaller.
• In addition, the cells lining the bronchi and other
areas of the lung, such as the bronchioles or
alveoli, are where lung malignancies generally
develop (Hoffman 2021).
STRUCTURE:
● Trachea - Its primary purpose is to transport air
into and out of your lungs. It offers a dependable
route for oxygen to enter your body since it is a
strong, flexible tube.
● Bronchi - The bronchi are the two large tubes that
carry air from the windpipe to the lungs. There is a
left and right main bronchus in each lung. These
tubes branch out into sections that resemble tree
branches after the main bronchi.
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● Alveoli - despite their small size, are where gas DNA sequence and will then cause disruption in the cell cycle
exchange occurs in your respiratory system. and alters the protein synthesis. Those alterations will produce
an abnormal growth of the cell and encourages the
carbon dioxide during the process of breathing in
development of cancer or process by which healthy, normal
and breathing out. cells develop into cancer cells, also known as carcinogenesis.
There are two main types of lung cancer, non-small cell and
OTHER FUNCTIONS OF THE LUNGS: small cell where the small cell lung cancer happens in the
neuroendocrine cells which makes up the minority of lung
1.) Balancing pH malignancies while non-small cell happens in the epithelial cells
and has two common types which include squamous cell
o The body can become acidic from carcinoma and adenocarcinoma. SCLC metastasized rapidly
consuming too much carbon dioxide. When which requires chemotherapy, while NSCLC which
the lungs notice an increase in acidity, they metastasized slowly and requires a surgical management.
speed up breathing to release more waste SCLC grows in hilum where the mutation occurs and will
gas, which helps maintain pH balance. produce two hormones the Adrenocorticotropic hormone
(ACTH) and Antidiuretic hormone (ADH) which triggers the
onset of Neuroplastic syndrome. The secretion of ACTH results
in Cushing syndrome which leads to a certain symptom like
2.) Protecting the body weight gain.
o The lungs aid in protecting the body against Genetic mutations include MYC, BCL2, and p53 for small cell
dangerous toxins. lung cancer (SCLC) and EGFR, KRAS, and p16 for non-small
o It can secrete immunoglobulin, which can cell lung cancer (NSCLC) which are most frequently linkedto the
fight infection. development of lung cancer. SCLC forms the central tumors
o The lungs can also benefit from mucociliary and NSCLC can be form both the central tumors and
peripheral tumors. The primary tumor's symptoms are
clearing.
dependent on where it is located whether it is centrally or
o Pathogens and dust particles are captured peripherally. Peripheral tumors can spread and infiltrate into the
by mucus, which then moves them upward pleural surface which leads the person to experience chest
with the help of tiny hair-like projections discomfort, pleural effusion, hyperplasia, metaplasia, and
called cilia so the body can either cough dysplasia. Central tumor causes a partial obstruction in the
them out or swallow and digest them. lungs which physically obstruct the airway which leads to
inability to clear the inhaled pathogen, that is why the person
may manifest persistent cough, fever, dyspnea, wheezing, and
3.) Speech hemoptysis. The obstruction also causes infection which
o Without airflow, a person would be unable to stimulates the hypersecretion of mucusand desquamation of
speak. the cells which then forms a lesion in the lung tissues that an
happen in bronchi, bronchioles or even at the alveoli which will
SIGNS AND SYMPTOMS lead to the onset of bronchogenic carcinoma or known as lung
cancer. If the patient receives treatment, there are some health
doctors use a more thorough prognostic tool based on the
● Persistent Cough tumor, nodes, and metastatic staging approach (TNM). These
● Hemoptysis survival rates represent the actual percentage of a sample of
● Chest pain patients with either NSCLC or SCLC who were still alive at 2
● Shortness of Breath years and 5 years after receiving their diagnosis. However, if the
● Wheezing lung cancer is left untreated this would eventually metastasize
to the other cell tissue of the body causing organ failure which
● Hoarseness leads to death.
● Fatigue
● Unexplained weight loss MEDICAL MANAGEMENT
ETIOLOGY DIAGNOSTIC EXAMS
PREDISPOSING FACTORS ● Chest x-ray
● CT scan
● Family History ● PET-CT scan
● Air pollution ● Sputum Cytology
● Gender (Men) ● Fiberoptic bronchoscopy
● Gene mutation in TP53
MEDICATIONS
PRECIPITATING FACTORS
1.) ALKYLATING AGENTS
● Cigarette smoking
● Second hand smoking It keeps the cell from reproducing (making copies of
● Radon exposure itself) by damaging its DNA. These drugs work in all
● Asbestos exposure phases of the cell cycle and are used to treatmany
different cancers, including cancers of the lung,
PATHOPHYSIOLOGY breast, and ovary as well as leukemia, lymphoma,
Hodgkin disease, multiple myeloma, and sarcoma.
Tumors coming from the bronchi or the lung parenchyma are
referred to as bronchogenic carcinomas or lung cancer. It is DRUG: CISPLATIN (PLATINOL)
one of the main reasons why people die from cancer.
Predisposing factors such as family history of lung cancer, air
pollution, and gender and certain precipitating such as cigarette 2.) ANTINEOPLASTIC AGENTS
smoking, second hand smoking, and radon exposure and
exposure to asbestos which leads the person at risk of the lung
These are drugs used to treat cancer. These
cancer. Continued exposure causes genetic alterations to the

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medications contain chemicals that kill cells that

rapidly divide such as cancer cells. They may alsokill CERVICAL CANCER
healthy cells in your body that replicate quickly such
as skin cells or cells in your hair follicles. DATA & STATISTICS

DRUG: DOCETAXEL (TAXOTERE) • Cervical cancer occurs when the cells in the
cervix, specifically in the lower portion of the uterus,
3.) VINCA ALKALOID start to grow out of control.
• Before this type of cancer happens, the cells will
They have been used to treat diabetes, high blood start to appear in the cervical tissue, which is also
pressure and have been used as disinfectants and known as dysplasia.
anti-cancer. The vinca alkaloids have cytotoxic • Cervical cancer can be prevented through
effects that can arrest the division of cells and cause screening exams and the HPV vaccine.
cell death. • HPV infection was found in 9.2% of Filipino women
with normal cervixes.
DRUG: VINORELBINE (NAVELBINE) • Cervical cancer is expected to be the fourth most
common cancer in women by 2020, with an
4.) ANTIFOLATE AGENTS estimated 604,000 new cases worldwide.
A type of drug that stops cells from using folic acid • Cervical cancer deaths were estimated to be
to make DNA and may kill cancer cells. Certain 342,000 in 2020, with 90% occurring in low- to
antifolates are used to treat some types of cancer middle-income countries and an estimated 5%
and inflammatory conditions, such as rheumatoid being related to HIV.
arthritis. • The 5-year relative survival rate for cervical cancer
patients who receive an early diagnosis is 92%;
DRUG: PEMETREXED (ALIMTA) • the 5-year relative survival rate for cervical cancer
is 59% when it is discovered after it has spread to
TREATMENTS neighboring tissues, organs, or local lymph nodes;
• the 5-year relative survival rate is 17% when
● Radiation Therapy cervical cancer is discovered after it has
● Chemotherapy progressed to a distant area of the body, and
● Palliative Therapy • the overall 5-year relative survival rate for cervical
cancer patients is 67%.
SURGICAL MANAGEMENT
DEFINITION
● Lobectomy
● Bilobectomy o Cervical cancer is a type of cancer that occurs in
● Pneumonectomy the cells of the cervix — the lower part of the uterus
● Wedge resection that connects to the vagina.
● Segmentectomy (segmental resection) o Various strains of the human papillomavirus (HPV),
● Sleeve Resection (Bronchoplastic) a sexually transmitted infection, play a role in
causing most cervical cancer.
NURSING MANAGEMENT o Cervical cancer begins when healthy cells in the
cervix develop changes (mutations) in their DNA.
1: Impaired gas exchange related to altered oxygen o The accumulating abnormal cells form a mass
supply as evidenced by dyspnea. (tumor).
o Cancer cells invade nearby tissues and can break
2: Ineffective airway clearance related to narrowed off from a tumor to spread (metastasize) elsewhere
airway asevidenced by wheezing. in the body.
o Cervical cancers are named after the type of cell
3: Acute pain related to surgicalincision as evidenced where the cancer started.
by guarding of the affected area. o The two main types of cervical cancer:

1.) Squamous cell carcinoma (90%)

o Develop from cells in the ectocervix.
2.) Adenocarcinoma
o Develop in the glandular cells of the
endocervix.
o Clear cell adenocarcinoma or clear cell
carcinoma or mesonephroma, is a rare
type.
o Mixed carcinoma or adenosquamous
carcinoma cervical cancer has features of
both types.
o Very rarely, cancer develops in other cells
in the cervix

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ANATOMY AND PHYSIOLOGY
CERVIX
• The cervix is part of the female reproductive
system.
• The cervix is the lower, narrow part of the uterus
(womb).
• The cervix connects the main body of the uterus
to the vagina (birth canal).
STRUCTURE:
The cervix is about 3 to 4 cm long. It is made up
mostly of connective tissue and muscle. It is
divided into 2 main parts:
• The endocervix is the inner part of the cervix
lining the canal leading into the uterus.
• The ectocervix (exocervix) is the outer part of
the cervix. It is rounded and lip-like and sticks
out into the vagina.
2 MAIN TYPES OF CELLS IN THE CERVIX:
• Glandular cells
o line the endocervical canal.
o They are tall and shaped like columns and
are called columnar cells.
• Squamous cells
o line the ectocervix and vagina.
o They are flat and thin like the scales on a
fish.
o The squamous cells join the columnar
cells in an area of the cervix called the
squamo-columnar junction.
o This is also called the transformation zone
because the columnar cells are
constantly being changed into squamous
cells, especially during puberty and child-
bearing years.
o Precancerous changes of the cervix and
most cervical cancers start in the
transformation zone.
Karis’ notes (BSN4K) Love yourself !
FUNCTIONS:
• The cervix connects the body of the uterus to the
vagina.
• When a mature egg is released from an ovary
each month (called ovulation), the mucus
changes and becomes thinner. The thinner
mucus allows sperm to pass through the cervix
into the uterus.
• Every month, except during pregnancy or
menopause, the lining of the uterus (called the
endometrium) is shed through the cervix into the
vagina, then out of the body. This process is
called menstruation.
• During childbirth, the cervix widens (dilates),
allowing the baby to pass through the birth canal.
SIGNS AND SYMPTOMS
● Longer or heavier menstrual bleeding
● Abnormal vaginal bleeding
● Painful Sexual Intercourse
● Pelvic or Lower Back Pain
● Unusual color and smell of vaginal discharge
(Malodorous discharge)
● Vaginal bleeding after menopause
● Complication in Bowel Movements
● Blood in the urine
ETIOLOGY
PREDISPOSING FACTORS
● Age (under 45 yo)
● Genetics
● Race / Ethnicity (Hispanic women)
● Gender (younger women)
PRECIPITATING FACTORS
● Herpesvirus 2 and other bacterial or viral venereal
infection
● Weakened immune system
● Multiple sexual partners
● Smoking
● Socioeconomic status
PATHOPHYSIOLOGY
Cervical cancer is the uncontrolled growth of abnormal cells in
the lining of the cervix and it is the fourth most common cancer
among women globally and currently, one life is lost every 2
minutes to this disease. Importantly, it is the leading cause of
cancer deaths in women in 36 countries. The predisposing
factors of cervical cancer are advancing age, the sex
specifically on females only because cervical cancer only
affects women, Hispanic and African-American, family history
and HIV positive. Precipitating factors such as long term use of
contraceptive, having multiple full term pregnancies, risky
sexual habits, low socioeconomic status, lack of immunization,
exposure to Diethylstilbestrol, and smoking.
With these predisposing and precipitating factors, it will lead to
Human Papillomavirus entering the cervix. After the HPV enters
the cervix, it attaches to the heparan sulfate receptor which
transforms the HPV and it will attach to the DNA of a healthy
cell that results in HPV mitosis. HPV produces E6 and E7. E6
protein inhibits p53 and it is an important tumor suppressors in
regulating the cell cycle which is the cycle that ensures that
there are checks and balances when producing new cells. E7
protein produced by HPV inhibits retinoblastoma protein or Rb
which is also important in the cell cycle. These both p53 and Rb
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proteins are cell division checkpoint proteins. So in inhibiting MEDICAL MANAGEMENT

these 2 types of proteins, you’re going to increase the cell cycle
which is going to cause more cellular proliferation and because
of that you’re going to get dysplasia. Dysplasia is growth of
DIAGNOSTIC EXAMS
more cells and oftentimes these cells can become abnormal.
So overtime, those abnormal cells can increase the risk for a ● Papanicolau (Pap) Test
patient getting cancer after years of this occurring. ● HPV DNA Test
● Colposcopy
CIN means Cervical Intraepithelial Neoplasia. Using the CIN ● Biopsy
system, this will break down the pre-cancerous lesions into ● Imaging test
three grades so that precancerous area can become
CIN 1 and after some time it can become CIN2. It’s important
to note that a minority of HPV infections will develop into CIN
MEDICATIONS
grade 2 to 3 in about 3 years. So as mentioned before, most
cases are going to be dealt with by the immune system. Then 1.) ALKYLATING AGENTS
after even more time, CIN 2 can become CI 3. It is estimated
that 20% of CIN 3 will progress to cervical cancer in 5 years Alkylating agents keep the cell from replicating
and 40% of CIN 3 will progress to cervical cancer in 30 years (making copies of itself) by impairing its DNA. These
so it can take many years and decades to get to actual cervical drugs are used to treat various cancers, including
cancer. Pap smear and screening is going to be important to leukemia, lymphoma, Hodgkin's disease, multiple
detect these early stages to deal with those before they get to
myeloma, and sarcoma. They operate on all stages of
cervical cancer and after many years of CIN 3 is not detected
and not dealt with, it can become cervical cancer and it will start the cell cycle.
out often as Carcinoma In Situ or stage zero cervical cancer
mentioned before. Diagnosis in certain treatment methods that DRUG: CISPLATIN (CISPLATIN)
can be used with particular stages of precancerous changes of
the cervix such as Papsmear, colposcopy, and biopsy.
Papsmear is commonly used for the early detection of cervical 2.) ANTIMICROTUBULE AGENTS
cancer and it also detects changes in the cervical cells and can Antimicrotubule agents are chemotherapy drugs that
identify precancerous or cancerous lesions. Colposcopy is a are used to kill lung cancer (malignant) cells.
unique device called a colposcope and it is used for a
colposcopy. Like a microscope, the colposcope magnifies the
Antimicrotubule agents act by stabilizing
cells of the cervix and vagina. It provides the doctor with a microtubules, thus stopping cell growth and blocking
lighted, magnified view of the vaginal and cervix tissues. The cell division. Antimicrotubule agents interfere with
colposcope is not inserted into the body, the examination which microtubules which are cellular structures that help
is similar to a speculum examination. This test helps in the move chromosomes during mitosis.
detection of curable cervical precancers and allows for
conservative treatment of anomalies that are unlikely to
progress. Biopsy is a procedure in which small amounts of DRUG: PACLITAXEL (TAXOL)
tissue is removed and examined under a microscope. A biopsy
can provide a definitive diagnosis indicating cancer.
Cryosurgery, conization, and radical trachelectomy are in the 3.) ANTIANGIOGENIC AGENTS
surgical management. If carcinoma in situ is treated, the
A drug or substance that keeps new blood vessels
carcinoma will be removed and will lead to good prognosis. If
not treated, carcinoma will be confined around the cervix. It from forming. In cancer treatment, antiangiogenesis
belongs to Stage 1A and 1B cancer. It will result in an invasive agents may prevent the growth of new blood vessels
cervical cancer which will cause the growth of the tumor. that tumors need to grow. They are also called
angiogenesis inhibitors.
Cytokines production promotes tumor growth which leads to
decreased appetite and symptoms such as fatigue and weight DRUG: BEVACIZUMAB (AVASTIN)
loss. Tumor growth causes pressure in the blood vessels and
causes bleeding between periods and abnormal vaginal
bleeding. Tumor growth if treated, cervix will be removed doing
TREATMENTS
surgical management such as radical trachelectomy, and
conization resulting in fair prognosis. If not treated, carcinoma ● Radiation Therapy
will start to spread in the uterus and vagina causing the o External Beam Radiation (EBRT)
carcinoma to spread in parametrium There are 2 stages called o Brachytherapy (internal radiation therapy)
Stage 2A Cancer and stage 2B cancer. Signs and symptoms ● Chemotherapy
such as vaginal bleeding, vaginal discharge, and malodorous
smell occur. Preferred diagnostic exams are pap smear,
● Targeted Therapy
colposcopy, biopsy, CT scan, MRI, and PET scan while the ● Immunotherapy
medical management is radiation therapy and chemotherapy. If
the carcinoma that spreads in parametrium is treated by SURGICAL MANAGEMENT
removing the cervix and uterus using surgical management
such as radical trachelectomy and radical hysterectomy, it will ● Cryosurgery
lead to fair prognosis. Carcinoma that spreads over the pelvic
wall will have metastasis to the adjunct organ and it will
● Conization
metastasis to distant organs which results in pressure on the ● Bilateral Salphingo-oophorectomy
kidneys, bladder and colon. This will be classified as Stage 4A ● Radical trachelectomy
cancer and Stage 4B cancer. Diagnostic exams for these are ● Hysterectomy
still pap smear, colposcopy, biopsy, CT scan, MRI, and PET ● Pelvic exenteration
scan. Signs and symptoms are dysuria, hematuria,
constipation, and back pain. If treated by radiation therapy and
chemotherapy, it will result in fair prognosis and if it is not NURSING MANAGEMENT
treated, it will cause death resulting in poor prognosis.
1: Acute pain related to destruction of nerve tissue
aeb reports of pain, restlessness, guarding
behavior, and facial grimace.

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2: Impaired Urinary Elimination related to

obstruction of the bladder outlet aeb burning BREAST CANCER
sensation during urination and palpable mass on
the pelvis area. DATA & STATISTICS

3: Anxiety related to situational crisis of new cancer • Breast cancer is a condition in which the breast
diagnosis as evidenced by decreased attention cells proliferate out of control.
span, restlessness, shortness of breath, • Breast cancer comes in several forms; it depends
disorganized thought process, crying, and on what cells in the breast turn into cancer sign
verbalization of feeling hopeless. breast cancer can start in various parts of the
breast.
• A breast comprises three main components:
lobules, ducts, and connective tissue. However,
most breast cancers begin in the ducts or lobules.
• Breast cancer is currently the most common
cancer globally, accounting for 12.5% of all new
annual cancer cases worldwide.
• In the Philippines, breast cancer is the most
common type of cancer in women.
• Three out of 100 Filipino women are estimated to
develop breast cancer before the age of 75.
• It was also noted that breast cancer accounts for
15% of all new cancer cases and 8% of all cancer
deaths in the country.

DEFINITION

• Breast cancer is a disorder in which cells in the

breast proliferate uncontrollably.
• The type of breast cancer is determined by which
cells in the breast become cancerous.
• Breast cancer can develop in a variety of locations
within the breast.
• A breast is made up of three major components:
lobules, ducts, and connective tissue.
• The majority of breast cancers begin in the ducts or
lobules.
• Breast cancer can spread outside the breast via
blood and lymph arteries.

ANATOMY AND PHYSIOLOGY

BREAST

• The breast is a structure that represents its unique

function: milk production for lactation (breast
feeding).
• The tissue's epithelial component consists of milk-
producing lobules that link to ducts that lead to the
nipple.

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• The cells that produce the lobules and terminal invasive carcinomas. Intraductal carcinoma is the most
ducts are responsible for the majority of breast common noninvasive cancer in elderly women (ductal
carcinoma in situ). 20% of cases return locally after partial
malignancies. mastectomy and are often multicentric. Axillary lymph nodes
• These lobules and ducts are distributed throughout are involved in 2% of cases. Lobular cancer in situ after
the fibrous tissue and adipose tissue (fat) that menopause is rare, typically multicentric, and affects both
constitute the majority of the breast. breasts. The most common invasive cancer in women of all
• The male breast structure is virtually comparable to ages is invasive ductal carcinoma, which accounts for nearly
70% of all cases. Mucinous (colloid) carcinoma, a slow-growing
the female breast structure, with the exception that tumor, is more common in older women. The frequency of
male breast tissue lacks the specific lobules medullary carcinoma, which is typically bilateral, decreases
because males do not have a physiological need with age. Inflammatory breast cancer, an extremely aggressive
for milk production. malignancy, affects both premenopausal and postmenopausal
• The adult breast is anatomically located on the women equally. Paget's disease of the nipple is caused by the
spread of ductal carcinoma to the nipple skin. It is more
pectoralis muscle (the "pec" chest muscle), which
commonly related to intraductal carcinoma than to invasive
is located atop the ribcage. cancer. In 50% of instances, a palpable breast lump is present.
• The breast tissue stretches horizontally from the Although several risk factors may raise the likelihood of getting
sternum's border. breast cancer, it is unclear how some of these risk factors
• Each breast contains blood vessels as well as induce malignant cells to form. Hormones appear to have a role
in many occurrences of breast cancer, although the exact
vessels that transport a fluid known as lymph.
mechanism is unknown. Normal breast cells can become
• The ovaries produce the hormones estrogen and malignant due to certain abnormalities in DNA. DNA is the
progesterone, which are required for breast molecule that makes up the genes in each of our cells. The
development and function. instructions govern how our cells work. Because our parents
• Estrogen causes the ducts to lengthen and form are the source of our DNA, we generally resemble them.
side branches. However, DNA has an impact on more than just our
appearance. Some genes carry instructions for determining
• Progesterone increases the quantity and size of when our cells grow, divide, and die. Tumor suppressor genes
lobules in the breast to prepare it for breastfeeding. are those that cause cells to divide faster or die at the
Progesterone causes breast cells to develop and appropriate moment. Certain inherited DNA alterations can
blood vessels to swell and fill with blood after raise the chance of getting cancer and are the cause of
ovulation. During this period, the breasts are malignancies that run in families. Mutations in these genes can
be passed down via families. When they become mutated, they
frequently engorged with fluid and may be painful
no longer control aberrant growth, making cancer more likely.
and puffy. Advances in understanding the genetic underpinnings of breast
cancer have already begun to assist women. These women can
SIGNS AND SYMPTOMS then take steps to reduce their risk of developing breast cancer
and carefully monitor changes in their breasts to detect cancer
at an earlier, more treatable stage. However, most DNA
● Swelling of all or part of a breast
mutations related to breast cancer occur in single breast cells
● Skin dimpling (Peau d’orange) during a woman's life rather than being inherited. Other
● Breast or nipple pain conditions, such as cancer-causing chemical radiation, may
● Nipple retraction result in acquired mutations of oncogenes and/or tumor
● Red, flaky, or thickened nipple or breast skin suppressor genes. However, the reasons for the majority of
● Swollen lymph nodes under the arm or near the acquired mutations that may lead to breast cancer remain
unclear. Most breast tumors contain numerous acquired gene
collar bone
alterations. Nonetheless, if breast cancer is treated in its early
● Nipple discharge stages, all of the tumor as well as a margin of healthy tissue
may be removed, thereby lowering the chance of recurrence.
ETIOLOGY On the other hand, if it is not treated, the prognosis may be poor
IOLOGY to poor, leading to death.
PREDISPOSING FACTORS
MEDICAL MANAGEMENT
● Age (over 50 yo – 80%)
● Genetics DIAGNOSTIC EXAMS
● Race / Ethnicity (Black women)
● Gender (Women) ● Breast Self-Exam (BSE)
● Reproductive history ● Estrogen Receptor / Progesterone Receptor Tests
● Family history of breast or ovarian cancer ● Breast ultrasound
● Dense breast ● Diagnostic mammogram
● Breast Magnetic Resonance Imaging (MRI)
PRECIPITATING FACTORS ● Breast Biopsy
● Breast Imaging Reporting and Data System (BI-
● Sedentary lifestyle RADS)
● Smoking ● Bone scan
● Drinking alcohol
● Obesity MEDICATIONS
● Radiation exposure
● Hormone Replacement Therapy (HRT) 1.) ALKYLATING AGENTS

PATHOPHYSIOLOGY Alkylating agents keep the cell from reproducing

(making copies of itself) by damaging its DNA. These
Breast cancer can be classified as invasive (in situ) or drugs work in all phases of the cell cycle and are used
noninvasive (in situ) pathologically (infiltrating). Non Invasive to treat many different cancers, including cancers of
carcinomas, according to popular belief, are precursors of the lung, breast, and ovary as well as leukemia,

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lymphoma, Hodgkin disease, multiple myeloma, and regulates growth factors responsible for stimulating
sarcoma. Examples of alkylating agents include cell growth and controlling cell division and
Altretamine, Bendamustine, Busulfan, Carboplatin, angiogenesis (development of new blood vessels).
Carmustine, Chlorambucil, Cisplatin, mTOR kinase inhibitors bind to an intracellular protein
Cyclophosphamide, Dacarbazine, Ifosfamide, (FKBP-12), and the resulting protein-drug complex
Lomustine, Mechlorethamine, Melphalan, Oxaliplatin, inhibits the activity of mTOR, leading to G1 growth
Temozolomide, Thiotepa, Trabectedin. arrest in treated tumor cells and thus blocking the
mTOR pathway, which is overactive in certain
DRUG: CYCLOPHOSPHAMIDE (CYTOXAN) cancerous cells. Examples of drugs in mTor kinase
inhibitor are everolimus, Sirolimus and Temsirolimus
2.) SELECTIVE ESTROGEN RECEPTOR
DRUG: EVEROLIMUS (AFINITOR)
MODULATOR (SERM)
SERMs work by either blocking or activating estrogen TREATMENTS
in your body. Estrogen receptors (chemical binding
sites) respond differently to estrogen in different parts ● Radiation Therapy
of the body. Some SERMs affect estrogen receptors ● Chemotherapy
in your breasts and bones, while others affect your ● Hormonal therapy
uterus. SERMs can bind to estrogen receptors in ● Targeted therapy
breast cells. This stops your body’s own natural ● Immunotherapy
estrogen from attaching to them. Since SERMs
occupy the estrogen receptor instead of natural
SURGICAL MANAGEMENT
estrogen, the cancer’s fuel source is cut off. This
prevents cancer from growing and spreading.
● Mastectomy
Common SERM medications include Tamoxifen,
● Breast reconstruction
Raloxifene, Bazedoxifene, and conjugated equine ● Lymph node dissection
estrogens, Ospemifene, Clomiphene, Fulvestrant, and
Toremifene
NURSING MANAGEMENT
DRUG: TAMOXIFEN (NOLVADEX)
1: Acute pain related to inflammation of the breast.
3.) AROMATASE INHIBITORS (AIs) 2: Imbalanced nutrition: less than body requirements
Are drugs that stop most estrogen production in the related to increase metabolic state.
body. Before menopause, most estrogen is made by
the ovaries. But in women whose ovaries aren’t 3: Anticipatory grieving related to possible loss of
working, either because they have gone through body part (breasts).
menopause or because of certain treatments,
estrogen is still made in body fat by an enzyme called
aromatase. AIs work by preventing aromatase from
making estrogen. These drugs are useful for women
who have gone through menopause, although they
can also be used in pre-menopausal women when
they are combined with ovarian suppression.These AIs
are pills taken every day to treat breast cancer:
Letrozole (Femara), Anastrozole (Arimidex) and
Exemestane (Aromasin)

DRUG: ANASTROZOLE (ARIMIDEX)

4.) HER2 RECEPTOR ANTAGONIST

Anti-HER2 medicines work by blocking the HER2
receptors from receiving the growth signals in HER2-
positive breast cancer. By blocking the growth signals,
anti-HER2 medicines can slow or stop the growth of
HER2-positive and HER2-low breast cancer. Anti-
HER2 medicines only work on HER2-positive and
HER2-low breast cancer. They do not work on HER2-
negative breast cancer. An example of HER2 receptor
antagonist drugs is Trastuzumab, pertuzumab,
Margetuximab, Ado-trastuzumab emtansine, Fam-
trastuzumab deruxtecan, Lapatinib, Neratinib, and
Tucatinib.

DRUG: TRASTUZUMAB (HERCEPTIN)

5.) mTOR KINASE INHIBITOR

mTOR kinase inhibitors are a derivative of rapamycin
that blocks the activity of the mTOR pathway, which

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DEFINITION
CO L O R EC T A L
CANCER • Colorectal cancer, or CRC, is a disease of the
colon or rectum, which are parts of the digestive
DATA & STATISTICS system.
• Colorectal cancer most often begins as a polyp, a
noncancerous growth that may develop on the
• Colorectal cancer begins when healthy cells in the
inner wall of the colon or rectum as people get
lining of the colon or rectum change and grow out
older.
of control, forming a mass called a tumor.
• Colorectal cancer can begin in either the colon or • If not treated or removed, a polyp can become a
the rectum. potentially life-threatening cancer. Finding and
removing precancerous polyps can prevent
• Most colon and rectal cancers are a type of tumor
called adenocarcinoma, which is cancer of the cells colorectal cancer.
that line the inside tissue of the colon and rectum. • There are several forms of polyps. Adenomatous
This section specifically covers adenocarcinoma. polyps, or adenomas, are growths that may
• Other types of cancer that occur far less often but become cancerous.
can begin in the colon or rectum include • They can be found with a colonoscopy.
neuroendocrine tumors of the gastrointestinal tract, • About 10% of colon polyps are flat and hard to
gastrointestinal stromal tumors (GIST), small cell find with a colonoscopy unless a dye is used to
carcinoma, and lymphoma. highlight them. These flat polyps have a high risk
• According to numbers in the same database, there of becoming cancerous, regardless of their size.
were a total of 17,364 cases of colorectal cancer Hyperplastic polyps may also develop in the
recorded in the Philippines in 2020 for both sexes colon and rectum. They are not considered
and all ages. precancerous.
• Colorectal cancer was the third most common type
of cancer that year, with at least 11.3 percent of the ANATOMY AND PHYSIOLOGY
total 153,751 cases of cancer recorded in the
country. DIGESTIVE SYSTEM
• The cancer type was more common among Filipino
men during the same year, with a 23.7 percent
incidence rate, and an incidence rate of 15.1
percent among Filipino women.
• Data also showed a total of 9,091 deaths due to
colorectal cancer in the Philippines in 2020—
around 6,109 deaths were due to colon cancer and
2,982 deaths due to rectum cancer.
• Worldwide, colorectal cancer is the third most
commonly diagnosed cancer.
• An estimated 1,880,725 people were diagnosed
with colorectal cancer in 2020.
• These numbers include 1,148,515 colon cancer
cases and 732,210 rectal cancer cases.
• Colorectal cancer is the second leading cause of
cancer death for men and women combined.
• It is the third leading cause of cancer death in men
and the third leading cause of cancer death in
women.
• Worldwide, colorectal cancer is the second leading
• The digestive system performs mechanical
processing, digestion, absorption of food,
cause of cancer death. In 2020, an estimated
secretion of water, acids, enzymes, buffer, and
915,880 people will have.
salt, as well as excretion of waste materials.
• The 5-year survival rate of people with localized
stage colorectal cancer is 91%. • The digestive tract and accessory organs
comprise the digestive system.
• About 37% of patients are diagnosed at this early
stage. • The oral cavity, pharynx, esophagus, stomach,
• If the cancer has spread to surrounding tissues small intestine, and large intestine make up the
or organs and/or the regional lymph nodes, the gastrointestinal system.
5-year survival rate is 72%. • The teeth, tongue, and glandular organs such
• If the cancer has spread to distant parts of the the pancreas, liver, gallbladder, and salivary
body, the 5-year survival rate is 15%. glands are examples of accessory organs.
• However, for patients who have just 1 or a few • These organs work together to provide
tumors that have spread from the colon or mechanical processing, the production of bile
rectum to the lung or liver, surgical removal of and enzymes to aid in compound breakdown,
these tumors can sometimes eliminate the and the excretion of waste.
cancer, which greatly improves the 5-year
survival rate for these patients.

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 TRANS: CANCER
SIGNS AND SYMPTOMS
● Weight loss
● Anemia
● Ribbon like stools
● Hematochezia
● Fatigue
● Persistent abdominal pain
● Nausea and vomiting
● Tenesmus
● Palpable mass
● Constipation / obstipation (severe constipation)
ETIOLOGY
PREDISPOSING FACTORS
● Age (over 50 yo – 90%)
● Genetic syndrome (FAP-familial adenomatous
polyposis)
● Race / Ethnicity (Non-hispanic)
● Family history of colorectal cancer
PRECIPITATING FACTORS
● Lack of regular physical activity
● Obesity
● Excessive alcohol consumption
● Tobacco use
● Diet (high in processed meats)
PATHOPHYSIOLOGY
Colorectal cancer is a type of cancer that affects the colorectal
region, which includes the colon and rectum. It is the third most
common type of cancer in both men and women, with about
140,000 cases diagnosed each year in the United States. The
predisposing factors that put a person at risk for colorectal
cancer include age, family history, race and ethnicity, and
genetic syndrome. On the other hand, the precipitating factors
include lack of regular physical activity, obesity, excessive
alcohol consumption, tobacco use, and a diet high in
processed meats. Although colorectal tumors are
heterogenous at a genetic level, they appear to develop via
several distinct pathways. There are two important molecular
pathways to consider. First, and the most common among the
two, is the chromosomal instability pathway. This pathway
starts by the rise and formation of adenomatous polyposis coli
gene (APC) which then binds to and promotes degradation of
β- catenin, which facilitates cancer stem cell renewal, cell
proliferation and differentiation. In the absence of a Wnt
stimulus, the transcriptional coactivator β-catenin is degraded
by a multiprotein “destruction complex” that includes the tumor
suppressors Axin and adenomatous polyposis coli (APC),
which then results in no proliferation, ending to cell death/
apoptosis. Moreover, when there is presence of a WNT
signaling, it prevents the formation of “destruction complex”,
making a stabilized β-catenin. It then translocates from
cytoplasm into the nucleus making the transcriptional activation
complex happen, paving the way for adenomatous cancer cells
to proliferate in the epithelial cells.
In the hyperproliferative epithelium phase, mutation of Kras
occurs making it more easy for cells to grow and multiply. Then,
it leads to small adenoma, which further mutations in tumor
suppressor genes happen. When there are even more
mutations, larger adenomas form and TP53 gene occurs which
provides instruction in making tumors, and has a very important
role in regulating cell division. This division of cells becomes
uncontrolled and could further lead to polyps formation in the
colon. In order to intervene the polyps, certain diagnostic
exams are needed such as colonoscopy, biopsy, and CT
colonography. Doctors also advise the surgical procedure
called polypectomy or the removal of the polyp. If left untreated,
Karis’ notes (BSN4K) Love yourself !
these polyps will lead to the formation of adenocarcinoma,
which is the most common type of colorectal cancer. The other
pathway, called Microsatellite Instability Pathway, is caused by
the mutation in DNA mismatch repair genes (MLH 1, MLH 2,
MSH 6, PMS 2). MSI-high is a subset of colon cancer in which
the tumor cells have a lot of instability. When these cells fail to
correct post DNA replication in the microsatellite regions, these
cancer cells will look and behave in an abnormal way. Further
mutations will happen, which then accumulates in the genes
that regulate growth differentiation and apoptosis leading to the
formation of adenocarcinoma.
With the presence of adenocarcinoma in the colon, colon
cancer happens. This can be detected through certain
diagnostic exams such as laboratory tests (CBC, Liver Function
test, CEA test, Fecal Occult Blood test), and imaging tests (CT
scan, MRI, Ultrasound, PET scans, Colonoscopy, Chest X-ray,
Sigmoidoscopy). If these tumor cells start to progress and
metastasize it could lead to the invasion of the rectal sphincter,
muscle, vessels, and nerves, resulting to Colorectal cancer.
Colorectal cancer can then be monitored through diagnostic
exams such as rectum palpation, colonoscopy, CT scan, MRI,
sigmoidoscopy, stool DNA tests, and FOBT. The same with the
other types of cancer, cervical cancer also develops in stages
as it would take time for cancer to invade the cells of the person.
It starts from stage 0, also called cancer in situ, which are
abnormal cells that are found in the innermost layer of the colon
or rectum. It can be managed through regular check up, and
surgical management of polypectomy and colectomy. Next
stage is Stage 1: Duke’s A Colon Cancer. During this stage, the
cancer cells are found in deeper layers of the colon or rectum
wall, but they haven’t spread beyond the walls. Management
includes regular check up, chemotherapy, and partial
colectomy. The third stage is Stage 2: Duke’s B Colon Cancer,
wherein the tumor cells have not spread to the lymph nodes,
but some may have spread through and beyond the wall of the
colon or rectum, sometimes into the nearby tissues and organs.
Management includes regular check up, chemotherapy,
radiation therapy, chemoradiation therapy (a combination of
both) or partial colectomy is considered. Most common
symptoms included in stages 0 to 2 include constipation,
diarrhea, excessive gas, abdominal cramps, ribbon like stools,
blood in stool, anemia, and hematochezia.
In more advanced stage of colorectal cancer, we have Stage 3:
Duke’s C Colon Cancer wherein the cancer cells have spread
to one or more nearby lymph nodes, but they have not grown
beyond the lymph nodes and colon or rectum wall to other parts
of the body. Managed through regular check up, adjuvant
chemotherapy, radiation therapy, chemoradiation therapy (a
combination of both). Nursing management includes providing
emotional support and surgical management including partial
colectomy, segmental resection, and temporary/permanent
colostomy. Signs and symptoms include excessive fatigue,
unexplained weakness, unintentional weight loss, ribbon like
stools, tenesmus, and vomiting. Lastly, stage 4: Duke’s D Colon
Cancer has spread beyond the colon or rectum to distant areas
of the body, including tissues and/or organs. Management
includes regular check-up and adjuvant chemotherapy. Nurses
could also provide emotional support for their clients. As the
cancer comes to the end stage, palliative care for patients is
considered.
The prognosis of colorectal cancer highly depends on the
disease stage. So with early detection of the disease
progression and complications through regular check up,
chemotherapy, radiotherapy, polypectomy, partial colectomy,
segmental resection, temporary colostomy, and the
administration of meds as ordered would benefit the prognosis
of the disease. The patient will have a good prognosis if it’s in
stages 0-2 with a survival rate of 90%, fair prognosis if they are
in stage 3 with a survival rate of 73%, and poor prognosis if it’s
in the end stage or stage 4 of colorectal cancer with the survival
rate of only 17%. However, if not treated, complications such
as bowel obstruction, cancer returning in the colon, metastasis
in the lung, liver, lymph nodes and other body parts, and anemia
may arise. All of the complications without appropriate
management would eventually lead to death.
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MEDICAL MANAGEMENT

DIAGNOSTIC EXAMS

● Physical exam
● Colonoscopy
● Biopsy
● CBC
● Carcinoembryonic antigen test (CEA test)
● Liver enzyme test
● Fecal Occult Blood Test (FOBT)
● CT scan
● Ultrasound
● MRI
● Chest X-ray
● Sigmoidoscopy

MEDICATIONS

DRUG #1: BEVACIZUMAB (AVASTIN)

Binds to and inhibits vascular endothelial growth
factor, a protein that plays a major role in formation of
new blood vessels to tumors

CLASSIFICATION:
Monoclonal Antibody and Antineoplastic

DRUG #2: FLUOROURACIL (5-FU)

Blocks formation of thymidylic acid. Cell cycle–
specific for S phase of cell division. Therapeutic Effect:
Inhibits DNA, RNA synthesis.

CLASSIFICATION:
Antimetabolite; antineoplastic; immunosuppressive

TREATMENTS

● External Beam Radiation Therapy (EBRT)

● Systemic Chemotherapy
● Targeted therapy
● Immunotherapy

SURGICAL MANAGEMENT

● Polypectomy
● Colectomy
● Colostomy

NURSING MANAGEMENT

1: Acute pain related to bowel obstruction aeb

swelling of the abdomen associated to colorectal
cancer.

2: Imbalanced nutrition: less than body requirements

related to inability to absorb nutrients aeb vomiting.

3: Diarrhea related to increased peristaltic movement

of the intestine aeb loose bowel movement of more
than 4x with watery to mucoid consistency
associated to colorectal cancer.

Karis’ notes (BSN4K) Love yourself ! 11

Seminar in Nursing
Lecture
[TRANS] IMMUNOLOGY: SLE, RHD, AGN, HIV/AIDS, & KAWASAKI DISEASE
ANATOMY AND PHYSIOLOGY:
THE IMMUNE SYSTEM
• The immune system is an incredibly complex and
intricate system that helps protect us from
diseases.
• It protect us from foreign invaders such as bacteria,
viruses, and other harmful organisms.
• Our immune system, which consists of white blood
cells, antibodies, and other molecules.
• White blood cells are specialized cells that can
recognize and destroy invading organisms.
• Antibodies are proteins that recognize and bind to
foreign substances, such as bacteria, viruses, and
toxins.
• Other molecules, such as interferon, can help
activate white blood cells and increase their
effectiveness in fighting off foreign invaders.
• Specific Immune System:
o When the immune system is functioning
properly, it is able to recognize and attack
foreign invaders while leaving the body’s own
cells unharmed.
o The specific immune response is important
because it helps the body to recognize and
remember foreign invaders that it has
encountered in the past, so that it can more
quickly and effectively respond to them in the
future.
• Nonspecific Immune System:
o This response is triggered when the body is
exposed to foreign organisms that it has not
encountered before.
o During this response, the body produces a
variety of molecules, such as cytokines and
chemokines, which help to alert the body to
the presence of foreign invaders and initiate an
immune response.
Karis’ notes (BSN4K) Love yourself !
SEM 101
• Through the specific and non-specific immune
responses, the body is able to recognize and
attack foreign organisms while leaving its own
cells unharmed.
• The immune system helps the body fight
infections and other diseases. It includes white
blood cells and organs and tissues of the lymph
system, such as the thymus, spleen, tonsils,
lymph nodes, lymph vessels, and bone marrow.
Lymph nodes – are small glands that filter and destroy
germs so they can’t spread to other parts of the body.
Lymph nodes contain immune cells that analyze the
foreign invaders present in the body. They then
activate, replicate and send a specific lymphocyte to
fight off a particular invader. Hundreds of lymph nodes
are over the body, which includes the neck, armpits,
and groin. Swollen, tender lymph nodes are a clue that
the body is fighting an infection
Tonsils and adenoids – are located in the throat and
nasal passage. They help by trapping foreign invaders
like bacteria or viruses as soon as they enter the body.
They also have immune cells that produce antibodies
to stop foreign invaders that cause throat and lung
infection.
Spleen - makes lymphocytes, filters the blood, stores
blood cells, and destroys old blood cells. It is located
on the left side of the abdomen near the stomach
Thymus- are small glands in the lymphatic system
that makes and trains special white blood cells called
T-cells. The T-cells help the immune system fight
disease and infection. The thymus gland produces
most of the T-cells before birth.
Bone Marrow - is the spongy tissue on the inside of
the bones. It produces blood cells and later becomes
responsible for storing fat and certain stem cells.
There are actually two types of bone marrow:
Red bone marrow helps produce blood cells
(hematopoiesis).
Yellow bone marrow helps store fat.
Skin, mucous membranes and other first-line
defenses skin is the first line of defense in preventing
and destroying germs before they enter the body. Skin
produces oils and secretes other protective immune
system cells. Mucous membranes line the respiratory,
digestive, urinary and reproductive tracts. These
membranes secrete mucus, which lubricates and
moistens surfaces. Germs stick to mucus in the
respiratory tract and then are moved out of the airways
by hair-like structures called cilia. Tiny hairs in the
nose catch germs. Enzymes found in sweat, tears,
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 TRANS: CANCER

saliva and mucus membranes as well as secretions in different types of antibodies that are used to fight
the vagina all defend and destroy germs. different types of invaders.

Stomach and bowel - Stomach acid kills many IgG antibodies are the most common type and are
bacteria soon after they enter the body. Good bacteria found in the blood and other bodily fluids. They
are also found in the intestines that kill harmful recognize and bind to antigens, which are substances
bacteria. that are foreign to the body.

White Blood cells (leukocytes) - protects the body
from infection. These cells circulate throughout the
bloodstream and tissues to respond to injury or illness
by attacking any unknown organisms that enter your
body. There are different types of white blood cells
which are the following:
o Neutrophils kill bacteria, fungi and foreign debris
o Monocytes clean up damaged cells
o Eosinophils kill parasites, cancer cells and
involved in allergic response
o Lymphocytes help fight viruses and make
antibodies
o Basophils involved in allergic response
o Macrophage surrounds and kills microorganisms,
removes dead cells, and stimulates the action of
other immune system cells.
IgA antibodies are found in the gastrointestinal tract,
respiratory system, and other mucosal areas and help
keep harmful microorganisms out of the body.
IgM antibodies are the first to respond to a new
infection and are found in the blood and lymphatic
system. When an antibody binds to an antigen, it
triggers a chain reaction that causes other parts of the
immune system to respond. This includes the
production of more antibodies, which can help to fight
off the infection. The immune system also produces
other molecules, such as cytokines, which can help to
kill the invading microorganism.

Lymphocytes are the primary cells of the immune

system. It is divided into B cells and T cells:

I. B cells create a type of protein called an

antibody. These antibodies bind to pathogens
or to foreign substances, such as toxins, to
neutralize them. For example, an antibody can
bind to a virus, which prevents it from entering
a normal cell and causing infection.
II. T cells are part of the immune system and
develop from stem cells in the bone marrow.
Their roles include directly killing infected host
cells, activating other immune cells, producing
cytokines and regulating the immune
response.

The specialized microenvironment of the bone

marrow generates and develops B cells, whereas the
thymus provides a specialized and architecturally
organized microenvironment for the development of T
cells.

Antibodies are a type of protein used by the body to

help fight off infections and disease. They are
produced by the immune system when it detects a
foreign substance, such as a virus or bacteria.
Antibodies then bind to the foreign substance, helping
to stop it from causing harm. There are several

Karis’ notes (BSN4K) Love yourself ! 2

 TRANS: CANCER

SLE
(SYSTEMIC LUPUS ERYTHEMATOSUS)
DEFINITION
• Systemic Lupus Erythematosus or SLE is one of
autoimmune diseases where the immune system
attacks its own tissues that causes tissue damage
and inflammation in the affected organs.
• Systemic lupus erythematosus is a chronic,
progressive, inflammatory connective tissue
disorder that can cause major organs and systems
to fail.
• This autoimmune disease commonly affects the
skin, blood vessels, joints, serous membranes
(pleura, pericardium), renal, and neurologic
systems.
• In SLE, the body's immune system mistakenly
identifies one or more nucleus-related parts of cells
as foreign substances, or antigens.
• The immune system begins to produce nuclear
antigen-specific antibodies.
• The B-lymphocyte stimulator (BLyS), which is
overexpressed in SLE, is one cytokine that helps B
cells start to overproduce antibodies. Inflammation
is brought on by antigen-antibody complexes that
the antibodies and antigens often generate in the
capillaries of visceral regions and the host cells are
also destroyed by the antibodies.
• The exact cause of SLE is unknown but a number
of factors, including genetic, epigenetic, ethnic,
immunoregulatory, hormonal, and environmental
factors, are linked to the disease's onset and 90%
of SLE cases are observed in women, especially
when they reach at childbearing age.
SIGNS AND SYMPTOMS
● Fatigue
● Fever
● Rashes
● Sun or light sensitivity
● Muscle or joint pain
● Memory problem
● Mouth ulcers
● Chest pain
● Dry eyes
● Hair loss
● Anemia
ETIOLOGY
PATHOPHYSIOLOGY
Systemic Lupus Erythematosus is a systemic inflammatory, an
autoimmune disorder that could affect almost every organ in
the body. Although it can affect nearly every organ in the body,
it usually affects the skin, joints, kidneys, blood cells, and
nervous systems. The specific cause of Systemic Lupus
Erythematosus is unknown. A person may be at risk for this
condition due to several risk factors. Some of these are Genetic,
immunologic, hormonal, and environmental factors could all
have a role. For genetics, there is no single gene or collection
of genes that has been confirmed to cause lupus, while various
gene variants have been related to the disease. Lupus, on the
other hand, appears in certain families. For example, if one
identical twin develops lupus, the other twin (who shares the
same genes) is more likely to have it as well. According to
research, having a family member with lupus increases your
chances of obtaining it. Hormones are the body's messengers,
and they control many of its processes. The sex hormone
estrogen plays a function in lupus. Both men and women
generate estrogen, but females produce far more. Many women
experience increased lupus symptoms before menstruation
and/or during pregnancy when estrogen levels are high. This
could imply that estrogen influences the severity of lupus in
some way. However, this does not imply that estrogen, or any
other hormone, causes lupus. Furthermore, most experts now
believe that a randomly encountered environmental element,
such as a virus or maybe a chemical, operates to trigger the
disease in a genetically predisposed individual. Researchers
have yet to identify a specific environmental contaminant,
although the theory remains plausible. While the environmental
factors that can trigger lupus and produce flares are not fully
understood, the most usually reported include ultraviolet
radiation (UVA and UVB); infections (particularly the effects of
the Epstein-Barr virus); and silica dust exposure in agricultural
or industrial environments.
These risk factors are thought to trigger immunoregulatory
disruption in a person's body, such as an apoptotic deficiency
that can lead to an increase in cell number death and a
disruption in immunological tolerance. The two recognized
processes that oversee Systemic Lupus Erythematosus clinical
manifestations are anomalies in the signaling and effector
activities of the body's T cells. This results in the inappropriate
release of inflammatory cytokines encourage cell
overproduction of antibodies; another example is the formation
of the presence of autoantibodies in a person's body. These
antibodies attack the person's cell as it faulty recognizes it as
foreign. These antibodies and antigens would then combine to
produce antigen-antibody complexes, which might become
trapped in the body's microvasculature and activate
complement and cause inflammation. Furthermore, these
antigen-antibody complexes can lodge on the capillaries of
visceral organs. When the patient's immune system develops
antibodies against its cells, it begins attacking the host's cells,
resulting in manifestations such as hematologic disorders such
as anemia. Additionally, because the antibody-antigen
complexes stimulated complement activation and inflammation
in the patient's body, the patient's immune system became
overactivated, resulting in fatigue, fever and dry eyes.

PREDISPOSING FACTORS When these antibody-antigen complexes bind to the capillaries

of the patient's visceral structures, they create inflammation of
these organs or organ systems, which can lead to harm if not
● Genetic History addressed. Inflammatory reaction in the skin caused various of
● Race rashes such as the Malar rash, Discoid rash, and
● Age (15 -45 yo) Photosensitivity. The inflammation in the skin can also cause
● Hormones hair loss. Moreover, SLE can also cause joint inflammation,
which doctors refer to as "inflammatory arthritis," which causes
PRECIPITATING FACTORS your joints to pain and feel stiff, tender, warm, and swollen.
Lupus arthritis most commonly affects joints located further out
from the center of your body, such as your fingers, wrists,
● Pregnancy elbows, knees, ankles, and toes. Lupus most commonly affects
● Stress the lungs by inflammation of the pleura, the lining that covers
● Medications the outside of the lungs. Pleuritis symptoms include severe,
● UV Rays / Light frequently sharp, stabbing pain in a specific place or parts of
● Smoking your chest.

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 TRANS: CANCER

The treatment of Systemic Lupus Erythematosus focuses on 4.) IMMUNOSUPPRESIVES

limiting disease activity, which can affect any organ system,
through general immunosuppression, as well as precisely
targeting disease symptoms. Anemia should be managed by Immunosuppressive medications help to prevent the
iron, folic acid, and vitamin supplements. Encourage regular immune system from attacking healthy body tissue. If
rest intervals and energy-saving ways to address the patient's the patient is experiencing severe organ-related lupus
fatigue; for fever, give the patient a tepid sponge bath and also symptoms, such as those that impact the brain,
administer over-the-counter or NSAIDS medicine as ordered; kidneys, heart, or lungs, the doctor may advise
and for dry eyes, give eye drops as ordered. Advise the patient
immunosuppressive medications.
to avoid sunlight and UV light exposure, which may aggravate
her rashes, and to use prescription ointments and lotions.
Moreover, supporting the joints with pillows to alleviate pain, SURGICAL MANAGEMENT
gently guiding the patient in PROMs to improve flexibility, and
delivering prescribed medications such as antimalarials and ● Splenectomy
NSAIDs to treat acute inflammatory arthritis. Additional tests ● Joint replacement
will be performed to rule out any pulmonary tract issues that
● Autologous Stem Cell Transplantation
may be causing the chest pain.
● Kidney transplantation
MEDICAL MANAGEMENT
NURSING MANAGEMENT
DIAGNOSTIC EXAMS
1: Acute pain related to the inflammatory response
aeb verbal description of pain in the joints.
● CBC
● Basic Metabolic Panel
2: Disturbed body image related to situational
● Antinuclear Antibody Test (ANA)
chancers aeb refusal to look at or touch the altered
● Liver function test
body part.
● Inflammatory markers
● Urinalysis anti-dsDNA
3: Fatigue related to disease condition aeb the
● Chest x-ray
inability to maintain usual level of physical activity.
● Echocardiogram
● Biopsy

MEDICATIONS

1.) ANTIMALARIAL
Anti-malarial drugs reduce the symptoms of lupus by
modifying the immune system without increasing the
risk of infection. Antimalarials can block Ultraviolet
radiation and occasionally even treat skin lesions that
don't respond to topical therapy (ointments). The
immune system's plasmacytoid dendritic cells, which
are in charge of producing interferon, may not activate
in response to anti-malarial drugs.

DRUG: HYDROXYCHLOROQUINE (PLAQUENIL)

2.) STEROIDS
Steroids have a strong and quick-acting anti-
inflammatory effect, and they also have a strong
immunosuppressive effect when given in high doses.
As a result, steroids are important in the care and
treatment of SLE patients, particularly those with
severe and active SLE. However, due to their severe
side effects, lack of responsiveness, and resistance to
steroids, steroids' effectiveness and usefulness are
restricted. In these cases, additional plasmapheresis
immunosuppressive frequently used with steroids.
therapy like or drugs

DRUG: PREDNISONE (APO-PREDNISONE)

3.) NSAIDS
By lowering the inflammation that causes the muscles,
joints, and other tissues to stiffen and hurt, these anti-
inflammatory drugs help some lupus symptoms.
NSAIDs can be used alone to treat a minor flare-up or
in combination with other medications because they
are milder than many other lupus medications.

DRUG: CELECOXIB (CELEBREX)

Karis’ notes (BSN4K) Love yourself ! 4

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• The heart has five (5) parts, this include:

RHD 1) Walls or layers of the heart
(RHEUMATIC HEART DISEASE) 2) Chambers
3) Valves
DEFINITION
4) Blood vessels
• Rheumatic heart disease is a disorder in which 5) Electrical conduction system
the heart valves have been irreversibly damaged
due to rheumatic fever. 3 LAYERS OF THE HEART
• Rheumatic fever is an infection that can spread • Endocardium (inner layer)
from person to person. • Myocardium (middle / muscular layer)
• The damage to the heart valves may begin • Epicardium (protective outer layer)
immediately after a streptococcal infection such as
strep throat or scarlet fever, particularly if the 4 CHAMBERS OF THE HEART
infection is left untreated or just partially treated. • Right Atrium
• An inflammatory state in the body can be the result • Right Ventricle
of an immune reaction, and this disease can cause • Left Atrium
ongoing damage to valves. • Left Ventricle
• Repeated infections with strep throat can lead the
immune system to react against the body's tissues, 4 VALVES OF THE HEART
resulting in inflammation and scarring of the heart
• Atrioventricular valve
valves.
• Tricuspid valve
• The mitral and aortic heart valves are the ones that
• Mitral valve
are typically affected by the condition. These valves
• Pulmonary valve
regulate the flow of blood.
• If the valves are not functioning correctly, blood will
BLOOD VESSELS
step backward into the heart rather than flow out of
the heart. • Arteries (away)
• The inflammation and scarring of the heart valves • Veins (back)
produced by rheumatic fever lead to the • Capillaries (connects arteries and veins)
development of rheumatic heart disease.
ELECTRICAL CONDUCTION SYSTEM
ANATOMY AND PHYSIOLOGY • Sinoatrial (SA) Node
• Atrioventricular (AV) Node
HEART • Bundle of His
• Purkinje Fibers

SIGNS AND SYMPTOMS

● Swelling of the extremities

● Dyspnea
● Chest pain
● Fatigue
● Chorea
● Heart murmur

ETIOLOGY

• The heart pumps blood throughout the body and is PREDISPOSING FACTORS
about the size of a fist.
• In terms of blood circulation, it is the most ● Genetics
important organ in the body. ● Gender (female)
• The activity of the heart is controlled by the brain ● Children and adolescents (5 – 15 yo)
and nerve system.
• The heart's primary job is to pump blood through PRECIPITATING FACTORS
the circulatory system.
• The heart is placed in the front of the chest. It sits ● Pregnancy
somewhat behind and to the left of the sternum ● Unhygienic living
(breastbone) slightly on the left side of the body. ● Overcrowded areas
• The heart is protected by the ribcage while it rests ● Lack of access to healthcare
between the right and left lungs. ● Low socioeconomic status
• The left lung is slightly smaller to provide room for ● Streptococcal infection (S. pyogenes)
the heart in the left chest. Everyone’s heart is a ● Acute rheumatic fever
somewhat different size. ● Tobacco smoking
• Generally, adult hearts are about the same size as ● Poor oral hygiene
two clenched fists, while children’s hearts are
around the same size as one clenched fist.

Karis’ notes (BSN4K) Love yourself ! 5

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PATHOPHYSIOLOGY
According to Dass, C. & Kanmanthareddy, A. (2022),
rheumatic heart disease (RHD) is the result of the
damage of valves caused by an abnormal immune
response to Streptococcus pyogenes infection, which
is classified as a group A streptococcus that causes
acute rheumatic fever. Studies states that a genetic
factor increases the risk for acquiring RHD. Females
are also susceptible due to the differences in calcium
metabolism and bone resorption among
postmenopausal females (Mutagaywa et al., 2020).
Children and adolescents ages 5 to 15 years old is also
susceptible to develop RHD due to the increased
exposure in school while having immature immune
systems (Khan, 2021) as well as women who are
pregnant due to their increase in cardiac demand
(Sika-Paotonu et al., 2017). A person’s lifestyle may
also predispose them from having the said disease
such as unhygienic living, staying in overcrowded
areas, lack of access to healthcare, and low
socioeconomic status. On top of that, recurrent
streptococcal infection that results to acute rheumatic
fever, along with tobacco smoking and having poor
oral hygiene, all precipitates the development of
rheumatic heart disease.
When there is a recurrence of Group A beta hemolytic
Streptococcus (GABHS) bacteria infection, tissue
damage in the pharynx happens which triggers the
immune response of the body, leading to vasodilation
to increase the permeability which aims to increase the
white blood cells and other proteins to gather at the
site of inflammation. With that, neutrophils and
macrophages engulf and breakdown the bacteria
causing the antigens to be released to the lymph
nodes. Antigens are presented to the MHC II molecule
at CD4 T cells causing the release of cytokines. This
triggers the B cells to proliferate and differentiate into
plasma cells. Plasma cells produce antibodies which
attack the antigens of GABHS. This leads to tissue
injury and inflammation of pharynx resulting to the
complication, pharyngitis with a symptom of fever. If
treated immediately, bacterial cell death happens,
thus having fair prognosis. If not treated, the
inflammation and tissue damage increases leading to
acute rheumatic fever in which the antibodies attack
other tissues such as the skin, joints, brain, and heart.
Erythema marginatum and subcutaneous nodules are
the manifestations on the skin. Swollen joints are also
found. The central nervous system is also affected and
manifested through sydenhams chorea. The heart is
also affected, thus leading to carditis. This can be
diagnosed through echocardiogram,
electrocardiogram, chest x-ray, cardiac MRI, and
blood test.
Specifically, the heart is affected in all three layers. For
the pericardium, visceral and parietal layers are
inflamed causing pericarditis. In the myocardium, this
is also inflamed leading to fibrinoid necrosis thus,
decreasing the preload, contractility, and stroke
volume of the heart. This causes the heart function to
fail, thus congestive heart failure. Clinical
manifestations include dyspnea, chest pain, and
fatigue. Lastly, the endocardial valves become
inflamed leading to rheumatic vegetation. This triggers
the activation of fibroblasts producing collagen,
Karis’ notes (BSN4K) Love yourself !
leading to thickening of valves. This leads to
complications such as mitral stenosis, mitral
regurgitation, aortic stenosis, and aortic regurgitation.
Surgical management for this include valvuloplasty,
valve repair and cardiac catheterization. When
rheumatic heart disease is managed well with
medications such as antibiotics, anticoagulants,
diuretics, ACE inhibitors, glucocorticoids, and beta-
blockers, the patient will have good prognosis. With
valve replacement, the patient will have fair prognosis.
However, with severe RHD, poor prognosis is
expected, thus it may lead to death.
MEDICAL MANAGEMENT
DIAGNOSTIC EXAMS
● Echocardiogram
● Electrocardiogram (ECG)
● Chest x-ray
● Cardiac MRI
● C-reactive protein (CRP)
MEDICATIONS
DRUG #1: BENZATHINE PENICILLIN G (BICILLIN LA)
During the active multiplication stage, penicillin G has
a bactericidal effect on penicillin-sensitive microbes. It
works by inhibiting the formation of cell-wall
mucopeptide. It is ineffective against penicillinase-
producing bacteria, which include many staphylococci
types. Because it is a long-acting penicillin, it is
administered once to three times each week.
CLASSIFICATION:
Penicillin; antibiotic
DRUG #2: COUMARIN (WARFARIN)
Interferes with hepatic synthesis of vitamin K–
dependent clotting factors, resulting in depletion of
coagulation factors II, VII, IX, X. Therapeutic Effect:
Prevents further extension of formed existing clot;
prevents new clot formation, secondary
thromboembolic complications.
CLASSIFICATION:
Vitamin K antagonist; Anticoagulant
DRUG #3: AMOXICILLIN (AMOXIL)
Interferes with cell wall replication of susceptible
organisms; bactericidal and inhibits the biosynthesis
and repair of the bacterial mucopeptide wall
CLASSIFICATION:
Penicillin antibiotics
SURGICAL MANAGEMENT
● Balloon Valvotomy / Commissurotomy
● Valve replacement
● Valve repair
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NURSING MANAGEMENT
1: Acute pain related to inflammation aeb verbal
description of pain.
2: Hyperthermia related to inflammatory disease aeb
increased body temperature above normal range.
3: Activity intolerance related to decreased cardiac
output aeb imbalance between oxygen supply.
Karis’ notes (BSN4K) Love yourself !
AGN
(ACUTE GLUMERULONEPHRITIS)
DEFINITION
• Acute glomerulonephritis is characterized as an
inflammation and subsequent damage to the
glomeruli, which results in hematuria, proteinuria,
and azotemia.
• This is due to impaired filtration of the glomeruli
secondary to loss of function of the electrical
barrier in the basement membrane, leading to loss
of protein in large amounts.
• The loss of albumin results in generalized edema
from the loss of oncotic pressure that typically
holds the fluid within the intravascular space.
• If left undiagnosed, this condition can lead to
permanent kidney damage.
• Acute Glomerulonephritis is more common in
children older than 2 years of age but it can occur
at any age.
• This condition usually results secondary to group A
beta hemolytic streptococcal infection of the throat
or skin or a history of upper respiratory infection
that precedes the onset of the disease by 2 to 3
weeks.
• Acute post-streptococcal glomerulonephritis
(PSGN), for example, is a common type of acute
glomerulonephritis caused by a streptococcal
infection; similarly, Staphylococcus aureus
infection can cause glomerulonephritis.
• However, in recent years, the incidence of
staphylococcal glomerulonephritis has increased,
despite a decrease in PSGN in the United States
and most developed countries
ANATOMY AND PHYSIOLOGY
KIDNEY
• Our kidneys eliminate waste and toxins from the
bloodstream and excess water, which is excreted
in the urine.
• They contribute to the production of hormones for
the production of red blood cells and convert
vitamin D into its active form, making it usable by
the body.
• The kidneys are situated on either side of the spine
in the retroperitoneal area between the parietal
peritoneum and the posterior abdominal wall.
• They are protected by muscle, fat, and ribs.
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• The left kidney is positioned between the T12 and
L3 vertebrae, while the right is slightly lower due to
liver displacement.
• A frontal view of the kidney reveals two regions:
the renal cortex and the renal medulla 5-8 renal
pyramids are separated by connective tissue renal
columns in the medulla.
• Each pyramid ends in a renal papilla and produces
urine.
• Each renal papilla drains into a collecting pool
known as a minor calyx; several minor calyces
combine to form a major calyx, and all major
calyces connect to the single renal pelvis, which is
connected to the ureter.
SIGNS AND SYMPTOMS
● Hematuria
● Proteinuria
● Oliguria
● Hypertension
ETIOLOGY
Y DRUG: PENICILLIN G BENZATHINE (BICILLIN L-A)
PREDISPOSING FACTORS
● Family history of Glomerulonephritis
● Diabetes
● Hypertension
● Autoimmune diseases
PRECIPITATING FACTORS
● Exposure to toxins
● Certain medications
● Infection
PATHOPHYSIOLOGY
It starts with an infection by strains of group A beta-
hemolytic streptococci that affects throat or skin. The
disease develops 6 weeks after skin infection, and 1
to 2 weeks after throat infection or pharyngitis. Group
A beta-hemolytic streptococci infection triggers a type
III hypersensitivity reaction in which immune
complexes made of IgG or IgM antibodies and
antigens are produced, they eventually find their way
to the glomerulus and are trapped there, more
precisely in the glomerular basement membrane.
These complexes trigger an inflammatory reaction in
the glomerulus that damages the podocytes by
activating and depositing C3 complement,
inflammatory cytokines, oxidants, and proteases. Due
to this damage, bigger molecules including proteins
and red blood cells are eventually able to enter the
urine and cause hematuria and proteinuria. Those red
blood cells in the urine often make it darker, and
oliguria can occur, a condition in which there is
abnormally little urine production. Nephrotic
Syndrome has a variety of characteristics including
inflammation and the ones mentioned above.
Moreover, since there is less fluid that is being
excreted, and more is retained by the body, it causes
peripheral edema as well as periorbital edema. It will
eventually have a favorable prognosis if treated. It will
result in renal failure if left untreated.
Karis’ notes (BSN4K) Love yourself !
MEDICAL MANAGEMENT
DIAGNOSTIC EXAMS
● Urinalysis
● Urine concentration test
● Total protein
● Creatinine clearance
● Intravenous pyelogram (IVP)
● X-rays
● Kidney ultrasound
● Kidney biopsy
MEDICATIONS
1.) ANTIBIOTICS
Early antibiotic therapy may prevent antibody
response to exoenzymes and render throat cultures
negative in streptococcal infections; however, it may
not prevent the development of acute granulomatous
necrosis (AGN).
2.) LOOP DIURETICS
Loop diuretics cause diuresis, which in turn reduces
plasma volume as well as edema. As a result of
diuresis, there is a drop in both plasma volume and
stroke volume, which leads to a lower cardiac output
and, as a consequence, also in blood pressure.
DRUG: FUROSEMIDE (LASIX)
3.) VASODILATORS
These medicines lower systemic vascular resistance,
which in turn may enable forward flow, resulting in an
increase in cardiac output.
4.) IMMUNOSUPPRESSANTS
Immunosuppressant medications are sometimes used
to treat severe glomerulonephritis situations that are
brought on by immune system issues. The immune
system is suppressed by these medications.
DRUG: AZATHIOPRINE (AZAMUN)
5.) CALCIUM HANNEL BLOCKERS
Calcium channel blockers prevent calcium ions from
moving across the cell membrane, which slows down
both the production of impulses (automaticity) and the
speed at which they are conducted.
NURSING MANAGEMENT
1: Fluid volume excess related to decreased
regulatory mechanism aeb decreased urinary
output.
2: Activity Intolerance related to decreased
erythropoietin production aeb weakness and
fatigue.
3: Risk for infection related to impaired immune
response.
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HIV/AIDS
DEFINITION
• HIV stands for Human Immunodeficiency Virus.
• It’s a virus that breaks down certain cells in the
immune system.
• When HIV damages the immune system, it’s easier
to get really sick and even die from infections that
the body could normally fight off.
• About 1.1 million people in the U.S. are living with
HIV, and more than 38,000 new infections happen
every year. Once diagnosed with HIV, the virus
stays in your body for life. There’s no cure for HIV,
but medicines can help you stay healthy. HIV
medicine lowers or even stops your chances of
spreading the virus to other people. Studies show
that using HIV treatment as directed can lower the
amount of HIV in your blood so much that it might
not even show up on a test when this happens, you
can’t transmit HIV through sex. Without treatment,
HIV can lead to AIDS. But with medicine, people
with HIV can live long, healthy lives and stop the
spread of HIV to others. HIV is the virus that causes
AIDS.
• AIDS stands for Acquired Immune Deficiency
Syndrome. HIV and AIDS are not the same. And
people with HIV do not always have AIDS. HIV is
the virus that’s passed from person to person.
• AIDS is the disease caused by the damage that HIV
does to the immune system. A person will have
AIDS when they get dangerous infections or have a
super low number of CD4 cells. AIDS is the most
serious stage of HIV, and it leads to death over
time.
• The first 2-4 weeks after being infected with HIV, a
person may feel feverish, achy, and sick. These flu-
like symptoms are the body’s first reaction to the
HIV infection. During this time, there’s a lot of the
virus in the system, so it’s really easy to spread HIV
to other people. The symptoms only last for a few
weeks and then the infected person usually doesn’t
have symptoms again for years. But HIV can be
spread to other people whether or not they have
symptoms or feel sick.
• HIV destroys cells in the immune system called
CD4 cells or T cells. Without CD4 cells, your body
has a hard time fighting off diseases. This makes it
more likely to get really sick from infections. Over
time, the damage HIV does to the immune system
leads to AIDS. The signs of AIDS include thrush,
sore throat, bad yeast infections, chronic pelvic
inflammatory disease, getting bad infections a lot,
feeling really tired, dizzy, and lightheaded,
headaches, losing more weight quickly, bruising
more easily than normal, having diarrhea, fevers, or
night sweats for a long time, swollen or firm glands
in the throat, armpit, or groin, deep and dry
coughing spells, feeling short of breath, purplish
growths on the skin or inside the mouth, bleeding
from the mouth, nose, anus, or vagina, skin rashes,
feeling very numb in the hands or feet, losing
control of the muscles and reflexes, not being able
to move, and losing strength in the muscles.
Karis’ notes (BSN4K) Love yourself !
SIGNS AND SYMPTOMS
● Swollen lymph nodes
● Rapid weight loss
● Extreme tiredness or fatigue
● Fever
● Dry cough
● Joint pain
● Rash night sweats
● Diarrhea
ETIOLOGY
PREDISPOSING FACTORS
● Gender (men)
● Age (13 – 24 yo)
● Race / Ethnicity (African-American / black descent)
PRECIPITATING FACTORS
● Unprotected sexual activity
● Sexual orientation (gay, bisexual and other men
who have sex with men)
● Contaminated or shared needles
● Transmission from mother to child
● Blood transfusion
PATHOPHYSIOLOGY
Immune deficiency can be acquired due to an infection from
pathogens such as human immunodeficiency virus (HIV). HIV is
a retrovirus, which means that the genetic material that it carries
is in the form of ribonucleic acid (RNA) rather than
deoxyribonucleic acid (DNA). It consists of a viral core that
contains the viral RNA, which is surrounded by an envelope of
protruding glycoproteins GP120 and GP41. Primary insult starts
when HIV enters the human host through unprotected sexual
activity, sharing needles, mother to child transmission, same-
sex intercourse, and blood transfusion and is mitigated by
factors such as gender, age, and race or ethnicity. All viruses
target specific cells in the bodies of their host. HIV specifically
targets cells that have CD4+ receptors which are found on the
surface of T lymphocytes. The first step is attachment or
binding. In this step, HIV glycoproteins GP120 and GP41 bind
to the host’s CD4+ receptor and coreceptor, either CCR5 or
CXCR4. This then results in the fusion of HIV and the host’s
CD4+ T-cell membrane. After this step, only the contents of the
HIV viral core will be emptied into the cell. The HIV viral core
consists of three enzymes namely reverse transcriptase,
integrase, and protease. Through the action of reverse
transcriptase, DNA synthesis then occurs wherein HIV converts
its genetic material from RNA to DNA, which carries the
instructions needed for viral replication. After which, is
integration. In this step, the viral DNA (vDNA) enters the nucleus
and binds with the DNA of the host’s CD4+ cell. This results in
permanent, lifelong HIV infection. In a resting or nondividing
CD4+ cell, the HIV survives in a latent state as a provirus.
Once the CD4+ T cell is activated against other pathogens, the
cell will begin to produce new copies of RNA and viral proteins.
First is transcription, where the DNA will form single-stranded
messenger RNA (mRNA) in the nucleus to build new viruses.
Next is translation, where the mRNA creates new proteins and
enzymes (polyprotein) that are needed to make new viruses.
The polyprotein chain is cut using HIV enzyme protease into
individual proteins that can make up the virus. Last is budding,
where the newly formed proteins and viral RNA migrate to the
cell membrane of the CD4+ T cell, exit the cell, and infect more
cells. This then results in a widespread dissemination of the HIV
virus throughout the body. As this happens, there will be a
destruction of a lot of CD4+ T cells which leads to a dramatic
drop in the body’s CD4+ T cell count. If the count reaches to
around 500-1500 cells/mm , this is known as Stage 1 or Acute
HIV Infection. In this stage, the infected person will manifest flu-
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like symptoms such as fatigue, fever, rash, dry cough, swollen
lymph nodes, night sweats, and diarrhea. The host’s immune
system then responds to the infection that causes other
immune cells to increase their killing of the infected cells. The
body produces antibodies against HIV to do so. The amount of
virus in the body of the host after the initial immune response
subsides is called viral set point. Here, there is an equilibrium
between the immune response and HIV levels which then
results in a chronic HIV phase. This occurs since despite its best
efforts, the immune response cannot eliminate the virus any
longer. The virus also widely disseminates in the lymphoid
tissue, and a latent reservoir is created within the memory of
the CD4+ T cells. This chronic phase lasts on an average of 8
to 10 years and during this time, the host is in an apparent state
of good health. However, over time, the number of CD4+ T cells
still continues to decrease.
Once the CD4+ T cells drop to around 500-1500 cells/mm , this
is known as Stage 2. Stage 2 presents with swollen lymph
nodes, hairy leukoplakia, and oral thrush. Stage 3 then occurs
once the count drops to below 500 cells/mm . At this point the
person is now considered to have acquired immunodeficiency
syndrome or AIDS.
As the amount of HIV in the blood continues to increase
significantly, the immune response weakens. This leads to the
body being more susceptible to a variety of diseases from
infections to cancer. This includes respiratory complications
such as Pneumocystis pneumonia, Mycobacterium avium
complex, and tuberculosis. These manifest with signs and
symptoms such as chest pain, dyspnea, and chronic cough.
Those with HIV/AIDS are also at risk of developing cancers such
as Kaposi sarcoma which manifests with cutaneous lesions that
can be either flat or raised, usually brownish pink or purple, and
surrounded by ecchymosis and edema. AIDS-related
lymphomas are another oncologic complication which includes
both Hodgkin and non-Hodgkin lymphoma. The patient is also
at risk for fungal infections such as
Cryptococcus Neoformans, which causes Cryptococcal
Meningitis with manifestations including nuchal rigidity,
headache, and seizures. Vaginal candidiasis is also another
complication in women, with white adherent vaginal discharge
and mucosal burning and itching. Moreover, oropharyngeal and
esophageal candidiasis can also occur which is characterized
by painless, white lesions on the hard palate, buccal surface,
oropharyngeal mucosa, or tongue. This risk for such is also
increased due to the direct inflammatory effect of HIV to the
lining of the person’s gastrointestinal tract. Such an effect can
also lead to the patient experiencing HIV wasting syndrome,
which is the involuntary loss of 10% of body weight while
experiencing weakness or diarrhea and fever for not less than
30 days. HIV/AIDS can be diagnosed with the use of enzyme-
linked Immunosorbent assay (ELISA) test, western blot test,
indirect fluorescent antibody, polymerase chain reaction, and
nucleic acid test. It can be managed with pharmacologic
medications such as antiretroviral therapy, nucleoside reverse
transcriptase inhibitors, and antiviral combinations. Surgical
management of the disease includes open lymph node biopsy,
splenectomy, endoscopic sphincterotomy without laparotomy,
anorectal surgery, and solid organ transplantation in people
with HIV. Nursing priorities include to promote skin integrity,
promote usual bowel patterns, prevent infection, improve
activity tolerance, maintain thought processes, improve airway
clearance, relieve pain and discomfort, and improve nutritional
status. If given timely medical attention, the person may expect
to live as long as people without HIV. Outpatient individuals
must also adhere to follow-up check-ups to manage
complications conservatively. On the other hand, a poor
prognosis is possible for clients who leave the disease
untreated. This causes a faster progression of the disease
which can eventually result in death.
MEDICAL MANAGEMENT
DIAGNOSTIC EXAMS
● Indirect Fluorescents Antibody (IFA)
● Polymerase Chain Reaction (PCR)
● Nucleic Acid Test (NAT)
MEDICATIONS
DRUG #1: ZIDOVUDINE (RETROVIR)
Zidovudine enters a host cell and is then converted
into triphosphate by endogenous thymidine kinase
and other cellular enzymes. It then attaches itself into
growing DNA chains thus terminating HIV Viral
replication.
CLASSIFICATION:
Nucleoside Reverse Transcriptase Inhibitor
DRUG #2: ZIAGEN (ABACAVIR)
It helps to decrease the amount of HIV in your body so
your immune system can work better. This lowers your
chance of getting HIV complications (such as new
infections, cancer) and improves your quality of life.
Guanosine analog that inhibits HIV-1 reverse
transcriptase by competing with dGTP as substrate,
which in turn inhibits viral replication
CLASSIFICATION:
Nucleoside Reverse Transcriptase Inhibitor HIV,
Antiretroviral Agents
DRUG #3: EMTRICITABINE AND TENOFOVIR
DISOPROXIL FUMARATE (TRUVADA)
Tenofovir/emtricitabine, trademark Truvada by Gilead
Sciences, is a fixed-dose combination of two
antiretroviral drugs used for the treatment of HIV. It
consists of 300 milligrams of tenofovir disoproxil
fumarate and 200 milligrams of emtricitabine. The drug
has been approved for pre-exposure prophylaxis
against HIV infection.
CLASSIFICATION:
Antiviral Combinations
SURGICAL MANAGEMENT
● Open lymph node biopsy
● Splenectomy
● Endoscopic sphincterotomy w/o laparotomy
● Anorectal surgery
● Solid Organ Transplantation in people with HIV
NURSING MANAGEMENT
1: Social isolation related to inadequate personal
support system aeb expressed feeling of aloneness
and absence of supportive significant others.
2: Impaired oral mucous membrane related to
immunological deficit and presence of lesions aeb
open ulcerated lesions.
3: Fatigue related to overwhelming psychological and
emotional demands aeb decreased performance an
inability to maintain usual routines.

● Enzyme-linked Immunosorbent Assay (ELISA)

Test
● Western Blot

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KAWASAKI DISEASE
DEFINITION
• Kawasaki disease (KD), it is also known as
Kawasaki syndrome or mucocutaneous lymph
node syndrome.
• It was first described in Japan and was discovered
by Tomisaku Kawasaki in 1967.
• This disease primarily affects children who are 5
years old and below, and is known as the leading
cause of acquired heart disease in the United
states.
• Kawasaki disease is an acute, self-limited medium
vessel vasculitis that has a predilection for the
coronary arteries.
• Clinical signs include fever, rash, irritation and
redness of the sclera, irritation and inflammation of
the mouth, lips, and throat, swollen lymph glands in
the neck, and swelling of hands and feet.
• Up until now, it is still not known if KD may be
related to a wind-borne or water-borne pathogen.
• Several organisms of bacterial and viral origin have
been under study due to its suspicion but there is
still no single agent identified as its leading cause.
• However, in recent studies, it was shown that
certain genetic markers show a predisposition to
the disease.
• It was found out that siblings are 10 to 20 times
more likely to develop KD if compared to the
general population. Although there is no evidence
that the disease can be passed from person to
person.
ANATOMY AND PHYSIOLOGY
HEART: CORONARY ARTERIES
Kawasaki disease commonly leads to inflammation of
the coronary arteries, which supply oxygen-rich
blood to the heart. Kawasaki disease was previously
called mucocutaneous lymph node syndrome
because it also causes swelling in glands (lymph
nodes) and mucous membranes inside the mouth,
nose, eyes and throat.
SIGNS AND SYMPTOMS
● High fever for 5 days or more (more than 39C)
● Conjunctivitis without any discharge
● Rash on the body including buttock / diaper area
(Polymorphous rash)
● Erythema or edema of the palm and sole
● Cervical Adenopathy / enlarged lymph nodes on
the neck
● Mucosal involvement (red and/or cracked lips with
strawberry tongue)
● Peeling skin
● Arrhythmia
ETIOLOGY
Y outward protrusion, resulting in an aneurysm
PREDISPOSING FACTORS
● Age (under 5 yo)
● Gender (male)
● Genetic variant
Karis’ notes (BSN4K) Love yourself !
● Ethnicity (Asian children)
● Environment (winter, summer, & spring)
PRECIPITATING FACTORS
● Unknown Infection
PATHOPHYSIOLOGY
Despite the fact that the root cause of Kawasaki
disease remains unknown, researchers have
dismissed the possibility that it may be spread easily
from person to person. Several hypotheses have been
put up as to what causes Kawasaki disease, but the
most common is exposure to harmful bacteria or
viruses. Kawasaki disease also was observed to run in
families. According to researches, 1 out of 100
Japanese children, 10 to 40 out of 100, 000 children in
United States, China, and UK acquire Kawasaki
disease which means it is prevalent in Japan. It is
common in children 5 years old and younger, having
90% of the cases and was also commonly seen in
males than females. Kawasaki disease is a systemic
and an inflammatory disease that primarily affects the
medium-sized arteries. The unknown cause, which is
suspected to be an unknown infection makes the
immune system attack its own medium-sized arteries.
The immune system becomes hyper stimulated
resulting to activation of bunch of different immune
cell types such as macrophages, neutrophils, and T
cells. They start causing damage to the endothelial
cells, collagen, and smooth muscle which composes
the tubular structure of the medium-sized arteries. The
further damage causes the structure to be less intact
and lose its integrity. This results to dilation of blood
vessels and causes medium-sized inflammation.
The mandatory diagnostic criteria for Kawasaki is
when the patient has a fever for more than five (5) days
without any other cause with at least four (4) out of five
(5) of the following criteria: Bilateral conjunctival
infection (reddening of the eyes) which we can
observed in 75% of the patients having Kawasaki
disease, Oral mucous membrane changes such as
cracked lips and strawberry tongue which was
observed in 90% of the patients, Erythema and
Edema, Polymorphous rash or rash all over the body,
and/or cervical lymphadenopathy or enlargement of
lymph nodes in the neck. Other diagnostic tests such
as CBC, ESR, CRP, and Echocardiogram can also be
utilized but it is strictly followed to observe first for the
diagnostic criteria. The treatment for Kawasaki
disease includes Aspirin which is an anti-inflammatory
drug that helps induce inflammation, swelling,
discomfort, and fever. The medical team can also give
the patient Immunoglobulin intravenously or IVig. The
IVIg inactivates the auto-receptive T-cells by
competing for and interrupting their interaction with
antigen-presenting cells. If the repair that occurs was
not enough or it was not treated, there is still a
weakened wall and the blood continue to pass through
that weakened vessel, the pressure will cause an
formation and eventually if not prevented, rupture of
that artery affected and resulting to bad prognosis.
However If it is treated, most children recover fully and
result to a good prognosis.
11
 TRANS: CANCER

MEDICAL MANAGEMENT

DIAGNOSTIC EXAMS

● CBC
● ESR (Erythrocyte Sedimentation Rate)
● CRP (C-reactive Protein)
● Echocardiogram

MEDICATIONS

1.) INTRAVENOUS IMMUNOGLOBULIN (IVIg)

Intravenous Immunoglobulin (IVIg) is given to patients
with Kawasaki Disease (KD) in order to prevent
damage to the coronary artery and to reduce
inflammation. It also manages conditions such as
fever, rash, and systemic malaise.

DRUG: IMMUNOGLOBULIN (IMMUNOREL)

2.) ASPIRIN
Aspirin is given to a patient with Kawasaki Disease
(KD) to ease the patient’s pain and discomfort,
manage hyperthermia, and at high doses, reduce
swelling. It is usually given concomitantly with
intravenous immunoglobulin (IVIg) to prevent coronary
artery abnormalities.

DRUG: ACETYLSALICYLIC ACID (ASPILET)

SURGICAL MANAGEMENT

● Thromboendarterectomy
● Aneurysmal reconstruction
● Coronary artery bypass grafting

NURSING MANAGEMENT

1: Impaired oral mucous membrane related to

dehydration, mouth breathing and inflammatory
process.

2: Hyperthermia related to inflammatory disease

process.

Karis’ notes (BSN4K) Love yourself ! 12

 SEM 101 – CANCER AND IMMUNOLOGY (PRELIM)
CANCER
1) __________ approved as adjuvant
treatment for stage IB, II or IIIA Lung
Cancer
ANSWER: KEYTRUDA
2) ___________is approved to treat
some people with non-small cell lung
cancer after surgery
ANSWER: ATEZULIZUMAB
3) ________most treatable Lung cancer.
Better outlook than other types of
lung cancer.
ANSWER: ADENOCARNIMA IN SITU
4) ___________tends to grow and
spread quickly, so it can be harder to
treat than the other types.
ANSWER: LARGE-CELL
(UNDIFFERENTIATED) CARCINOMA.
5) Around 40 out of every 100 people
(around 40%) survive their cancer for
1 year or more. around 15 out of
every 100 people (around 15%) will
survive their cancer for 5 years or
more. 10 out of every 100 people
(10%) will survive their cancer for 10
years or more.
ANSWER: TRUE
6) Common sites of metastasis for
Breast Cancer
ANSWER: BONE, LUNG, BRAIN, LIVER
7) Common site of metastasis for
Colorectal Cancer
ANSWER: LIVER
8) The Best Position for CBE
ANSWER: SUPINE
9) _____________ surgery performed to
improve quality of life during the
survival time.
ANSWER: PALLIATIVE SURGERY
10) External Radiation is also called as
____________
ANSWER: TELETHERAPY
11) Painless vaginal postmenstrual and
post coital bleeding are common on
what type of cancer
ANSWER: CERVICAL CANCER
12) It involves freezing of the tissues,
using a probe, with subsequent
necrosis and sloughing.
ANSWER: CRYOSURGERY
13) A type of surgery in which Breast
tissue and the nipple are removed.
Lymph nodes are usually left intact.
ANSWER: SIMPLE MASTECTOMY
14) Most outstanding sign for Breast
cancer
ANSWER: PEAU D ORANGE OR SKIN
EDEMA WITH DIMPLING
 SEM 101 – CANCER AND IMMUNOLOGY (PRELIM)

15) Age older than 60 years is one of the
risk factors for colorectal cancer
ANSWER: FALSE…..50 YO
16) Blood in stool (most common
manifestation) detected by fecal
occult blood testing, sigmoidoscopy,
and colonoscopy
ANSWER: TRUE
23) The nurse is assessing the colostomy
of a client who has had an abdominal
perineal resection for a bowel tumor.
Which assessment finding indicates
that the colostomy is beginning to
function?
a. The passage of flatus
b. Absent bowel sounds
c. The client’s ability to tolerate food
d. Bloody drainage from the
colostomy

17) Ascending colon tumor manifests __ ANSWER: A.

R: Following abdominal perineal
ANSWER: DIARRHEA resection, the nurse would expect the
colostomy to begin to function within 72
18) Rectal tumor usually hours after surgery, although it may take
manifests__________ up to 5 days. The nurse would assess for
a return of peristalsis, listen for bowel
ANSWER: ALTERNATING DIARRHEA sounds, and check for the passage of
AND CONSTIPATION flatus. Absent bowel sounds would not
indicate the return of peristalsis. The
19) Colostomy is functional within client would remain NPO (nothing by
________ days mouth) until bowel sounds return and the
colostomy is functioning. Bloody
ANSWER: 2-3 DAYS AFTER drainage is not expected from a
colostomy.
20) Best position after
LOBECTOMY___________ 24) The nurse is caring for a client after a
mastectomy. Which nursing
ANSWER: UNAFFECTED SIDE intervention would assist in
preventing lymphedema of the
21) Best position after affected arm?
PNEUMONECTOMY ___________ a. Placing cool compresses on the
affected arm
ANSWER: AFFECTED SIDE b. Elevating the affected arm on a
pillow above heart level
22) ______________late manifestation of c. Avoiding arm exercises in the
extensive malignancy that occurs immediate postoperative period
most often with bone metastasis, d. Maintaining an intravenous site
when the bone releases calcium into below the ante- cubital area on
the bloodstream. the affected side

ANSWER: HYPERCALCEMIA ANSWER: B

 SEM 101 – CANCER AND IMMUNOLOGY (PRELIM)
R: Following mastectomy, the arm needs
to be elevated above the level of the
heart. Simple arm exercises should be
encouraged. No blood pressure
readings, injections, intravenous lines, or
blood draws would be performed on the
affected arm. Cool compresses are not a
suggested measure to prevent
lymphedema from occurring.
25) The community health nurse is
instructing a group of young clients
about breast self-examination. The
nurse would instruct the clients to
perform the examination at which
time?
a. At the onset of menstruation
b. Every month during ovulation
c. Weekly at the same time of daY
d. One week after menstruation
begins
ANSWER: D
R: The breast self-examination needs to
be performed regularly, 7 days after the
onset of the menstrual period.
Performing the examination weekly is
not recommended. At the onset of
menstruation and during ovulation,
hormonal changes occur that may alter
breast tissue.
IMMUNOLOGY
1) Nurse Raquel developed a nursing
diagnosis of Imbalanced Nutrition:
Less Than Body Requirements for a
hospitalized patient with AIDS who
has anorexia and nausea. Which of
these nursing actions is most
appropriate to delegate to a nurse
assistant who is providing care for
this patient?
A. Provide oral care with a soft
toothbrush every 8hrs
B. Do health teaching about high-
calorie, high-protein diet
C. Give bedside meds as
prescribed
D. Assess patient for other
nutrition risk factors
2) A patient with acquired
immunodeficiency syndrome (AIDS)
has a negative tuberculosis (TB) skin
test. Which action of Nurse Rita is
indicated next?
A. Do health teaching about the
multi-drug therapy
B. Obtain a chest x-ray and
sputum smear
C. Schedule TB testing again after
6 months
D. No further action is needed
since he is confirmed free of TB
3) Nurse Morgan suffered a needle stick
injury with no information about the
patient’s HIV status. What is the most
appropriate method for obtaining this
information about the patient?
A. Mark, an occupational health
nurse should discuss HIV
status with the patient
 SEM 101 – CANCER AND IMMUNOLOGY (PRELIM)
B. HIV testing should be done the
next time blood is drawn for
other tests
C. Morgan should ask the patient
to authorize HIV testing as
soon as possible
D. Riza, the nurse manager for the
unit is responsible for obtaining
additional information
4) Raul is working in an AIDS hospice
facility that is also staffed with
nursing assistants. Which of these
nursing actions is best to delegate to
an NA you are supervising?
A. Collect data about patient’s
response to medications used
for pain and anorexia
B. Assist patients with personal
hygiene and other ADL’s as
needed
C. Assess patients’ nutritional
needs and individualize diet
plans to improve nutrition
D. Teach about how to lower risk
for spreading infections
5) Keith, an 18-year-old college student
with an exacerbation of systemic
lupus erythematosus (SLE) has been
receiving prednisone 20 mg daily for
4 hours. Which of these medical
orders should you question?
A. Discontinue prednisone after
today’s dose
B. Check patient’s C-Reactive
Protein Levels
C. Administer first dose of
varicella vaccine
D. Give Mefenamic acid 500mg
q6hrs
6) Nurse Methyl is completing an
assessment and health history for an
HIV-positive patient who is
considering starting antiretroviral
therapy with several medications.
Which patient information concerns
you the most?
A. Patient has many questions
and concerns regarding how
effective and safe the
medications are
B. Patient continues to be
sexually active with multiple
partners and says that he is
careful to use condoms
C. Patient has been HIV positive
for 8 years and has never been
on any drug therapy for the HIV
infection
D. Patient tells you that he never
has been very consistent
about taking medications in
the past
7) Nurse Ryan is evaluating an HIV-
positive patient who is receiving IV
pentamidine antibiotic as a treatment
for Pneumocystis carinii pneumonia.
Which information is most important
to communicate to the physician?
A. Blood glucose is 66 mg/dL
after the medication
administration
B. The blood pressure decreased
to 110/70 during administration
C. The patient is complaining of
pain at the site of the infusion
D. The patient is not taking in an
adequate amount of oral fluids
8) Uno is working with Jorge, a student
nurse who is assigned to care for an
HIV-positive patient with severe
esophagitis caused by Candida
albicans. Which action by the student
 SEM 101 – CANCER AND IMMUNOLOGY (PRELIM)
indicates that you need to intervene
most quickly?
A. The student puts on a mask
and gown before entering the
patient room
B. The student gives the patient
a glass of water after the oral
nystatin suspension
C. The student offers the patient a
warm soup for lunch
D. The student places a “No
Visitors” sign on the door of the
patient’s room
9) A patient who has received a kidney
transplant has been admitted to the
medical unit with acute rejection and
is receiving IV cyclosporine and
methylprednisolone. Which staff
member is best to assign to care for
this patient?
A. An RN with 3 years of
experience as supervisor in the
operating room
B. An RN who has worked on
the medical unit for 5 years
and is working a double shift
today
C. An RN who floated to the
medical unit from the coronary
care unit for the day
D. A new graduate RN who needs
experience with IV medication
administration
10) A patient with systemic lupus
erythematosus (SLE) is admitted to
the hospital for evaluation and
management of acute joint
inflammation. Which information
obtained in the admission laboratory
testing concerns you most?
A. The C-reactive protein (CRP)
level is increased
B. The Creatinine level is
elevated
C. The anti-nuclear antibody (ANA)
test is positive
D. The lupus erythematosus (LE)
cell prep is positive
11) As the nurse manager in a public
health department, you are
responsible for developing a plan to
reduce the incidence of infection with
the human immunodeficiency virus
(HIV) in the community. Which
nursing action is best delegated to
health assistants working for the
agency?
A. Determine which population
groups to target for educational
based on community
assessment
B. Provide pretest and post-test
counseling to those patients
who are seeking HIV testing
C. Educate high-risk community
members about the use of
condoms in HIV prevention
D. Supply injection drug users
with bleach solution for
cleaning needles and
syringes
12) An HIV-positive patient who has been
started on antiretroviral therapy (ART)
is seen in the clinic for follow-up.
Which test will be most helpful in
determining the response to therapy?
A. ELISA testing
B. Western blot analysis
C. Viral load testing
D. Lymphocyte count
 SEM 101 – CANCER AND IMMUNOLOGY (PRELIM)

13) Nurse Miko is assessing a client 19) Mainstay treatment of KAWASAKI

diagnosed with SLE. He knows that 20) __________ together with __________
is a chronic disease that could affect
the following except? ANSWER: IVIg (INTRAVENOUS
A. Kidney IMMUNOGLOBULIN; ASPIRIN (?)
B. Joints
C. Heart 21) Untreated or under-treated staph
D. None of the above infections can increase the risk for
rheumatic heart disease.
14) Nurse Miko is assessing a client with
SLE. Which of the following is not ANSWER: FALSE
included?
A. Seizures 22) _____________can show damage to
B. Hypothermia the valve flaps, backflow of blood
C. Malar Rash through a leaky valve, fluid around
D. Myalgia the heart, and heart enlargement. It’s
the most useful test for diagnosing
15) The most common cardiac heart valve problems.
manifestation of Lupus is
A. Myocardial Infarction ANSWER: ECHOCARDIOGRAM
B. Pericarditis
C. Angina Pectoris 23) Rheumatic fever is an inflammatory
D. CHF disease that can affect many
______________ tissues
16) The single most important
medication available for treatment is ANSWER: CONNECTIVE TISSUE
A. 6-mercaptopurine
B. Steroid 24) Rheumatic heart disease is the most
C. Antimalarial commonly acquired heart disease in
D. NSAID people under age 25.

17) Kawasaki disease (KD) is a rare ANSWER: TRUE

systemic inflammatory disease that
predominately affects children less
than 5 years of age.
ANSWER: TRUE
18) The most common rash pattern seen
in clients with Kawasaki disease.
ANSWER: DIFFUSED
MACULOPAPULAR RASH
25) ________________ is the jerky
uncontrollable body movements in
RHD.
ANSWER: CHOREA
26) _______________Still the drug of
choice in preventing RHD. Give via
________________
ANSWER: BENZATHINE PENICILLIN G;
INTRAMUSCULARLY (IM)