INFECTION AND INFLAMMATION Uncontrollable Risk Factors

- HEREDITY (Chromosomal Traits & Family

History)
Nature of Infection
- AGING (Vulnerability Increases with Age)
- Infection : invasion of the host ( patient ) by
potentially harmful microorganisms ( pathogen ), - ENVIRONMENTAL CHANGES (Unsanitary
resulting in disease. Conditions, Drugs, Chemicals and Pollutants)
- Infecting Agents : Bacteria, Viruses, Fungi and
- ORGANISM RESISTANCE (some pathogens
Protozoa
are resistant to body’s defenses / or medical
- Colonization : presence and growth of
treatments)
microorganisms within the host but without tissue
damage and invasion
- All persons have microorganisms on their skin but
Controllable Risk Factors
no disease results
- Disease and infection results only if the pathogen - STRESS
grows or multiply and alter normal tissue damage
- NUTRITION
Facts about Microorganism
- PHYSICAL FITNESS LEVEL
- Not all are harmful
- SLEEP
- Normal or Resident Flora are found in the skin,
intestines and vagina - DRUG USE
- Some are necessary to maintain normal bodily - HYGIENE
functions
- HIGH RISK BEHAVIORS
- Some microorganisms are part of the normal flora
but have no beneficial role
- Normally, they do no harm, unless the person is
susceptible to infection due to suppression of the
body’s immune response (HIV and Cancer Patients)
Pathogens – disease producing microorganism
- disease causing agents that have the ability to
make one sick or even cause death
- found in air, food and nearly every object or
person who one can come in contact INFECTIOUS DISORDERS OF ADULTS
- virus, fungi or bacteria
Pathogenicity – ability of microorganism to PNEUMONIA
produce disease
- is an inflammation of the lung parenchyma caused
Virulence – refers to the frequency with which a by various microorganisms, including bacteria,
pathogen causes disease mycobacteria, fungi, and viruses.
- Pneumonitis is a more general term that describes *The most common form of aspiration pneumonia
an inflammatory process in the lung tissue that may is bacterial infection from aspiration of bacteria that
predispose or place the patient at risk for microbial normally reside in the upper airways.
invasion.

Classifications & Definitions

1. Community-acquired pneumonia (CAP) -
Pneumonia occurring in the community or ≤48
hours after hospital admission or institutionalization
of patients who do not meet the criteria for health
care–associated pneumonia (HCAP)
2. Health care–associated pneumonia (HCAP) -
Pneumonia occurring in a nonhospitalized patient
with extensive health care contact with one or more
of the following:
a. Hospitalization for ≥2 days in an acute care
facility within 90 days of infection
b. Residence in a nursing home or long-term care Streptococcus pneumoniae
facility
- a gram positive organism that resides naturally in
c. Antibiotic therapy, chemotherapy, or wound care the upper respiratory tract, colonizes the upper
within 30 days of current infection respiratory tract and can cause disseminated
invasive infections, pneumonia and other lower
d. Hemodialysis treatment at a hospital or clinic
respiratory tract infections, and upper respiratory
e. Home infusion therapy or home wound care tract infections such as otitis media and
rhinosinusitis. It may occur as a lobar or
f. Family member with infection due to multidrug-
bronchopneumonic form in patients of any age and
resistant bacteria
may follow a recent respiratory illness.
3. Hospital-acquired pneumonia (HAP) -
- is the most common bacterial cause of CAP in
Pneumonia occurring ≥48 hours after hospital
people younger than 60 years without comorbidity
admission that did not appear to be incubating at the
and in those 60 years and older with comorbidity
time of admission.
Predisposing factors: supine positioning and
aspiration, coma, malnutrition, prolonged Haemophilus Influenzae
hospitalization, hypotension, metabolic disorders.
- causes a type of CAP that frequently affects older
4. Ventilator-associated pneumonia (VAP) - A adults and those with comorbid illnesses (e.g.,
type of HAP that develops ≥48 hours after chronic obstructive pulmonary disease [COPD],
endotracheal tube intubation alcoholism, diabetes)

5. Aspiration Pneumonia - refers to the pulmonary Mycoplasma Pneumonae

consequences resulting from entry of endogenous or
exogenous substances into the lower airway.
- causes Mycoplasma pneumonia which is spread by a. sudden onset of chills
infected respiratory droplets through person-to-
b. rapidly rising fever (38.5° to 40.5°C )
person contact
c. pleuritic chest pain that is aggravated by deep
breathing and coughing
d. tachypnea
e. shortness of breath
f. use of accessory muscles in respiration
g. Rusty, blood-tinged sputum
2. VIRAL infection, MYCOPLASMA infection, or
infection with a LEGIONELLA organism
a. febrile
b. bradycardia
3. STAPHYLOCOCCAL and KLEBSIELA
PNEUMONIA
a. Rusty, blood-tinged sputum
Assessment and Diagnostic Findings
General Clinical Manifestations
1. History – recent respiratory tract infection
1. headache
2. low-grade fever 2. Physical examination

3. pleuritic pain 3. Chest Xray

4. myalgia 4. Blood culture – blood stream invasion occurs

frequently (bacterimia)
5. rash
6. pharyngitis 5. Sputum examination

7. mucoid or mucopurulent sputum 6. Fiberoptic Bronchoscopy – done when a

diagnosis cannot be made from an expectorated or
8. cheeks are flushed and the lips and nail beds
induced specimen, and in patients who are
demonstrate central cyanosis – severe
mechanically ventilated
9. orthopnea
10. Poor appetite
Prevention - Pneumococcal Vaccination
11. Diaphoretic
TYPES:
12. tires easily
1. pneumococcal conjugate vaccine (PCV13)

Clinical Manifestations by Causative Agent > protects against 13 types of pneumococcal

bacteria
1. STREPTOCOCCAL PNEUMONIA:
> recommended for all adults 65 years of age or > Outpatients must be instructed to avoid
older as well as adults 19 years or older with overexertion and to engage in only moderate
conditions that weaken the immune system, such as activity during the initial phases of treatment
HIV infection, organ transplantation, leukemia,
3. Promoting fluid intake
lymphoma, chronic kidney disease and asplenism,
or with cerebrospinal fluid leak or with cochlear > 2L/day if not contraindicated
implants
4. Maintaining nutrition
2. pneumococcal polysaccharide vaccine (PPSV23)
> small frequent meals
> PPSV23 is a newer vaccine
> fluids with electrolytes may help provide fluid,
> protects against 23 types of pneumococcal calories, and electrolytes
bacteria
> IV fluids and nutrients may be given if necessary
> recommended for all adults 65 years of age or
5. Promoting pt’s knowledge
older & for those adults 19-64 years of age who
smoke cigarettes or who have chronic heart, lung, or > educate pt & family members about the cause of
liver disease, or alcoholism pneumonia, management of symptoms or S/S that
should be reported to the primary provider or nurse,
and the need for follow-up.
Medical Management
> Explanations should be given simply and in
- Prescribing appropriate antibiotics for bacterial language that the patient can understand
pneumonias – oral or IV
> in some cases, the instructions and explanations
- Assisting the patient to get adequate rest and must be repeated several times.
hydration
- Managing complications if they occur
- Supplemental oxygenation as ordered

Nursing Management
1. Improving airway patency
> Humidification may be used to loosen secretions
and improve ventilation
> deep breathing with an incentive spirometer

PULMONARY TUBERCULOSIS
2. Promote rest and conserve energy
- is an infectious disease that primarily affects the
> assume a comfortable position to promote rest and
lung parenchyma
breathing (semifowler’s)
- It also may be transmitted to other parts of the
> change positions frequently to enhance secretion
body, including the meninges, kidneys, bones, and
clearance and pulmonary ventilation and perfusion
lymph nodes
- The primary infectious agent, M. tuberculosis, is
an acid-fast aerobic rod that grows slowly and is
sensitive to heat and ultraviolet light.
- TB is a worldwide public health problem that is
closely associated with poverty, malnutrition,
overcrowding, substandard housing, and inadequate
health care.
Transmission and Risk Factors
- TB spreads from person to person by airborne
transmission
- An infected person releases droplet nuclei
(usually particles 1 to 5 mcm in diameter) through
talking, coughing, sneezing, laughing, or singing
- Larger droplets settle; smaller droplets remain
suspended in the air and are inhaled by a susceptible
person.
Pathophysiology
- TB begins when a susceptible person inhales
mycobacteria and becomes infected
- The bacteria are transmitted through the airways to
the alveoli, where they are deposited and begin to
multiply.
- The bacilli also are transported via the lymph
system and bloodstream to other parts of the body
(kidneys, bones, cerebral cortex) and other areas of
the lungs (upper lobes).
- The body’s immune system responds by initiating
an inflammatory reaction. Phagocytes (neutrophils
and macrophages) engulf many of the bacteria, and
TB-specific lymphocytes lyse (destroy) the bacilli
and normal tissue.
- This tissue reaction results in the accumulation of
exudate in the alveoli, causing bronchopneumonia.
- The initial infection usually occurs 2 to 10 weeks
after exposure
Granulomas, new tissue masses of live and dead
bacilli, are surrounded by macrophages, which form
a protective wall.
- They are then transformed to a fibrous tissue
mass, the central portion of which is called a Ghon
tubercle.
- The material (bacteria and macrophages) becomes
necrotic, forming a cheesy mass.
- This mass may become calcified and form a
collagenous scar.
- At this point, the bacteria become dormant, and
there is no further progression of active disease.
- After initial exposure and infection, active disease
may develop because of a compromised or
inadequate immune system response.
- Active disease also may occur with reinfection and
activation of dormant bacteria.
- In this case, the Ghon tubercle ulcerates, releasing
the cheesy material into the bronchi.
- The bacteria then become airborne, resulting in the
further spread of the disease.
- Then, the ulcerated tubercle heals and forms scar
tissue.
- This causes the infected lung to become more
inflamed, resulting in the further development of
bronchopneumonia and tubercle formation.
- Unless this process is arrested, it spreads slowly
downward to the hilum of the lungs and later
extends to adjacent lobes.
- The process may be prolonged and is
characterized by long remissions when the disease
is arrested, followed by periods of renewed activity.
- Approximately 10% of people who are initially
infected develop active disease
- Some people develop reactivation TB (also called
adult-type progressive TB)
- The reactivation of a dormant focus occurring
during the primary infection is the cause.
Clinical Manifestation
- Low-grade fever
- Cough – nonproductive or with mucopurulent
sputum
- Night sweats
- Fatigue
- Weight loss
- Hemoptysis
Assessment & Diagnostic Findings
- positive sputum culture for acid-fast bacilli
- complete history
- physical examination
- tuberculin skin test – Mantoux test (PPD)
- chest x-ray
- drug susceptibility testing
- assessment of respiratory function—for example,
assessing the lungs for consolidation by evaluating
breath sounds (diminished, bronchial sounds;
crackles), fremitus, and egophony
- chest x-ray usually reveals lesions in the upper
lobes
Medical Management
2 PHASES of TREATMENT GUIDELINES for
newly diagnosed cases of PTB
1. INITIAL PHASE - consists of a multiple-
medication regimen of isoniazid, rifampin,
pyrazinamide, and ethambutol plus vitamin B6 50
mg
- All are taken once a day and are oral medications
- This initial intensive-treatment regimen is given
daily for 8 weeks
2. CONTINUATION PHASE - include isoniazid
and rifampin or isoniazid and rifapentine
- lasts for an additional 4 or 7 months
- The 4-month period is used for the large majority
of patients
- The 7-month period is recommended for patients
with cavitary pulmonary TB whose sputum culture
after the initial 2 months of treatment is positive
Isoniazid also may be used as a prophylactic
(preventive) measure for people who are at risk for
significant disease, including:
- Household family members of patients with active
disease
- Patients with HIV infection who have a PPD test
reaction with 5 mm of induration or more
- Patients with fibrotic lesions suggestive of old TB
detected on a chest x-ray and a PPD reaction with 5
mm of induration or more
- Patients whose current PPD test results show a
change from former test results, suggesting recent
exposure to TB and possible infection (skin test
converters)
- Patients who use IV/injection drugs who have
PPD test results with 10mm of induration or more
- Patients with high-risk comorbid conditions and a
PPD result with 10mm of induration or more
- instruct the patient about correct positioning to
facilitate airway drainage, referred to as postural
drainage
- Postural drainage allows the force of gravity to
assist in the removal of bronchial secretions.
2. PROMOTE ADHERENCE TO TREATMENT
REGIMEN
3. PROMOTE ACTIVITY & ADEQUATE
NUTRITION
4. PREVENT TRANSMISSION OF
TUBERCULOSIS INFECTION

Other candidates for preventive isoniazid therapy

INFLAMMATORY BOWEL DISEASE
are those 35 years or younger who have PPD test
results with 10 mm of induration or more and one of - Inflammatory bowel disease (IBD) is a group of
the following criteria: chronic disorders: Crohn’s disease and ulcerative
colitis that result in inflammation or ulceration (or
- Individuals who are foreign-born from countries
both) of the bowel
with a high prevalence of TB
- Both disorders have striking similarities but also
- Populations that are high-risk and medically
several differences Approximately 10% to 15% of
underserved
patients with IBD have characteristics of both
- Patients living in institutions disorders and cannot be definitively diagnosed with
either disorder and are classified as having
* Prophylactic isoniazid treatment involves taking
indeterminate colitis
daily doses for 6 to 12 months
- Despite extensive research, the cause of IBD is
*Liver enzymes, blood urea nitrogen (BUN), and
still unknown
creatinine levels are monitored monthly
- Three underlying factors are genetic
* Sputum culture results are monitored for AFB to
predisposition, altered immune response, and an
evaluate the effectiveness of treatment and the
altered response to gut microorganisms
patient’s adherence to the treatment regimen.

Nursing Management
1. PROMOTE AIRWAY CLEARANC
COMPARISON of CROHN’s DISEASE &
- encouraged to increase OFI to promote systemic
ULCERATIVE COLITIS
hydration and serves as an effective expectorant

CROHN’s DISEASE (Regional Enteritis)
- is characterized by a subacute and chronic
inflammation of the GI tract wall that extends
through all layers (i.e., transmural lesion)
- Although its characteristic histopathologic changes
can occur anywhere in the GI tract, it most
commonly occurs in the distal ileum and the
ascending colon.
- Approximately 35% of patients have ileitis (only
ileal involvement); 45% have ileocolitis (diseased
ileum and colon); and 20% have granulomatous
colitis (only colon involvement)
Pathophysiology
- The inflammatory process in Crohn’s disease
begins with crypt inflammation and abscesses,
which develop into small, focal ulcers.
- These initial lesions then deepen into longitudinal
and transverse ulcers, separated by edematous
patches, creating a characteristic cobblestone
appearance in the affected bowel.
- Fistulas, fissures, and abscesses form as the
inflammation extends into the peritoneum.
- Granulomas can occur in lymph nodes, the
peritoneum, and through the layers of the bowel in
about half of patients.
- Diseased bowel segments are sharply demarcated
by adjoining areas of normal bowel tissue. These
are called skip lesions, from which the label
regional enteritis is derived.
- As the disease advances, the bowel wall thickens
and becomes fibrotic, and the intestinal lumen
narrows. Diseased bowel loops sometimes adhere to
other loops surrounding them
Clinical Manifestation
- Diarrhea
- Prominent right lower quadrant abdominal pain
unrelieved by defecation
- Crampy abdominal pain
- Abdominal tenderness and spasm
- Weight loss
- Malnutrition
- Secondary anemia
- Fever
- Leukocytosis
- Steatorrhea (excessive fat in the feces)
- Anorexia
- Nutritional deficiencies
Assessment & Diagnostic Findings
- CT scan - indicated to find bowel wall thickening
and mesenteric edema, as well as obstructions,
abscesses, and fistulas, and may help specify
abscess formation and location
- MRI - highly sensitive and specific in terms of
identifying pelvic and perianal abscesses and
fistulas
- CBC - performed to assess hematocrit and
hemoglobin levels (which may be decreased) as
well as the WBC count (may be elevated)
 - the erythrocyte sedimentation rate (ESR) is - The mucosa becomes edematous and inflamed.
usually elevated
- The lesions are contiguous, occurring one after the
- Albumin and protein levels may be decreased, other.
indicating malnutrition
- Eventually, the bowel narrows, shortens, and
thickens because of muscular hypertrophy and fat
deposits.
Complications
- Because the inflammatory process is not
- intestinal obstruction or stricture formation
transmural (i.e., it affects the inner lining only),
- perianal disease abscesses, fistulas, obstruction, and fissures are
uncommon in ulcerative colitis
- fluid and electrolyte imbalances
- malnutrition from malabsorption
Clinical Manifestations
- Fistula - The most common type of small bowel
fistula caused by Crohn’s disease is the - Diarrhea with passage of mucus, pus, or blood (6x
enterocutaneous fistula (i.e., an abnormal opening or more per day)
between the small bowel and the skin) - Left lower quadrant abdominal pain
- Abscess formation - abscesses can be the result of - Intermittent tenesmus
an internal fistula that results in fluid accumulation
- Bleeding may be mild or severe
and infection
- Pallor
- Patients with colonic Crohn’s disease are also at
increased risk of colon cancer - Anemia
- Fatigue
- Anorexia
ULCERATIVE COLITIS
- Weight loss
- Ulcerative colitis is a chronic ulcerative and
inflammatory disease of the mucosal and - Fever
submucosal layers of the colon and rectum that is - Vomiting
characterized by unpredictable periods of remission
- Dehydration
and exacerbation with bouts of abdominal cramps
and bloody or purulent diarrhea. - Cramping

- The inflammatory changes typically begin in the Tenesmus – feeling that you need to pass stools,
even though your bowels are already empty
rectum and progress proximally through the colon

Pathophysiology
- Ulcerative colitis affects the superficial mucosa of
the colon and is characterized by multiple
ulcerations, diffuse inflammations, and
desquamation or shedding of the colonic epithelium.
- Bleeding occurs as a result of the ulcerations.
- Hypoalbuminemia
-Electrolyte imbalances
- Extraintestinal manifestations include skin lesions
(e.g., erythema nodosum), eye lesions (e.g., uveitis),
joint abnormalities (e.g., arthritis), and liver disease

Assessment & Diagnostic Findings
- Abdominal x-ray studies are useful for
determining the cause of symptoms
- Colonoscopy is the definitive screening test that
can distinguish ulcerative colitis from other diseases
of the colon with similar symptoms. It may reveal
friable, inflamed mucosa with exudate and
ulcerations
- Biopsies are typically taken to determine
histologic characteristics of the colonic tissue and
extent of disease.
- CT scanning, MRI, and ultrasound studies can
identify abscesses and perirectal involvement
- CBC – low hematocrit and hemoglobin levels;
elevated WBC count
- low albumin levels (indicating malabsorptive
disorders), and an electrolyte imbalance.
- C-reactive protein levels are elevated
- Stool analysis is positive for blood
- Careful stool examination for parasites and other
microbes is performed to rule out dysentery caused
by common intestinal organisms, especially
Entamoeba histolytica, C. difficile and
Campylobacter, Salmonella, Shigella, and
Cryptospora species
Complication
- toxic megacolon, perforation, and bleeding as a
result of ulceration
- In toxic megacolon, the inflammatory process
extends into the muscularis, inhibiting its ability to
contract and resulting in colonic distention.
- If the patient with toxic megacolon does not
respond within 72 hours to medical management
with NG suction, IV fluids with electrolytes,
corticosteroids, and antibiotics, surgery is required.
- A subtotal colectomy may be performed if bowel
perforation has not occurred. Otherwise, colectomy
is indicated; it is ultimately needed in up to one
third of patients with severe ulcerative colitis
Management Of Inflammatory Bowel Disease
- Medical treatment for both of these types of IBD
is aimed at inducing disease remission, using a
management process called induction therapy, and
preventing flare-ups of the disease process while
maximizing quality of life, using a management
process called maintenance therapy
- Pharmacologic therapy is indicated to meet the
goals of inducing and maintaining remission of
IBD.
Pharmacologic Management
- Aminosalicylates such as sulfasalazine are
typically the first pharmacologic agents selected to
induce and maintain remission of mild to moderate
IBD
- Aminosalicylates tend to be more effective agents
in treating ulcerative colitis than Crohn’s disease
- Sulfa-free aminosalicylates (e.g., mesalamine,
olsalazine, balsalazide) are indicated for patients
with sulfa allergies
- These drugs are administered orally or topically
(by enema or rectal suppository) for patients with
more distal disease involvement
- Common adverse effects of aminosalicylates
include headaches, nausea, and diarrhea
- The most commonly prescribed antibiotics include
a combination therapy of both metronidazole and
ciprofloxacin, taken orally.
- Corticosteroids can be given orally (e.g.,
prednisone) in outpatient treatment or parenterally
(e.g., hydrocortisone) in patients who are
hospitalized
- Immunomodulators (e.g., azathioprine, portion of the distal ileum to the abdominal wall and
mercaptopurine, methotrexate, cyclosporine); used creating a stoma
as maintenance therapy
- This procedure eliminates the need for an external
fecal collection bag.
Nutritional Therapy
- During induction therapy, oral fluids and a low-
residue, high-protein, high-calorie diet with
supplemental vitamin therapy and iron replacement
are prescribed to meet nutritional needs, reduce
inflammation, and control pain and diarrhea.
- IV therapy as necessary – to correct electrolyte
imbalance due to diarrhea
- FODMAP diet – fermentable oligosaccharides,
disaccharides, monosaccharides and polyols which
are short chain carbohydrates (sugars) that the small
intestine absorbs poorly

Surgical Management
Proctocolectomy and Total Colectomy with
Ileostomy
- Proctocolectomy (i.e., surgical excision of the
colon and rectum) with ileostomy (i.e., a surgical
opening into the ileum by means of a stoma to allow
drainage of bowel contents)
Restorative Proctocolectomy with Ileal Pouch
Anal Anastomosis
- establishes an ileal reservoir that functions as a
“new” rectum, and anal sphincter control of
elimination is retained.
- The procedure involves connecting the ileum to
the anal pouch (made from a small intestine
CELLULAR ABERRATIONS (CANCER)
segment), and the surgeon connects the pouch to the
anus in conjunction with removing the colon and
the rectal mucosa
- Cancer is the number 3 killer of Filipinos today-
Continent Ileostomy 189 of every 100,000 Filipinos are afflicted with
cancer while 4 Filipinos die of cancer every hour or
- The procedure consists of a proctocolectomy, with
96 Filipinos die every day. A study conducted by the
30 to 45 cm of the terminal ileum used to create a J-
or S-shaped continent ileal reservoir by diverting a
University of the Philippines, Institute of Human
Genetics, National Institute of Health.
- Second leading cause of death and is responsible
for the estimated 9.6 million deaths in 2018 and 1 in
6 death is due to cancer.
- Cancer is on the rise and is projected to be the no.
1 killer in the next 5 years.
- The survival rate of adult Filipinos is just 50%
compared to at least 70% in the West.
- Breast Cancer is the top most occurring cancer in
the Philippines and in the world ( equal to lung
cancer deaths )
- The Philippines has the highest rate of breast
cancer in Asia.
Can cancer be preventive?
- At least 1/3 of all cancers can be prevented
- Cancer protecting mechanism prevent cancer. A
healthy lifestyle started in childhood particularly
eating HEALTHY DIET maintaining PHYSICAL
FITNESS and MINIMIZING / PROPERLY
COPING WITH STRESS may decrease the risk of
cancer, CAD, HPN, stroke and diabetes.
- HEALTHY DIET : low in animal fat, rich in
starchy foods with substantial fruits and vegetables
- UNHEALTHY DIET : rich in fat, salt and free
sugars, smoked, salt pickled and preserved foods
- PHYSICAL FITNESS : achieved through life long
active lifestyle
- Physically fit individuals are not overweight, quite
productive, with high self-esteem and successful in
coping with stress (exercise 30mins a day for 2-3
times per week)
- Increasing social, mental psychological and
spiritual stress seem to accompany economic
progress and the eroded coping mechanisms
(stressed with financial difficulties)
- Stress is inevitable. Traditional support structures
within the family and community must be
strengthened with establishment of new institutional
mechanisms help the individual, family and
community cope with day to day stress.
- Cancer Promoting Activities should be avoided.
- Cigarette smoking is the most pervasive cancer
causing substance.
- Numerous carcinogenic agents found in cigarette
smoke causes cancer of the mouth, lungs, pharynx,
larynx, esophagus
- Damage is not inflicted on the smoker alone but
on everyone who inhales cigarettes smoke (2nd
hand smokers (SHS) or passive smoking)
- High Alcohol Consumption also increases the risk
for cancer
- Hepatitis B virus (HBV) is the most common
cause of liver cancer. HBV vaccination should
prevent majority of cases.
- Human Papilloma Virus (HPV) causes cancer of
uterine cervix and is transmitted to sexual
intercourse.
- Safe sex and using condoms is currently the most
effective means of preventing STD
- Ultraviolet rays from the sun are capable of
causing skin cancer. Avoid excessive sun exposure.
NEOPLASM - Abnormal mass or growth of a
tissue that can be benign (con cancerous) or
malignant (cancerous)
Factors : Exposure to radiation, Environment
toxins, genetics, diet, stress , inflammation,
infection, local trauma or injury
Classification Of Neoplasms
Benign
- A condition capable of disturbing the function of
the organ but without endangering the life of an
individual
- “Bene” good and “Genus “ sort
- Benign tumor “ a good sort of tumor”
Malignant
- Resistant to treatment and of fatal nature having
the property of uncontrollable growth and
dissemination, capable of metastasizing
Benign Characteristics
CELL CHARACTERISTICS : Well differentiated
mature cells
MODE OF GROWTH : Localized
SPEED OF GROWTH : Grows Slowly
CAPSULE : Encapsulated
METASTASIS : Never occurs
RECURRENCE : Extremely unusual when
surgically removed
- FIBROMAS ( fibrous tissue in the uterus will
cause no manifestation, unless it presses on bone or
nerve )
- LIPOMAS ( arises from adipose tissues, may exert
pressure on surrounding tissue as they expand )
- LEIOMYOMAS ( smooth muscle origin, growth
site is the uterus )
Malignant
- CARCINOMA IN SITU ( neoplasms in epithelial
cells that remains confined to the site of origin )
- FIBROSARCOMA (bulky well-differentiated
tumor masses in the connective tissues )
- BRONCHOGENIC CARCINOMA ( develop in
the lower trachea which can easily metastasize )
Top 5 Cancer Incidence by Site And Sex

EFFECT OF NEOPLASM: Not harmful to host Male

PROGNOSIS : Very Good Prognosis Prostate

Lungs

Malignant Characteristics Colon

Urinary tract
CELL CHARACTERISTICS : Poorly differentiated
( Anaplastic type) Leukemia

MODE OF GROWTH : Infiltrates surrounding Female

tissues Breast
SPEED OF GROWTH : Grows Rapidly Lungs
CAPSULE : Not Encapsulated Colon

METASTASIS : Very Common Uterus

RECURRENCE : Common following surgery Leukemia and lymphoma

EFFECT OF NEOPLASM: Always harmful to the

host
PROGNOSIS : Poor Prognosis
BENIGN VS MALIGNANT
Benign
TUMOR STAGING AND GRADING
- Treatment options and prognosis are based on
tumor stage and grade
STAGING
- Determines the size of tumor, the existence of
local invasion, lymph node involvement and distant
metastasis

Etiologic Factors (Carcinogens)

Viruses
- “ Oncologic Viruses”
- Prolonged or Frequent viral infections that may
cause breakdown of the immune system or
overwhelm the system
Chemical Carcinogens
Cause cell mutation or alteration in cell enzymes
and proteins
1. Industrial Compounds ( fertilizers, dyes, drugs )
2. Hormones ( estrogen diethylstilbestrol )
3. Food Preservatives ( nitrates, talc, food
sweeteners )
Physical Agents
- Radiation ( xray or radioactive isotopes , sunlight
or UV rays )
- Physical Irritation or Trauma ( pipe smoking )
Hormones

Genetics
- Oncogene : when exposed to carcinogens, changes
structure and becomes malignant

Predisposing Factors to Cancers

- Age : High risk for Older People Indigestion and difficulty in swallowing
- Sex : Women ( breast, uterus and cervical cancer ) Overt changes in the moles
Men ( Prostate and Lungs )
Nagging cough and voice hoarseness
- Urban vs. Rural Residence : Cancer more common
in urban dwellers
1. Identify the WARNING SIGNS OF CANCER
- Occupation
2. Implement SAFEGUARD AGAINST CANCER
- Heredity : greater risk if with familial history
BASIC : Annual Physical Exam and Laboratory
- Depression : Grief, Anger, Aggression, Despair of
Life Stresses SKIN : Avoid overexposure to sunlight
- Precancerous Lesions : may undergo Oral : Annual Oral Examination
transformation cancer lesions and tumors
Colon : Digital Rectal Exam for persons over 40.
- Obesity : linked to breast and colorectal cancer Rectal Biopsy and Proctoscopic Exam. Guaiac Stool
Exam or Fecal Occult Blood Test for persons over
50
Assessment
UTERUS : Annual Pap’s Smear from age 40
1. Nursing Assessment
Lungs : Avoid Cigarette Smoking and Annual Cxray
2. Physical Assessment
3. Diagnostic Assessment 3. Identify CLASSIFICATION OF CANCER
according to type of tissue ( carcinoma or sarcoma )
Nursing History
4. Identify SYSTEMIC EFFECTS ( Anorexia,
- Any previous exposure to known or suspected risk
weakness, weight loss, muscle wasting, Metabolic
factor
Disturbances, Fluid and Electrolyte imbalances,
- Health History Pain and Hormonal Imbalances )
- Lifestyle 5. Assist in DIAGNOSTIC TESTS
- Familial History
Diagnosis Assessment
Physical Assessment - TISSUE SAMPLING
Warning Signs Of Cancer Caution! - IMAGING TECHNIQUES
- LABORATORY STUDIES ( Tumor Markers )

Change bladder and bowel habits ROUTINE LABORATORY EXAMS (CBC,

Bleeding Time, Lipid Profile, Liver Profile, Serum
A sore that does not heal
Electrolytes etc)
Unusual bleeding and discharges
Thickening or lump in the breast
Tissue Sampling
1. Exfoliative Cytology Treatment Modalities
- Use to study cells that the body has shed during Surgery - Often the primary treatment for cancer
normal sequence of body tissue growth and and may be performed for various purposes
development
Preventive
2. Biopsy
Diagnostic
- Surgical removal of a piece of tissue for
Curative
microscopic examination. Most definitive diagnosis
for Cancer Palliative

3 Kinds of Biopsy Radiation - High energy ionizing radiation to treat

Needle Biopsy – Cells are aspirated through placed
in tissue
Incisional Biopsy – Removing or taking a small
sample out of tissue mass
Excisional Biopsy – Simple surgical procedure
when an entire lump or entire area is removed from
the skin
Imaging Techniques
tumors
Purpose : kill the tumor, reduce size of tumor,
relieve obstruction or decrease pain
Lethal injury to DNA : destroy rapidly multiplying
cancer and normal cells as well ( xrays, gama rays
an radioactive particles
3 SAFETY PRINCIPLES:
Time - Length of exposure minimize time spent in
close proximity to the radiation source ( 30 mins in
8 hours shift )

Direct Visualization - Involves introduction of fiber Distance - Minimize distance 6 feet from radiation
optic endoscopy tubes into hollow organs to view source
internal surfaces Shielding - Use lead shields and other precautions
1. Bronchoscopy to reduce exposure to radiation

2. Esophagoscopy Sources of Radiation: External ( Teletherapy ) and

Internal ( Brachytherapy- Sealed )
3. Sigmoidoscopy
- Implanted into affected tissue or body cavity
4. Colonoscopy
Indirect Visualization - Radiologic and Imaging - Ingested as solution
Tests -Injected as a solution into the blood stream or body
1. Mammography cavity

2. Barium Enema - Introduced through a catheter into the tumor

3. GI Series 1. Sealed : involves temporarily implanting sealed

applicators that contain radioactive substance into
4. Computed Tomography
various organs of the body
5. MRI
2. Unsealed : involves the administration of isotopes
6. Radioisotope Studies orally or by injection
7. Ultrasound
SIDE EFFECTS OF RADIATION
Alopecia
- Wear wig, hat, bonnet, bandana, scarf or anything
that could be worn as a headdress
- Inform patient that hair will eventually grow back
after chemotherapy
Skin Reactions
- Erythema, Dry Moist Desquamation
- Observe early signs of this skin reaction and refer
- Keep area dry
- Wash area with Water and pat dry
- Do not apply ointment, powder or lotion
- Do not apply heat, avoid direct sun or cold
- Use soft cotton fabrics for clothing
- Do not erase skin markings : serve as guide for
areas of irradiation
Weight Loss Due To Anorexia, Nausea And
Vomiting
- Arrange meal times
- Encourage bland foods
- Provide small attractive meals
- Avoid extreme temperatures
- Administer antiemetics as ordered before meals
Diarrhea
- Encourage low residue, bland, high protein foods
- Administer antidiarrheal meds as ordered
- Provide good perineal care
- Monitor electrolytes ( Na, K )
- Fluid replacement and correct imbalance ( Fluid
and Electrolyte )
Headache
Social Isolation
Anorexia, Nausea and Vomiting
- Arrange meal times
- Encourage bland foods
- Provide small attractive meals
- Avoid extremes of temperature
- Administer antiemetics as ordered before meals
Bone Marrow Transplant
Chemotherapy
- Uses antineoplastic agents to treat cancer cells
locally and systematically
-Provide palliative measure for the patient who has
widespread metastasis
- Disrupts the cell cycle in various phases,
interfering with cellular metabolism and
reproduction
Contraindications:
Infection
Recent Surgery
Impaired Renal or Hepatic Function
Recent Radiation Therapy
Pregnancy
Bone Marrow Depression
SAFETY PRECAUTIONS IN HANDLING
CHEMOTHERAPEUTIC AGENTS
- All used and unused equipment and drugs should
be treated as hazardous wastes
- Place contaminated material in leak proof labeled
as “hazardous waste “
- Prepare chemotherapeutic in private and clean
setting.
- Strict use of body protection techniques include
gloves, garment with close front, cuffed long
sleeves, face shield and mask
- Prevent spillage, use lock fitting on syringes and
IV sets
- Flush immediately with water if it comes in Premature Menopause or Amenorrhea : Reassure
contact with skin and mucous membranes that menstruation resumes after chemotherapy

NURSING INTERVENTIONS
1. GIT SYSTEM :
Nausea and vomiting : Administer Antiemetics
Diarrhea : Replace fluid-electrolytes losses, low
fiber diet
Constipation : Increase Oral Fluid Intake and Fiber
in Diet
2. INTEGUMENTARY SYSTEM
Pruritus, Urticaria : Provide good skin care
Stomatitis : Provide Oral Care and Avoid Hot and
Spicy Food
Alopecia : Reassure that it is only temporary and
encourage to wear wigs, hats, bonnet head scarf
Skin Pigmentation : Inform that it is temporary
Nail Changes : Reassure that nails may grow
normally after chemotherapy
3. HEMOTOPOIETIC SYSTEM
Anemia : Provide frequent rest periods
Neutropenia : Protect from infection and avoid
people with infection
Thrombocytopenia : Protect from trauma and avoid
Aspirin

4. GENITO-URINARY SYSTEM
Hemorrhagic cystitis : Provide 2-3 liters of fluids
per day
Urine Color Changes : Reassure its harmless
5. REPRODUCTIVE SYSTEM