ALTERATIONS WITH INFECTIOUS, Antimicrobial proteins: Complement Proteins
INFLAMMATORY AND IMMUNOLOGIC
RESPONSES
THE IMMUNE SYSTEM
• consists of a complex network of cells
interacting to protect the body against
invasion by foreign substance
• Two mechanisms that make up the
immune system defend us from foreign
materials
1. Innate (nonspecific) defense system
2. Adaptive (specific) defense system
• Immunity—specific resistance to disease
Innate (Nonspecific) Body Defenses
• Innate body defenses are mechanical
barriers to pathogens (harmful or disease-
causing microorganisms) and include:
• Body surface covering
o Intact skin
o Mucous membranes
• Specialized human cells
• Chemicals produced by the body
Surface Membrane Barrier
• skin and mucous membranes, provide the
first line of defense against the invasion of
microorganisms
• Protective secretions produced by these
membranes
o Acidic skin secretions inhibit
bacterial growth
o Sebum is toxic to bacteria
o Mucus traps microorganisms
o Gastric juices are acidic and kill
pathogens
o Saliva and tears contain lysozyme
(enzyme that destroys bacteria)
INTERNAL DEFENSES: CELLS AND
CHEMICALS
Phagocytes
• Cells such as neutrophils and
macrophages engulf foreign material by
phagocytosis
• The phagocytic vesicle is fused with a
lysosome, and enzymes digest the cell’s
contents
Natural killer (NK) cells
• Lyse (burst) and kill cancer cells, virus
infected cells
• Release chemicals called perforin and
granzymes to degrade target cell contents
Antimicrobial proteins
• Enhance innate defenses by:
• Attacking microorganisms directly
• Hindering reproduction of
microorganisms
• Most important types
• Complement proteins
• Interferon
• Complement refers to a group of at least
20 plasma proteins that circulate in the
plasma
• Complement is activated when these
plasma proteins encounter and attach to
cells (known as complement fixation)
• Membrane attack complexes (MACs), one
result of complement fixation, produce
holes or pores in cells
• Pores allow water to rush into the cell
• Cell bursts (lyses)
• Activated complement enhances the
inflammatory response
Antimicrobial Proteins: Interferons
• Interferons are small proteins secreted by
virus-infected cells
• Interferons bind to membrane receptors on
healthy cell surfaces to interfere with the
ability of viruses to multiply
Inflammatory response
• Triggered when body tissues are Injured
• Four most common indicators (cardinal
signs) of acute inflammation
1. Redness
2. Heat
3. Pain
4. Swelling (edema)
• Damaged cells release inflammatory
chemicals
o Histamine
o Kinin
• These chemicals cause:
o Blood vessels to dilate
o Capillaries to become leaky
o Phagocytes and white blood cells
to move into the area (called
positive chemotaxis)
Functions of the inflammatory response
• Prevents spread of damaging agents
• Disposes of cell debris and pathogens
through phagocytosis
• Sets the stage for repair
Process of the inflammatory response
1. Neutrophils migrate to the area of
inflammation by rolling along the vessel
wall (following the scent of chemicals
from inflammation)
2. Neutrophils squeeze through the capillary
walls by diapedesis to sites of
inflammation
3. Neutrophils gather in the precise site of
tissue injury (positive chemotaxis) and
consume any foreign material present
Fever
• Abnormally high body temperature is a
systemic response to invasion by
microorganisms
• Hypothalamus regulates body temperature
at 37ºC (98.6ºF)
 • The hypothalamus thermostat can be reset
higher by pyrogens (secreted by white
blood cells)
• High temperatures inhibit the release of
iron and zinc (needed by bacteria) from
the liver and spleen
• Fever also increases the speed of repair
processes
ADAPTIVE BODY DEFENSES
Three aspects of adaptive defense
• Antigen specific—the adaptive defense
system recognizes and acts against
particular foreign substances
• Systemic—immunity is not restricted to
the initial infection site
• Memory—the adaptive defense system
recognizes and mounts a stronger attack
on previously encountered pathogens
Two arms of the adaptive defense system
• Humoral immunity = antibody-mediated
immunity
o Provided by antibodies present in
body fluids
• Cellular immunity = cell-mediated
immunity
o Targets virus-infected cells, cancer
cells, and cells of foreign grafts
CELLS OF THE ADAPTIVE DEFENSE
SYSTEM
Crucial cells of the adaptive system
1. Lymphocytes- respond to specific antigens
• B lymphocytes (B cells) produce
antibodies and oversee humoral immunity
• T lymphocytes (T cells) constitute the
cell-mediated arm of the adaptive
defenses; do not make antibodies
2. Antigen-presenting cells (APCs)—help the
lymphocytes but do not respond to specific
antigens
Lymphocytes
• Arise from hemocytoblasts of bone
marrow
• Whether a lymphocyte matures into a B
cell or T cell depends on where it
becomes immunocompetent
• T cells develop immunocompetence in the
thymus and oversee cell-mediated
immunity
o Identify foreign antigens
o Those that bind self-antigens are
destroyed
o Self-tolerance is important part of
lymphocyte “education”
• B cells develop immunocompetence in
bone marrow and provide humoral
immunity
Immunocompetence
• The capability to respond to a specific
antigen by binding to it with antigen-
specific receptors that appear on the
lymphocyte’s surface
• Immunocompetent T and B lymphocytes
migrate to the lymph nodes and spleen,
where encounters with antigens occur
• Differentiation from naïve cells into
mature lymphocytes is complete when
they bind with recognized antigens
• Mature lymphocytes (especially T cells)
circulate continuously throughout the
body
T cells
• differentiated from lymphocytes which is
a type of antigen-recognition mechanism
Types:
• T helper cells (TH) T4 (CD4)
o assist B cells and cytotoxic T cells
to mature
o depleted during HIV infection,
when depleted →AID
• Cytotoxic T lymphocytes- establish a
contact boundary required for target
destruction through lytic molecules called
porins
• Suppressor T cells- slow or stop the
immune response once the foreign invader
is defeated
B cells
• differentiates into memory cells and
plasma cells (Immunoglobulins)
Immunoglobulins
• antibodies
• a family of glycoprotein molecules
present in the body as solutes in body
fluids
• inactivate and binds to antigens to
facilitate phagocytosis
Types of Immunoglobulins:
• IgG- only antibody that can pass thru the
placenta
• IgA- predominant in saliva, tears,
colostrum, breast milk, intestinal and
bronchial secretions
• IgM- the largest immunoglobulin; acute
inflammation; bacterial response
• IgE – allergic reaction; parasitic
infections
• IgD- chronic inflammation
Antigen-presenting cells (APCs)
• Engulf antigens and then present
fragments of them on their own surfaces,
where they can be recognized by T cells
• Major types of cells behaving as APCs
o Dendritic cells
o Macrophages
 o B lymphocytes
• When they present antigens, dendritic
cells and macrophages activate T cells,
which release chemicals
IMMUNE RESPONSE
• body’s action plan devised to combat
invading organisms or substances by
leukocyte and antibody activity
• antigen is any foreign substance
• immunity is the ability to destroy
antigens
• Autoimmunity inability of the immune
system to distinguish self from non-self
NEWBORN’S IMMUNE SYSTEM
• limited immunologic protection at birth
• not able to produce antibodies until about
2 months. Newborns are, however, born
with
• passive antibodies (IgG) passed from their
mother that crossed the placenta
o include antibodies against
poliomyelitis, measles, diphtheria,
pertussis, chickenpox, rubella, and
tetanus
IMMUNODEFICIENCY DISORDERS
• When any one portion of the immune
system is not functioning adequately
TYPES:
• Primary (congenital)
o born without or with inadequate
amounts of immune substances
• Secondary(acquired)
o from viral invasion or exposure to
a toxic substance
o factors such as severe systemic
infection, severe stress,
immunosuppressive therapy,
cancer (radiation/chemo therapy),
malnutrition, renal disease, and
aging
HIV INFECTION & AIDS
• acts by attacking the lymphoreticular
system, in particular CD4- bearing helper
T lymphocytes
• virus enters the cell, substitutes its own
RNA and DNA for the cell’s DNA, and
begins to replicate, destroying the
lymphocytes in the process and the ability
to initiate an effective B-lymphocyte
response.
• no effective way to destroy the virus, so it
remains in the body for life
• can activate if the immune system
becomes even more depressed
Transmission
▪ exposure to blood and other body
secretions
▪ sexual contact
▪ Sharing of contaminated needles for
injection
▪ transfusion of contaminated blood or
blood products
▪ perinatally from mother to fetus or
newborn, and possibly through
breastfeeding
▪ Sexual maltreatment
▪ needle punctures
Assessment
▪ poor resistance to infection
▪ Fever
▪ swollen lymph nodes
▪ respiratory tract infections
▪ oral candidiasis
Diagnostic Test
▪ PCR (polymerase chain reaction) tests -
antigen
▪ ELISA (Enzyme-linked Immunosorbent
Assay) - antibody
▪ Western blot confirmation – antibody
***CD4 counts are used to document the disease
status and predict disease progression
CLASSIFICATION OF HIV INFECTION IN
CHILDREN (CDC,1994):
1. Category A, Mildly Symptomatic (2 or more
S/Sx)
▪ enlarged lymph nodes, liver, or spleen
▪ Recurrent or persistent URTI, sinusitis, or
otitis media
2. Category B, Moderately Symptomatic
▪ oropharyngeal candidiasis
▪ bacterial meningitis
▪ Pneumonia
▪ Sepsis
▪ Cardiomyopathy
▪ Cytomegalovirus (CMV)
▪ Hepatitis
▪ herpes simplex virus (HSV)
▪ bronchitis
▪ Pneumonitis or esophagitis
▪ herpes zoster (shingles)
▪ Lymphoid interstitial pneumonia (LIP)
▪ pulmonary lymphoid hyperplasia complex
▪ toxoplasmosis
3.Category C, Severely Symptomatic (AIDS)
▪ Septicemia
▪ mycobacterial pneumonia
▪ meningitis
▪ bone or joint infection
 ▪ abscess of an internal organ or body
cavity
▪ candidiasis (esophageal or pulmonary)
▪ Encephalopathy
▪ herpes simplex lasting over 1 month
▪ histoplasmosis
▪ Lymphoma
▪ Tuberculosis
▪ Pneumocystis carinii pneumonia
▪ Kaposi sarcoma
Management
▪ birth control education focused on the
needs of HIVpositive women
▪ Antiretroviral therapy (ART)
o Zidovudine
o Ritonavir (Norvir)
o Indinavir(Crixivan)
o allergic shiners
***Goal of ART is to maintain the CD4 cell
count at greater than 500 cells/mm³
HYPERSENSITIVITY
• excessive antigen–antibody response
when the invading organism is an allergen
rather than a simple immunogen.
Laboratory tests
▪ Radioallergosorbent test (RAST)
▪ Eosinophil Counts
o most children with allergies have
5% or more of eosinophils on a
differential count and a total
eosinophil count of 250 or more
cells/mm³
▪ Skin testing / Patch Testing
o done to detect the presence of IgE
in the skin
o to isolate an antigen (allergen) to
which the IgE is responding or to
which a child is sensitive
Management
▪ Environmental control
▪ Pharmacologic therapy
o Intranasal cromolyn sodium
(prophylaxis)
o Second- and third-generation
antihistamines- cetirizine (Zyrtec)
and loratadine (Claritin)
o Decongestants e.g.
pseudoephedrine (Sudafed)
o Intranasal corticosteroids
▪ Hyposensitization / Immunotherapy
o works by increasing the plasma
concentration of IgG antibodies,
which then act to prevent or block
IgE antibodies from coming in
contact with an allergen
ATOPIC DISORDERS
ALLERGIC RHINITIS
• aka “hay fever”
• IgE-mediated inflammatory response to
allergen exposure
• Allergen causes:
o Pollens
o Molds
o Pet hair
o Dust
▪ perennial (year round) allergic rhinitis
Assessment
▪ • sneezing
▪ nasal engorgement/ congestion
▪ profuse watery nasal discharge
▪ Watery eyes
▪ conjunctivae may be pruritic
▪ blackened areas under the eyes, termed
▪ Children constantly rub their noses in an
upward motion, termed an “allergic
salute.”
o leads to a horizontal crease across
the tip of the nose, called an
allergic crease or Dienne line
Management
▪ Avoidance of offending allergens
▪ Pharmacologic agents – antihistamines,
leukotriene inhibitors, or corticosteroids
▪ Hyposensitization or immunotherapy
ATOPIC DERMATITS
• aka Infantile Eczema
• primarily a disease of infants, beginning
as early as the second month of life and
possibly lasting until the child is 2 to 3
years old
• related to food allergy
Assessment
▪ papular and vesicular skin eruptions with
surrounding erythema with weeping and
crusting
▪ pruritus
Management
▪ aimed at reducing the amount of allergen
exposure – milk, eggs, wheat, chocolate,
fish, tomatoes, and peanuts
▪ reducing pruritus so children do not
irritate lesions and cause secondary
infections by scratching
▪ Hydrating the skin
▪ bathing or applying wet dressings (wet
with tap water / Burow’s Solution) for
15 to 20 minutes, followed by the
application of a moisturizer such as
Eucerin
CONTACT DERMATITIS
• a reaction to skin contact with an allergen
(a substance irritating to the child only
with prior sensitization)
• allergen causing the irritation is often
suggested by the part of the child’s body
that is affected
– Eg. dermatitis from a diaper-washing
compound appears in the diaper area
Assessment
▪ Erythema
▪ intensely pruritic papules
▪ Vesicles
▪ Patch testing
o After 48 hours, the patches used
for testing are
o removed and the reactions are
graded 1+ to 4+, the same as in
regular skin testing.
Management
▪ removing the identified allergen from the
child’s environment
▪ Dressings moistened with water, saline, or
Burow’s solution relieves itching
▪ Calamine, Caladryl lotion, Hydrocortisone
lotions or creams reduce itching and also
promote healing
▪ Baths withbaking soda or oatmeal in the
water may be helpful if a large area of the
body is involved
INFECTIOUS DISORDERS
THE INFECTIOUS PROCESS
• Pathogens are any organism that causes
disease and can be classified into five
types of microorganisms:
o Viruses
o Bacteria
o Rickettsia
o Helminths
o Fungi
VIRAL INFECTIONS
VIRAL EXANTHEMS
• majority of childhood exanthems (rashes)
are caused by viruses
o Viruses are the smallest infectious
agents known.
o They actually are not true cells
because they contain either RNA
or DNA, but not both
o Because they are incomplete in
this way, viruses cannot replicate
on their own
EXANTHEM SUBITUM (ROSEOLA
INFANTUM)
• Causative agent: human herpesvirus 6
(HHV-6)
• Incubation period: 9 to 10 days
• Period of communicability: during febrile
period
• Mode of transmission: unknown
• Immunity: contracting the disease offers
lasting natural immunity; no vaccine is
available
Assessment
▪ high fever (104° to 105°F [40.0° to
40.6°C])
▪ Infants become irritable and anorexic
▪ Pharynx may appear slightly inflamed
▪ occipital, cervical, and postauricular
lymph nodes may be enlarged
▪ After 3 or 4 days, the fever falls abruptly
and a distinctive rash of discrete, rose-
pink macules approximately 2 to 3 mm in
size and flat with the skin surface appears
(trunk)
Management
▪ reduce the discomfort of the rash and
fever such as acetaminophen (Tylenol) or
ibuprofen (Motrin)
▪ WOF: febrile seizure
RUBELLA (GERMAN MEASLES)
• Causative agent: Rubella Virus
• Incubation period: 14-21 days
• Period of communicability: 7 days before
to approximately 7 days after the rash
appears
• Mode of transmission: direct and indirect
contact with droplets
• Immunity: contracting the disease offers
lasting natural immunity; a high rubella
antibody titer reveals infection has
occurred.
• Active artificial immunity: attenuated live
virus vaccine (e.g., MMR vaccine)
• Passive artificial immunity: Immune
serum globulin
Assessment
▪ 1-5 days prodromal period
o low-grade fever, headache,
malaise, anorexia, mild
conjunctivitis,
o possibly a sore throat, a mild
cough, congestion, coryza, and
swollen lymph nodes
▪ discrete pink red maculopapular rash
begins on the face, then spreads
downward to the trunk and extremities
▪ on the third day, the rash disappears
Management
▪ reduce the discomfort of the rash and
fever such as acetaminophen (Tylenol) or
ibuprofen (Motrin)
MEASLES (RUBEOLA)
• Causative agent: measles virus
• Incubation period: 10 to 12
• Period of communicability: 5 th of
incubation period through the first few
days of rash
• Mode of transmission: direct contact with
droplets / airborne
• Immunity: contracting the disease offers
lasting natural immunity.
• Active artificial immunity: attenuated live
measles vaccine (e.G., Mmr)
• Passive artificial immunity: immune
serum globulin
Assessment
▪ brown or black, regular, or 7-day measles
rash
▪ High grade fever
▪ Lymphadenitis
▪ Malaise
▪ coryza (rhinitis and a sorethroat)
▪ conjunctivitis with photophobia
(sensitivity to light)
▪ Koplik spots (small, irregular, bright red
spots with a blue-white center point)
appear on the buccal membrane
▪ fourth day of fever, a deep-red
maculopapular rash (forehead, to lower
extremities
Management
▪ reduce the discomfort of the rash and
fever such as acetaminophen (Tylenol) or
ibuprofen (Motrin)
▪ cough suppressant
▪ Applying a lubricating jelly or an
emollient on the skin below the nose
▪ blinds or curtains drawn
CHICKENPOX (VARICELLA)
• Causative agent: Varicella-zoster Virus
(VZV)
• Incubation period: 10 to 21 days
• Period of communicability: 1 day before
the rash to 5 to 6 days after its initial
appearance, when all the vesicles have
crusted
• Mode of transmission: highly contagious;
spread by direct or indirect contact of
saliva or open vesicles
• Immunity: contracting the disease offers
lasting natural immunity to chickenpox; it
causes herpes zoster (shingles) when it is
reactivated at a later time
• Active artificial immunity: attenuated
live virus vaccine
• Passive artificial immunity: children
who are immunosuppressed, such as those
with leukemia or HIV/AIDS, or those who
are being treated with corticosteroids are
offered varicella-zoster immune globulin
(VZIG) within 72 hours of exposure to
help prevent or modify disease symptoms
Assessment
▪ low-grade fever
▪ malaise
▪ Lesions first begin as a macula, then
progress rapidly within 6 to 8 hours to a
papule, and then a vesicle that becomes
umbilicated and then forms a crus
Management
▪ scabs from crusting are allowed to fall off
naturally
▪ preventing scratching
▪ Antihistamine & antipyretic
administration
▪ Acyclovir, an antiviral, may be prescribed
to reduce the number of lesions and
shorten the course of the illness
POLIOVIRUS INFECTIONS:
POLIOMYELITIS (INFANTILE PARALYSIS)
• Causative agent: Poliovirus
• Incubation period: 7 to 14 days
• Period of communicability: Greatest
shortly before and after onset of
symptoms, when virus is present in the
throat and feces (1 to 6 weeks)
• Mode of transmission: Direct and indirect
contact
• Immunity: Contracting the disease causes
active immunity against the one strain of
virus causing the illness
• Active artificial immunity: Inactivated
polio virus (IPV) vaccine
• Passive artificial immunity: None
Assessment
▪ Fever
▪ Headache
▪ Nausea
▪ Vomiting
▪ abdominal pain
▪ Mild stiffness of the neck, back, and legs
▪ pain and tremors of the extremities and
then paralysis as the virus invades the
CNS
Management
▪ bed rest with analgesia and moist hot
packs to relieve pain
▪ If the respiratory muscles are involved,
long-term ventilation may be necessary
MUMPS (EPIDEMIC PAROTITIS)
• Causative agent: Mumps Virus
• Incubation period: 14-21 days
• Period of communicability:
communicable for 5 days from onset of
the swollen parotid gland (CDC, 2016)
• Mode of transmission: direct contact with
respiratory droplets (Rubin, Kennedy, &
Poland, 2016)
• Immunity: contracting the disease gives
lasting natural immunity.
• Active artificial immunity: attenuated live
mumps vaccine in combination with
measles and rubella (MMR)
• Passive artificial immunity: mumps
immune globulin
Assessment
▪ Fever
▪ Headache
▪ Anorexia
▪ Malaise
▪ pain on chewing and an “earache”
▪ Parotid gland swelling
▪ Boys may also develop testicular pain and
swelling (orchitis)
Management
▪ soft, bland, or liquid foods
▪ analgesic for pain and an antipyretic for
fever
BACTERIAL INFECTIONS
SCARLET FEVER
• Causative agent: β-hemolytic streptococci,
group A
• Incubation period: 2 to 5 days
• Period of communicability: greatest
during acute phase of respiratory illness; 1
to 7 days
• Mode of transmission: direct contact and
large droplets,
• Immunity: one episode of disease gives
lasting immunity to scarlet fever toxin.
• No vaccination is available
Assessment
▪ rash is unique in that it is both
enanthematous and exanthematous (i.e.,
on both the mucous membrane and the
skin)
o red with pinpoint lesions that
blanch on pressure and feel as
rough as sandpaper
o Tend to be densest on the trunk
and very prominent in skin folds
(Pastia’s sign).
▪ Tonsils covered with white exudates
▪ “strawberry tongue”
Management
▪ soft, or liquid foods
▪ analgesic for pain and an antipyretic for
fever
▪ prevent the complications of ß-hemolytic,
group A streptococcal infections (acute
glomerulonephritis or rheumatic fever)
DIPHTHERIA
• Causative agent: Corynebacterium
Diphtheriae (Klebs–löffler bacillus)
• Incubation period: 2 to 6 days
• Period of communicability: Rarely more
than 2 weeks to 4 weeks in untreated
persons; 1 to 2 days in children treated
with antibiotics
• Mode of transmission: direct contact or
indirect contact droplets
• Immunity: contracting the disease gives
lasting natural immunity.
• Active artificial immunity: Diphtheria
toxin given as part of diphtheria, tetanus,
and pertussis (DTaP) vaccine
• Passive artificial immunity: diphtheria
antitoxin
Assessment
▪ inflammation and necrosing cells form a
characteristic gray membrane on the
nasopharynx
▪ purulent nasal discharge and a brassy
cough
▪ myocarditis with heart failure and
conduction disturbances may occur
Management
▪ Intravenous administration of antitoxin in
large dose
▪ penicillin or erythromycin intravenously
▪ Complete bed rest
▪ Droplet precautions
▪ WOF: airway obstruction – intubation set
at bed side
▪ Vaccination
WHOOPING COUGH (PERTUSSIS)
• Causative agent: Bordetella Pertussis
• Incubation period: 5 to 21 days
• Mode of transmission: direct or indirect
contact
• Period of communicability: greatest in
catarrhal (respiratory illness) stage
• Immunity: contracting the disease offers
lasting natural immunity
• Active artificial immunity: pertussis
vaccine given as part of DTAP vaccine
• Passive artificial immunity: pertussis
immune serum globulin

Assessment
▪ catarrhal stage begins with upper
respiratory symptoms such as coryza,
sneezing, lacrimation, cough, and a
lowgrade fever
▪ paroxysmal stage - 5 to 10 short, rapid
coughs, followed by a rapid inspiration,
which causes the “whoop” or highpitched
crowing sound of whooping cough
▪ convalescent stage, there is a gradual
cessation of the coughing and vomiting

Management
▪ Maintained on bed rest until the
paroxysms of coughing subside
▪ Urge parents to keep them secluded from
environmental factors, such as cigarette
smoke and dust, and to avoid strenuous
activities
▪ frequent small meals
▪ A full 10-day course of erythromycin or
azithromycin
CELLULAR ABERATION • Importance in Cellular Aberration:
Aberration development of chemotherapeutic drugs
• Deviation
• Distortion
• Cellular aberration- Cells that deviate Pathogenesis of Cancer
from normal Cellular Transformation and Derangement
Definition of Terms Theory
Cancer • Normal cells are transformed into cancer
• Disease process that begins when a cell is cells due to exposure to etiologic agents
transformed by the genetic mutation of the
cellular DNA Failure of the Immune Response Theory
Oncology • All individuals has cancer cells and failure
• Field of study of cancer of the immune system to recognize the
Invasion cells leads to cancer development
• Growth of the primary tumor into the
surrounding host tissue Etiologic Factors for Cancer
Metastasis Chemical Carcinogens
• Spread of cancer cells from the primary to • Act by causing cell mutations
distant sites
Neoplasia 1. Industrial compounds
• New growth a. Vinyl chloride- plastic manufacture,
• Typically used to refer to a new abnormal asbestos factories, construction works
growth that does not respond to normal b. Polycyclic Aromatic Hydrocarbons-
growth- control mechanism refuse burning, auto and truck
• Neoplasm are either: emissions, oil refineries (air pollution)
o Benign (growth is limited) c. Fertilizers, weed killers
o Malignant (cancerous or with d. Dyes- aniline dyes (beauty shops; hair
unlimited growth) bleach, wood working, textile
industries)
2. Tobacco- tar nicotine
3. Alcohol
Characteristics Benign Malignant
4. Cytotoxic Drugs
(Tumor) (Ca)
5. Hormones
Speed of Slowly Rapidly
a. Estrogen- amphiregulin gene
growth
b. Diethylstilbestrol (DES)-
Mode of Remains Infiltrates
6. Food and Preservatives
Growth localized surrounding
a. Nitrites- processed meats through
tissue
smoking, curing, salting or adding
Capsule Encapsulated Not
preservative
Encapsulated
b. Talc
Cell Well; Poorly c. Food sweetener- e.g. Saccharine
Characteristic differentiated differentiated aspartame
mature cells; d. Nitrosomines- rubber baby nipples
function and pacifier (1980)
properly e. Aflatoxins- mold in nuts, grains,
Recurrence Extremely Commonly milk, cheese, peanut butter
unusual when following f. Polycyclic aromatic hydrocarbons-
surgically surgery e.g. Charred flesh foods (meat,
removed poultry, fish)
Metastasis Never occur Very
common Physical Agent
Effect of Not harmful Always a. Radiation
Neoplasm to host harmful o X-rays or radioactive isotopes
Prognosis Very good Poor o Sunlight/ UV rays
b. Physical irritation/ trauma
o E.g. multiple deliveries
The Cell Cycle o Breast Ca and trauma history
• Any malfunction can result in the rapid Genetic
proliferation of immature cells a. Oncogenes
• In some cases, proliferating immature o Hidden/ repressed genetic code
cells are considered cancerous (malignant) existing in all individuals
b. Familial pattern/ History

Leukemia
• Distorted and uncontrolled proliferation of
WBC (leukocytes)
• Most frequently occurring type of cancer
in children
Lymphoma
• Malignancies of the lymph or
reticuloendothelial system
• They account for about 11 % of all
malignancies
• Categorized as
o Hodgkin
o Non-Hodgkin lymphomas
Hodgkin Disease
• Lymphocytes proliferate in the lymph
glands and special Reed-Sternberg cells
(large, multinucleated cells that are
probably nonfunctioning monocyte
macrophage cells develop)
Assessment
• Enlargement of only one painless,
enlarged, rubbery lymph node. Other
nodes then become involved and
potentially spread to the liver, spleen, and
bone marrow. The child may report
accompanying symptoms of anorexia,
malaise, night sweats, and loss of weight.
• Fever may be present.
Therapeutic Management
• Hodgkin disease once was treated mainly
with radiation therapy, today the standard
of care is combination chemotherapy
using the agents cyclophosphamide,
vincristine, procarbazine, and prednisone;
with radiation reserved for those who
have a limited response to chemotherapy
or those with recurrent/progressive
disease
Non-Hodgkin Disease
• malignant disorders of the lymphocytes
(either B or T cells) and occur in a number
of forms. Unlike Hodgkin disease, spread
from the original site is through the
bloodstream rather than directly by lymph
flow, making the course of the disease
unpredictable. Metastatic spread to CNS
may occur early in the disease, with the
common age of occurrence at 5 to 15
years.
Assessment
• involve the lymph glands of the neck and
chest most commonly, although axillary,
abdominal, or inguinal nodes may be the
first involved. If mediastinal lymph glands
are swollen, the child may notice a cough
or chest "tightness."
Therapeutic management
• Non-Hodgkin lymphomas are treated with
systemic chemotherapy, similar to that
used acute lymphocytic (lymphoblastic)
leukemia
Neoplasm of the Brain
• Brain tumors are second most common
form of cancer and most common solid
tumor in children
• Tumors tend to occur between 1 and wo
years of age, with 5 years being the peak
age of incidence
Assessment
• increased intracranial pressure: headache,
vision changes, vomiting, a enlarging
head circumference, or papilledema.
• Lethargy, projectile vomiting, and coma
are late signs.
Management
• Combination of surgery, radiation, and
chemotherapy, depending on the location
and extent of the tumor
Bone Tumors
• Tumors derived from connective tissue,
such as bone and cartilage, muscle, blood
vessels, or lymphoid tissue, are termed
sarcomas
• They are second most frequently
occurring neoplasm in adolescent
Nephroblastoma (Wilms Tumor)
▪ Malignant tumor that rises from the
metanephric mesoderm cells of the upper
pole of the kidney
Assessment
▪ Firm, nontender abdominal mass
▪ Hematuria
▪ Low-grade fever
▪ Anemia
Management
• "No Abdominal Palpation" sign over the
child's crib
• Nephrectomy (excision of the affected
• Kidney)
• Radiation Therapy
• Chemotherapy
Skin Cancer • Monitor blood count
• Melanomas can be differentiated from
benign moles by an a-b-c-d assessment: Leukopenia
o Asymmetry • Hand washing, reverse isolation
o Border irregularity • Note signs and symptoms and respiratory
o Color (variables or dark infection
pigmentation) • Avoid crowd or person with infection
o Diameter (over 6 mm)
• Melanomas are treated with surgery,
radiation and immunotherapy to improve
overall survival Anemia
• Adequate rest period
Treatment Modalities for Cancer • H & H monitoring
Chemotherapy • O2 PRN
• To destroy all malignant cells w/o
destruction of normal cells Hemorrhagic cystitis
• To control tumor growth • Increase fluid intake to 3L/day
• Adjuvant Therapy
Genito-Urinary System
Contraindications Urine Color Changes
• Infection • Reassure that it is harmless
• Recent surgery
• Impaired renal or Hepatic function Reproductive System
• Recent radiation therapy
Premature menopause or Amenorrhea
• Pregnancy
• Reassure that menstruation resumes after
• Bone marrow depression
chemo
Nursing Interventions for Chemo Side Effects
GI System
Radiation Therapy
Nausea and Vomiting
• Causes lethal injury to DNA, so it can
• Antiemetics 4-6 hrs and prophylactically
destroy rapidly multiplying cancer cells
(Metochloropramide, Plasil or Tigan)
• Used to
Diarrhea
• Kill a tumor
• Antidiarrheal drugs
• Reduce the tumor size
• Clear liquid if tolerated
• Relieve Obstruction
• Good perineal care
• Decrease pain
• Monitor K, Na and Cl levels
Stomatitis
External Radiation therapy (Teletherapy)
• Good oral hygiene
• Viscous lidocaine before meals
Internal Radiation therapy (Brachytherapy)
• Gargle and rinse with water and dilutes
hydrogen peroxide after meals • Delivers a high dose of radiation to
localized area
• KY jelly to crackled lips
• Implanted to tissue (interstitial implants)
• Suck popsicles
or cavity (intracavitary) by use of
o Needle
Integumentary System
o Seed
Alopecia
o Catheter
• Temporary Scalp hypothermia- ice pack;
• Administer orally
Wig during treatment; hair grows back 6
mos after chemotherapy
Pruritus
Nursing Management
• Provide good skin care
• Exposure to small amounts of radiation is
Skin Pigmentation- temporary
possible during close contact with the
Nail Changes- temporary
patient receiving internal radiation
Hematological System
• Principles of protection from exposure
Thrombocytopenia o Time- minimize time spent in
• Epistaxis, petechiae, ecchymosis close proximity to the radiation
• Avoid bumps or bruise of skin source; to limit contact time to 30
• Protect from physical injury/ trauma minutes total per 8- hour shift
• Avoid aspirin and aspirin products o Distance- Maintain the maximum
• Avoid IM injection distance possible from the
 radiation source; minimum
distance of 6 feet used when
possible
o Shielding- use lead shields and
other precautions to reduce
exposure to radiation
• Place client in a private room
• Post appropriate notices about radiation
safety precaution
• Instruct visitors to maintain at least 6 feet
from the patient and limit visits to 10-30
minutes
• Ensure proper handling and disposal of
body fluids, assuring the containers are
marked appropriately
• Ensure proper handling of linens and
clothing
• In the event of dislodged implant, use
long-handed forceps and place the implant
into a lead container.
• Do not allow pregnant women to come
into contact with radiation sources; screen
visitors and staff for pregnancy
• If working routinely near radiation
sources, wear a monitoring device to
measure exposure
• Avoid close contact with others until
treatment is completed
• Maintain daily activities unless C/I,
allowing for extra rest periods as needed
• Maintain balance diet, small frequent
meals
• Maintain adequate fluid intake
• Excreted body fluids may be radioactive;
double flush toilet after use.
External Radiation Therapy (Teletherapy)
• Wash the marked area with plain water
and pat skin dry
• Do not wash off the treatment site marks
• Avoid rubbing, scratching, and scrubbing
the treatment site
• Avoid using lotion, ointments, lotion or
powders on the area
• Do not apply extreme temp to the
treatment site
• If shaving, use electric razor only
• Wear soft, loose-fitting clothing over the
treatment area
• Protect skin from sun exposure during the
treatment and for at
• least a year after the treatment is
completed
• Use sunblock (at least SPF 15) when
going outdoors
• Maintain proper rest, diet, fluid intake as
essential to promoting health and repair of
normal tissue
• Hair loss may occur, choose a wig, hat or
scarf to cover and protect head
Immunotherapy/ Biologic Response Modifiers
• Mobilizes the immune system to fight off
cancer
• Goal: destroy or stop malignant growth
• Basis: the restoration, modification,
stimulation or augmentation of body’s
natural immune defenses against cancer
Side effects:
• FLU- like symptoms such chills, fever,
muscle aches, weakness, loss of appetite
• Nausea, vomiting, and diarrhea
• Rash, bleeding or bruise
• Interleukin therapy-swelling
Bone Marrow Transplant
• is a procedure to replace damaged or
destroyed bone marrow with healthy bone
marrow stem cells.
• A stem cell transplant is done after
chemotherapy and radiation is complete.
• The stem cells are delivered into your
bloodstream through a tube called a
central venous catheter.
• The process is similar to getting a blood
transfusion.
• The stem cells travel through the blood
into the bone marrow.
• Usually, no surgery is needed.
Side Effects:
• PAIN: chest pain, headache
• ALTERED BODY TEMPERATURE:
fever, chills
• SKIN: hives, flushing
• CARDIO/RESPI: drop in blood pressure,
SOB
• ALTERED TASTE: Dysgeusia
• GASTRO: nausea and vomiting, mouth
sores