TYPHOID FEVER

11/29/21

FINALS !!!!!!!!!!

- Systemic infection
 Cause by
4 SATAGES OF TYPHOID FEVER
- salmonellae are gram-negative, flagellate ,
motile, nonsporulating facultative 1. Prodromal stage
o Mode of transmission - Microorganism travel in blood stream
- fecal  S/SX:
Fever Dull head ache
- oral route ingestion of contaminated food & Abdominal pain Nausea
water Vomiting Diarrhea
o Incubation period Constipation
- 1-3 weeks
o Source of infection 2. Fastidial stage
- 5 F’s - Organism has reached peyer’s patches
- Feces
- Finger
3 clinical features of typhoid
- Food
- Presence of rose spots ( abdomen and chest
- Flies ) – only symptom specific to typhoid
- Fomites ( pathognomonic , present in 25 % of cases )
- Blanching in pink macular spots 2-3mm over
trunk

2.ladderlike fever

3.spienomegaly

3. Defervescence stage

a. Intestinal hemorrhages
- melena ,hematochezia
- !!!! avoid dark colored foods
b. Intestinal perforation - Peritonitis
- Sudden , severe , abdominal pain ,
Note:
persistence of fever , rigid abdomen
- Peyer’s patches may become necrotic -
 2. Maintenance of nutrition
- High calorie , low residue diet
- !! do not give milk which can lead to
= acidity and diarrhea

3. Isolation of patient
 CDT IMMUNIZATION
Adults : 0.5 cc Im deltoid
Children <10 years old 0.25cc IM deltiod
4. Lysis/convalescence *6months immunity
S/SX: will subside

- Patient will should be watched because VIVOTIF – in capsule form

patinet may developed relapse
- 3 doses : 1 hour before meal q other day
Dx.
- 3 years immunity
a. Blood culture
- Done during prodromal stage ( 1st week )  Protect / purify water supplies
b. Widal test  Proper excrete disposal
 Handwashing
- Antibody test
 Proper preparation and handling food
- Becomes positive on the 2nd week  Avoid eating fresh and uncooked vegetables
c. Typhidot in endemic areas
- ELISA kit that detects IgM and IgG antibodies .  Do not put anything in your mouth
becomes positive after 2-3 days of infection
d. Stool culture
- Done on the 2nd week

Tx: Treatment

Antibiotic :

 Chloramphenicol
- 100mg/kg in 4 doses for 14 days

(side effect is bone marrow depression)

Ceftriaxone , cefixime , ciprofloxacin

Nursing care

1. Maintenance of fluid and electrolyte imbalance

- Proper regulation of IVF
- Adequate fluids
- Assess for the sign of dehydration
 DYSENTERY

- Intestinal inflammation , primarily of colon

- Can lead to mild  severe stomach cramps
& severe diarrhea w/ mucus or blood in the
feces
CHOLERA ( EL TOR)
- Diarrhea with blood
- Infcetious disease = cause severe watery
3 types of dysentery
diarrhea
- Organism survives well at ordinary
1. Bacillary dysentery – shigellosis temperatures and miltiplies well
2. Violent dysentery – cholera temperature 22-40 degree Celcius
3. Amoebic dysentery – amoebiasis
- Usually found in brackish water
- Survived longer in refrigerated food

Pathognomonic sign – RICE WATER STOOL

MODE OF TRANSMISSION

o Fecal oral route

Preventive Measures - Ciprofloxacin
Amoeba:
Metronidazole

Brand name of metronidazole : fladgyl

 CDT Vaccine (Cholera/Dysentery/Typhoid)

 months immunity – given only on outbreaks.
Nursing Care:  Personal hygiene - handwashing
 Environment sanitation – boiling of water,
protect food from flies

 Control of fever
 Maintenance of fluid and electrolyte balance
AMOEBIC DYSENTERY  Oral Rehydration Salt (ORS)
 NaCl, Sodium Bicarbonate, Potassium
Chloride, Glucose
 Given in large amounts as tolerated and
the amount of intake and loss should be
recorded
o Acute - can present as diarrhea (watery foul
Rehydration with ORS (Brunner)
smelling) with tenesmus, frequent, small and often
blood streaked stools.
o Chronic- can present with gastrointestinal
symptoms plus fatigue, weight loss and occasional  Mild dehydration
fever, hepatomegaly
- mild oral mucous membranes and
o Extraintestinal- can occur if the parasite spreads
increased thirst-

Diagnosis - 50ml/kg over a 4-hour interval

to other organs, most commonly the liver where it  Moderate dehydration
causes amoebic liver abscess
- sunken eyes,loss of skin turgor, increased
Abcess may break through the lungs by coughing
thirst, dry oral mucous membrane
“anchovy sauce” sputum
- 100ml/kg over a 4-hour interval
o Stool Examination
 Severe dehydration
Amoebiasis ( stool should be fresh within 30 minutes
- IVF
Treatment
 NURSING ALERT-Sports drinks do not replace
to one hour to find trophozoites) fluid losses correctly and should not be used.

Cholera – dark field microscopy of fresh stool

o Rectal Swab – for cholera and shigellosis

Shigellosis:
- Co-trimoxazole
- ciprofloxacin
Cholera:
- Co-trimoxazoleTetracycline
  Tx rest
- CHO diet
Note: Acute no tendency to be chronic)

3 stagesHEP
of Bmanifestations
(serum hepatitis)

1. Pre-icteric
- Fever
- RUQ pain
- Fatigability
- weight loss anorexia
- N/V
- headache
HEPATITIS
2. Icteric
- Jaundice
- Inflammation of the liver - Itchiness
Due to : - pruritis-bile salts in skin
- alcoholism - tea colored urine
- drug intoxication - stools-clay-colored
- parasite - hepatomegaly
- chemical arsenic - tender liver
- microorganism 3. Post -Icteric stage
- viral communicable disease - jaundice subsides
1. Hepatitis A
- infectious hepatitis
-
catarrhal jaundice hepatitis
 Mode of Transmission:
- fecal-oral, oral-anal sex
 Incubation period:
- 2-7 weeks
 Most common 2. Hepatitis B
 MOT- Fecal oral route, water and food borne
 Syn: Serum Hepatitis, DNA Virus
 Contaminated food, water
 MOT:
 Oral anal contact during sex
 Incubation Period- 15–50 days Average: 30 days - Percutaneous
- sexual contact
 S/s with or without symptoms - mother to child (time at the birth)
- low grade fever  Population at risk:
- nausea - healthcare workers, blood recipients
- Fatigue - drug addicts
- hepatomegaly - sex workers
  Incubation period:  HEP B Vaccine for pre –exposure
- 6 weeks- 6 months  POST EXPOSURE PROPHYLAXIS
- (28-160 days)
Hep B immunoglobulin and vaccine ASAP to 72hrs post
- average- 70-80 days exposure.

Note: Has tendency to go chronic, cirrhotic, CA 14 days after sexual exposure to non immune people
who have close contact with Hep B patient

(needle prick, sexual contact)

If mother has Hep B, her newborn should be given Hep

B vaccine and immune.with this treatment, less than
Percutaneous, permucosal routes) contaminated blood, 10% of infants become infected with Hep B
Semen , vaginal secretions, saliva
o s/s
- jaundice
- hepatomegaly (12-14 cm vertically)
- pale stools
- Lethargy
- Nausea
- arthralgia
more than 90% develop antibodies and recover
spontaneously in 6 months.
10% of patients progress to a carrier state or develop
chronic hepatitis with persistent HBV infection and
hepatocellular injury.

Medical Mx 3. Hepatitis C

 Tx
Syn: Post-transfusion hepatitis, multiple drug use,
- Rest
Transmission possible with sex with infected partner;
- Nutrition  MOT:
- no alcohol -percutaneous
- alpha-interferon as the single modality of  Population at risk
therapy that offers the most promise. A - Healthcare workers
regimen of 3x weekly for 16 to 24 weeks - Blood recipients
result in remission
- Drug addicts
-antiviral agents-
 Incubation period:
 lamivudine (Epivir)
 Adefovir (Hepsera), oral nucleoside analogs
- 2 weeks- 6 months-
- 15–160 days- Average: 50 days
- Transfer from mother to baby
- IV drug use, multiple blood transfusion
 T- TESTING RESULTS (ALT,AST,.
NOTE: Tendency to go Chronic > CA!!! BILIRUBIN,AMMONIA)
4. Hepatitis D
- IV drug use
 Transmission I- INTERFERON/ IMMUNIZATION
- parenteral co infects with HVB to replicate S- SMALL FREQUENT MEALS
5. Hepatitis E
- Water borne
- Fecal oral

- Resemble HVA

- No chronicity

o Dx:
- Liver function Test- determine extent of liver
damage
- ALT/SGPT- Alanine Aminotransferase
- Hepatitis Profile

o Tx:
- Symptomatic and supportive
- Antiviral: lamivudine  OD x 1 yr
- Interferon 3x a week for 6 months
o Nursing Care:
1. CBR
2. Nutrition: inc. CHO in diet
o Preventive:

Oncologic nursing
1. Immunization
2. Universal precaution

12/6/21

- Study about cancer & cancer patient

TUMOR ( NEPOLASM )
H- HAND WASHING
- Mass
E- EAT LOW FAT , HIGH CARB
NEO – new
P- PERSONAL HYGIENE NO SHARING PLASM – growth
A- ACTIVITY CONSERVATION- REST  Benign
 Malignant - Cancer
T- TOXIC PRODUCTS AVOIDANCE- ALCOHOL, o Theories
ASPIRIN, SEDATIVES, ACETAMINOPHEN 1. Cellular differentiation theory
I- INDIVIDUAL BATHROOM
- It Arises from the changes that we have , adaptation
or adjustment
- Benign growth patterns
o HYPERTROPHY
 increase in the size of the cell
o HYPERPLASIA
 in the number of cells Carcinogenesis
o METAPLSIA
 change in one cell type to another cell
type
o DYSPLASIA - Precursor of cancer
 Abnormal changes in the cell  Initiation
o ANAPLASIA  Exposure to initiating agents
 Loss of cellualr differentation ( carcinogens
 Promotion
 Carcinogens cause unregulated
accelerated growth in previously
initiated cells :reversible
 Progression
 Tumor cells acquire malignant
characteristics

RISK FACTORS :
1. Hereditary – oncogenes
2. Obesity age
3. Smoking
4. Alcohol
2. Failure of the immune response theory
5. Radiation
Failure of the immune response theory 6. Chemicals
7. Microbes
o Kaposi’s sarcoma - HPV, HBV , HCV
- in HIV – AIDS patient - H, pylori
- the patient is immune compromised 8. Food ( process foods , preservatives , high
o Tumor terminology fat , low fiber

CHARACTERISTIC OF CANCER CELLS

Suffix - OMA

- Altered cell differentiation

- Appearance change
 Cancer cells vary in size and shape
( pleomorphism )
 Abnormal nuclei or multiple nuclei
 Abnormal number of chromosomes
( aneuploidy )
 Abnormal chromosome arrangement
  The more undifferentiated , the more  Chemicals
aggressive a malignant cells ROUTE OF SPREAD
- Altered metabolism  Radiation
 Production of surface enzymes that aid
- Lymphatics
in invasion and metastasis
- Blood vessels
 Higher rate of anearobic glucosis
 Production of abnormal growth factor MOST COMMON CANCER IN THE PHILLIPINES
 Inappropriately seceret hormone r - Direct seedingDirect seeding
hormone like subtance resulting in - Breast cancer .
paraneplastic syndrome
- lung cnacer
- Tumor specific agents
- cervical
 Proteins marking the cancer cells as
- colorectal
“non-self”
- prostate
- Altered cellular function
Normal control mechanism fail to stop
- adult leukemia
proliferation of cancer cells - head &neck
 Loss of contact inhibition - thyroid
 METASTASIS- hallmark of cancer LEVELS OF CARE
o TUMOR GROWTH note :read other types of cancer sa module !!
- Cell cycle
Primary level - Prevention
-
- Secondary
 Screening
 Detection
 Diagnosis
 treatment
Tertiary - Palliative treatment
o Prevention , screening and detection
MEMORIZE !!!!! - Warning singns of cancer .
C - changes in bowel or bladder habbit (bladder cancer )
o Labile cells – rapidly dividing
A - a sore that does not heal (skin cancer )
- Pag mahaba G0 mas mabagal sila mag divide
- Pag maiksi yug G0 mabilis sila mag divide U - unusual bledding or discharge
- Cell cycle time ( cervical cancer , uterine cancer)
T- thickening or lump in the breast or else where(bukol)

I – indifestion & difficulty of swallowing

Carcinogenic factors
 Heredity O – obvious changes in warts & moles
 Hormonal factors
 Bacteria and parasites N – nagging cough & hoarseness
 Oncogenic viruses U – unexplained anemia
LEVELS OF CARE
S – severe weight loss
 Immune system deficiency
 Environmental factors 1. Lung cancer
- CHX
- 40 y/o and above anually STAGING OF CANCER
2. Breast cancer
- Breast self examination (BSE) monthly - Process of describing the extent or spread of a
After menses disease from its origin
- Clinical breast exam
- <40 y/o – every 3 years a. Surgical staging
- >40y/o – yearly - Utilizes invasive surgical techniquies to actually
- Mammography ( pag may mass ) visualize structures and assess the extent of the
3. Prostate cancer disease .
- DRE ( digital rectal exam ) done to men b. Clinical staging
40 annually - Based on professional judgement and measurement
- PSA( prostate espicific antigen ) of primary tumor’s size , location in the body and
=0-4 ng/Ml (normal value ) evudence of the disease through physical
4. Colorectal cancer examination
- (Anal ) c. pathologic staging
- DRE 50y/o annualy - the pratice of examintion of the tissue of interest
- Colonoscopy – 5 years both grossly and mcroscopically to evaluate its
characteristic and make an assessment a to the
5. Cervical cancer
aggreassiveness of the malignant tumor
- Papsmear
TNM staging
 Class 1 -normal
 Class 2 - inflammation T – tumopr size
 Class 3 - dysplasia
 Class 4 - probably malignat N – nodal involvement
 Class 5 - malaignant M – metastasis
Diagnostic TEST
TUMOR MARKERS T1 – T4
a. Prostate specific antigen No- no nodal involvement
b. S-100 – melanoma antigen
c. Thyroglobulin N1 – w/nodal involement
d. CA 15 – 3 / CA 27 – 29 – breast cancer
Nx – nodal involmenet cannot be assessed
e. Carcinoembronic antigen ( CEA)/CA 19-9
colorectal cancer Mo – no mets
f. CA 125 – ovarian cancer
M1 – w/mets

Mx – mets cannot be assessed

Diagnostic IMAGING

1. X ray
2. Mammography Stage 1 – tumore confined to an area
3. CT scan
Stage 2 – w/ local nodes
4. Ultrasound
5. Nuclear medicine Stage 3 – 2/ regional nodes
6. Position emission tomography
Stage 4 – w/ distant nodes
7. Lymphoscontigraphy
8. MRI
 STAGING

Stage 0 - the cancer is where it started ( in -situ ) , it NURSES ROLES IN THE CARE OF SURGICAL ONCOLOGY
has not spread a. To identify risk factors or behaviors that prompt a
[reventive surgical procedure
Stage 1 - confined to the tissue and small, it has not b. Nurses must understand the fundamentals of
spread Stage surgical oncology
c. Plat role during the initial assessment and
Stage 2 - with increase growth of cancer, has not evaluation of symptoms , testing , and diganosis
spread Stage throughtout the preoperative , intraoperative ,
and post operative care or primary or secondary
Stage 3 - larger and has spread to surrounding tissues surgical procedure .
and LN Stage d. Nurses must be instrumental in the
identification , planning , implementaion , and
Stage 4 - with distant metastasis evaluation phases of surgcial treament .
e. To provide a comprehensive plan of care and
enhance patient outcomes.
GRADING OF CANCER (type of cells / agressiveness

Grade 1 – well differentiated

Grade 2 – poorly differentitaed HISTORCAL PERSPECTIVE

- Surgery in the mid eighteenth century provided the
Grade 3 – undifferentiated ( very aggressive ) era of observation and
discovery of the clinic - pathologic features of
MODALITIES OF TREATMENT
malignant tumors.
a. Surgery - Surgery is the oldest cancer intervention, and one
- As the branch of medicine that uses maual and that has offered the
possibility of cure.
instrumental to deal w/ the diagnosis and
- Historically, cancer surgery can be traced back over
treatment of injury , deformity , & disease
5000 years to treatment of
 Prevent a cancer occurenc in the high – risk
breast cancer, albeit primitive, in the pre -
patient anesthesia era.
 Diagnose a primary or metastatic of - In 1809, Ephraim MacDowell excised a massive
malignancy ovarian tumor, which initiated
 Provide a primary or secondary treatment of the prospect of successful cancer surgery.
an identified malignancy - Elliot, in 1822, reported microscopic examination of a
 Provide a route of administration of theraphy lymph node related to
 To rehanilitate by means of reconstruction breast Ca cases
intervention - Surgical procedure significantly advanced through the
 To offer palliative care through symtom work of Halted in radical
management in advance cancer . mastectomy;
b. Chemotherapy - Billroth in gastrectomy, laryngectomy
c. Radiation  Principles:
d. Biotherapy - The principles of surgical oncology, are based in the
foundations of surgery,
e. Stem cell therapy oncology, nursing, and medicine.
- Principles create the basic framework, but rapidly
advancing scientific and
technologic methods may change the
identification or ranking of principle
 CHEMOTHERAPY
related to new and possibly unidentified needs of
the cancer patient.
Factors influencing chemotherapy selection and
administration
 Blood-Brain Barrier
- inhibit certain substances from entering the brain or
• is the use of cytotoxic drugs in the treatment of
CNS.
cancer.
- Intrathecal route (Omaya reservoir / lumbar puncture)
• Its function is to kill tumor by interfering with
cellular functions and reproduction
- Systemic Treatment rather than localized
treatment
GOAL
 CURE- To cure tumor and cancer, to disappear and do
not re-occur
 CONTROL- To control or to stop the cancer from Chronotherapy / Circadian Rhythm
growing and spreading. - regular repeated fluctuation in biologic functions during
 PALLIATION- If / when cure and control is no longer 24 hour period
possible, its goal is to relieve symptoms caused by - “diurnal” means events happening in the daytime
cancer. Cell cycle generation - Circadian Variables
 G1 Phase - the phase where RNA and protein - Influence drug absorption, metabolism, distribution
synthesis occur. and elimination.
 S Phase- the phase where DNA synthesis occur.
 G2 Phase- pre-mitotic phase. For further protein Cytoprotectants
- is used to prevent or decrease specific system effects
synthesis in preparation for mitosis
related to drug therapies.
 M Phase- Mitosis and cell division. (cardiotoxicity,nephrotoxicity)
 G0 Phase- resting phase
 It protects normal tissues from cytotoxic effects
Tumor growth of drugs or irritation while preserving their anti-
• Doubling time – time required to reach certain size. tumor effects
• Micrometastasis- the possibility for the tumor to Liposomes
th th
shed cells (7 -10 ) - use to enhance drug delivery to specifically target
Gompertzian function- a pattern where doubling time is tissue

more rapid during the early stages.

Chemotherapeutic agent
1. Adjuvant therapy- chemotherapy used in conjunction
with another treatment modality and aimed to treat
micrometastases.
2. Neoadjuvant chemotherapy- done to shrink a tumor
before it is removed surgically.
3. Primary therapy- treatment for patient who have
localize cancer, alternative way but less than
completely effective treatment.
4. Induction chemotherapy- primary treatment for
patients who have cancer for which no alternative
treatment exist.
5. Combination therapy- combination of 2 or more
agents / drugs to treat cancer.
6. Myeloablative therapy- dose intensive therapy used
in preparation for peripheral blood stem cell
transplantation.
 Chemotherapy drug classification
Cell Cycle Phase- specific Drug calculation
- Most effective against actively growing tumors that - The calculation of the Drug Dosage is based on the
have greater proportion of cell cycling. body surface area (BSA) in both adult and children.
(the drugs attack the cell). - BSA is calculated in square meter. (m2)
- Mostly affect the cell in S phase by interfering DNA - Patient’s BSA (m2) x drug dose (mg)
& RNA. 1.73m2
o anti-metabolites - interfere or block essential Adult drug dose = 100 mg child bsa= 0.83m2
enzymes necessary for DNA and RNA synthesis Child dose = 0.83m2 x 100 mg =47.97 or 48 mg
(cyclophosphamide) 1.73m2
Cell Cycle Phase- Non specific o Body surface area
- Active in all phases of the cycle and maybe
effective in large tumors that have few active cells
(height (cm) x weight (kg))
dividing at the time of administration.
BSA (m2) / 3600
- It has long acting effect on the cells. Resulting
damage or death to the T- cells.
o Alkylating agents – preventing mitosis. Bond to
nucleic acid that interfere its duplication.
 Carboplatin
o Antibiotic (anti-tumor agents) – disrupt DNA
transcription and inhibit DNA and RNA synthesis.
 Dactinomycin
Hormonal Agents
- secreted by the endocrine glands
Affecting the cell membrane permeability, manipulating
hormone levels, tumor growth can be suppressed.
- not cytotoxic and not curative and
 purpose
- prevent cell division
- prevent further growth of hormone-dependent
tumors.
 anti-androgen, antii-estrogen
Nitrousoureas
- Action is similar to alkylating agents, inhibits
synthesis of DNA & RNA
 Carmustine
Monoclonal antibodies ROUTS OF MEDICATION
- Destroys cancer cells and spare ORAL – most convinient
normal cells. - Need patinet complaince w/ the predescribe schedule
 Rituximab, Gentuzumab - Plan for drugs w/emetic potential to be taken w/
meals
IVTRAVENOUS (IV)
- Most common
- Medication is given directly to the vein
- In some drug
- …….
- Can be perform “bolus “or short ….
-
INTRA ARTERIAL

- Catheter placement in artery near the tumor

 ROUTS OF MEDICATION
ORAL – most convinient
- Need patinet complaince w/ the predescribe schedule
- Plan for drugs w/emetic potential to be taken w/
meals
IVTRAVENOUS (IV)
- Most common
- Medication is given directly to the vein
- In some drug
- …….
- Can be perform “bolus “or short ….
-
INTRA ARTERIAL

- Catheter placement in artery near the tumor

 o SAFE ADMINISTRATION  MANGEMENT
1. Chemo drugs are dangerous 1. Oral hygiene
2. There should be NO CONTACT w/ it 2. Assess for dehydration ( anti emetic )
3. Pregnant should not undergo chemotherapy 3. Ice chips
4. Round the clock medication ( the anti emetic
Note : pregenant women cannot take chemotherapy
drugs
o PREPARATIONS OF CHEMOTHERAPY DRUGS  ALOPECIA
1.Prepare in well ventilated area  Begins 2-3 weeks
2.Wash hands before and after procedure  Ends after 3 months /regrowth of the
3... hair may begin in 8 weeks
4..  Mangement
5.. - Wigs for female , cap for for male
6.Wrap gauze or alcohol pad around amplus - Pre-emptive hair cut
neck  SOMATITIS
7. Label prepared medication - Singaw beh
8. Wrap gauze around the injection site when  Management
withdrawing syringes -inspect mouth rountinly
9. Dispose in a leak and procedure proof -oral care ( saline )softdrinks , soft bristle
container toothbrush/ do not use listerine
10. Do not chew and smoke when preparing -avoid spicy & citrus foods
medication - provide ice chips &popsicles
o MANAGEMANET OF CHEMOTHERAPY PILLS - soft bland diet
1. Shoulkd be clean up immediately by properly - viscous lidocane( adult)
protected personmnel and must be trained (contraindicated ..)
2. A spill be identified w/warning signn so that  ANOREXIA
other people will not be contaminated - Makes the food taste metalic ( meat )
 PROCEDURE  Management
- Restrict the area of spill -place the patient in a comfotable position
- Obtaine the drug spill kit - Maintain good hygein
- Put PPE and if powder spill involve use respirator - Serve food atractively
mask ….
- Open waste disposal ( double the abg put a label on  ANEMIA
it ) - Blood cells – BM supression
- … - ¯ RBC – anemia
- ¯ wbc infection
.. ¯ platelets – bleediong
o COMMON SIDE EFFECT OF CHEMOTHERAPY
- Nausea & vomiting - Methrotrexate – inhibit
- Mos common for the first 24-48 hrs - ..
- Delayed N&V! week after chmotherapy  Management
 Cause unknown -assess skin for pallor
 Activation receptor - schedule activities w/rest periods
 Stimulation of the peripheral autonomic - adminsiter erythropoetine as ordered
and vertibular pathways
 Serotonin
 NEUTRPENIA
 Management
 - assess sign of infection – Fever 1. Check for Phlebitis and Vesicant extravasation
- abnormal lung sound – cough (leak of drug into subcutaneous tissue) (pain,
- practice cleanliness – handwashing and necrosis, sloughing of tissues)
after procedure 2. High calorie and high protein diet
- no flowers , fish , fruits , vegetables , and 3. Encourage hydration
raw fruits 4. Monitor cbc
5. Oral examination for stomatitis
 THROMBOCYTOPENIA
 Management
Note : !!CBC must be taken before under go
-assess skiin &mouth for sign of bleeding
chemotherapy
- check stool and urine for bleedinh
-… o …
. 1. Teratogenic
 VESICANT ETRAVASATION 2. Hair loss concerns
- Leak of chemo drugs to subcutaneous tissue that 3. Encourage counseling
cause pain , necrosis & sloughing of tissue 4. Report complications
 Flare 5. Administer anti emetic drugs
- Localized allergic reaction ,w/out. 6. Practice aseptic techniques at all time
- ….
 Anaphylaxis
- • Aminophyline, Dipenhydramine hydrochloride,
Dopamine, Epinephrine, Heparin, Hydrocortisone
O2 set-up, tubing cannula or mask and airway
devices
• Suction equipment
• IV fluids - isotonic solutions
• IV tubings and supplies for venous access -
anxiety, hypotension, urticaria, cyanosis,
respiratory distress, abdominal cramping,
flushed appearance and chills.

= stop the drug infusion = maintain IV line,

isotonic saline
= Position comfortably to promote
perfusion of the vital organs
= notify the physician
= maintain airway and anticipate the need
for cardiopulmonary resuscitation
= monitor vs
= administer medication as prescribed
= follow the institution protocol for follow
up care
= document the incident in patients
medical record.

o MEDICAL …
 o Metrotrexate
- Can use of rheumathoid ..
o GLUCOCORTICOIDS, ESTROGEN, PROGESTINS
SERM (Selective Estrogen Receptor Modulators )
- TAMOXIFEN. TOREMIFENE
o SERD (Selective Estrogen Down Regulators )
- FULVESTRANT
o AROMATASE INHIBITORS
- LETROZOLE, ANASTROZOLE
- ANTIANDROGENS
- FLUTAMIDE
- GRH ANALOGUE
- NAFARELIN.
- 5 ALPHA REDUCTASE INHIBITORS
- FINASTERIDE
 RADIATION THERAPHY
- Kill the cancer cells .
TYPES OF RADIATION THERAPY

o External radiation theraphy

- Pag uuwi si patinet hindi sya radio active
a. ..
b. ..
- Expose of a bim radiation
o Internal

Makinig knanalng sa record bilis ni doc

BONE MARROW & STEM CELL TRANSPLANT

(hematopoietic stem cell)

- The soft spongey tissue found in the .
- ..
- Is a process of replacing disease or damage marrow
w/ normally functioning bine marrow .
- ..

The 2 Main Types of Transplant

Autologous

» Is a transplant in which the patient's own bone

marrow ox stem cells are collected (harvested), placed
in frozen storage (cryopreserved) and reinfused into the
patient after the conditioning regimen.

 The Patient is his own donor. Allogenic a

transplant in which the patient's receives
someone else's bone marrow or stem cells.

Types of Allogenic Transplant

 Syngeneic
- A patient is given stem cells from their twin or
triplet Related
- The donor related to the recipient's, usually a
sibling
 Unrelated Peripheral Blood Stem Cells
- The donor is no relation to the recipient More Common

- requires growth factors (G-CSF)

- apheresis procedure
- no anesthesia
» Peripheral Blood ( PBSC)
- stem cells engraft faster
» Bone Marrow - Higher chance of GVHD
» Umbilical Cord Umbilical Cord Blood Stem Cells
Bone Marrow Harvest - removed from the umbilical cord andplacenta after
» aspirated from the donor's pelvis. This procedure the baby no longer needs them
occurs in the operating room under patients general - birth, collected, tissue-typed,processed and stored
anesthesia. frozen
- no access to donor
» Bone marrow is obtained by performing multiple
- unknown genetic disease
puntures with a large-bore needle into the patient's
- Expensive!
posterior and occasionally the anterior iliac crests.

- Less common
Diseases Treated with Hematopoietic Stem Cell
Malignant:

Acute / Chronic Myelogenous Leukemia(AML)(CML)

Acute Lymphocytic Leukemia(ALL) Juvenile

Myelomonocytic Leukemia(JMML) - Myelodysplastic
syndrome(MDS) » Hodgkin's disease -Non-Hodgkin's
Lymphoma(NHL)

Multiple Myeloma

Renal Cell Carcinoma Neuroblasto ma Testicular Cancer

Ewing's Sarcoma

Bilis nanaman ni doc

BIOTHERAPHY Lymphocytes. • IFN-y is more potent in
activating macrophages.
- A treatment with agents derived from
Interferons (IFN)
biological responses and sources.
- IN have a wide range of biologic effects
- A treatment of disease using substances
including
obtained or derived from living organisms.
- Antiviral
- Antiproliferative
Note : BCG ( can give)
• Immunomodulatory
• Antiviral: Renders uninfected cells resistance to
Approaches of Biotherapy
attack by the virus.
o Active Immunotherapy - giving tumor-bearing
• Antiproliferative: Extends all phases of the cell
host agent that are designed to elicit an
cycle and lengthens
immune response to retard or eliminate tumor
overall cell generation time.
growth.
• Immunomodulatory: Increases the potential of
- Specific - immunization with tumor cell or
NK cellsN
tumor cell extracts as antigens or vaccines.
- Non-specific - to boost overall immunity • Low doses of IFN stimulate antibody production and
through adjuvants. high doses have suppressive effects. • IN has shown
o Passive Immunotherapy - administration or efficacy in tumors such as melanoma, renal cancer
transfer of previously sensitized immunologic cells, ovarian carcinoma and superficial bladder
reagents or immune reactive cell to a tumor- cancers. • Route of Administration: IM, SubQ and IV
bearing host. but also given intralesion, intraperitoneal, intravesical,
o Adoptive Immunotherapy - transfer of intraarterial and intrathecal. • Side effects: Flu-like
symptoms, Fever (40°c), Headaches, Myalgias,
sensitized cells.
Arthralgias, Malaise, Fatigue, Anorexia with weight
Major agents used in Biotherappy loss
1. Interferons (IFN)
2. Lymphokines-Interleukins (LI-2)
Interferons (IFN) • IN therapy have to be held or dose
3. Hematopoeitic Growth Factor (HGF) reduced if the side effects became too severe or
4. Monoclonal Antibodies (MoAb). chronic. • Administered before bedtime • X Patients
5. Radioimmunotherapy with strong history of CVD!!!
6. Epidermal Growth Factor Receptor -
Tyrosine Kinase Inhibitor (EGFR-TKI) Interleukins (IL-2) • Activates T-cells • Supports the
7. Angiogenesis Factor growth and maturation of subpopulations of T-cells •
Stimulates cytotoxic -cells and proliferation and
Interferons (IFN) activity of NK cells • LAK (Lymphosine Activated
Killer) cells is the basis for adoptive immunotherapy.
- Is a family of glycoproteins hormones
• IL-2 can reverse immunodeficiency • Approved
possessing pleiotrophic biologic effects. treatment of both renal cell cancer and melanoma •
3 major classes High doses by IV bolus every 8 hours for up to 14
1. Alpha (IFN-a) doses
2. Beta (IFN-B)
3. Gamma (IFN-V)
• IFN-a and IFN-B
- are produced by leukocytes and fibroblast
meanwhile IFN-y Is produced by T-