NCM 109 Finals - Medical-Surgical Nursing PDF

NCM 109 - FINALS TOPIC I: CELLULAR ABERRATION infection may cause breakdown of the immune system or this may...

NCM 109 - FINALS TOPIC I: CELLULAR ABERRATION infection may cause breakdown of the immune system or this may overwhelm the immune system. CELLULAR ABBERATIONS  Chemical Carcinogens – act by causing cell mutation or alteration in cell causing alteration in cell replication. Chemical carcinogens may include industrial compounds, drugs, hormones,  This video will show how cancer is identified that is by aberrations food preservatives, and polycyclic hydrocarbons. in cellular structure and cellular functions.  Physical Agents – may include radiation, physical irritation or  A gross morphological changes are evident in both the cellular and trauma. Radiation may include radiation from x-rays, sunlight or nuclear membranes in tumor cells UV rays. Physical irritation or trauma may include trauma from smoking, multiple delivery, and overuse of any organ or body part.  Hormones – estrogen as replacement therapy has been found to What is CANCER? increase incidence of vaginal and cervical cancer. __________________________________________________  Genetics – people cannot control like family history. - A disease of the cell in which the normal mechanisms of the control PREDISPOSING FACTORS of growth and proliferation have been altered.  Age - An uncontrolled proliferation of cells It was recognized in ancient  Sex times by skilled observers who gave it the name “CANCER” which  Urban residence came from a Latin word CANCRI which also means crab because  Geographic distribution it stretches out many directions like the leg of the crab.  Occupation - Invasive and spreads directly to the surrounding tissues.  Heredity - Also called as MALIGNANT NEOPLASM.  Stress - Afflicts ALL people and ALL ages/sexes, regardless of  Precancerous lesions socioeconomic and cultural background.  Obesity - Possesses tremendous physiologic, psychosocial, cognitive, spiritual and economic impact to the afflicted individuals and to In general, cancerous tumor growth is triggered by DNA mutation within their significant others. the cells. The DNA contains chains that help cell grow and divide. The causes of neoplastic growth: Exact origin is unknown TERMINOLOGIES related to CANCER __________________________________________________ NEOPLASIA - Refers to a mass that has developed due to abnormal cell or tissue 1. Benign Neoplasm growth. - Refers to various type of growth which includes the non-cancerous 2. Neoplasia or benign tumor. - Also includes pre-cancerous growth or carcinoma in situ. 3. Hyperplasia NEOPLASTIC DISEASES 4. Hypertrophy - Conditions that cause tumor growth. - Can be benign or malignant. 5. Metaplasia NEOPLASM 6. Dysplasia - Considered as abnormal growth of cells which is also known as tumor. 7. Anaplasia - May be benign or malignant. 8. Metastases Cancer is an unchecked cell growth, the mutations in genes can cause cancer by 9. Oncology accelerating the cell division rates or inhibiting normal controls on the system such as cell cycle arrest or programmed cell death. 10. Adenocarcinoma As a mass of cancerous cell grows, it can develop into a TUMOR. 11. Carcinoma Today, Cancer causes 1 in every 7 deaths worldwide. 12. Sarcoma How does the CANCER starts and what is being done to combat it? 13. Carcinogens Our body contains trillions of highly specialized cells and each carry genes responsible for regulating cell growth and division. PATHOGENESIS OF CANCER EPITHELIAL CELLS - Cancer has a complex pathophysiology - Pathologists are physicians who are concerned primarily in the study of the disease in all of its aspects such as the cause, diagnosis and how the disease develops, as well, as the mechanism and the natural course of the disease. Carcinoma, 80-90 % of cancers CONNECTIVE TISSUE CELLS THEORIES RELATED TO CANCER 1. Cellular Transformation & Derangement Theory - Conceptualizes that normal cells may be transformed into cancer cells due to exposure to some etiologic agents.. Failure of the Immune Response Theory Sarcomas 1% of cancers - Advocates that all individuals possess cancer cells. However, the cancer cells are recognized by the immune response system, in which the cancer cells undergo destruction. BLOOD AND LYMPHATIC CELLS - Failure of the immune response system leads to inability to destroy the cancer cells. ETIOLOGIC FACTORS  Viruses – oncogenic viruses may lead to one of the multiple agents which acts to initiate carcinogenesis. Prolonged or frequent viral Leukemias and Lymphomas ,7 % of cancers 1 Ainie 3D  NCM 109 - FINALS BUT when a genetic change disrupts this process, cells begin to grow and divide NEOPLASIA uncontrollably. Thereby, becoming cancerous. __________________________________________________ The genetic changes that cause cancer usually happen in three types - Refers to a mass that has developed due to abnormal cell or tissue genes. growth. 1. PROTO-ONCOGENE - Also refers to various types of growths including non-cancerous or - Which signals cells to grow and divide. benign tumors, pre-cancerous growths carcinoma in-situ, 2. TUMOR SUPPRESOR malignant tumors. - Which signals cells to stop dividing. 3. DNA-REPAIR - Which preserve and maintain genetic codes. Difference between a Tumor and a Neoplasm __________________________________________________ CHANGES in these genes lead to abnormal cell growth, resulting in masses of tissues called TUMOR. TUMOR NEOPLASM Refers to swelling or a lump like Refers to any new growth, lesion, TUMORS swollen state that would or ulcer that is abnormal. normally be associated with - May be BENIGN which remains on one place/ area. inflammation. - Or MALIGNANT which means they are capable of spreading Causes of Neoplastic Growth Through a process called METASTASIS, a malignant tumor cells will eventually  Exact origin is unknown break off, travel throughout the body and begin forming TUMORS in other regions.  Cancerous tumor growth is triggered by DNA mutations within the When this happens, the cancerous becomes metastatic and is most dangerous. cells. The CAUSE of cancer is still a mystery. Inherited traits may be behind some Take note: the skin, bladder, lungs and intestines are organs which are of the genetic changes that lead to formation of cancerous cells. Some might, usually involved because they are exposed to such outside influence and irritations. environmental exposure such as excessive radiation from the sun or Thus, they become COMMON SITE for abnormal growths. chemicals, cigarette smoke. ADULTS:  Tumors may grow because normal cell growth has been altered by MALIGNANT environmental exposure such as chronic exposure to chemical - the term malignant and cancerous irritants or cigarette smoke. describes cells that are growing and proliferating in a disorderly and chaotic CHILDREN fashion.  Tumors most frequently occurs in organs unexposed to the In adults, cancer usually occurs in a environment such as: form of solid tumor. While in children, o Leukemia of the bone marrow the most frequent type of cancer is that o Nephroblastoma of the kidney (Wilms Tumor) of immature white blood cells o Tumors of the brain; or o Neuroblastoma in the abdomen overgrowth or Leukemia. - Cancerous, non-capsulated, fast growing, metastasize to other CHILDHOOD CANCER parts of the body, cells have large dark nuclei; may have abnormal shape. WHO (February 12, 2021 Report)  Each year, approximately 400,000 children and adolescents of 0-19 years old are diagnosed with cancer. BENIGN  The most common types of childhood cancer include leukemia, brain cancers, lymphomas and solid tumors, such as - Non-cancerous neuroblastoma and Wilms tumours. - Capsulated  In high income countries, more than 80% of children with - Non-invasive cancer are cured. (because of their technological advancements in - Slow growing their respective healthcare facilities) - Do not metastasize to other parts of  In low- and middle-income countries (LMICs), an estimated 15- the body 45% is cured. - Cells are normal  Childhood cancer cannot be generally be prevented or identified through screening.  Most childhood cancers can be cured with generic medicines and HOW IS CHILDHOOD CANCER DIFFERENT FROM ADULT other forms of treatment, including surgery and radiotherapy. CANCER?  Treatment of childhood cancer can be cost effective in all income settings. DEVELOPMENT  Avoidable deaths from childhood cancers in LMICs result from - Childhood cancers are often the result of DNA changes in cells that lack of diagnosis, misdiagnosis, or delayed diagnosis, obstacles take place very early in life, sometimes even before death. to accessing care, abandonment of treatment, death from - Cancers in adults are strongly linked to lifestyle or environmental toxicity and higher rates of relapse. risk factors.  Childhood cancer data systems are needed to drive continuous improvements in the quality of care and to inform policy decisions. TREATMENT - Children’s bodies can handle chemotherapy better than adults. The problem… - HOWEVER, cancer treatments such as chemo and radiation - Cancer is a leading cause of death for children, adolescents, therapy can cause long-term side effects. particularly in high-income countries. - Children who have had cancer need careful follow-up for the rest of - The likelihood of surviving a diagnosis of childhood cancer depends their lives. on the country in which the child lives. - In high-income countries, more than 80% of children with cancer NEOPLASTIC GROWTH are cured, but in many LMICs only 15-45% is cured. - An abnormal mass tissue that forms when cells grow and divide The reasons for lower survival rates in LMICs include: more than they should or do not die when they should. a) Delay in diagnosis and advanced diseases - Neoplasm may be benign or malignant. b) Inability to obtain an accurate diagnosis - A benign neoplasm may grow large but do not spread into or invade c) Inaccessible therapy nearby tissue or other parts of the body. d) Abandonment of therapy e) Death from toxicity (side effects) 2 Ainie 3D  NCM 109 - FINALS f) Avoidable relapse (3) L— Lump: Abdomen and pelvis, head and neck, limbs, testes, glands; Improving access to childhood cancer care, including to essential medicines (4) U—Unexplained: Prolonged fever over 2 weeks, loss of weight, pallor, and technologies, is highly cost effective, feasible and can improve survival in fatigue, easy bruising, or bleeding; all settings. (5) A—Aching: Bones, joints, back, and easy fractures; What causes childhood cancer? (6) N—Neurological signs: Change or deterioration in walk, balance, or speech, regression of milestones, headache for more than a week with or Cancer occurs in people all ages and can affect any part of the body without vomiting, enlarging head. unlike cancer in adults. - Vast majority of childhood cancers do not have a known cause. CANCER DETECTION EXAMINATION - Many studies on the other hand, have sought to identify the 1. Cytologic examination causes of childhood cancer. 2. Biopsy - But very few cancers in children are caused by environmental 3. Ultrasound exposure or lifestyle factors. 4. MRI - Cancer prevention efforts should focus on behaviors that will 5. Radio diagnostic test prevent the child from developing preventable cancer as an 6. CT scan adult. 7. Endoscopic examination - Some chronic infections, such as HIV, Epstein-Barr virus and 8. Laboratory blood test 9. Lumbar puncture malaria are risk factors for childhood cancer. 10. Physical examination - Current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors. STAGING OF CANCER IMPROVING OUTCOMES OF CHILDHOOD CANCER A STAGE of a cancer is used to help plan treatment and predict chance of Because it is generally not possible to prevent cancer in children. recovery. The most effective strategy to reduce the burden of cancer in children and improve outcomes. Stage is usually determined by three factors:  Size and growth of the tumor, - Focus on prompt, correct diagnosis followed by effective, evidence-based therapy with tailored supportive care.  whether cancer has spread to the lymph nodes and - A correct diagnosis is essential to prescribe appropriate therapy for  whether it has spread to other body parts. type and extent of the disease. TREATMENT STAGE DEFINITION - Standard therapies include chemotherapy, surgery and / or Stage 0 Carcinoma in situ (literally means “cancer in place"). radiotherapy. The cancer cells have not yet invaded into - Children also need special attention to their continuous physical surrounding tissues; without invasion the tumor and cognitive growth and nutritional status, which requires a can’t spread and the cure is 100 % dedicated, multidisciplinary team approach. Stage I The primary tumor is small but invaded into surrounding tissues and has not spread. - Access to effective diagnosis, essential medicines, pathology, blood products, radiation therapy. Technology and psychosocial Stage II The primary tumor is larger, but there is still no and supportive care. clinical evidence of spread. Stage III The primary tumor has spread to lymph glands (also SIGNS & SYMPTOMS called lymph nodes) in that region of the body. Stage IV The tumor has spread beyond the region where it - Are nonspecific and include many findings observed in a variety of childhood initiated to a distant tissue or organ. disorder. These include:  Fever  Musculoskeletal symptoms  Pain, fatigue DIAGNOSTIC PROCEDURE  Pallor  Physical Exam  Bruising  MRI or CT Scan  Bleeding  Lumbar Puncture  Headache  Hormone Blood Test  Lymphadenopathy & loss of appetite  Biopsy  Vomiting and weight loss  Exfoliative Cytology CELL INJURY  X-ray (barium and dye studies)  Injury to the components of cells can lead to disease as cells post  Blood and Urine Examination inability to adapt.  Digital Examination  Cell injury may result from any intrinsic or extrinsic causes and  Physical Examination may be classified as toxic infectious physical deficit.  Direct Visualization  Brain Scan WARNING SIGNS  Ultra Sonography and Bone Scan  Computed tomography scan  C – Change in bowel/bladder habits  A – Sore that does not heal Therapy for a child with cancer focuses on devising ways to kill the growth  U – Unusual bleeding/discharges of abnormal cells while protecting the surrounding cells.  U – Unexplained sudden weight loss  U – Unexplained anemia CANCER TREATMENT MEASURES USED  T – Thickening/lump in the breast /elsewhere  I – Indigestion or difficulty in swallowing A. Immunotherapy  O – Obvious change in wart or mole - a type of cancer treatment that help immune system fight cancer  N – Nagging cough/ hoarseness of voice - the immune system helps your body fight infections and other diseases (1) S— Seek medical help early for persistent symptoms; - it is made up of white blood cells and organs & tissues of the lymph system (2) I—Eye: White spot in the eye, new squint, new blindness, bulging - a type of biological therapy eyeball; 3 Ainie 3D  NCM 109 - FINALS - Is an exciting area in cancer research that is changing the way we think about cancer treatments. - Immunotherapy works by using the body’s immune system to fight cancer. - Immune system is a complex network of organs, tissues and cells and the substances they make. - One of the purposes of this is to get rid of the germs such as bacteria and abnormal cells such as cancer cells. - Immunotherapy uses different ways to boost the immune system to do a better job of killing cancer cells. ❏ 3 TYPES OF IMMUNOTHERAPY - Are effective ways to treat cancer - But they don’t work for other patients and can cause serious side effects - Researchers supported by the National Cancer Institute are working to learn more about how the immune system works to fight cancer. - By studying this, researchers can learn how to improve immunotherapy. MOST COMMON CANCER IN CHILDREN: ➔ Leukemia- type of cancer of the blood or bone marrow ➔ Brain and spinal cord tumors ➔ Neuroblastoma ➔ Wilms tumor ➔ Lymphoma (including both Hodgkin and non-Hodgkin) ➔ Rhabdomyosarcoma ➔ Retinoblastoma ➔ Bone cancer (including osteosarcoma and Ewing sarcoma) A. LEUKEMIA - From the Greek word: - “Leukos” - white - “Haima” – blood NONSPECIFIC IMMUNE STIMULATION - Characterized by an abnormal increase of immature white blood - Is a type of immunotherapy that stimulates the patient’s immune cells (WBC) called “blasts”. response in a general way. Drugs and other substances are used to - Leukemia is cancer that starts in blood-forming tissues, such as the increase the overall immune response which can help kill cancer bone marrow and causes white blood cells (WBC) to grow cells. uncontrollably. These cells do not function as expected, meaning - For example, some patients who have had surgery to remove they do not fight infection or die as they should. They also bladder cancer, may also be treated with the substance called BCG, overcrowds healthy white blood cells, red blood cells and platelets when BCG is put into the bladder, it can cause an non-specific in the bone marrow, preventing them from functioning properly. immune response that kills cancer cells, that remain in the bladder - Leukemia is a distorted and uncontrollable proliferation of WBC/ after the surgery. This may keep the cancer from getting worse or leukocytes. coming back. - Most frequently occurring type of cancer in children. T-CELL TRANSFER THERAPY - T-cells are a type of immune cell, and a powerful weapon that the immune system uses to fight off cancer. - For t-cell transfer therapy, t-cells are taken from a patient and changed in a laboratory and make them better able to target the patient’s cancer cells and kill them. - Millions of copies of this specially changed t-cells are then grown in the laboratory and given back to the patients to fight the cancer. IMMUNE CHECKPOINT INHIBITORS - Are third-type of immune therapy CLASSIFICATIONS - Immune checkpoints on cell surfaces are controlled by immune response ACUTE LYMPHOCYTIC LYMPHOBLASTIC LEUKEMIA (ALL) - Usually, Immune checkpoints keep t-cells - A type of cancer of the blood and bone inactive that is, in an off state until they are marrow. The spongy tissues inside bones needed. These keep the t-cells from take advantage of these where blood cells are made. checkpoints to switch t-cells off. This keeps the cancer cells from - The word “acute” comes from the fact that being killed. the disease progresses rapidly and creates - Immune checkpoint inhibitors are drugs that block the checkpoints, immature blood cells rather than creating this freezes the t-cells to attack the cancer. mature ones. ACUTE MYELOID LEUKEMIA (AML) - A cancer of the myeloid line of blood cells characterized by the rapid growth/fast growing of abnormal cells that builds up in the bone marrow and in the blood and this interfere with the normal blood cells. 4 Ainie 3D  NCM 109 - FINALS CLASSIFICATIONS: ACUTE LYMPHOCYTIC LYMPHOBLASTIC LEUKEMIA (ALL) - common forms of leukemia in children - most account 75% of leukemias and involve lymphoblasts (immature lymphocytes) - Rapid proliferation of so many immature lymphocytes causes decreased production of RBC and Platelets. - With ALL, it caused the bone marrow to overproduce lymphocytes and therefore is unable to continue normal production of other blood components. For a child with leukemia, a bone marrow aspiration can also be performed in the iliac crest wherein it will be prescribed to identify LEUKEMIA SYMPTOMS the type of WBC in all. - Nose bleeds - Weight loss THERAPEUTIC MANAGEMENT - Swollen lymph nodes  Up to 95% of children with ALL will achieve a first - Fever remission. - Night sweats  If a child experiences relapse, the chances of long term - Bleeding easily survival are reduced and bone marrow transplantation - Bone pain may be required to achieve long term survival - Red spots on skin  Chemotherapy  Radiation Therapy  Biological Therapy  Stem cell therapy ACUTE MYELOID LEUKEMIA (AML) - Includes the over proliferation of the granulocytes: neutrophils, basophils, and eosinophils - Immature cells are not able to carry out immune cell functions and put the child at risk for infections - The same with ALL, over proliferation of granulocytes which limit production of RBCs and platelets - Is a cancer of the myeloid line of blood cells, characterized by the rapid growth (fast-growing) of abnormal cells that build up in the bone marrow and blood and interfere with normal blood cells. - In AML, immature cells are unable to carry out normal immune functions and put the child at risk for infection ASSESSMENT: - The same ALL, there is an over proliferation of WBC that With ALL causes the bone marrow to over-produce lymphocytes and therefore is limits the production of RBC and platelets unable to continue normal production of other blood components. So, the first - Most often seen in adults symptoms of ALL in children usually are those associated with: - Accounts for only about 20% of all childhood leukemia 1) Pallor - decrease in RBC production resulting to anemia - The frequency of the disorder increases in late adolescence. 2) Low-grade fever 3) Lethargy ASSESSMENT: 4) A low thrombocyte count - or low platelet count which could lead Signs and symptoms: to petechiae and bleeding from oral mucous membranes and cause - Shortness of breath easy bruising on arms and legs - Easy bruising 5) Spleen and liver begin to enlarge causing abdominal pain, vomiting - Fever and anorexia occur - Weakness - Pale skin 6) Bone and joint pain- due to invasion of abnormal lymphocytes - Infections 7) Headache or unsteady gait- due to invasion of CNS thus the symptoms of headache and unsteady gait THERAPEUTIC MANAGEMENT: The main treatment for AML is chemotherapy and sometimes along with On physical assessment, painless generalized swelling of lymph drug and this might be followed by stem cell transplant. nodes, especially of the submaxillary or cervical nodes is revealed. Laboratory studies reveal an elevated leukocyte count  Bone marrow aspiration and biopsy Platelet and hematocrit count will be low RBCs are of normal size and color but few in number X-rays of long bones may reveal lesions Lumbar puncture - shows evidence of blast cells in the CSF NURSING DIAGNOSIS: ➔ Risk for infection r/t non- functioning WBCs and immunosuppressive effects of therapy (While children are receiving care at home, we need to teach parents to observe them carefully and to promptly report any indication of infection such as low-grade fever or any other behavior that does not seem typical of the child because the sooner the symptoms are reported, the sooner anti-infective therapy can begin) ➔ Risk for deficient fluid volume r/t increased chance of hemorrhage from poor platelet production (B/c platelet production is limited, children are prone to hemorrhage, take note after IM injection or 5 Ainie 3D  NCM 109 - FINALS removal of IV needle, we should apply thin pressure to injection sites to 4) Night sweats prevent bleeding from these sites) 5) Unexplained weight loss ➔ Pain r/t invasion of leukocytes (B/c of the vast number of WBC’s that 6) Severe Itching (pruritus) invade the periosteum of the bones, we should assess pain with standard 7) Increased sensitivity to the effects of alcohol or pain in the lymph scale for highest accuracy, handle the legs and arms gently to minimize nodes after drinking alcohol. pain and movement and use alternating mattress to avoid skin irritation, administer analgesia as needed) HOW CAN IT BE DETECTED? DURING MAINTENANCE PHASE OF THERAPY ➔ INEFFECTIVE health maintenance r/t long-term therapy for leukemia (Children that participate in usual activities and attempt regular school. Evaluation of children includes not only the state of their blood but also whether they are taking forward, making plans or beginning to think of themselves as children again.) B. LYMPHOMA - A cancer that begins in infection-fighting cells of the immune- system called LYMPHOCYTES. - These cells are in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body - Account for about 11% of all malignancies - Can be detected through blood tests that include: - When you have lymphoma, the lymphocytes change and grow out Complete Blood Count in control. Analysis of the different types of WBCs, that is again in addition to the erythrocytes sedimentation rate (ESR) and the liver and kidney function tests BLOOD TEST ALONE CANNOT DETECT HODGKIN LYMPHOMA CONFIRMATION TEST  Bone Marrow Analysis  Liver function test  Chest and Abdominal CT SCAN/MR  Lymphangiography (detects size and location of deep nodes involved)  Abdominal biopsy PHARMACOLOGIC INTERVENTIONS 1) Chemotherapy alone but can be followed by radiotherapy, and in other cases chemotherapy can be done alongside with steroid medications. MANAGEMENT: ➔ Initial drug treatment often begins with a specific four-drug regimen known as MOPP (Mustragen, Oncovin, Procarbazine and Prednisone) ➔ Three or four drugs may be given in intermittent or cyclical courses, with periods of treatment to allow recovery from toxicities. ❏ When Hodgkin’s does recur, the use of high doses of chemotherapeutic medications followed by autologous bone LYMPHOMA marrow or stem-cell transplantation, can be very effective (Surgical Category: intervention) 1. HODGKIN DISEASE (40%) NURSING INTERVENTIONS: 2. NON-HODGKIN DISEASE (60%) Protect the skin receiving radiation, we need to instruct the client to avoid rubbing, avoid use of powders, deodorants, lotions or HODGKIN DISEASE ointments unless it is prescribed by the physician. Form the application of heat and cold (29:00) - A type of lymphoma Encourage the patient to keep clean and dry and to pat the area - First sign of Hodgkin disease is often an enlarged lymph nodes affected by radiation gently with tepid water and mild soap. and later can spread into the lungs, liver and bone marrow - Lymphoma is a cancer of a part of the immune system called the Encourage wearing loose-fitting clothes and to protect skin from lymph system. exposure to sun chlorine and temperature extremities - Etiology is unknown, but both genetic and environmental factors Protect the oral and gastro-intestinal tract mucous membranes, we probably play a part. need to encourage frequent small meals, using a bland soft diet at - many researchers have suspected an infectious component (viral) mild temperatures - rarely seen in children younger than 7 years old (increase in Teach the patients to avoid irritants, such as alcohol, tobacco, spices adolescence and young adult) and extremely hot or cold foods - Common in patients ages 20 to 40 and in those older than age 60. Administer or teach self-administration of pain medication or antiemetic before eating or drinking , if needed. Encourage mouth care at least twice per day and after meals using SIGNS AND SYMPTOMS a soft toothbrush or toothpaste and mild mouth rinse 1) Painless swelling of lymph nodes in the neck, armpits or groin. Assess for ulcers, plaques or discharge that may be indicative of 2) Persistent fatigue superimposed infections 3) Fever and chills. 6 Ainie 3D  NCM 109 - FINALS For diarrhea, switch to a low-residue diet and administer anti- Types of NHL: diarrheal as ordered. __________________________________________________ Teach patient about the risk of infection so we have to advise patient to monitor temperature and to report any fever and any signs of  The American Society (ACS) estimates that 85% of NHL cases infection conflict are B-cell lymphomas  The less common types of B-cell lymphoma include: Explain to patient that radiation therapy may cause sterility Burkitt’s lymphoma (a form of non-Hodgkin’s lymphoma in which cancer Primary Nursing Diagnosis starts in immune cells called B-cells)  Risk for infection r/t impaired primary and secondary defenses  30-50 day incubation  Most cases symptomatic  Burkitt’s lymphoma o Associated w/ chronic co-infections w/ malaria  Nasopharyngeal carcinoma in Chinese & African men MANAGEMENT 1. Chemotherapy 2. Radiation 3. A stem cell transplant 4. Medication NON- HODGKIN LYMPHOMA  Tumors develop in lymphocytes so this are type of white blood cells  More common than the other general type of Lymphoma  Is a cancer that originates in lymphatic system, the disease-fighting network spread throughout the body C. NEOPLASMS OF THE BRAIN  A second common form of cancer in solid tumor for children which occur 2 – 10 years old and with peak age of 5 years old is a neoplasms of the brain  Neoplasms of the brain occur in the midline of brainstem or cerebellum. 3 TYPES OF NEOPLASMS OF THE BRAIN 1. Cerebellar astrocytomas  Account of ¼ of all brain tumor in children and the peak age incidence is 5 to 8 years old. SIGNS AND SYMPTOMS  Slow-growing, cystic tumor that arise from glial or support tissue surrounding  Abdominal pain/ swelling neural cells.  Chest pain  Coughing 2. Medulloblastomas  Difficulty breathing  Fast-growing tumor found most commonly in  Swollen lymph nodes the cerebellum.  Fatigue  The peak age of incidence of medulloblastomas  A fever is 5 to 10 years old.  Night sweats  Causes 4th ventricle compression and  Weight loss disturbance in the flow of CSF. CAUSES  Unknown  It occurs when the body makes too many abnormal lymphocytes 3. Brainstem gliomas  Around 75% of brainstem gliomas Who is at Risk? are diagnose in children and young  Older age adults under the age of 20 but it has been  The use of immunosuppressant drugs known that it affects also the older adult.  An infection  Brainstem gliomas start or begin in  Exposure to certain chemicals the brain or spinal cord tissue and typically spread throughout the nervous DIAGNOSTIC TEST system  A cancerous glioma tumor in the a. X-rays brainstem. b. CT scans  Causes paralysis of the 5th, 6th, 7th, c. MRIs 9th, and 10th cranial nerves. d. PET scans  May produce symptoms of ataxia, nystagmus, and changes in RR & PR findings because of pressure. 7 Ainie 3D  NCM 109 - FINALS BRAIN TUMOR SYMPTOMS  Common sites of occurrence include the eye orbit, para-nasal sinuses, uterus, prostate bladder, retro-peritoneum, and arms & General signs and symptoms legs  Headache  Seizures  Changes in vision  Problems with walking  Inability to concentrate  Speech difficulties  Personality or behavior changes  Numbness or tingling in the arms or legs DIAGNOSTIC TESTS - Neurologic exam (by a neurologist or neurosurgeon) Signs and symptoms  Bulging of the eye - CT (computer tomography scan) and/or Magnetic resonance  Drooping eyelid imaging (MRI)  Headache - Other tests like an angiogram, spinal tap, and biopsy.  Blood in the urine MANAGEMENT  Sinus infection symptoms  Surgery  Bleeding of the nose/ rectum  Radiation therapy  Chemotherapy Diagnostic Test 1. X-ray Patients diagnosed with neoplasm of the brain 2. CT scan  Before the treatment begins most patients are given steroids, so 3. MRI these are drugs that will leave swelling or edema 4. PET scan  The client will also receive anti-contraction medicine to prevent 5. Bone scan or control seizure. 6. Biopsy 7. Bone marrow aspiration NURSING DIAGNOSIS OTHER CHILDHOOD NEOPLASM: I. Neuroblastoma 3. Nephroblastoma (Wilms tumor) II. Rhabdomyosarcoma  Usually discover early in life, that is about 6 months to 5 III. Nephroblastoma (Wilms Tumor) years and the peak period is at 3 – 4 years although it IV. Retinoblastoma apparently arises from anembryonic structure present to the child before birth. 1. Neuroblastoma  Is a malignant tumor that arises from the metanephric  Tumor that arise from the cells of the sympathetic nervous mesoderm cells of the upper pole of the kidney. system.  Accounts for 20% of solid tumor in childhood.  Occur most frequently in the abdomen near the adrenal glands or  Wilms tumor is commonly seen in the kids from 3-4 and spinal ganglia. tends to occur less frequently after the age of 5. The most  Occurs primarily in infants and preschool children. common kidney cancer in children is Wilms’ tumor  The common sites of metastasis include the bone marrow, liver, Signs and symptoms of Wilms’ Tumor and subcutaneous tissue. Symptoms of Neuroblastoma 1. Swelling in the abdomen 1. Lump in the abdomen 2. Pain in the abdomen 2. Lump in the chest 3. Mass in the abdomen which can be felt 3. Bone pain 4. Fever 4. Bruising around the eyes 5. Hematuria or blood in the urine Birth defects & Risk factors of Wilms’ Tumor 1. Aniridia 2. Cryptorchidism 3. Hypospadias Diagnostic Test 1. MRI 2. CT scan 3. Ultrasound (sonogram) 4. Bone scan 5. PET scan 6. X-ray 7. Biopsy Assessment: Management  Tumor is felt as firm, non-tender, abdominal mass 1. Surgery  Child’s abdomen should not be palpated –may aid to metastasis. 2. Radiation Place a sign reading “NO Abdominal palpation” over the child’s 3. Chemotherapy crib. 2. Rhabdomyosarcoma Therapeutic Management:  Tumor will be removed by nephrectomy  A tumor of strained muscle.  Followed by radiation therapy  Arises from the embryonic mesenchyme tissue that form muscle, connective, and vascular tissue.  Chemotherapy – given for as long as 15 months  Second surgical procedure may be scheduled after 2 or 3 months  The peak age of this incidence is 2- 6 years old and second peak is to remove any remaining tumor. during puberty. 8 Ainie 3D  NCM 109 - FINALS Both inadequate and excessive intakes of nutrients result in MALNUTRITION. MALNUTRITION  Is commonly defined as the lack of necessary or appropriate food substances, but in practice includes both undernutrition and overnutrition. OVERNUTRITION  Refers to a caloric intake in excess of daily energy requirements, Complications: resulting in storage of energy in the form of adipose tissue.  Nephritis, small bowel obstruction, hepatic damage caused by fibrotic scarring from radiation can occur National Heart, Lung and Blood Institute  Sterility in girls – radiation related damage to the ovaries overweight = BMI is between 25 and 29.9 kg/m2 and obese when the  Radiation to the lungs – interstitial pneumonia BMI is > 30 kg/m2.  Spine radiation scoliosis UNDERNUTRITION 4. Retinoblastoma  Refers to intake of nutrients insufficient to meet daily energy  An eye cancer that begins in the retina – the sensitive lining on requirements because of inadequate food intake or improper the inside of the eye. digestion and absorption of food.  Retinoblastoma is a rare tumor which accounts about 1 to 3% of childhood malignancies and about 10% of children. This tumor Inadequate food intake may be caused by: develops because of an inherited autosomal dominant pattern - Inability to acquire and prepare food - Inadequate knowledge about essential nutrients and a balanced Signs and symptoms diet  A pupil that looks white or red, instead of the normal black - Discomfort during or after eating  A crossed eye, which is an eye looking either toward the ear or - Dysphagia toward the nose - Anorexia  Poor vision - Nausea  A red, painful-looking eye - Vomiting  An enlarged pupil  Different-colored irises Improper digestion and absorption of nutrients may be caused by: an inadequate production of hormones or enzymes Diagnostic tests: medical conditions  Scans and other imaging tests  Imaging tests may include ultrasound, computerized tomography Inadequate nutrition can be associated with: (CT) scan and magnetic resonance imaging (MRI) marked weight loss generalized weakness TOPIC 2: Alteration in Nutrition altered functional abilities delayed wound healing NUTRITION increased susceptibility to infection  The sum of all the interactions between an organism and the food it consume. decreased immunocompetence impaired pulmonary function NUTRIENTS Prolonged length of hospitalization.  Are organic and inorganic substances found in foods that are required for body functioning. Protein-calorie malnutrition (PCM) significant problem of clients with long-term deficiencies in caloric FACTORS AFFECTING NUTRITION intake Development Gender Characteristics of PCM: Ethnicity and Culture - depressed visceral proteins (e.g., albumin) Beliefs about Food - weight loss Personal Preferences Religious Practices - Visible muscle and fat wasting. Lifestyle Economics NURSING MANAGEMENT Medications and therapy A comprehensive nutritional assessment is often performed by a nutritionist Health or a dietitian, and the primary care provider. Alcohol Consumption Advertising Components of a Nutritional Assessment: Psychological factors Anthropometric Biochemical Daily Food Guide: Clinical Dietary NUTRITIONAL SCREENING  An assessment performed to identify clients at risk for malnutrition or those who are malnourished. NUTRITION HISTORY Age, sex, and activity level Difficulty eating Condition of the mouth, teeth, and presence of dentures Changes in appetite Changes in weight Physical disabilities that affect purchasing, preparing, and eating Cultural and religious beliefs that affect food choices Living arrangements (e.g., living alone) and economic status General health status and medical condition Medication history. 9 Ainie 3D  NCM 109 - FINALS DIAGNOSING VII. Liver Transplantation Imbalanced Nutrition: Less Than Body Requirements Obesity INTESTINAL DISORDER Overweight I. Intussusception Readiness for Enhanced Nutrition II. Volvulus with malrotation Activity Intolerance related to inadequate intake of iron-rich foods III. Necrotizing enterocolitis resulting in iron deficiency anemia IV. Short Bowel/Short –Gut Syndrome Constipation related to inadequate fluid intake and fiber intake V. Appendicitis Chronic Low Self-Esteem related to obesity Ruptured Appendicitis Risk for Infection related to immunosuppression secondary to VI. Meckel’s Diverticulum insufficient protein intake. VII.Celiac Disease (Malabsorption syndrome, Gluten-Induced Enteropathy, Celiac Sprue) PLANNING Maintain or restore optimal nutritional status. DISORDERS OF THE BOWEL Promote healthy nutritional practices. I. CONSTIPATION Prevent complications associated with malnutrition. II. INGUINAL HERNIA Decrease weight VII. III.HIRSCHPRUNG DISEASE (Aganglionic Megacolon) Regain specified weight. III. INFLAMMATORY BOWEL DISEASE : Ulcerative Colitis ALTERATION IN GASTROINTESTINAL SYSTEM Crohn Disease IV. IRRITABLE BOWEL SYNDROME V. CHRONIC RECURRENT ABDOMINAL PAIN DISORDERS caused by FOOD, VITAMIN & MINERAL DEFICIENCIES I. Kwashiorkor II. Nutritional Marasmus III. Vitamins and Mineral Deficiencies GASTRO INTESTINAL TRACT DISORDER NURSING PROCESS: I. ASSESSMENT assessed for signs of fluid loss. Compare the child’s current weight with past weight measurements. Refer II. NURSING DIAGNOSIS III. OUTCOME IDENTIFICATION AND PLANNING Include the person who prepares or supervises the child’s nutrition when helping plan a new nutritional pattern for a child. If feedings will be given by nasogastric or gastrostomy tube, parents need enough practice to be proficient with the equipment and the technique before they are given the responsibility of doing it alone at home. I. IMPLEMENTATION Parents need a great deal of support to adapt their busy life to these alternative methods of feeding or care. Be certain to give clear, simple explanations and praise both parents and child after they demonstrate these procedures II. OUTCOME EVALUATION Recording children’s height and weight. making certain children gradually learn more about their specific nutritional measures. COMMON GASTROINTESTINAL SYMPTOMS OF ILLNESS IN CHILDREN I. VOMITING  Or throwing up is a forceful discharge of stomach content  Recurrent vomiting may be caused by underlying medical COMMON GASTROINTESTINAL SYMPTOMS OF ILLNESS IN conditions CHILDREN Is Vomiting Harmful? Vominting Some examples of serious conditions that may result in nausea or Diarrhea (mild, severe) vomiting include: Bacterial Infectious Diseases that cause diarrhea & vomiting Concussions Protozoan or Viral Diarrhea Meningitis Intestinal blockage COMMON DIORDER OF THE STOMACH AND DUODENUM Appendicitis I. Gastroesophageal reflux Brain tumors II. Pyloric Stenosis Dehydration III. Peptic Ulcer Disease IV. Hepatic Disorders: A. Hepatitis > Hepa A, Hepa B, Hepa C,D and E > Chronic Hepatitis.> Fulminant Hepatic Failure V. Obstruction of the Bile Ducts VI. Nonalcoholic Fatty Liver Disease & Cirrhosis > esophageal varices 10 Ainie 3D  NCM 109 - FINALS - A concussion is a traumatic brain injury that affects your brain DIARRHEA may be either: function.  Short-term (acute) - Effects are usually temporary but can include headaches and  Long term (chronic) problems with concentration, memory, balance and coordination. Symptoms - Concussions are usually caused by a blow to the head Cramping ASSESSSMENT Belly (abdominal) pain Differentiation between Regurgitation & Vomiting Swelling (bloating)  Vomiting is the ejection of contents of the stomach and upper Upset stomach (nausea) intestine Urgent need to use the bathroom  Regurgitation is the ejection of small amounts of chyme or Fever gastric juice from the mouth and antecedent nausea. Bloody stools Loss of body fluids (dehydration) DIFFERENTIATION BETWEEN REGURGITATION AND Incontinence VOMITING Characteristic Regurgitation Vomiting Diagnostic Test Timing Occurs w/ feeding Timing unrelated to Stool evaluation to check the stool for blood or fat feeding Blood tests to rule out certain diseases Forcefulness Runs out mouth w/ Forceful: often Imaging tests to rule out structural problems little force projected as much as Tests to check for food intolerance or allergies 4 ft (most often Stool culture to check for abnormal bacteria or parasites in your associated with child’s digestive tract. A small stool sample is taken and sent to a lab pyloric stenosis) Sigmoidoscopy Description Smells barely sour; Extremely sour - Helps to check the child’s large intestine. only slightly curdled smelling and curdled, - It tell/shows what is causing diarrhea, stomach pain, constipation, yellow, green, clear abnormal growths, and bleeding. or watery, or black or blood tinged. - It uses a short, flexible, lighted tube (sigmoidoscope). The tube is put into the intestine through the rectum. Distress Nonpainful; no Possible crying just - This tube blows air into the intestine to make it swell. This makes appearance of before vomiting as if it easier to see inside. distress; may even abdominal pain is smile as if sensation present and after is enjoyable vomiting as if the NURSING DIAGNOSIS force of action is Deficient fluid volume related to loss of fluid through diarrhea. frightening Duration Occurs once per Continuing until Related Interventions feeding stomach is empty; Promote Hydration and Comfort. followed by dry Record Fluid Intake and Output retching Amount 1-2 teaspoons Full stomach contents III. BACTERIAL INFECTIOUS DISEASES THAT CAUSE DIARRHEA & VOMITING When to seek immediate medical care? Salmonellosis  Blood in the vomit (bright red or “coffee grounds” in appearance) Listeriosis  Severe headache or stiff neck Shigellosis (Dysentery)  Lethargy, confusion or a decreased alertness Staphylococcal Food Poisoning  Severe abdominal pain  Diarrhea IV. PROTOZOAN OR VIRAL DIARRHEA  Rapid breathing or pulse THERAPEUTIC MANAGEMENT COMMON DISORDER OF THE STOMACH AND DUODENUM - water; ORS; IVF; PediaLyte; Fresh Ginger Tea I. GASTROESOPHAGEAL REFLUX DISEASE (GERD) II. DIARRHEA  A digestive disorder that affects the ring of muscle between the  When stools (bowel movements) are loose and watery esophagus and stomach.  MILD  The ring is called the lower esophageal sphincter (LES)  SEVERE  GERD occurs when stomach acid frequently flows back onto the tube connecting the mouth and stomach (esophagus). CAUSES:  This backwash (acid reflux) can irritate the lining of the esophagus. -Bacterial infection  Stomach acid - Hydrochloric acid in the gastric juice breaks down the -Viral infection food and the digestive enzymes split up the proteins. -Trouble digesting certain things (food intolerance) -An immune system response to certain foods (food allergy) -Parasites that enter the body through food or water -Reaction to medicines -An intestinal disease, such as inflammatory bowel disease. DIFFERENTITATION BETWEEN NORMAL STOOL AND DIARRHEA STOOL IN AN INFANT Diarrheal stool in an infant Characteristic Infant Normal Diarrheal Stool Stool Frequency 1-3 daily Unlimited number Color Yellow Green Effort of expulsion Some pushing Effortless; may be explosive effort pH More than 7.0 Less than 7.0 ( acidic) Diagnostic workup may include the ff: (alkaline) - Upper GI Series Odor Odorless Sweet or foul smelling - Ph Probe Occult blood Negative Positive; blood may be overt - Esophageal Manometry Reducing Negative positive - Endoscopy substances 11 Ainie 3D  NCM 109 - FINALS THERAPEUTIC MANAGEMENT Risk Factors: - conservative treatment Sex - medication Race - surgery Premature birth Family history - In infants, it is treated by feeding a thickened formula and keeping Smoking during pregnancy the infant upright after feedings. Early antibiotic use - Adolescents are prescribed a proton pump inhibitor and advised to Bottle-feeding sleep with two pillows. - avoid lying down until 3 hours after a meal Complications: - Sleep at night with their upper body elevated on a foam wedge or extra Failure to grow and develop pillow. Dehydration - avoid acidic foods Stomach irritation Jaundice - Avoiding foods that delay gastric emptying such as fatty foods, chocolate, or alcohol When to see a doctor? - losing some weight if overweight Projectile vomits after feeding - avoid bending over after meals Seems less active or unusually irritable - Remove tight belts Urinates much less frequently or has noticeably fewer bowel movements RISK FACTORS Isn't gaining weight or is losing weight Cerebral palsy Down syndrome Treatment of Pyloric Stenosis Cystic fibrosis - A shallow excavation formed in the mucosal wall of the stomach, Obesity the pylorus, or the duodenum. - Includes gastritis (irritation of the lining of the stomach or