NCM112N-LEC-Midterm-REVIEWER PDF

NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C CARE OF CLIENT WITH PROBLEM IN 7. Cancer CELLULAR ABBERATION - A group of disorders characterized by...

NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C CARE OF CLIENT WITH PROBLEM IN 7. Cancer CELLULAR ABBERATION - A group of disorders characterized by abnormal cell proliferation. CANCER 8. Carcinogenesis - A large group of disorders with different - Process of transforming normal cells into causes, manifestations, treatments, and malignant cells. prognoses. 9. Carcinogens - Involve any organ system and treatment - Chemicals, physical factors, and other approaches have the potential for agents that cause cancer. multisystem effects. 10. Chemotherapy - The use of medications to kill tumor cells by Nursing Management: interfering with cellular functions and ✓ Care of patients throughout the cancer reproduction. trajectory from prevention through end-of- 11. Cytokines life care. - Messenger substances ✓ Education: avoid foods that are high in fats. - May be released by a cell to create an action at that site. COMMONLY USED TERMS - Synonyms: Biochemical mediators, 1. Alopecia inflammatory mediations - Hair loss 12. Extravasation 2. Anaplasia - Leakage of intravenous medication from - Pattern of grown in which cells lack normal veins into the subcutaneous tissues. characteristics and differ in shape and 13. Grading organization. - Identification of the type of tissue from - Anaplastic cells are malignant which the tumor originated and the degree to 3. Angiogenesis which the tumor cells retain the functional - Growth of new blood vessels that allow and structural characteristics of the tissue of cancer cells to grow. origin. 4. Apoptosis 14. Graft-Versus-Host Disease (GVHD) - A normal cell mechanism of programmed - An immune response initiated by T cell death. lymphocytes of donor tissue against the 5. Benign recipient’s tissues. - Not cancerous - An undesirable response - May grow but are unable to spread to other 15. Graft- Versus-Tumor Effect organs or body parts. - The donor immune cell response against the 6. Brachytherapy malignancy. - Delivery of radiation therapy through - A desirable response internal implants placed inside or adjacent to 16. Immunotherapy the tumor. 1|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - The use of medications or other agents to - Relief of symptoms and promotion of stimulate or suppress components of the comfort and quality of life. immune system to kill cancer cells. 26. Precision Medicine - E.g Ipilimumab (Yervoy), Nivolumab - Using advances in research, technology, and (Opdivo) policies to develop individualized plans of 17. Malignant care to prevent and treat disease. - Having cells or processes that are 27. Radiation Therapy characteristic of cancer. - Use of ionizing radiation to kill malignant - Cancerous cells. 18. Metastasis 28. Staging - Spread of cancer cells from primary tumor - Process of determining the extent of disease, to distant sites. including tumor size and spread or 19. Mucositis metastasis to distant sites. - Inflammation of the lining of the mouth, 29. Stomatitis throat, GI tract often associated with cancer - Inflammation of the oral tissues. therapies. - Often associated with some 20. Myelosuppression chemotherapeutic agents and radiation - Suppression of the blood cell-producing therapy to the head and neck region. function of the bone marrow. 30. Targeted Therapies - Low RBC- Anemia - Use of medications or other agents to kill or - Low WBC- Leukopenia prevent the spread of cancer cells by - Low Platelet- Thrombocytopenia targeting specific part of the cell, with less 21. Nadir negative effect on healthy cells. - Lowest serum level of blood cells after 3. Thrombocytopenia therapy that has toxic effects on the bone - Decrease in the number of circulating marrow. platelets - Most often used to describe the lowest - Associated with the potential for bleeding. absolute neutrophil count following 32. Toxicity chemotherapy. - An unfavorable and unintended sign, 22. Neoplasia symptom, or condition associated with - Uncontrolled cell growth that follows no cancer treatment. physiologic demand; cancer. 33. Vesicant 23. Neutropenia - Substance that can cause inflammation, - Abnormally low absolute neutrophil count. damage, and necrosis with extravasation - Normal Range: 2,000-7,000 mm3 from blood vessels and contact with tissues. 24. Oncology - Drugs: Potassium chloride, vancomycin, - Study of cancer dopamine, actinomycin D, doxorubicin. 25. Palliation 2|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C EPIDEMIOLOGY The leading causes of cancer-related death in the US in order of frequency and location: - Lung cancer - Prostate cancer - Colorectal cancer in men - Lung cancer - Breast cancer - Colorectal cancer in women PATHOPHYSIOLOGY 1. Begins when a cell is transformed by genetic mutations of the cellular deoxyribonucleic acid (DNA). 2. Genetic mutations may be inherited or acquired, leading to abnormal cell behavior. 3. The initial genetically altered cell forms a clone and begins to proliferate abnormally, 4. Evading normal intracellular and ABCDE’S OF MELANOMA extracellular growth-regulating processes or signals as well as the immune system defense mechanisms of the body 5. Genetic mutations may lead to abnormalities in cell signaling transduction processes (signals from outside and within cells that turn cell activities either on or off) that can in turn lead to cancer development. 6. Ultimately cells acquire a variety of capabilities that allow them to invade surrounding tissues or gain access to lymph and blood vessels, which carry the cells to CARCINOGENESIS other areas of the body resulting in metastasis or spread of the cancer. CHARACTERISTICS OF BENIGN AND MALIGNANT CELLS 3|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C MOLECULAR PROCESS - Cell proliferation is how quickly a cancer Three step cellular process: cell copies its DNA and divides into 2 cells. 1. Initiation Process - Carcinogens such as chemicals, physical RISK FACTORS factors, or biologic agents, cause mutations - Older Age in the cellular DNA. - Genetics - Normally, these alterations are reversed by - Immunosuppression DNA repair mechanisms or the changes - Viruses initiate apoptosis or cell senescence. - Smoking - Cells escape these protective mechanisms - Sun Exposure with permanent cellular mutations occurring, - High-Fat, Low-Fiber Diet but these mutations usually are not significant to cells. 2. Promotion Process - Repeated exposure to promoting agents causes proliferation and expansion of initiated cells. - >>> Causing increased expression or manifestations of abnormal genetic information. - Thus, >>> Promoting agents are not mutagenic and do not need to interact with the DNA. - Promotion is reversible if the promoting substance is removed (a key focus in the prevention of cancer). 3. Progression Period - Altered cells exhibit increasingly malignant behavior. - These cells acquire the ability to stimulate ETIOLOGY angiogenesis (growth of new blood vessels Factors implicated or known to induce that allow cancer cells to grow), to invade carcinogenesis adjacent tissues, and to metastasize. 1. Viruses and Bacteria PROLIFERATIVE PATTERNS - Production of carcinogenic metabolites and - Cancerous cells, described as malignant, inflammatory reactions. demonstrate neoplasia, or uncontrolled cell - Examples of bacteria: growth that follows no physiologic demand. o Helicobacter pylori (stomach cancer), o Salmonella enteritidis (colon cancer) 4|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C o Chlamydia trachomatis (ovarian and - ENDS are relatively new to the market; the cervical cancers) long-term health effects of these products remain unknown. 2. Physical Agents - The extensive list of suspected chemical - Exposure to sunlight substances continues to grow and includes; - Radiation o Aromatic amines and aniline dyes; - Chronic irritation or inflammation o Pesticides and Formaldehydes; - Tobacco carcinogens o Arsenic, soot, and tars; - Industrial chemicals o Asbestos; - Asbestos o Benzene; o Cadmium; 3. Chemicals o Chromium compounds; - Most hazardous chemicals produce their o Nickel and zinc ores; toxic effects by altering DNA structure. o Wood dust; - Cigarette smoking is strongly associated o Beryllium compounds; with 12 different cancer types including: o Polyvinyl chloride; o Cancers of the oral cavity and pharynx 4. Genetic or Familial Factors o Larynx - 5% to 10% of cancers in adults display a o Lungs pattern of cancers suggestive of a familial o Esophagus predisposition. o Pancreas - Hallmarks of families with a hereditary o Uterine cervix cancer syndrome include cancer in two or o Kidney more first-degree relatives (the parent, o Bladder sibling, or child of an individual). o Stomach o Colorectal 5. Lifestyle Factors o Live - Lifestyle factors (e.g., obesity, alcohol o Myeloid leukemia intake, poor diet, physical inactivity) were - Secondhand smoke, has been linked to lung estimated to account for 16% of all cancer cancer. cases. - About a 20% to 30% greater risk of - Lifestyle factors were second only to developing lung cancer. cigarette smoking as a major modifiable risk - Electronic nicotine delivery systems (ENDS) factor. including e-cigarettes, e-pens, e-pipes, e- - Dietary substances; hookah, and e-cigars. o Fats - Most contain nicotine, which is highly o Alcohol addictive, and other potentially harmful o Salt substances o Cured or Smoked Meats 5|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C o Nitrate and nitrite containing foods ▪ HPV vaccine prevents o Red and processed meats cervical and head and neck cancers 6. Hormones - Early onset of menses before age 12 SECONDARY PREVENTION - Delayed onset of menopause after age 55 - Early detection and screening - Null parity (never giving birth) - Delayed childbirth after age 30 Breast Self-Examination - Increased numbers of pregnancies are How: associated with a decreased incidence of 1. Start at Upper to Outer Quadrant breast, endometrial, and ovarian cancers. 2. Use finger pads 3. Use fingertips 4. Press deeply 5. Can be done in the shower 6. In front of the mirror 7. Lying down or sitting When: ✓ Done MONTHLY ✓ Regular period: 7 days after menses/few days post-menses ✓ Irregular Period: same day each month ✓ Menopause: same day each month Testicular Self-Examination How: 1. Stand in front of the mirror DETECTION AND PREVENTION OF 2. Support testicle with one hand and feel each CANCER other with other hand 3. Check one testicle at a time PRIMARY PREVENTION 4. Hold testicle between thumb and fingers of - Lifestyle changes that helps in reducing the both hands, roll gently risks of disease through health promotion. 5. Report any lumps, bumps, changes in size - Risk reduction strategies and shape o Example: When: ▪ Nutrition and physical ✓ Done after a warm shower activity ▪ Immunization to reduce the Normal: Soft, cord-like structure risk of cancer Abnormal: Pea sized lump, painless 6|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C Mammography 4. Obtain tissue and cells for analysis, - Xray of the breast, to check for calcium including evaluation of tumor stage and deposits, with discomfort. grade - Radiation effect is equivalent to 1 hour sun exposure. TUMOR STAGING AND GRADING When: - This is accomplished prior to treatment for ✓ Yearly evaluating outcomes of therapy and to Starting: maintain a consistent approach to ongoing ✓ 40 yrs old and above diagnosis and treatment. Preparation: Staging ✓ No deodorant - Describes the size of the tumor ✓ No power - The existence of local invasion ✓ No cream - Lymph node involvement, and ✓ No lotion - Distant metastasis. Grading Digital Rectal Examination - The pathologic classification of tumor cells. When: - Seek to define the type of tissue from which ✓ Yearly the tumor originated. Starting: - Degree to which the tumor cells retain the ✓ 40 years old functional. Position: - Describes the histologic characteristics of ✓ Knee-chest position the tissue of origin (differentiation). - Samples of cells used to establish the tumor Normal: Soft, boggy like the tip of the nose grade may be obtained from: Abnormal: Stony hard prostate o Tissue scrapings o Body fluids TERTIARY PREVENTION o Secretions - Monitoring for and preventing recurrence of o Washings the primary cancer. o Biopsy - Screening for the development of second o Surgical excision malignancies in cancer survivors. - This information helps providers predict the behavior and prognosis of various tumors. DIAGNOSIS OF CANCER Patients with suspected cancer undergo extensive testing to: 1. Determine the presence and extent of cancer 2. Identify possible disease metastasis 3. Evaluate the function of involved and uninvolved body systems and organs, and 7|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Mammography - Magnetic Resonance Imaging (MRI) - Computed Tomography (CT) Scan - Fluoroscopy - Ultrasonography (Ultrasound) - Endoscopy - Nuclear Medicine Imaging - Positron Emission Tomography (PET) - PET Fusion - Radioimmunoconjugates MANAGEMENT OF CANCER - Treatment options offered to patients with cancer are based on treatment goals for each specific type, stage, and grade of cancer. - Open communication and support are vital as those involved periodically reassess treatment plans and goals when complications of therapy develop or disease DIAGNOSTIC TEST progresses. Tumor Marker Identification - Analysis of biochemical mediators found in 1. Cure tumor tissue, blood, or other body fluids that - A complete eradication of malignant are indicative of cancer cells or specific disease; characteristics of cancer cells. - Remission is a period of time when the - These biochemical mediators may also be cancer is responding to treatment or is found in some normal body tissues. under control. - E.g., Breast, colon, lung, ovarian, testicular, 2. Control prostate cancer - Which includes prolonged survival and containment of cancer cell growth. 3. Palliation - Which involves relief of symptoms associated with the disease and improvement of quality of life. Surgery - Removal of the entire cancer remains the ideal and most frequently used treatment method. 8|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Diagnostic Surgery - Performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant. - Biopsy is taken from the actual tumor. - In some situations, it is necessary to take a sample of lymph nodes near a suspicious tumor. Biopsy Types 1. Excisional Biopsy - Used for small, easily accessible tumors. 2. Incisional Biopsy - Performed if the tumor mass is too large to be removed. 3. Needle Biopsy - Performed to sample suspicious masses that are easily and safely accessible. 4. Fine-Needle Aspiration (FNA) Biopsy - Involves aspirating cells rather than intact tissue through a needle that is guided into a suspected diseased area. 9|RN2026  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C Prophylactic Surgery (or Risk Reduction Surgery) - Used to kill cells. - Involves removing nonvital tissues or organs that are at increased risk of developing 1. Neoadjuvant Radiation Therapy cancer. - Used to reduce tumor size in order to - The following factors are considered when facilitate surgical resection. discussing possible prophylactic surgery: 2. Radiation Therapy o Family history and genetic - May be given prophylactically to predisposition prevent local recurrence or spread of o Presence or absence of signs microscopic cells from the primary and symptoms tumor to a distant area. o Potential risks and benefits 3. Palliative Radiation Therapy o Ability to detect cancer at an - Used to relieve the symptoms of locally early stage advanced or metastatic disease. o Alternative options for managing increased risk Two types of ionizing radiation: o The patient’s acceptance of 1. Electromagnetic radiation (x-rays and the postoperative outcome gamma rays) Palliative Surgery 2. Particulate radiation (electrons, beta - Overall goal is to relieve symptoms and to particles, protons, neutrons, and alpha improve the patient’s quality of life. particles) - When surgical cure is not possible, honest and informative communication with the Radiation Dosage patient and family about the goal of - Dosage depends on the sensitivity of the palliative surgery is essential to avoid false target tissues to radiation, the size of the hope and disappointment. tumor. Reconstructive Surgery ADMINISTRATION OF RADIATION - Curative or extensive surgery in an attempt External-Beam Radiation Therapy (EBRT) to improve function or obtain a more - Commonly used form of radiation desirable cosmetic effect. therapy. - Reconstructive surgery may be indicated for: - Is generated either from a linear o Breast accelerator or from a unit that generates o Head and Neck energy directly from a core source of o Skin Cancers radioactive material. - Through computerized software Radiation Therapy programs, both approaches can shape an - Radiation may be used to cure cancer. invisible beam of highly charged - Used to control cancer when a tumor cannot photons or gamma rays to penetrate the be removed surgically. 10 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C body and target the tumor with pinpoint o Prohibiting visits by children or accuracy. pregnant visitors. o Assigning the patient to a private Internal Radiation / Brachytherapy room. - Localized implantation or systemic o Posting appropriate notices about radionuclide administration. radiation safety precautions. - Brachytherapy delivers the dose of radiation o Making sure that pregnant staff to a localized area while systemic members are not assigned to the radiotherapy relies on strategies for getting patient’s care. the radionuclides closer to the tumor. o Having staff members wear dosimeter badges. NURSING MANAGEMENT FOR RADIATION o Limiting visits from others to 30 THERAPY minutes daily. - In particular, advanced age, elevated o Maintain 6-foot distance from the radiation dose, and BMI have been radiation source. associated with greater toxicity and symptoms. CHEMOTHERAPY o For example, a decreased BMI was - Use of antineoplastic drugs in an attempt to found to be associated with an destroy cancer cells by interfering with increased incidence of toxicities in cellular functions. women with cervical cancer - Used primarily to treat systemic disease. - In patients receiving EBRT; assesses - Eradication of 100% of the tumor is almost patient’s skin, nutritional status, and general impossible; the goal of treatment is feelings of well-being eradication of enough of the tumor so that - If systemic symptoms such as fatigue occur the remaining malignant cells. the nurse explains that these symptoms are a result of the treatment and do not represent CLASSIFICATION OF deterioration or progression of the disease. CHEMOTHERAPEUTIC AGENTS - Alkylating agents PROTECTING CAREGIVERS - Nitrosoureas - Patients receiving internal radiation emit - Antimetabolites radiation while the implant is in place. - Antitumor antibiotics - Health care team is guided by principles of - Topoisomerase inhibitors time, distance, and shielding to minimize - Plant alkaloids (also referred to as mitotic exposure of personnel to radiation. inhibitors) - Specify the maximum time that can be spent - Hormonal agents safely in the patient’s room. - Miscellaneous agents - Safety Precautions in patient receiving brachytherapy: 11 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C NURSING MANAGEMENT - Nurses provide patient and family education Assessing Fluid and Electrolyte Status that emphasizes two key points: - Anorexia, nausea, vomiting, altered taste, o The importance of adhering to mucositis, and diarrhea put patients at risk prescribed self-administered for nutritional and fluid and electrolyte premedication before presenting to disturbances. the infusion center and recognizing. - Therefore, it is important for the nurse to o Reporting the signs and symptoms to assess the patient’s nutritional and fluid and the nurse once the infusion has electrolyte status on an ongoing basis and to started. identify creative ways to encourage an adequate fluid and dietary intake. Preventing Nausea and Vomiting - Nurses provide education for patients and Assessing Cognitive Status families regarding antiemetic regimens and - Nurses should assess patients routinely for care for delayed CINV that may continue at indications of cognitive impairment. home after the chemotherapy infusion has - Prior to the initiation of treatment, patients completed. and families should be informed about the possibility of cognitive impairment. Managing Cognitive Changes - Nurses should assist patients to address Modifying Risks for Infection and Bleeding factors, such as fluid and electrolyte - Suppression of the bone marrow and imbalances, nutrition deficits, fatigue, pain, immune system is expected and frequently and infection to minimize their contribution serves as a guide in determining appropriate to cognitive impairment. chemotherapy dosage but increases the risk of anemia, infection, and bleeding disorders. Managing Fatigue - Fatigue is a common side effect of Administering Chemotherapy chemotherapy. - Observed closely during administration of - Nurses assist patients to explore the role that the agent because of the risk and the underlying disease processes, combined consequences of extravasation treatments, other symptoms, and - Indications of extravasation during psychosocial distress play in the patient’s administration of vesicant agents include the experience of fatigue. following: o Absence of blood return from the IV Protecting Caregivers catheter. - Precautions must also be taken when o Resistance to flow of IV fluid. handling any bodily fluids or excreta from o Burning or pain, swelling, or redness the patient. at the site. - Use of personal protective equipment. 12 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Handling and disposal of chemotherapy Types of Hematopoietic Stem Cell agents and supplies. Transplantation - Management of accidental spills or - Types of HSCT are based on the source of exposures. donor cells and the treatment (conditioning) - Linens contaminated with chemotherapy or regimen used to prepare the patient for stem blood and body fluids of patients receiving cell infusion and eradicate malignant cells. chemotherapy should be placed in the following: 1. Allogeneic HSCT (AlloHSCT) o Closed-system, puncture- and leak- - From a donor other than the patient (may be proof containers labeled “hazardous: a related donor such as a family member or chemotherapy contaminated linens” a matched unrelated donor) o Above referenced container 2. Autologous maintained in the infusion center - From the patient soiled utility room for outpatient 3. Syngeneic settings. - From an identical twin o Above referenced container 4. Myeloablative maintained in the patient room or - Consists of giving patients high-dose soiled utility room for inpatient chemotherapy and, occasionally, total-body settings irradiation. 5. Nonmyeloablative HEMATOPOETIC STEM CELL - Also called mini-transplants; does not TRANSPLANTATION completely destroy bone marrow cells. - Used to treat several malignant and nonmalignant diseases for many years. NURSING MANAGEMENT FOR PATIENTS - Commonly addresses hematologic UNDERGOING HSCT malignancies in adults like: Before Treatment: o Malignant myeloma - Extensive evaluations: clinical status, o Acute leukemia nutritional, physical, organ function, o Non-Hodgkin lymphoma; less psychological assessments, and infections common for solid tumors screening. - Historically, HSCs were harvested from - Evaluate social support, financial resources, bone marrow under anesthesia; now, and obtain informed consent with patient peripheral blood stem cell collection via education. apheresis is the predominant method. - Apheresis is safer and more cost-effective During Treatment: than bone marrow harvesting. - Monitor and manage acute toxicities from - HSCs can also be collected from high-dose chemotherapy and total-body cryopreserved umbilical cord blood at birth. irradiation, such as nausea, diarrhea, and mucositis. 13 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Monitor vital signs and assess for adverse Monoclonal Antibodies (MoAbs) effects during stem cell infusion, including - Destroy the cancer cells and spare normal reactions to cryoprotectants like DMSO. cells. - Be vigilant for infections (bacterial, viral, - Dependent on identifying key antigen fungal) and complications (tumor lysis proteins on the surface (outside) of tumors syndrome, acute tubular necrosis, GVHD, that are not present on normal tissues. HSOS). - Implement a neutropenic diet to reduce Cancer Vaccines infection risk. - Mobilize the body’s immune response to prevent or treat cancer. After Treatment: - Continuous assessment for late effects post- 1. Autologous Vaccines HSCT, including chronic infections, - Made from the patient’s own cancer cells, pulmonary issues, and fertility concerns. which are taken from tumor tissue obtained - Address potential psychological distress; during biopsy or surgical intervention. ongoing psychosocial assessments for both 2. Allogeneic Vaccines patients and their families. - Made from cancer cell lines that are immortalized cells that were originally Caring for Donors: obtained from other people who had a - Provide support and education to donors specific type of cancer. about emotional impacts and maintain - These cancer cells are grown in a laboratory realistic expectations regarding patient and eventually killed and prepared for outcomes. injection. 3. Prophylactic Vaccines IMMUNOTHERAPY AND TARGETED - Three vaccines have been approved by the THERAPY FDA for the protection of HPV. Immunotherapy - Stimulate or suppress components of the HPV2 (Cervarix) immune system to kill cancer cells. - Recommended for use in females only. HPV4 (Gardasil) Nonspecific Immunotherapy - Provides protection against four HPV types - Boosts the immune system to enhance (6, 11, 16, and 18) and is recommended for cancer cell destruction alone use in both genders. - Common nonspecific immunotherapy agents HPV9 (Gardasil-9) include; - Recommended for both males and females o Bacille Calmette Guérin (BCG) - Protects against nine HPV types associated o Cytokines (interferon, interleukins, with cervical, anal, vaginal, and vulvar and colony stimulating factors). cancers. 14 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C Chimeric Antigen Receptor (CAR) T-Cell - Oral cavity assessment is performed daily or Immunotherapy at each patient visit - A type of targeted immunotherapy that uses tumor-specific antigen recognition to target Radiation-Associated Impairment of Skin specific malignancies. Integrity - The process of making CAR genetically - Maintenance of skin integrity modified T–cells begin with collecting T– - Cleansing cells. - Promotion of comfort - The T–cells are sent to the laboratory where - Pain reduction they are genetically altered by adding a - Prevention of additional trauma specific. - Prevention and management of infection - Chimeric antigen receptor. - Promotion of a moist wound-healing environment NURSING MANAGEMENT - Patients are advised to use moisturizer on Promoting Home, Community-Based, and the skin Transitional Care - Avoid sun exposure to the area of treatment - Educates patients about self-care and assists - Avoid tape or bandages and other sources of in providing for continuing care. irritation or trauma - Principles of infection control. - Hand Hygiene Alopecia - Nutrition and Hydration - Alopecia usually begins 1 to 3 weeks after - Safe sexual practices the initiation of chemotherapy and radiation - Good skin care therapy; - Instructions to notify the doctor about any - Regrowth most often begins within 8 weeks newly prescribed or over-the-counter after the last treatment. medications, including herbs, vitamins, and - The use of cryotherapy to the head (scalp dietary supplements. cooling) has been shown to be effective in reducing alopecia during chemotherapy NURSING CARE OF THE PATIENT WITH administration. CANCER Malignant Skin Lesions MAINTAINING TISSUE INTEGRITY - Wound cleansing Stomatitis - Reduction of superficial bacteria - Stomatitis commonly develops within 3 to - Control of bleeding 14 days after patients receive certain - Odor reduction chemotherapeutic agents - Protection from further skin trauma - Stomatitis affects up to 100% of patients - Pain management undergoing high-dose chemotherapy 15 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C PROMOTING NUTRITION - Anxiolytics for those with anxiety Nutritional Impairment - Hypnotics for patients with sleep - Impaired nutritional status may contribute to disturbances both physical and psychosocial - Psychostimulants for some patients with consequences. advanced cancer - Nutritional concerns include: o decreased protein and caloric intake IMPROVING BODY IMAGE AND SELF- o Metabolic or mechanical effects of ESTEEM the cancer - Creative and positive approach is essential o Systemic disease when caring for patients with altered body o Side effects of the treatment image. o The patient’s emotional status - The nurse serves as an active listener and counselor to both the patient and the family. General Nutrition Considerations - Oral nutritional supplements are encouraged ADDRESSING SEXUALITY to meet nutritional needs - Nurses should initiate discussions about - Approaches incorporate nutritional sexuality and assess sexual health. counseling - The potential for impaired fertility is - Exercise discussed and options reviewed for fertility - Pharmacologic interventions to combat preservation anorexia - Symptom management when feasible ASSISTING IN THE GRIEVING PROCESS - Grieving is a normal response to these fears RELIEVING PAIN and to actual or potential losses: - Assesses the patient for the source and site o Loss of health of pain o Normal sensations - For many patients, pain is often seen as a o Body image signal that cancer is advancing, and that o Social Interaction death is approaching. o Intimacy - The nurse provides education and support to o Independence correct fears and misconceptions about o Usual social roles opioid use. - Assess the patient and family for positive or maladaptive coping behaviors. DECREASING FATIGUE - Interpersonal communication - Exercise is an effective approach to the - Evidence of the need for additional management of cancer-related fatigue psychosocial support or - Pharmacologic interventions are utilized, - Interventions such as referral for - Including antidepressants for patients with professional counseling. depression 16 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Assists the patient and family to PROVIDING CARE TO THE PATIENT WITH acknowledge and cope with their reactions ADVANCED CANCER and feelings. - Empowers the patient and family to explore PROVIDING CARE IN ONCOLOGIC preferences for issues related to end-of-life EMERGENCIES care. - Treatment for the patient with advanced - Consider the patient’s cultural beliefs and cancer is likely to be palliative rather than practices when addressing issues related to curative. grief. - The use of long-acting analgesic agents at set intervals, rather than on an “as needed” MANAGEMENT OF PSYCHOSOCIAL basis, is recommended in addressing pain DISTRESS management. - Referral to mental health providers may be - Nurse works with the patient and family to helpful to address specific concerns. identify realistic goals and promote comfort. CANCER SURVIVORSHIP HOSPICE - In the United States, there are currently an - Focuses on quality of life estimated 16.9 million adult cancer - Palliation of symptoms survivors - Provision of physical, psychosocial, and - Cancer survivorship has been defined as the spiritual support for patients and families period from cancer diagnosis through the - The concept of hospice best addresses these remaining years of life and focuses on the needs health and life of a person beyond diagnostic and treatment phases. ALTERATION IN INFLAMMATORY AND - Advocacy organizations across the country IMMUNOLOGIC RESPONSE have recommended that a survivorship care plan be provided to all patients with cancer FUNDAMENTAL CONCEPTS and their primary provider at the completion - Four key concepts: constancy, homeostasis, of treatment. stress, and adaptation. - The survivorship care plan includes; o A summary of cancer diagnosis 1. Constancy o Treatment - Constancy refers to the idea that certain o Recommendations for follow-up care physiological variables (such as temperature, including approaches to treat pH, and electrolyte concentrations) maintain symptoms relatively stable levels within the body. o Rehabilitative needs 2. Homeostasis o Monitoring for late effects - Homeostasis is the overarching principle o Surveillance and screening for new that describes the body's ability to maintain and recurrent cancer. a stable internal environment. 17 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - It involves various physiological processes - Traffic jams, computer downtime, and feedback loops that work together to arguments. correct deviations from the set point, or ideal e. Major Stressors state. - Terrorism, war, economic changes 3. Stress f. Infrequent Stressors - Stress refers to any factor that disrupts - Death, birth, marriage, divorce homeostasis or challenges the body’s ability g. Acute, Time-Limited Stressor to maintain equilibrium. - Studying for final exams - This can include physical stresses (such as h. Stressor Sequence injury or illness), psychological stresses - Series of events after job loss or divorce. (such as anxiety or depression), or i. Chronic Intermittent Stressor environmental stresses (such as extreme - Daily hassles temperatures). j. Chronic Enduring Stressor 4. Adaptation - Chronic illness, disability, poverty - Adaptation is the process by which the body adjusts to changes in internal and external STRESS AS A STIMULUS FOR DISEASE environments in order to maintain - Stress and Illness: Constant stress increases homeostasis. the likelihood of developing health problems. - This can involve cellular, tissue, or - Stress Measurement: Researchers measure systemic-level changes that enhance the stress using scales that quantify life events, organism's ability to cope with stressors. such as: o Recent Life Changes OVERVIEW OF STRESS Questionnaire (RLCQ) Stressor ▪ Assesses stress from various - May be defined as an internal or external life events. event or situation that creates the potential o Positive-Negative Relationship for physiologic, emotional, cognitive, or Quality Scale (PNRQS) behavioral changes. ▪ Evaluates relationship stress. o Stress Overload Scale (SOS) TYPES OF STRESSORS ▪ Identifies feelings of being a. Physical Stressors overwhelmed. - Cold, heat, chemical agents b. Physiologic Stressors PSYCHOLOGICAL RESPONSES TO STRESS - Pain, fatigue - The mediating process - to how a person c. Psychological Stressors reacts to a stressor (consciously or - Fear (e.g., fear of failing an exam, losing a unconsciously) job), Life Transitions: Puberty, marriage, - Cognitive appraisal and coping as important childbirth. mediators of stress (Lazarus, 1991) d. Day-to-Day Stressors influenced by internal and external resources. 18 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C Appraisal of the Stressful Event o Ability to function well in stressful - Cognitive appraisal evaluates what is at situations; involves flexibility and stake (primary) and what can be done managing emotions. (secondary). - Strong supportive relationships and positive - Primary appraisal role models enhance resilience. o Determines if the situation is - A health-promoting lifestyle buffers the nonstressful or stressful. effects of stressors. - Secondary appraisal - Nurses play a key role in promoting healthy o Assesses possible actions. lifestyles to mitigate stress effects. - Reappraisal occurs with new information - Promoting health can be more achievable and influences emotion development. than altering stressors. Coping with the Stressful Event PHYSIOLOGIC RESPONSES TO STRESS - Coping involves cognitive and behavioral - Stress activates protective mechanisms efforts to manage stress. within the body to maintain homeostasis - Emotion-Focused Coping through neurologic and hormonal processes, o Aims to lessen emotional distress. resulting in both short- and long-term effects. - Problem-Focused Coping o Makes direct changes to manage the Selye’s Theory of Adaptation situation. - General Adaptation Syndrome (GAS) - Both types of coping are used in response to developed by Hans Selye, comprising three stress. phases: Building Resilience 1. Alarm - Factors that build resilience: strong - Activation of fight-or-flight response, supportive relationships and positive role release of catecholamines (epinephrine, models. norepinephrine), and adrenocorticotropic - A resilient person knows when to act, rely hormone (ACTH). on others, and when to reenergize. 2. Resistance - Positive resilience influences rehabilitation - Adaptation to stressor, continued cortisol and overall improvement after challenges. activity. 3. Exhaustion Factors Affecting Coping and Resilience - Prolonged stress leads to detrimental effects - Internal characteristics on body systems. o Health, energy, beliefs, goals, self- esteem, skills. Life Process and GAS - Resilience a. Childhood - Limited stress encounters, vulnerable to stress. 19 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C b. Adulthood - Cells adapt to stress via: - Exposure to numerous stressors promotes resistance and adaptation. a. Atrophy d. Later Years - Decrease in cell size due to disuse or other - Accumulation of stressors reduces factors. adaptation ability, leading to decreased b. Hypertrophy resistance. - Increase in cell size from increased workload. Local Adaptation Syndrome (LAS) c. Hyperplasia - Occurs at the local site of tissue injury (e.g., - Increase in cell number in response to inflammatory response, repair process). stimuli (e.g., hormonal changes). - Applies to small, localized injuries such as d. Metaplasia contact dermatitis. - Transformation of one cell type into another for protection (e.g., lung cells in smokers). STRESS AT THE CELLULAR LEVEL e. Dysplasia Cellular Response to Stress - Abnormal cell growth that can indicate - Different cells respond differently to stress potential malignancy. based on their type and physiological state. For example, cardiac muscle cells react Cellular Injury more quickly to low oxygen (hypoxia) than - Injury represents a disruption in cell smooth muscle cells. regulation, resulting in either reversible or - The nature, severity, and duration of the irreversible damage. stressor impact the cellular response. - Common causes of injury include hypoxia (oxygen deficiency), nutritional imbalance, Homeostasis and Control Mechanisms and exposure to chemicals or infections. - Cells maintain a steady state through compensatory mechanisms regulated by the INFLAMMATION: CELLULAR RESPONSE autonomic nervous and endocrine systems. TO INJURY - Negative Feedback Inflammation o Restores homeostasis by triggering - Is the body’s natural response to injury or responses to offset deviations from damage. When our cells or tissues get hurt— normal function (e.g., regulating whether from a physical injury (like a cut), a blood pressure, body temperature). chemical (like a burn), or an infection—the - Positive Feedback body reacts with inflammation in the nearby o Amplifies the initial disturbance healthy tissues rather than correcting it, such as in blood clotting. The Five Signs of Inflammation - When inflammation occurs, you typically Cellular Adaptation notice five cardinal signs: 20 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C 1. Redness - These cells are always dividing and can - Blood flows to the area, making it red. quickly replace themselves. 2. Warmth b. Stable Cells - Increased blood flow warms the area. - These cells don’t usually divide much but 3. Swelling can regenerate if needed. - Fluids leak into the tissues, causing swelling. - Examples include cells in the liver and 4. Pain kidney. - Caused by pressure from swelling and c. Permanent Cells chemical signals irritating nerve endings. - These cells do not regenerate. 5. Loss of Function - It's harder to use that part of your body due 2. Replacement to pain or swelling. - This is when damaged cells are replaced by a different type of cell, usually connective TYPES OF INFLAMMATION tissue, which leads to scar formation a. Acute Inflammation - Immediate response lasting less than 2 a. Primary Intention Healing weeks, serves a protective function. - This happens when a wound is close b. Chronic Inflammation together, like a clean cut or surgical incision. - Occurs if the injurious agent persists, can - The edges of the wound are neatly aligned, last months or years. and healing occurs with little scarring. CELLULAR HEALING b. Secondary Intention Healing - Is how our bodies fix themselves after an - This occurs when the wound edges cannot injury. The process begins soon after the be brought together, like a larger or irregular injury occurs, and it takes place after any wound. debris from inflammation is cleared away. - It heals from the inside out, filling in with - There are two main ways our bodies can new tissue (granulation tissue), which takes heal: longer and often results in a larger scar. o Regeneration o Replacement NURSING MANAGEMENT OF STRESS Key Questions Nurses Ask: 1. Regeneration - How is the patient’s heart rate, breathing, - This is when the body repairs and replaces and temperature? damaged cells with new cells of the same - What emotional stress might be making type. them feel bad? - Are there signs that something is wrong with Type of Cells their health? a. Labile Cells - How is their blood pressure, height, and weight? 21 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Can they move normally? How about their - Nutritional status senses? - Infections and immunizations - Are there problems with their thinking or - Allergies remembering things? - Disease states (autoimmune disorders, - Do they have visible injuries or changes in cancer, chronic illnesses) appearance? - Surgeries, medications, blood transfusions - Physical examinations of various bodily 1. Healthy Lifestyle Choices systems - Eating well, exercising, and having a good support system are critical. These habits can DIAGNOSTIC EVALUATION help reduce stress and improve overall - Humoral (Antibody-Mediated) Immunity health. Tests 2. Relaxation Techniques - Cellular (Cell-Mediated) Immunity Tests - Progressive Muscle Relaxation - Benson Relaxation MANAGEMENT OF PATIENTS WITH - Guided Imagery IMMUNE DEFICIENCY DISORDERS 3. Promoting Family Health Primary Immune Deficiency Disease (PIDD) - Communication, emotional strengths, - They are rare genetic disorders that hinder community programs the body’s immune response. 4. Enhancing Social Support - Over 200 types exist and they affect about - Support groups 500,000 people in the U.S. - Psychological and biological health, stress - More than 270 genes are associated with management sources, and environmental these disorders. relationships predict health outcomes. - Nurses play a crucial role in identifying DIAGNOSTIC PATTERN health patterns of patients and their families. - Most cases are diagnosed in infancy, with a - - If health patterns lack physiological, male-to-female ratio of 5:1. psychological, and social balance, nurses - Some cases are not identified until must collaborate with patients to promote adolescence or early adulthood, leading to balance. an equal distribution of gender diagnosed at - Understanding coping mechanisms for stress that time. and relationships is essential for nurses. - In adults, frequent use of antibiotics can - A comprehensive assessment of a patient is mask symptoms, complicating diagnosis. necessary to evaluate health patterns and address disorders. CLINICAL MANIFESTATIONS - Symptoms include recurrent, unusual, or ASSESSMENT OF IMMUNE FUNCTION severe infections despite treatment. Immune function assessment includes health history - Patients may experience failure to thrive and physical examination focusing on: (poor growth) and fatigue. 22 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - A significant family history of immune - Hematopoietic stem cell transplantation issues is often noted. (HSCT) can be a curative treatment, though it has limitations. PATHOPHYSIOLOGY - Gene therapy is an emerging treatment Genetics and Immune Response option, but it has had adverse effects and - These disorders stem from genetic issues risks in initial studies. that prevent the normal development of immune responses. PHARMACOLOGIC THERAPY FOR PIDDs - Many symptoms can present in infancy and 1. Treatment Based on Infection and PIDD lead to chronic health problems. Diagnosis 2. Prophylactic Drug Treatment ASSESSMENT AND DIAGNOSTICS 3. Empiric Therapy Delay in Diagnosis 4. Immunoglobulin Replacement Therapy - There can be a significant gap between symptom onset and diagnosis of PIDDs. ACQUIRED IMMUNE DEFICIENCY - A thorough family history and consideration HIV Infection and AIDS of infectious agents are essential. - HIV is not transmitted through: o Air, water Laboratory Testing o Saliva, sweat tears that are not mixed - Initial tests include a complete blood count with the blood of an HIV + person. to identify issues like lymphopenia (low o Sexual activities that don’t involve lymphocyte count). the exchange of body fluids. - Testing serum immunoglobulin (IgG, IgM, o Mosquitoes, insects, ticks IgA) levels and responses to vaccines is o Pets critical for diagnosing humoral immune o Sharing toilets defects. o Food, drinks - HIV is transmitted through: PREVENTION AND MEDICAL o Body fluids MANAGEMENT o Sexual behaviors (anal, vaginal) Vaccination Cautions o Needle, and syringe use - - Live vaccines are not safe for those with o Breastfeeding antibody deficiency disorders due to the risk of causing disease. PREVENTION - Family planning and potential prenatal Prevent getting HIV from anal or vaginal sex testing can be important for at-risk families. - Abstinence - Use a condom the right way Management Strategies - Practice monogamy - A history of unusual infections may prompt - Choose less risky sexual behaviors testing and referral to an immunologist. 23 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Pre-Exposure Prophylaxis (- HIV) who is in - If on HAART; check viral load every 6 a relationship with + HIV person. months. - Encourage partner if +HIV to stay treatment - If the viral load is decreasing, treatment is with Antiretroviral Therapy (ART). effective - Get tested and treated for STDs and - If you are very high risk for HIV, ask your encourage partner to do the same. healthcare provider if pre-exposure prophylaxis is needed. Prevent getting HIV from drug use - If you think you’ve been exposed for the last - Use only new sterile needles and works each 3 days, ask your healthcare provider about time you inject. post-exposure prophylaxis (PEP). PEP can - Never share needles. prevent HIV but it must be started within 72 - Clean use needles with bleach only when hours. you can't get new ones. - HIV testing at baseline and at 6 weeks, 12 - Use sterile water to fix drugs. weeks, and 6 months after exposure. - Clean skin with new alcohol swab before injection. STAGES OF HIV INFECTION - Be careful not to get someone else’s blood Stage 0 (Primary Infection/Acute Infection) on your hands on your needles. - The period from HIV infection to the - Dispose of needles after one use. Use sharp development of antibodies. containers to keep used needles away from - Test negative but are highly contagious other people. - Fever and fatigue - Get tested for HIV at least once a year. - This stage features high viral loads and destruction of CD4+ T cells. Preventing passing HIV to baby - Seronegative when tested 3-6 months - If treated during early pregnancy, the risk of transmitting HIV to the baby can be 1% or Stage 1 (Chronic Stage) less. - After the initial immune response, a viral set - After delivery, avoid breastfeeding. point is established, denoting an equilibrium between HIV levels and the immune NURSING CONSIDERATION ON A response. PREGNANT WOMAN (+) HIV - Patients often feel well and are - If a mother is pregnant; the baby is either + asymptomatic, but CD4+ T-cell counts or – gradually decline over years. - If the mother is pregnant; the baby can be - Seropositive born CS or NSVD - Management: CD4 Monitoring - If pregnant; DO NOT BREASTFEED THE BABY. Stage 2 (Symptomatic Stage) - If pregnant; encourage to continue HAART. - CD4+ T-cell counts decrease to 200-499 cells/mm. 24 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Onset of symptoms, oral thrush. - Newer antigen/antibody tests can find HIV - Slippery recovery as early as 3 weeks post-exposure. - Management: Protect from further infection 4. Follow-up Testing - Necessary after a positive initial test to Stage 3 (AIDS) confirm diagnosis, such as: - Diagnosed when CD4+ T-cell counts fall o Antibody differentiation tests below 200 cells/mm3. (distinguishes between HIV-1 types) - HAART o HIV-1 RNA tests (detects virus - Management: Check for viral load every 6 directly) months - Effectivity: If viral load is decreasing HIV TEST RESULTS: IMPLICATIONS FOR PATIENTS HIV DIAGNOSTIC TESTS Positive Antibody Test Results Types: - Indicates presence of HIV antibodies in the - Antibody tests blood, confirming infection. - Antigen tests - HIV is active, allowing for transmission to - Nucleic acid (RNA) tests others. - Infection does not imply the patient has 1. STARHS AIDS. - A serologic testing algorithm to determine if an HIV infection is recent or ongoing. Negative Test Results 2. ELISA Test (Enzyme-Linked Immunosorbent - Suggests absence of HIV antibodies, Assay) meaning the patient may not be infected or - Purpose: Primarily used as the initial is in the early infection stage (stage 0). screening test for HIV. - Patients should continue precautions as they - Function: Detects antibodies against HIV in may still be infected but have not yet the blood. produced antibodies. - Sensitivity: Highly sensitive, but may yield - A negative result on a viral test is more false positive results; necessitates reliably indicative of no infection. confirmatory testing. 3. Western Blot Test TREATMENT OF HIV INFECTION - Purpose: Used as a confirmatory test HIV Treatment Guidelines following a positive ELISA result. - CD4+ count is a key indicator of immune - Function: Detects specific HIV proteins and function and disease progression. confirms the presence of HIV antibodies. - Reliability: More specific than ELISA, Goals of Antiretroviral Therapy (ART) reducing the likelihood of false positives. - Reduce morbidity and prolong quality of life. - Blood tests can detect HIV earlier than oral - Restore immunologic function and suppress fluid tests; viral load. 25 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Prevent HIV transmission. the basis of the assessment, provide HIV- related information. ART Recommendations - Identify facilitators, potential barriers to - Recommended for all HIV-infected adherence, and necessary medication individuals, regardless of viral load or CD4+ management skills before starting ART count. medication. - Optimal viral suppression defined as viral - Provided needed resources load below 20-75 copies/mL. - Involve patient on ARV regimen selection. - Assess adherence at every clinic visit. Combination ART Regimens - Use positive reinforcement to foster - Typically consist of three active drugs from adherence success at least two classes. - Identify the type of and reasons for - Achieves viral load suppression within 12- nonadherence. 24 weeks. - Select from among available effective treatment adherence interventions. Monitoring and Laboratory Tests - Systematically monitor retention in care. - Regular monitoring of CD4+ counts and - Consider options to enhance retention in viral loads to assess ART effectiveness. care given the resources available. - Adequate CD4+ response is characterized by an increase of 50-150 mm³ annually. IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME Adverse Effects of ART - Immune reconstitution inflammatory - - Potential side effects include syndrome (IRIS) occurs after initiating ART, hepatotoxicity, nephrotoxicity, and leading to rapid immune response and metabolic changes. worsening or new infections. - Body image issues arise from lipodystrophy - Common organisms involved: (fat distribution changes), affecting o Mycobacteria treatment adherence. o Herpes viruses o Deep fungal infections PROMOTING ADHERENCE TO ART - Symptoms include: - Use a multidisciplinary team approach. o Fever - Provide an accessible, trustworthy o Respiratory or abdominal issues healthcare team. o Worsening of opportunistic - Strengthen early linkage to care and infections retention in care. - Treatment: - Assess patient readiness to start ART. o Anti-inflammatory medications, - Evaluate patient’s knowledge about HIV notably cortisone disease, prevention and treatment and, on 26 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C o Vigilant monitoring by nurses is b. Mycobacterium Avium Complex critical, particularly in the first three - Mycobacterium avium complex (MAC) months. disease is an opportunistic infection occurring in patients with CD4+ T-cell Paradoxical TB-IRIS counts. - A complication in HIV-TB co-infected - It is caused by Mycobacterium avium, patients during ART initiation, especially in Mycobacterium intracellulare, or those with low CD4+ counts. Mycobacterium kansasii. - Early symptoms may be minimal but can RESPIRATORY MANIFESTATIONS include: - Shortness of breath o Fever - Dyspnea o Night sweats - Cough o Weight loss - Chest pain o Fatigue - Fever o Diarrhea o Abdominal pain Notable causative organisms include: - Pneumocystis jirovecii c. Tuberculosis - Mycobacterium avium-intracellulare - TB can occur at any CD4+ T-cell count, but - Cytomegalovirus (CMV) risk increases with immune deficiency. - Legionella species - Routine testing for latent TB should be conducted at HIV diagnosis, regardless of a. Pneumocystis Pneumonia exposure risk. - Pneumocystis pneumonia (PCP) is caused - Individuals with negative latent TB tests and by P. jirovecii and occurs in patients with stage 3 HIV: retested after CD4+ count CD4+ T-cell counts improvement due to ART. - Common symptoms: - Treatment for latent TB in HIV-positive o Subacute progressive dyspnea patients: o Fever o 9 months of isoniazid, with o Nonproductive cough pyridoxine to prevent neuropathy o Chest discomfort (worsening over - The treatment of suspected TB in HIV days to weeks) patients is identical to that for HIV-negative - Mild cases may show normal pulmonary patients: examination at rest, but exertion can reveal: o Starting with isoniazid, rifampin, o Tachypnea pyrazinamide, and ethambutol. o Tachycardia o Diffuse dry rales GASTROINTESTINAL MANIFESTATIONS o Hypoxemia and elevated lactate - Loss of appetite dehydrogenase levels - Nausea and vomiting 27 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C - Oral and esophageal candidiasis b. HIV Wasting Syndrome - Chronic diarrhea - Involuntary weight loss exceeding 10% of body weight. Common enteric pathogens identified in stool - Accompanied by diarrhea, weakness, and cultures or biopsies are: fever lasting over 30 days. - Cryptosporidium muris - Wasting primarily refers to loss of muscle - Salmonella species mass, but may also include loss of fat. - Isospora belli - Oncologic Manifestations - Giardia lamblia Individuals with HIV/AIDS have an - Cytomegalovirus (CMV) increased risk of certain cancers, including: - Clostridium difficile o Kaposi sarcoma (KS) - M. avium-intracellulare o Lymphoma In AIDS patients, diarrhea can lead to severe c. Kaposi Sarcoma complications such as: - Kaposi sarcoma (KS) is caused by human - Profound weight loss (>10% of body weight) herpesvirus-8 (HHV-8) - Fluid and electrolyte imbalances - Affects men more frequently than women - Perianal skin excoriation (eight times more). - Weakness and diminished daily living - AIDS-related KS can present as: activities. o Localized cutaneous lesions or disseminated disease affecting a. Candidiasis multiple organ systems. - Oropharyngeal candidiasis presents as o Cutaneous signs may be the first painless, creamy white, plaque-like lesions manifestation of HIV, typically on: brownish pink to deep purple. o Buccal surface o Hard or soft palate d. AIDS-Related Lymphomas o Oropharyngeal mucosa - AIDS-related lymphomas include: o Tongue o Hodgkin lymphoma o These lesions can be scraped off o Non-Hodgkin lymphoma (more easily, distinguishing them from oral common) hairy leukoplakia. - AIDS-related lymphoma is typically - In women with early-stage HIV, Candida aggressive, with three main types: vulvovaginitis typically manifests as: o Diffuse large B-cell lymphoma o White adherent vaginal discharge o B-cell immunoblastic lymphoma o Mucosal burning and itching (mild- o Small noncleaved cell lymphoma tomoderate) - Symptoms include: o Sporadic recurrences o Weight loss o Night sweats 28 | R N 2 0 2 6  NCM112-N (LEC) Lance Rover L. Magbanua BSN 3C o Fever behavioral, and motor functions due to HIV infection. NEUROLOGIC MANIFESTATIONS - Early signs include: - HIV-related brain changes significantly o - Memory deficits impact cognition, affecting: o Headache o Motor function o Difficulty concentrating o Executive function o Progressive confusion o Attention o Psychomotor slowing o Visual memory o Apathy o Visuospatial function o Ataxia - The immune system's response to HIV in the - Later stages can lead to severe impairments, CNS includes: including: o Inflammation o Global cognitive decline o Atrophy o Delayed verbal responses o Demyelination o Spastic paraparesis o Degeneration o Psychosis o Necrosis o Hallucinations o Tremor a. Subcortical Neurodegenerative Disease o Incontinence - Signs of HAND can be subtle, including: o Seizures o Changes in language o Mutism o Memory issues o Death o Problem-solving difficulties - Diagnosis: o Slowed psychomotor skills o Computed tomography (CT) scan o Magnetic resonance imaging (MRI) b. Peripheral Neuropathy o CSF analysis via lumbar puncture - It may result from side effects of certain o Brain biopsy ART drugs and manifests in various patterns, with distal sensory polyneuropathy or distal d. Cryptococcus Neoformans symmetric polyneuropathy being the most - Cryptococcus neoformans is a common common. opportunistic fungal infection in patients - Symptoms may include significant pain in with AIDS that leads to neurologic disease. the feet and hands, leading to functional - Cryptococcal meningitis presents with impairment. symptoms including: o Fever c. HIV Encephalopathy o Headache - HIV encephalopathy, previously known as o Malaise AIDS dementia complex, is characterized by o Stiff neck a progressive decline in cognitive, o Nausea 29 | R N 2 0 2 6  NCM112-N (LEC)