ALTERATIONS WITH INFECTIOUS, Antimicrobial proteins: Complement Proteins

INFLAMMATORY AND IMMUNOLOGIC • Complement refers to a group of at least

RESPONSES 20 plasma proteins that circulate in the
THE IMMUNE SYSTEM plasma
• consists of a complex network of cells • Complement is activated when these
interacting to protect the body against plasma proteins encounter and attach to
invasion by foreign substance cells (known as complement fixation)
• Two mechanisms that make up the • Membrane attack complexes (MACs), one
immune system defend us from foreign result of complement fixation, produce
materials holes or pores in cells
1. Innate (nonspecific) defense system • Pores allow water to rush into the cell
2. Adaptive (specific) defense system • Cell bursts (lyses)
• Immunity—specific resistance to disease • Activated complement enhances the
Innate (Nonspecific) Body Defenses inflammatory response
• Innate body defenses are mechanical Antimicrobial Proteins: Interferons
barriers to pathogens (harmful or disease- • Interferons are small proteins secreted by
causing microorganisms) and include: virus-infected cells
• Body surface covering • Interferons bind to membrane receptors on
o Intact skin healthy cell surfaces to interfere with the
o Mucous membranes ability of viruses to multiply
• Specialized human cells
• Chemicals produced by the body Inflammatory response
• Triggered when body tissues are Injured
Surface Membrane Barrier • Four most common indicators (cardinal
• skin and mucous membranes, provide the signs) of acute inflammation
first line of defense against the invasion of 1. Redness
microorganisms 2. Heat
• Protective secretions produced by these 3. Pain
membranes 4. Swelling (edema)
o Acidic skin secretions inhibit • Damaged cells release inflammatory
bacterial growth chemicals
o Sebum is toxic to bacteria o Histamine
o Mucus traps microorganisms o Kinin
o Gastric juices are acidic and kill • These chemicals cause:
pathogens o Blood vessels to dilate
o Saliva and tears contain lysozyme o Capillaries to become leaky
(enzyme that destroys bacteria) o Phagocytes and white blood cells
to move into the area (called
positive chemotaxis)
INTERNAL DEFENSES: CELLS AND Functions of the inflammatory response
CHEMICALS • Prevents spread of damaging agents
Phagocytes • Disposes of cell debris and pathogens
• Cells such as neutrophils and through phagocytosis
macrophages engulf foreign material by • Sets the stage for repair
phagocytosis Process of the inflammatory response
• The phagocytic vesicle is fused with a 1. Neutrophils migrate to the area of
lysosome, and enzymes digest the cell’s inflammation by rolling along the vessel
contents wall (following the scent of chemicals
Natural killer (NK) cells from inflammation)
• Lyse (burst) and kill cancer cells, virus 2. Neutrophils squeeze through the capillary
infected cells walls by diapedesis to sites of
• Release chemicals called perforin and inflammation
granzymes to degrade target cell contents 3. Neutrophils gather in the precise site of
Antimicrobial proteins tissue injury (positive chemotaxis) and
• Enhance innate defenses by: consume any foreign material present
• Attacking microorganisms directly Fever
• Hindering reproduction of • Abnormally high body temperature is a
microorganisms systemic response to invasion by
• Most important types microorganisms
• Complement proteins • Hypothalamus regulates body temperature
• Interferon at 37ºC (98.6ºF)
 • The hypothalamus thermostat can be reset • The capability to respond to a specific
higher by pyrogens (secreted by white antigen by binding to it with antigen-
blood cells) specific receptors that appear on the
• High temperatures inhibit the release of lymphocyte’s surface
iron and zinc (needed by bacteria) from
the liver and spleen • Immunocompetent T and B lymphocytes
• Fever also increases the speed of repair migrate to the lymph nodes and spleen,
processes where encounters with antigens occur
• Differentiation from naïve cells into
ADAPTIVE BODY DEFENSES mature lymphocytes is complete when
Three aspects of adaptive defense they bind with recognized antigens
• Antigen specific—the adaptive defense • Mature lymphocytes (especially T cells)
system recognizes and acts against circulate continuously throughout the
particular foreign substances body
• Systemic—immunity is not restricted to T cells
the initial infection site • differentiated from lymphocytes which is
• Memory—the adaptive defense system a type of antigen-recognition mechanism
recognizes and mounts a stronger attack Types:
on previously encountered pathogens • T helper cells (TH) T4 (CD4)
o assist B cells and cytotoxic T cells
Two arms of the adaptive defense system to mature
• Humoral immunity = antibody-mediated o depleted during HIV infection,
immunity when depleted →AID
o Provided by antibodies present in • Cytotoxic T lymphocytes- establish a
body fluids contact boundary required for target
• Cellular immunity = cell-mediated destruction through lytic molecules called
immunity porins
o Targets virus-infected cells, cancer
cells, and cells of foreign grafts • Suppressor T cells- slow or stop the
CELLS OF THE ADAPTIVE DEFENSE immune response once the foreign invader
SYSTEM is defeated
Crucial cells of the adaptive system
1. Lymphocytes- respond to specific antigens B cells
• B lymphocytes (B cells) produce • differentiates into memory cells and
antibodies and oversee humoral immunity plasma cells (Immunoglobulins)
• T lymphocytes (T cells) constitute the Immunoglobulins
cell-mediated arm of the adaptive • antibodies
defenses; do not make antibodies • a family of glycoprotein molecules
2. Antigen-presenting cells (APCs)—help the present in the body as solutes in body
lymphocytes but do not respond to specific fluids
antigens • inactivate and binds to antigens to
facilitate phagocytosis
Lymphocytes
• Arise from hemocytoblasts of bone Types of Immunoglobulins:
marrow • IgG- only antibody that can pass thru the
• Whether a lymphocyte matures into a B placenta
cell or T cell depends on where it • IgA- predominant in saliva, tears,
becomes immunocompetent colostrum, breast milk, intestinal and
• T cells develop immunocompetence in the bronchial secretions
thymus and oversee cell-mediated • IgM- the largest immunoglobulin; acute
immunity inflammation; bacterial response
o Identify foreign antigens • IgE – allergic reaction; parasitic
o Those that bind self-antigens are infections
destroyed • IgD- chronic inflammation
o Self-tolerance is important part of Antigen-presenting cells (APCs)
lymphocyte “education” • Engulf antigens and then present
• B cells develop immunocompetence in fragments of them on their own surfaces,
bone marrow and provide humoral where they can be recognized by T cells
immunity • Major types of cells behaving as APCs
Immunocompetence o Dendritic cells
o Macrophages
 o B lymphocytes • can activate if the immune system
• When they present antigens, dendritic becomes even more depressed
cells and macrophages activate T cells,
which release chemicals Transmission
▪ exposure to blood and other body
secretions
IMMUNE RESPONSE ▪ sexual contact
• body’s action plan devised to combat ▪ Sharing of contaminated needles for
invading organisms or substances by injection
leukocyte and antibody activity ▪ transfusion of contaminated blood or
• antigen is any foreign substance blood products
• immunity is the ability to destroy ▪ perinatally from mother to fetus or
antigens newborn, and possibly through
• Autoimmunity inability of the immune breastfeeding
system to distinguish self from non-self ▪ Sexual maltreatment
NEWBORN’S IMMUNE SYSTEM ▪ needle punctures
• limited immunologic protection at birth
Assessment
• not able to produce antibodies until about
▪ poor resistance to infection
2 months. Newborns are, however, born
▪ Fever
with
▪ swollen lymph nodes
• passive antibodies (IgG) passed from their ▪ respiratory tract infections
mother that crossed the placenta ▪ oral candidiasis
o include antibodies against
poliomyelitis, measles, diphtheria, Diagnostic Test
pertussis, chickenpox, rubella, and ▪ PCR (polymerase chain reaction) tests -
tetanus antigen
▪ ELISA (Enzyme-linked Immunosorbent
IMMUNODEFICIENCY DISORDERS Assay) - antibody
• When any one portion of the immune ▪ Western blot confirmation – antibody
system is not functioning adequately ***CD4 counts are used to document the disease
TYPES: status and predict disease progression
• Primary (congenital)
o born without or with inadequate CLASSIFICATION OF HIV INFECTION IN
amounts of immune substances CHILDREN (CDC,1994):
• Secondary(acquired) 1. Category A, Mildly Symptomatic (2 or more
o from viral invasion or exposure to S/Sx)
a toxic substance ▪ enlarged lymph nodes, liver, or spleen
o factors such as severe systemic ▪ Recurrent or persistent URTI, sinusitis, or
infection, severe stress, otitis media
immunosuppressive therapy,
cancer (radiation/chemo therapy), 2. Category B, Moderately Symptomatic
malnutrition, renal disease, and ▪ oropharyngeal candidiasis
aging ▪ bacterial meningitis
▪ Pneumonia
▪ Sepsis
▪ Cardiomyopathy
▪ Cytomegalovirus (CMV)
▪ Hepatitis
▪ herpes simplex virus (HSV)
HIV INFECTION & AIDS ▪ bronchitis
• acts by attacking the lymphoreticular ▪ Pneumonitis or esophagitis
system, in particular CD4- bearing helper ▪ herpes zoster (shingles)
T lymphocytes ▪ Lymphoid interstitial pneumonia (LIP)
• virus enters the cell, substitutes its own ▪ pulmonary lymphoid hyperplasia complex
RNA and DNA for the cell’s DNA, and ▪ toxoplasmosis
begins to replicate, destroying the 3.Category C, Severely Symptomatic (AIDS)
lymphocytes in the process and the ability ▪ Septicemia
to initiate an effective B-lymphocyte ▪ mycobacterial pneumonia
response. ▪ meningitis
• no effective way to destroy the virus, so it ▪ bone or joint infection
remains in the body for life
 ▪ abscess of an internal organ or body ATOPIC DISORDERS
cavity ALLERGIC RHINITIS
▪ candidiasis (esophageal or pulmonary) • aka “hay fever”
▪ Encephalopathy • IgE-mediated inflammatory response to
▪ herpes simplex lasting over 1 month allergen exposure
▪ histoplasmosis • Allergen causes:
▪ Lymphoma o Pollens
▪ Tuberculosis o Molds
▪ Pneumocystis carinii pneumonia o Pet hair
▪ Kaposi sarcoma o Dust
▪ perennial (year round) allergic rhinitis

Management Assessment
▪ birth control education focused on the ▪ • sneezing
needs of HIVpositive women ▪ nasal engorgement/ congestion
▪ Antiretroviral therapy (ART) ▪ profuse watery nasal discharge
o Zidovudine ▪ Watery eyes
o Ritonavir (Norvir) ▪ conjunctivae may be pruritic
o Indinavir(Crixivan) ▪ blackened areas under the eyes, termed
o allergic shiners
***Goal of ART is to maintain the CD4 cell ▪ Children constantly rub their noses in an
count at greater than 500 cells/mm³ upward motion, termed an “allergic
HYPERSENSITIVITY salute.”
• excessive antigen–antibody response o leads to a horizontal crease across
when the invading organism is an allergen the tip of the nose, called an
rather than a simple immunogen. allergic crease or Dienne line
Management
Laboratory tests ▪ Avoidance of offending allergens
▪ Radioallergosorbent test (RAST) ▪ Pharmacologic agents – antihistamines,
▪ Eosinophil Counts leukotriene inhibitors, or corticosteroids
o most children with allergies have ▪ Hyposensitization or immunotherapy
5% or more of eosinophils on a
differential count and a total ATOPIC DERMATITS
eosinophil count of 250 or more • aka Infantile Eczema
cells/mm³ • primarily a disease of infants, beginning
▪ Skin testing / Patch Testing as early as the second month of life and
o done to detect the presence of IgE possibly lasting until the child is 2 to 3
in the skin years old
o to isolate an antigen (allergen) to • related to food allergy
which the IgE is responding or to
which a child is sensitive Assessment
▪ papular and vesicular skin eruptions with
Management surrounding erythema with weeping and
▪ Environmental control crusting
▪ Pharmacologic therapy ▪ pruritus
o Intranasal cromolyn sodium
(prophylaxis) Management
o Second- and third-generation ▪ aimed at reducing the amount of allergen
antihistamines- cetirizine (Zyrtec) exposure – milk, eggs, wheat, chocolate,
and loratadine (Claritin) fish, tomatoes, and peanuts
o Decongestants e.g. ▪ reducing pruritus so children do not
pseudoephedrine (Sudafed) irritate lesions and cause secondary
o Intranasal corticosteroids infections by scratching
▪ Hyposensitization / Immunotherapy ▪ Hydrating the skin
o works by increasing the plasma ▪ bathing or applying wet dressings (wet
concentration of IgG antibodies, with tap water / Burow’s Solution) for
which then act to prevent or block 15 to 20 minutes, followed by the
IgE antibodies from coming in application of a moisturizer such as
contact with an allergen Eucerin
CONTACT DERMATITIS • Period of communicability: during febrile
• a reaction to skin contact with an allergen period
(a substance irritating to the child only • Mode of transmission: unknown
with prior sensitization) • Immunity: contracting the disease offers
• allergen causing the irritation is often lasting natural immunity; no vaccine is
suggested by the part of the child’s body available
that is affected
– Eg. dermatitis from a diaper-washing Assessment
compound appears in the diaper area ▪ high fever (104° to 105°F [40.0° to
40.6°C])
Assessment ▪ Infants become irritable and anorexic
▪ Erythema ▪ Pharynx may appear slightly inflamed
▪ intensely pruritic papules ▪ occipital, cervical, and postauricular
▪ Vesicles lymph nodes may be enlarged
▪ Patch testing ▪ After 3 or 4 days, the fever falls abruptly
o After 48 hours, the patches used and a distinctive rash of discrete, rose-
for testing are pink macules approximately 2 to 3 mm in
o removed and the reactions are size and flat with the skin surface appears
graded 1+ to 4+, the same as in (trunk)
regular skin testing.
Management
Management ▪ reduce the discomfort of the rash and
▪ removing the identified allergen from the fever such as acetaminophen (Tylenol) or
child’s environment ibuprofen (Motrin)
▪ Dressings moistened with water, saline, or ▪ WOF: febrile seizure
Burow’s solution relieves itching
▪ Calamine, Caladryl lotion, Hydrocortisone RUBELLA (GERMAN MEASLES)
lotions or creams reduce itching and also • Causative agent: Rubella Virus
promote healing • Incubation period: 14-21 days
▪ Baths withbaking soda or oatmeal in the • Period of communicability: 7 days before
water may be helpful if a large area of the to approximately 7 days after the rash
body is involved appears
• Mode of transmission: direct and indirect
INFECTIOUS DISORDERS contact with droplets
THE INFECTIOUS PROCESS • Immunity: contracting the disease offers
• Pathogens are any organism that causes lasting natural immunity; a high rubella
disease and can be classified into five antibody titer reveals infection has
types of microorganisms: occurred.
o Viruses • Active artificial immunity: attenuated live
o Bacteria virus vaccine (e.g., MMR vaccine)
o Rickettsia • Passive artificial immunity: Immune
o Helminths serum globulin
o Fungi
VIRAL INFECTIONS Assessment
VIRAL EXANTHEMS ▪ 1-5 days prodromal period
• majority of childhood exanthems (rashes) o low-grade fever, headache,
are caused by viruses malaise, anorexia, mild
o Viruses are the smallest infectious conjunctivitis,
agents known. o possibly a sore throat, a mild
o They actually are not true cells cough, congestion, coryza, and
because they contain either RNA swollen lymph nodes
or DNA, but not both ▪ discrete pink red maculopapular rash
o Because they are incomplete in begins on the face, then spreads
this way, viruses cannot replicate downward to the trunk and extremities
on their own ▪ on the third day, the rash disappears

EXANTHEM SUBITUM (ROSEOLA Management

INFANTUM) ▪ reduce the discomfort of the rash and
• Causative agent: human herpesvirus 6 fever such as acetaminophen (Tylenol) or
(HHV-6) ibuprofen (Motrin)
• Incubation period: 9 to 10 days
MEASLES (RUBEOLA) are being treated with corticosteroids are
• Causative agent: measles virus offered varicella-zoster immune globulin
• Incubation period: 10 to 12 (VZIG) within 72 hours of exposure to
• Period of communicability: 5 th of help prevent or modify disease symptoms
incubation period through the first few
days of rash Assessment
• Mode of transmission: direct contact with ▪ low-grade fever
droplets / airborne ▪ malaise
• Immunity: contracting the disease offers ▪ Lesions first begin as a macula, then
lasting natural immunity. progress rapidly within 6 to 8 hours to a
• Active artificial immunity: attenuated live papule, and then a vesicle that becomes
measles vaccine (e.G., Mmr) umbilicated and then forms a crus
• Passive artificial immunity: immune
Management
serum globulin
▪ scabs from crusting are allowed to fall off
naturally
Assessment
▪ preventing scratching
▪ brown or black, regular, or 7-day measles
▪ Antihistamine & antipyretic
rash
administration
▪ High grade fever
▪ Acyclovir, an antiviral, may be prescribed
▪ Lymphadenitis
to reduce the number of lesions and
▪ Malaise
shorten the course of the illness
▪ coryza (rhinitis and a sorethroat)
▪ conjunctivitis with photophobia
POLIOVIRUS INFECTIONS:
(sensitivity to light)
POLIOMYELITIS (INFANTILE PARALYSIS)
▪ Koplik spots (small, irregular, bright red
spots with a blue-white center point) • Causative agent: Poliovirus
appear on the buccal membrane • Incubation period: 7 to 14 days
▪ fourth day of fever, a deep-red • Period of communicability: Greatest
maculopapular rash (forehead, to lower shortly before and after onset of
extremities symptoms, when virus is present in the
throat and feces (1 to 6 weeks)
Management • Mode of transmission: Direct and indirect
▪ reduce the discomfort of the rash and contact
fever such as acetaminophen (Tylenol) or • Immunity: Contracting the disease causes
ibuprofen (Motrin) active immunity against the one strain of
▪ cough suppressant virus causing the illness
▪ Applying a lubricating jelly or an • Active artificial immunity: Inactivated
emollient on the skin below the nose polio virus (IPV) vaccine
▪ blinds or curtains drawn • Passive artificial immunity: None

CHICKENPOX (VARICELLA) Assessment

• Causative agent: Varicella-zoster Virus ▪ Fever
(VZV) ▪ Headache
• Incubation period: 10 to 21 days ▪ Nausea
• Period of communicability: 1 day before ▪ Vomiting
the rash to 5 to 6 days after its initial ▪ abdominal pain
appearance, when all the vesicles have ▪ Mild stiffness of the neck, back, and legs
crusted ▪ pain and tremors of the extremities and
• Mode of transmission: highly contagious; then paralysis as the virus invades the
spread by direct or indirect contact of CNS
saliva or open vesicles
Management
• Immunity: contracting the disease offers ▪ bed rest with analgesia and moist hot
lasting natural immunity to chickenpox; it packs to relieve pain
causes herpes zoster (shingles) when it is ▪ If the respiratory muscles are involved,
reactivated at a later time long-term ventilation may be necessary
• Active artificial immunity: attenuated
live virus vaccine
• Passive artificial immunity: children
who are immunosuppressed, such as those
with leukemia or HIV/AIDS, or those who
MUMPS (EPIDEMIC PAROTITIS) ▪ analgesic for pain and an antipyretic for
• Causative agent: Mumps Virus fever
• Incubation period: 14-21 days ▪ prevent the complications of ß-hemolytic,
• Period of communicability: group A streptococcal infections (acute
communicable for 5 days from onset of glomerulonephritis or rheumatic fever)
the swollen parotid gland (CDC, 2016)
• Mode of transmission: direct contact with
respiratory droplets (Rubin, Kennedy, &
Poland, 2016) DIPHTHERIA
• Immunity: contracting the disease gives • Causative agent: Corynebacterium
lasting natural immunity. Diphtheriae (Klebs–löffler bacillus)
• Active artificial immunity: attenuated live • Incubation period: 2 to 6 days
mumps vaccine in combination with • Period of communicability: Rarely more
measles and rubella (MMR) than 2 weeks to 4 weeks in untreated
• Passive artificial immunity: mumps persons; 1 to 2 days in children treated
immune globulin with antibiotics
• Mode of transmission: direct contact or
Assessment indirect contact droplets
▪ Fever • Immunity: contracting the disease gives
▪ Headache lasting natural immunity.
▪ Anorexia • Active artificial immunity: Diphtheria
▪ Malaise toxin given as part of diphtheria, tetanus,
▪ pain on chewing and an “earache” and pertussis (DTaP) vaccine
▪ Parotid gland swelling • Passive artificial immunity: diphtheria
▪ Boys may also develop testicular pain and antitoxin
swelling (orchitis)
Assessment
Management ▪ inflammation and necrosing cells form a
▪ soft, bland, or liquid foods characteristic gray membrane on the
▪ analgesic for pain and an antipyretic for nasopharynx
fever ▪ purulent nasal discharge and a brassy
cough
BACTERIAL INFECTIONS ▪ myocarditis with heart failure and
SCARLET FEVER conduction disturbances may occur
• Causative agent: β-hemolytic streptococci, Management
group A ▪ Intravenous administration of antitoxin in
• Incubation period: 2 to 5 days large dose
• Period of communicability: greatest ▪ penicillin or erythromycin intravenously
during acute phase of respiratory illness; 1 ▪ Complete bed rest
to 7 days ▪ Droplet precautions
• Mode of transmission: direct contact and ▪ WOF: airway obstruction – intubation set
large droplets, at bed side
• Immunity: one episode of disease gives ▪ Vaccination
lasting immunity to scarlet fever toxin.
• No vaccination is available
Assessment
▪ rash is unique in that it is both
enanthematous and exanthematous (i.e.,
on both the mucous membrane and the
skin)
o red with pinpoint lesions that
blanch on pressure and feel as
rough as sandpaper
o Tend to be densest on the trunk
and very prominent in skin folds
(Pastia’s sign).
▪ Tonsils covered with white exudates
▪ “strawberry tongue”
Management
▪ soft, or liquid foods
WHOOPING COUGH (PERTUSSIS)
• Causative agent: Bordetella Pertussis
• Incubation period: 5 to 21 days
• Mode of transmission: direct or indirect
contact
• Period of communicability: greatest in
catarrhal (respiratory illness) stage
• Immunity: contracting the disease offers
lasting natural immunity
• Active artificial immunity: pertussis
vaccine given as part of DTAP vaccine
• Passive artificial immunity: pertussis
immune serum globulin

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

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