DR. CARL E. BALITA REVIEW CENTER TEL. NO.

735-4098/410-0250 - 1 -
NEUROLOGY
CT SCAN
A structural imaging study using a computer-based-
x-ray to provide a cross sectional image of the
brain.
Advantages:
100% sensitivity
When M! is contraindicated "#$ is the procedure of
choice.
$o %o&s:
As' if ()* allergy to !odine
$ell the patient to expect a sensation of feeling
flushed if contrast is in+ected through !, catheter
-rocedure may last for 10 to .0 min
Maintain immobility on the entire process
!nstruct clients to remove metallic items
MRI
/oninvasive structural imaging procedure that uses
po0erful magnetic field and radiofre1uency 0aves
to create an image
$he imaging procedure of choice for most
neurololgic disorders.
$ypes:
#losed-tunnel-li'e
2pen M!-/2 close chamber.$he patient can
comfortably see all vie0s 0hile the scan is in
progress.
Advantages:
/2 radiation 3 exposure to contrast medium
4ensitivity to blood flo0
Ability to distinguish 0ater" iron" fat and blood.
%isadvantages:
/2 to patients 0ith pacema'ers" aneurysm
clips3implants
$o %2&s:
5se of bathroom prior to procedure-( may last 60 to
70minutes.*
!nstruct patients to remove metal items
8ncourage patient to remain still as possible during
the procedure
!nform that the scanner 0ill ma'e a dull " thumping
noise throughout the procedure
PET (Positron Emission Tomography)
A computer based functional imaging that permits
study of the brain&s metabolism " blood flo0 and
chemical processes.
-rovides information on patterns of glucose and 29
metabolism.
$o %o&s:
-rocedure re1uires in+ection or inhalation of a
radioactive substance that emits protons.
eassure patient that radiation exposure is minimal
Advise patient to void prior to procedure since it
may ta'e several hours
Cerera! Angiography
:ollo0ing local anesthesia " radiopa1ue dye is in+ected
through catheter in brachial or femoral artery and passed
through cervical blood vessels to assess cerebral circulation. #erebral ;emisphere "ronta! !oe $hought Memories 8motions Moral behavior Parieta! !oe $aste
$ouch
4patial orientation*
II Timothy 1:7
For God hath not given us the
spirit of fear, but of power, and
love, and a sound mind.
Tempora! !oe
4mell
;earing
Memory
8motional expression
O##ipita! !oe
<anguage
,isual interpretation
Crania! ner$es%
#/ %=4:5/#$!2/ !/$8,8/$!2/4
! %ecreased sense of
smell
!s often accompanied by impaired
taste and 0eight loss
!! %ecreased visual
acuity and
visual fields
:re1uent reorientation to
environment. -osition ob+ects around
client in deference to visual
impairment
!!!
!,",!
%ouble vision
(diplopia*
!ntermittent eye patching
<ubricate eyes to protect against
corneal abrasions
, %ecreased facial
sensation
!nability to che0
%ecreased corneal
reflexes
#aution in shaving and mouth care.
#hoose easy to che0 foods 0ith high
caloric content. -rotect corneas from
abrasion by using lubricant
,!! :acial 0ea'ness and
decreased taste(ant.
tongue*
2ral hygiene. Account for decreased
food inta'e. #osmetic approach to
hiding facial 0ea'ness.
,!!! ;earing loss"
imbalance" vertigo"
tinnitus
4A:8$=> Move slo0ly to prevent
nausea and emesis. Assist ambulation
!?
?
%ysarthria" %ysphagia"
cardiac and respiratory 40allo0 therapy
instability
Maintain air0ay. -revent aspiration.
?! !nability to turn
shoulders or turn head
from side to side
Mobility aids. -hysical therapy
?!! %ysarthria" dysphagia Maintain air0ay. -revent aspiration.
40allo0 therapy
@rainstem (Midbrain " -ons " Medulla*
Medulla 2blongata - Apneustic center.
-otent stimulus is hypoxia.
#erebellum- #oordination of movement
-ituitary Aland - the master gland
/eurons-the functional unit of the /ervous system
0rapped by myelin sheath.
#horoid plexus-esponsible for the production of #4:. EENT% Ophtha!mos#opi# Test 8xamination of the eye that combines an ophthalmoscope and a lens for observing minute structures in the cornea " iris and fundus. Tonometer applied to cornea-measures !2- /ormal: 19 B 91 mm;g
!"#$I!G F%&T$ I! '#I(F
'io )hysi*al &on*ept in !ursing and
#ehabilitation+laboratory tests



DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 2 -
!2- increased in glaucoma
Sne!!en&s Chart
/ormal: 90390
Assesses visual acuity
$he higher the denominator" the poorer the vision
GENERAL NURSING CARE "OR EYE SURGERY
PRE'OPERATI(E%
-8xplain procedures
-Allo0 verbaliCation of feeling and expectations
-$each post-op care
POST'OPERATI(E NURSING CARE
<ie on unoperated side
Avoid constipation
Avoid sneeCing and coughing
/ec' ;yperextension
eport any sudden sharp pain
Avoid sensory deprivation
/utrition
Inner$ation%
ALL 8xtraocular muscle-innervated by #/ !!! 8?#8-$:
4uperior 2bli1ue-$rochlear nerve
<ateral ectus-Abducens nerve
Laryn)-the voice box
, Phonation (,oice formation*-the most complicated
function of the larynx.
Epig!ottis-$he structure that overhangs the larynx that
prevents the foods from entering the larynx and the trachea
0hile s0allo0ing.
, S*M+tans an, S*(iri,ans-t0o of the normal flora of
the oral cavity implicated in the causation of
bacterial endocarditis.
Respiratory%
Chest - ray
A radiograph made by pro+ecting xrays through organs or
structures of the body onto the photographic film.
Sp+t+m E)am
4putum coughed out first thing in the morning and specimen
sent to the laboratory. %one for three consecutive mornings.
Manto+) Test (T+er#+!in Test)
Administration of !ntradermal in+ection of a purified protein
derivative of the tubercle bacilli.
845<$ 8A% A:$8 6D $2 E9 ;254-a hardened "raised " red
area of D to 10 mm is a positive reaction.
A.G
$his test helps to evaluate gas exchange in the lungs by
measuring the gas pressures and p; of an arterial sample
A@A normal values
- -a29 D0-100 mm;g
- -a#29 .F-6F mm;g
- p; E..F- E.6F
- ;#2. 99- 9G m813<
- 29 4at 7F-77%
(iraessae-group of hair in the nostrils use to filter the
inspired air .
M+#o#i!iary es#a!ator-group of fine cells called cilia
continuously moving bringing the minute dirt and mucus
accessible for expectoration.
[Link] .ONES ( CONC/AE)
!/#8A48 $;8 M5#254 M8M@A/8 45:A#8 2: $;8 /A4A< -A44AA84 A/% 4<!A;$<= 2@4$5#$ $;8 A! :<2W!/A $;25A; $;8M. $A-4 %54$ WAM4 !/4-!8% A! Pne+mo#ytes% Type I B responsible for the lining of the lungs and alveoli Type II-responsible for the secretion of surfactants Type III Bresposible for the natural defense of the lungs.
S+r0a#tants
#ertain lipoproteins that reduce the surface tension of
pulmonary fluids " allo0ing change of gases in the alveoli and
contributing to the elasticity of the pulmonary tissue.
<ecithin B4pingomyelin ( /ormal ratio - 9:1*.
A!$eo!i
4mall outpouching of 0alls of alveolar space through 0hich
gas exchange ta'es place.
Car,io!ogy
ECG
Measurement of the electrical current spread into the tissues
surrounding the heart.
1epo!ari2ation - reversal of the resting potential in
excitable cell membranes 0hen stimulated
Repo!ari2ation - the return to resting potential.
. P 3a$e- Atrial depolariCation
. 4RS #omp!e)- potentials generated 0hen the
ventricles depolariCe prior to contraction
. T 3a$e- ventricular repolariCation.
. PR inter$a! Bthe duration bet0een the beginning of
the - 0ave and the beginning of the H4 complex..
. 4'T inter$a!-contraction of the ventricles lasts
almost from the beginning of the H 0ave to the end
of the $ 0ave.
Laoratory Tests%
Creatinine Phospho5inase (CP6'M.)
A blood test used to detect damage to the heart
muscle" s'eletal muscle and brain.
La#tate 1ehy,rogenase (L1/)
Measures anaerobic carbohydrate metabolism and
as one of the several serum indicators of M! and
muscular dystrophies.
Troponin Test
Measures level of cardiac troponins to differentiate
cardiac from non-cardiac chest pain.
P+rposes%
, 8valuating patients 0ith unstable angina
, %etecting reperfusion after coronary
recanaliCation
, 8stimating M! siCe
, %etecting M! perioeperatively
Gastrointestina! System
GUAIAC TESTS (O##+!t .!oo, Test)
#ommon practices are the follo0ingI for . days
before the test and during the stool collection
period:
;igh fiber content.
Avoid red meat in the diet.
Avoid food 0ith a high peroxide content:
$urnips
#auliflo0er
@roccoli
;orseradish
Melon.
Avoid :
!ron preparations
!odides @romides Aspirin /4A!%s ,itamin # supplements greater than 9F0 mg3day /y,rogen .reathe Test


























































DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 3 -
Measures the amount of hydrogen produced in the
colon"absorbed in the blood"and then exhaled in the
breath.
/-2 19 hours before the procedure.
$he patient should not smo'e after midnight before
the test.
/2 Antibiotics and laxative 3 enemas 1 0ee' before
the test.
UPPER GASTROINTESTINAL SERIES AN1 SMALL .O7EL
SERIES
5pper A! series and small-bo0el series are
fluoroscopic x-ray examinations of the esophagus"
stomach" and small intestine after the patient
ingests barium sulfate.
As the barium passes through the A! tract"
fluoroscopy outlines the A! mucus and organs.
%ouble-contrast studies administer barium first
follo0ed by a radio lucent substance" such as air" to
produce a thin layer of barium to coat the mucusa.
!mportant:
8xplain procedure to patient.
!nstruct patient to maintain lo0-residue diet for 9
to . days before test and a clear li1uid dinner the
night before the procedure.
8mphasiCe /-2 after midnight before the test.
-atient 0ill be instructed at various times
throughout the procedure to drin' the barium (6D0
to G00 m<*.
!nstruct the patient that stool 0ill be light in color
for the next 9 to . days from the barium.
.ARIUM ENEMA
:luoroscopic x-ray examination visualiCing the entire
large intestine.
#an visualiCe structural changes" such as tumors"
polyps" diverticula" fistulas" obstructions" and
ulcerative colitis.
Air may be introduced to provide a double-contrast
study.
8xplain to the patient:
What the x-ray procedure involves.
$hat proper preparation provides a more
accurate vie0 of the tract and that
preparations may vary.
ULTRASONOGRAP/Y
1. A noninvasive test focuses high-fre1uency sound
0aves to obtain an image of the structure.
9. 5ltrasound can detect small abdominal masses"
fluid-filled cysts" gallstones" dilated bile ducts"
ascites" and vascular abnormalities.
.. 5ltrasound 0ith %oppler for vascular assessment.
/54!/A A/% -A$!8/$ #A8 #2/4!%8A$!2/4
Abdominal ultrasound usually re1uires the patient to
be /-2 for at least G hours before the procedure.
#hange position of patient" as indicated" for better
visualiCation of certain organs
EN1OSCOPIC PROCE1URES
8ndoscopy is the use of a flexible fiberoptic tube to
visualiCe the A! tract
8ndoscopes contain multipurpose channels that
allo0 for air insufflation" irrigation" fluid aspiration"
and the passage of special instruments.
2ther functions include:
@iopsy or cytology of lesions emoval of foreign ob+ects or polyps #ontrol of internal bleeding 2pening of strictures. !mportant: , An !, sedative 0ill be administered. , A plastic mouthpiece 0ill be used to help relax the +a0 and protect the endoscope.
, $he patient may be as'ed to
s0allo0 once in a 0hile as the
endoscope is being advanced.
, Air is inserted during the
procedure to permit better
visualiCation of the A! tract.
, Jeep patient /-2 until patient is
alert and gag reflex has returned.
, May resume regular diet after gag
reflex returns and tolerating fluids.
PROCTOSIGMOI1OSCOPY AN1 COLONOSCOPY
,isualiCation of the anal canal" rectum" and sigmoid
colon through a fiberoptic sigmoidoscope.
$he patient must be /-2 after midnight.
5se of 8nemas containing neomycin to decrease the
bo0el&s bacteria count .
Jayexalate enema to decrease the serum
potassium level*
$o soften the stool ( oil-retention enemas*
$o relieve gas( tidal"mil' and molasses"or
fleet enemas*
En,o#rine
Aro0th hormone
9. -rolactin
.. Aonadotrophins- <; and :4;
6. 4timulating hormones and trophic hormones
A#$;
$4;
M4;
4tores and releases
1. 2?=$2#!/
9. A%;3,asopressin
Aro0th ;ormone (4omatotrophic ;ormone*
#auses gro0th of almost all cells and tissues
of the body.
-romotes mitosis and cell siCe an specific
differentiation of certain types of cells.
-rolactin
-romotes development of the breasts and
secretion of mil'
Gona,othrophs
L/
-lays important role in ovulation
4ecretion of female sex hormones by the ovaries and
testosterone by the testes.
"S/
#auses gro0th of follicles in the ovaries prior to
ovulation
-romotes sperm formation in the testes.
A,rena!s%CORTE-
4ecretes three types of 4$82!% hormones
8* G!+#o#orti#oi,s
#ortisol" cortisone and
corticosterone
9* Minera!o#orti#oi,s
Aldosterone
:* Se) hormones
8strogen and testosterone
A1RENAL ME1ULLA
4ecretes Adrenergic ;ormones:










8pinephrine
/or-epinephrine
Pan#reas (En,o#rine)
A<-;A - A<5#AA2/
@8$A - !/45<!/
%8<$A - 42MA$24$A$!/
: B -ancreatic polpeptide
$he 2varies contains Aranulosa and $heca cells 0hich secrete 84$2A8/ and -rogesterone $he testes contains <eydig cells that secrete $estosterone Ra,io'A#ti$e io,ine +pta5e (RAI) Measures the absorption of the in+ected iodine isotope by the thyroid tissue !ncreased upta'e may indicate ;=-8functioning gland
























































DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 4 -
%ecreased upta'e my indicate ;=-2functioning
gland
Thyroi, S#an
-erformed to identify nodules or gro0th in the
thyroid gland
-retest
#hec' for pregnancy
$hyroid medication may be 0ithheld temporarily
/-2
-ost-test
8nsure proper disposal of body 0astes
"ASTING .LOO1 GLUCOSE
Aids in the diagnosis of %iabetes (4creening*
-re-test: /-2 for D hours
/ormal :@4- D0-107 mg3d<
G!y#osy!ate, /emog!oin A 8'C
@lood glucose bound to @# hemoglobin
eflects ho0 0ell blood glucose is controlled for the
past . months
:A4$!/A is /2$ re1uired>
/- 6-E%
Aood control- E.F%or less
:air control- E.F % to D.7%
-oor control- 7% and above
Thyroi,
Aro0th
#/4 maturation and development
@M regulation
4tro'e volume increased
#irculation
:at Metabolism
#;2 metabolism
/ypothyroi,ism
%2#-<evothyroxin( 4ynthroid* -should be ta'en on an
empty stomach
<2W calorie" <2W cholesterol and <2W fat diet
Manage constipation appropriately
-rovide a WAM environment
Avoid sedatives and narcotics
!nstruct patient to report chest pain promptly
/yperthyroi,ism
E)ophtha!mos-$he least seen yet he most pathognomonic in
hyperthyroidism
Goiter-the most common manifestation
PT/
Actions:
o !ncreases bone resorption
o !nhibits renal -26 reabsoprtion (-hosphaturic
effect*.
o !ncreases renal #a reabsorption
o !ncreases intestinal absorption of #a
Parathyroi, hormone reg+!ates ser+m #a!#i+m
!e$e!s
/Yperparathyroi,ism
!ncreased serum #a level
%ecreased serum -26
!ncrease bone resorption
/ypoparathyroi,ism
N+mness an, ting!ing sensation on the 0a#e (;) Trossea+&s an, Ch$oste5&s signs .ron#hospasms< !aryngospasms< ,ysphagia Car,ia# ,ysrhythmias /ypotension $2 %2&s: -lace a tracheostomy set. 29 tan' and suction at the bedside -repare #A<#!5M gluconate -rovide a ;!A;-calcium and <2W phosphate diet
Advise client to eat ,itamin % rich foods
P!a#e a tra#heostomy set< O9 = s+#tion ma#hine at
e, si,e
(IT 1%
Active form is 1"9F-dihydroxycholecalciferol
Ca!#itonin
:acilitates #a reabsorption in the 'idneys
!ncreases #a absorption in the A!$
4ynthesiCed and secreted by parafollicular cells of
the thyroid
4ecretion is stimulated by an increase in serum #a
!nhibits bone resorption
, Urine testing 0or g!+#ose
.ene,i#t&s test
6etones
, ONLY Reg+!ar ins+!in #an e +se,
INTRA(ENOUSLY
IMPORTANT%
Ins+!in is a,ministere, at home subcutaneously
C!o+,y ins+!in sho+!, e thoro+gh!y mi)e, y
gent!y in$erting the $ia! or ROLLING between the
hands
Se!e#t syringes that mat#h the ins+!in
#on#entration*
U'8>> means 8>> +nits per mL
Instr+#t the #!ient to ,ra3 +p the REGULAR (#!ear)
Ins+!in "IRST e0ore ,ra3ing the interme,iate
a#ting (#!o+,y) ins+!in
SOMOGYI E""ECT
No#t+rna! hypog!y#emia 0o!!o3e, y reo+n,
hyperg!y#emia
1+e to the pro,+#tion o0 #o+nter reg+!atory
hormones' g!+#agon* #ortiso! an, epinephrine
/emato!ogy
. %elivers nutrients"hormones
. 29 to tissues
. #ollect and dispose 0astes from the cellular
metabolism
. @#
. esponsible for carrying 29 and #29
bet0een the lungs and tissues via the
hemoglobin
. @iconcave" disc-shaped /2 nucleus.
W@#
#olorless" nucleated "primary function is
for protection against invading
microorganism
:unctions:
-hagocytocis
!mmunocytes















@ and $ lymphocytes
-lasma #ells (@M*
<ife 4pan of 1 0ee'.
W@# %ifferential:
Ne+ts% infection" inflammation" stress
Eosin% allergies
.aso% polycythemias" allergic reactions
Monos% <ymphoproliferative disorders" some
leu'emias
Lympho% infection" immunodeficiencies"
lymphoproliferative disordes" leu'emia
/emog!oin
/eme'the O9 #arrying #omponent o0 /emog!oin
G!oin'o+n, to Iron
4ites of @lood components formation <iver - active fro F to G 0ee's to G months A2A 4pleen -active 6 to D months A2A @M -active at F moths A2A and becomes the primary site from E month A2A and thereafter.








































DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 5 -
,ertebrae" 4ternum"!liac bones" 4'ull" and long
bones .
ANEMIA
6in,s%
Iron 1e0i#ien#y Anemia
"o!ate 1e0i#ien#y Anemia
Ap!asti# Anemia
Perni#io+s Anemia
1+o,en+m an, Upper ?e@+n+m'site o0 Iron Asorption
"e 1e0i#ien#y Anemia(Mi#ro#yti#< hypo#hromi# anemia)
Most common Anemia
#auses:
#hronic @lood <oss
@leeding
"OLATE 1E"ICIENCY ANEMIA
([Link] ANEMIA)
#auses
-oor dietary inta'e
Alcoholism
Anorexia nervosa
Malignancy
Perni#io+s
Macrocytic" hyperchromic anemia
A progressive megaloblastic macrocytic anemia that
results from the lac' of intrinsic factor resulting to
disorder in @# maturation.
May be caused by certain drugs as:
#olchicine
/eomycin
#imetidine
;ormonal contraceptives
S#hi!!ing&s Test
Most definitive diagnostic test to note absorption
of ,it @19.
To 1o%
,itamin @19 !M
!ron therapy
@lood transfusion as needed
-hysical examination every six months
KAt ris' for Aastric #ancer
Ap!asti# anemia
/ypop!asia o0 the one marro3 res+!ting to
PANCYTOPENIA
Anemia
Le+5openia
Thromo#ytopenia
Ca+ses
Congenita!
A#A+ire,
I,iopathi#
In0e#tions
Me,i#ations
/ea$y meta!s
Ce!!+!ar Gro3th an, 1i00erentiation
epair of $issues
-/eeds nutrients as ,itamins A#8 !ron and -rotein.
/ egeneration - 4ame cell type replacement after in+ury or
Apoptosis.
/ :ibroplasia - eplacement by connective tissue.
/ ;ypertrophy- #ompensatory mechanism as a result of increased
0or'load as exemplified by ,entricular hypertrophy in #;:.
Apoptosis - -rogrammed cell death to balance cell proliferation.
Metaplasia - Metaplasia-the reversible conversion of normal tissue
cells into another
Anaplasia - <oss of normal cell differentiation .A characteristic of a
tumor cell.
-leomorphism-variation in siCe and function
Can#er
/ormal mechanism and proliferation of cells are disturbed
0hich results in distinctive morphologic alterations of the
cell and aberrations in tissue patterns.
.ENIGN Well-differentiated 4lo0 gro0th 8ncapsulated /on-invasive %oes NOT metastasiCe 04uffix- LOMAM 0Adipose tissue- <ip2MA
0@one- oste2MA
0Muscle- my2MA
0@lood vessels- angi2MA
0:ibrous tissue- fibr2MA
MALIGNANT
5ndifferentiated
8rratic and 5ncontrolled Aro0th
8xpansive and !nvasive
4ecretes abnormal proteins
METASTATIC
S+00i) BSARCOMA C CARCINOMAD
Pro#esses In$o!$e,
Point m+tation - #hange in a gene occurring spontaneously affecting
the expression of the gene.
1e!etion - <oss of a piece of a chromosome.
STEPS%
INITIATION
#arcinogens alter the %/A of the cell
#ell 0ill either die or repair
PROMOTION
epeated exposure to carcinogens
Abnormal gene 0ill express
<atent period
PROGRESSION
!rreversible period
#ells undergo /82-<A4$!# transformation then malignancy
Etio!ogy o0 Can#er
1. -;=4!#A< AA8/$4
adiation
8xposure to irritants
8xposure to sunlight
9. #;8M!#A< AA8/$4
4mo'ing
%ietary ingredients
%rugs
@enCene
.. Aenetics and :amily ;istory
#olon #ancer
@reast cancer
6. %ietary ;abits
<o0-:iber
;igh-fat
-rocessed foods
Alcohol
F. ,iruses and @acteria
%/A viruses- ;epa @" ;erpes" 8@," #M," -apilloma ,irus
/A ,iruses- ;!,
@acterium- ;. pylori
G. ;ormonal agents
%84
2#- especially estrogen
E. !mmune %isease
A!%4
T+mor Chara#teristi#s
%ifferentiation extent to 0hich the parenchymal cells resemble
comparable normal cells both morphologically and functionally.
Anaplasia-Mar'ed morphologic and functional changes.
/ -leomorphism-variation in siCe and function
ate of Aro0th
<ocal !nvasion
/ $he gro0th of #ancer cells are accompanied by progressive
infiltration " invasion " and destruction of the surrounding tissue.
E
The Sprea, o0 Primary Can#er in Another Organ Ma,e Possi!e%
/%irect seeding into body cavities or surfaces
/<ymphatics
/
;ematogenous 1iagnosti# E$a!+ation #omplete medical history -8 @iopsy 8strogen and -rogesterone levels #@# -latelet count @lood #hem
DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 6 -
!maging -rocedures
S#reening
Male and female- 2ccult @lood" #?" and %8
:emale- @reast 8xamination" Mammography and -ap&s
4mear
Male- %8 for prostate" $esticular self-exam
N+rsing Assessment
, 5tiliCe the A#4 E Warning 4ignals
#A5$!2/
C- #hange in bo0el3bladder habits
A- A sore that does not heal
U- 5nusual bleeding
T- $hic'ening or lump in the breast
I- !ndigestion
O- 2bvious change in 0arts
N- /agging cough and hoarseness
N+rsing Assessment
Weight loss
:re1uent infection
4'in problems
-ain
;air <oss
:atigue
%isturbance in body image3 depression
-resence of mass
/on-healing 0ounds
-resence of discharge
The Ameri#an ?oint Committee o0 Can#er (The TNM C!assi0i#ation)
T--rimary tumor
T)--rimary tumor unable to assess
TO-/2 evidence or -rimary tumor
Tis-#arcinoma in 4itu
T8<T9<T:<TF- !ncreasing siCe and or local extent of primary tumor
N - -resence or absence or regional lymph node involvement
N) - egional lymph nodes are unable to assess
NO - /o regional lymph node involvement
N8<N9<N: - !ncreasing involvement of regional lymph nodes
M - Absence or presence of distant metastases
M) - 5nable to assess
Mo - Absence of distant metastasis
M8 - -resence of distant metastases
Management
%epends on type of malignancy histo!ogi# #e!! type< stage<
presen#e o0 metastasis an, #on,ition o0 the patient*
.IOPSY
/ "ine Nee,!e Aspiration .iopsy'Tiss+e is otaine, y app!i#ation
o0 s+#tion thro+gh a nee,!e atta#he, to a syringe*
/ Core nee,!e iopsy B /eedle biopsy 0ith a large hollo0
needle.;ighly accurate and done in 2-%
/ In#isiona! B @iopsy of a selected portion of a lesion.
/ E)#isiona! B @iopsy of tissue removed by surgical cutting.
Treatment an, Types o0 S+rgi#a! Pro#e,+res
Primary treatment B emoval of tumor 0ith margin
/ Lo#a! e)#ision- for small-siCed mass
/ 7i,e e)#ision -:or bigger siCed mass
/ A,@+$ant treatment- !n addition to the treatment rendered.
1e+!5ing Therapy B may be bone prior to surgery to lessen the
mass siCe and bleeding tendency.
Sa!$age treatment -$he use of an extensive surgical approach to
treat a local recurrence after implementing a less extensive
primary approach.
Pa!!iati$e Treatment - A control /2$ a treatment
Re#onstr+#ti$e or Rehai!itati$e
Pre$enti$e or Prophy!a#ti#
Chemotherapy

!ntent is to destroy as many tumor cells as possible 0ith minimal effect on healthy cells

An induction for advanced disease 0ith no alternative treatment exists

Ad+unct therapy Ce!! Cy#!e

A1 (Aap 1 *-/A and #;2/ synthesis

4 (4ynthesis*- %/A component doubles in preparation for cell
division
A9 (Aap 9 -hase * - #;2/ and /A synthesis occurs
M (mitosis* phase - %ivides in 9 identical daughter cells
A2 - esting" refractory to chemotherapy.
Therape+ti# Strategies
Ad+uvant therapy
/eoad+uvant therapy - Administration of several courses of
chemotherapy before definitive surgical intervention.
;igh dose 3!ntensive therapy B Administered in the @M
-reoperative #hemotherapy B%one prior to surgery
A,$erse E00e#ts o0 Chemotherapy
Alopecia
Anorexia
enal 3hepatic d3o
Mucositis
Anemia
/eutropenia
$hrombocytopenia
MAINTAIN TISSUE INTEGRITY
;andle s'in gently
%o /2$ rub affected area
<otion may be applied
Wash s'in only 0ith 42A- and Water
N+rsing Inter$ention
MA/AA8M8/$ 2: A<2-8#!A
Alopecia begins 0ithin 9 0ee's of therapy
egro0th 0ithin D 0ee's of termination
8ncourage to ac1uire 0ig before hair loss occurs
8ncourage use of attractive scarves and hats
-rovide information that hair loss is temporary @5$ anticipate
change in texture and color
Chemotherapy Genera! E00e#ts%
Assessment %
Integ+mentary
/ -ain
/ 40elling
/ ashes
/ 4'in pigmentation
/ $aste changes
/ 4tomatitis if present
Gastrointestina!
%;/
/ausea and vomiting
8lectrolyte !mbalance
Anorexia
Naundice
<iver enCymes"liver function tests and total bilirubin
/ematopoieti# 1isor,er
Anemia
/Co!or< T+rgor< #api!!ary re0i!!
/Presen#e o0 1yspnea<0atig+e<3ea5ness<$ertigo
/Pro$i,e 0reA+ent Rest Perio,s
Ne+tropenia
/ Assess signs of infection
/ Adventitious breath sounds
/ :ever
Thromo#ytopeniaG9>tho+
/ Assess s'in
/ 4tool"urine"gums
Respiratory an, Car,io$as#+!ar System
Assess%
<ung sounds

-ulmonary fibrosis (AgeOG0";as had pulmonary radiation"@leomycin or 0ith preexisting lung disease*

#ardiac studies before administering %oxorubicin and #yclophosphamide (#ardiotoxic* Ne+rom+s#+!ar 1 -aresthesia %$ GUT


DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 7 -
Monitor 52
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