N317 Adult dev's- Cancer

Cancer

Genetic changes in the way cells function​, Healthy respond to signaling and stop growing (apoptosis) or replicating and stay where they are supposed to​

Cancer cells are mutated, grow and replicated much faster. They can also create their own blood supply (angiogenesis) and ​

Causes ​= Inherited trait - errors in cell division ​

-Environmental factors – exposure to chemicals, UV light, etc.​

-Effects of Aging​, As we age, the body is less able to remove damaged cells.​

Cancer Naming​

Body part origin – Ex: Breast, Lung, Prostate​

Cell type – Ex: squamous cell carcinomas arise in squamous cells, lymphomas arise in lymphocytes​

Metastasis​

Process by which cancer spreads to other location​

Primary and secondary tumors​

Location of origin is primary tumor site​

Subsequent sites are secondary tumors​

Hyperplasia

increased cell division, leading to organ or tissue enlargement​

Dysplasia

abnormal growth of cells. Changes in size, shape and organization

Carcinoma in situ

abnormal cells confined to one location

Malignant cells

No apoptosis​

Angiogenesis- own blood supply.

Common Cancer risk factors

Smoking- most common, causes inflammation in body.​

Alcohol consumption- depends on amount, frequency​

Excess body weight​, Sedentary lifestyle ​

Dietary habits​

Viruses- implant sequence of DNA​

Age​, Genetics​

Immune disruption – certain viruses such as Epstein Barr, Herpes simplex, HPV,Hepatitis B, HIV​

Race​

Chemical Exposure

Cancers common in those assigned female at birth

Breast​

Lung​

Colorectal​

Uterine​

Melanoma

Cancers common in those assigned male at birth

Prostate​

Lung​

Colorectal​

Bladder- corrilation with smoking​

Melanoma

Cancer Impact on Overall Health

Psychosocial stressors​= Distress in cancer​, Depression​

Financial stressors​- Medical related debt​, Disparities in debt among races​, Significant loss of income​

Health promotion and disease prevention​- Smoking cessation​, Routine screenings- mammagrams​

Cancer Screening recommended for ages 25-39

Cervical cancer screening recommended for people with a cervix beginning at age _

-Cervical cancer screening can also begin at age 21

Cancer Screening recommended for age 40-49

Breast cancer screening recommended beginning at age 45 with the option to begin at age 40

Cervical cancer screening recommended for people with cervix

Colorectal cancer screening recommended for everyone beginning at age 45

At age 45 African americans should discuss prostate cancer screening with doctor

Cancer Screening Recommendation for age 50+

Breast cancer screening recommended

Cervical cancer screening recommended

Colorectal cancer screening recommended

People who currently smoke or formerly smoked should discuss lung cancer screening with a doctor

Discussing prostate cancer screening with doctor recommended.

Clinical Presentations of Cancer

Pain​, Infections​

Gastrointestinal​

Lymphedema​

Peripheral neuropathy​

Fertility​, Skin changes​

Fatigue​, Swelling​

Palpable masses​

Unexplained weight loss​

Cognitive manifestations: Sleep disturbances, delirium, impaired memory​

Cancer Warning Signs

Changes in bowel or bladder habits

A sore that does not heal

Unusual bleeding or discharge

Thickening or lump in breast or elsewhere

Indigestion or difficulty swallowing

Obvious changes in warts or moles

Nagging cough or persistent hoarsness

Unexplaned weight loss

Pernicious Anemia

Diagnostic testing for Cancer

Imaging tests​- CT, MRI, PET scan, Ultrasound​

Bone scans​

Angiography​

Biopsies- confirm​= Shave Biopsy​, Needle Biopsy. Incisional and Excisional Biopsy​, Sentinel Lymph Node Biopsy​

Tumor markers : ​Detect levels of normal proteins that are at higher levels than normal ​

Example: PSA (elevation indicates changes), BRCA1, BRCA2- gene mutation common in breast cancer

Cancer Staging

TNM (tumor, node, metastasis)​

Stages 0-IV: Stages 0 through IV are used as descriptors. ​

-Stage 0: Abnormal cells are present but have not spread.​

-Stage I: Cancers can be less serious and have a better prognosis.​

-Stages II, III, IV: cancer is larger and has had greater spread beyond the primary site.​

In situ

Abnormal cells are present, but they remain confined to the original location where they developed.

Localized

Cancer exists in a single organ and hasnot extended beyond it.​

Regional

Cancer has spread to nearby lymphnodes, tissues, or organs close to the original site.​

Distant

Cancer has spread (metastasized) tofaraway parts of the body.​

Unknown

There is insufficient information todetermine the cancer’s extent.​

T refers to

primary tumor. ​

TX means the primary tumor cannot be measured. ​

T0 means the primary tumor cannot be located. ​

T1-4 describes the size of the tumor. The higher the number, the bigger the tumor.​

N refers to

lymph nodes. ​

NX means the presence of cancer in lymph nodes is unmeasurable. ​

N0 means that nearby lymph nodes have no cancer. ​

N1-3 describes the number of lymph nodes with cancer. As the number increases, that means that there is cancer in more lymph nodes.​

M refers to

metastasis. ​

MX means that metastasis cannot be determined. ​

M0 means that cancer is not in other body parts. ​

M1 means cancer has reached other body parts. ​​

Complications of Cancer

Hypercalcemia - most common in clients who have multiple myeloma and breast cancer​. Can be caused by increases in certain proteins ​

-Manifestations include mental status changes, dehydration, weakness, nausea, vomiting, decreasedappetite, and constipation​

Spinal cord compression​=nTumor presses on spina cord, changes in function​. Manifestations: Early – pain, Late: immobility, numbness, incontinence​

Superior vena cava (SVC) syndrome​= Tumor compresses the SVC​. Manifestations include significant edema, including facial edema (classic sign), swelling, discolorationof upper extremities and neck, hoarse voice, cough, shortness of breath at rest, and chest or shoulderpain. ​

Malignant pericardial effusion – Cancerous fluid accumulates in membranous sacaround the hear- most common associated with leukemia, lymphoma, esophageal,breast and lung cancers.​

Tumor lysis syndrome​= Metabolic emergency that is triggered by cancer treatment​. Cancer cells are destroyed by treatment and release their intracellular contents into the bloodstream​

-Include low calcium level, elevated phosphorus level, elevated potassium level, elevated uric acidlevel, and elevated creatinine level. Cardiac arrythmias may occur​

-Treatment: IV fluids primary treatment​

Syndrome of inappropriate antidiuretic hormone – most commonly associated with smallcell lung cancer, also head and neck cancers​

Other possible complications of Cancer

secondary tocancer or treatment.​

GI related complications​

Infections​, Pain​, Swelling​

Nerve Problems​, Malnutrition​, Fatigue​

Sleep disturbances​

Delerium and other neurological changes​

Chemotherapy related anemia​

Pancytopenia​

Cancer Treatment Options: Surgical​

Tumor removal​, Tumor excision​, Lymph node dissection​. Prophylactic surgery​. Reconstructive surgeries​

Extensive or radical surgeries- removal of different structures.​

Complications: ​Infection, electrolyte/fluid imbalance,DVT, anxiety, depression​

Nursing Care/Client Education:​Provide peri-operative care: Baseline vitals, post-procedural prevention of complications (DVT, infection, electrolyte/fluid imbalance)​

-Provide supportive care: psychosocial needs, mobility needs, medication safety​

-Educate client of what to report after treatment​

Treatment Options: Chemotherapy​

Routes: Oral, Topical, IV, Intracavitary, etc.​

Central venous catheter usually placed.​

A port can be implanted for long-term treatment​

Many types of medications: antimetabolites, antimitotic medications, antitumor antibiotics, vaccines, etc.​

Complications: Nausea, vomiting, anorexia, alopecia, neutropenia, hypersensitivity, oral effects, anemia and thrombocytopenia, cognitive impairment, chemotherapy- induced peripheral neuropathy, increased bleeding.​

Nursing Care & Client Education: ​Education: Safe administration and what to expect following treatment, what to report to provider​

Monitor for complications​

Ensure safety to self and staff involved in administration

Treatment Options: Radiation​

Involves high-energy radiation to targeted areas​

Goal is to destroy and weaken cancer cells​

Typically given in multiple doses​

Adverse effects to skin and area in the radiation path, healthy skin can be affected too.​

Internal: ​Brachytherapy: internal administration of radiation –know safety related to this typeof treatment​

Vaginal​

Ensure safety of self and staff involved in care of client- PPE​

Other Treatment Options​

Hormone Therapy- tumor may be responsive to certain hormones like estrogen. Depends on tumor​

Immunotherapy (biotherapy)​

Targeted Therapy- focus on cancer tissue without harming healthy tissue​

Hematopoietic stem cell (bone marrow)transplantation (HSCT)= remove cancer bone marrow and replace with donor bone marrow.Monitor for rejection reaction.​

Photodynamic therapy- use different frequency of light, usually for skin cancer.

Role of the Nurse for Cancer ​

Assessment and Monitoring​

Managing side effects and effects of cancer​

Pain Management​

Nutritional Support​

Infection Prevention​

Psychosocial Support​

Patient Education​

Coordination of Care​

Considerations for the neutropenic patient​

Strict Hand Hygiene: ensure everyone washes hands thoroughly before contact, Use alcohol-based hand sanitizer if hands are not visibly soiled.​

Protective Environment: Limit visitor and avoid crowds, Useprotective gowns, masks, and gloves as needed. Keep patient'sroom clean and well-ventilated​

Avoid Exposure to Infection Sources: No fresh flowers, plants orstanding water in the room, Avoid raw or undercooked foods(meats, eggs, seafood), ensure all foods is properly washed andcooked.​

Patient Hygiene: Encourage daily bathing and oral care withgentile, non-irritating products, inspect skin and mucousmembranes daily for breaks or infection.​

Monitor for Infection Signs: Check temperature regulary; even aslightly fever is significant. Report any redness, swelling, pain, or drainage immediately. ​

Avoid Invasive Procedures When Possible: Limit injections, catheter insertions, and invasive monitoring to reduce infection risk.​

Educate Patient and Family: Teach about infection prevention measures and symptoms reporting, Stress importance of avoiding sick contacts.

Breast Cancer​

Types- Invasive versus noninvasive​, Ductal​. Estrogen receptor positive- respond to estrogen​. Progesterone receptor positive- respond to progesterone.​

Risk factors​= Gene mutations- BRCA1 and BRCA 2 Mutation​, Advanced age​. Family history​

-Obesity​, Alcohol use, Smoking use​, Radiation exposure​

-Breast disease- dense breast tissue or chronic issues- mastitis​. Dense breast tissue​. Estrogen exposure​

Prevalence and survival​= Increased annual rates​Decreased death rates​. Racial disparity​

Impact on Overall Health​= Physiological, Psychosocial​

Breast Cancer: Clinical Presentation & Assessment​

Manifestations​= Mass or lump​, Swelling​, Discharge​Nipple retraction​, Skin changes​. Swollen lymph nodes​

Lab and diagnostic studies​= Mammograms- Screening- normal screening​

Diagnostic- notice something is not normal and focus on specific part​. Clinical breast exam​. MRI​

-Biopsy- confirm​

-Hormone-sensitivity testing- test if responsive to hormone​

-Growth factor testing​

Breast Cancer: ​Treatments and Therapies​

Surgery​

Radiation​

Chemotherapy​

Hormone therapy​

Targeted therapy​

Lung Cancer

Respiratory system anatomy​- Upper, lower. Impact patients function to breath. Can also go undetected due to thinking respiratory virus.​

Types of lung cancer​; Small cell, Non-small cell​

Risk factors​- Smoking​, Radon gas​. Second hand smoke​. Exposure to: Asbestos, Radiation, Air pollution, Diesel exhaust, Metals, Chemicals​

Lung Cancer: Clinical Presentation​

usually respiratory.​ Cough- dry, not going away​Hemoptysis​, Shortness of breath​, Fatigue​

-Weight loss​, Chest pain​, Respiratory infections​. New wheezing​. Hoarse voice​

Diagnostic Testing​= Chest imaging- CT, MRI​

-Biopsy- confirm diagnosis​. Sputum cytology​

Lung Cancer: Treatment and Therapies​

Surgery​

Chemotherapy​

Radiation​

Targeted therapy

Prostate Cancer

Is Located below the bladder and anterior to the rectum​. Produces and holds fluid that becomes part of semen​

Made up of glandular tissue​. Testosterone plays a vital role in the function of the prostate​

Cell mutation ​= When healthy cells mutate, cancer can occur. ​Prostate cancer arises mostly from glandular tissue. ​

-As cancerous cells reproduce, they develop into a tumor nodule in the prostate​. Nodules can expand outside of the gland​

is diagnosed most frequently in older adult clients, and BPH patients​. The average age at diagnosis is 67. ​Adenocarcinomas make up more than 95% of prostate cancers​

Prostate Cancer: Epidemiological and Etiological Risk Factors​

Risk factors​= Age (50 and older)​. Family history -as BRCA1 or BRCA2 gene mutations​. Smoking. Increased body weight​

Racial disparities​= Significant for Black individuals in US and Caribbean and Hispanic​. Evidence has indicated that inequitable access to healthcare is a contributor​

Impact on Overall Health​= Physiological​. Psychosocial​Aging​. Health promotion and disease prevention​

Manifestations​= Urinary frequency​, Problems with urine flow​. Erectile dysfunction​. Blood in urine or semen​

Diagnostic tools​= Digital rectal examination​. PSA​Ultrasound​, MRI​. Biopsy- confirm​

Prostate Cancer: Treatment and Therapies​

Surgery- most common and radiation and chemo as well​

Continuous bladder irrigation (CBI) before surgery.​

Radiation​

Chemotherapy​

Immunotherapy​

Hormone therapy​

Targeted therapy​

Colorectal Cancer

Polyps and pre-cancerous polyps​

Adenocarcinomas​

Metastasis- when develops, spreads very rapidly​

Colorectal Cancer: Epidemiological and Etiological Risk Factors​

Risk factors​= Excess body weight​, Low activity level, Smoking​, Diet​, Alcohol intake​. Medical conditions​

Manifestations​= Changes in bowel habits​, Blood in stool​, Rectal bleeding​. Anemia​, Abdominal discomfort​

-Weight loss​, Fatigue​

Diagnostic tools​= Fecal occult testing- test for blood in stool, good indicator that something is wrong. ​

-CEA levels​

-Colonoscopy- see any tumors or polys​

-Biopsy- confirm​

Colorectal Cancer:Treatments and Therapies​

Surgery​

Chemotherapy​

Radiation​

Targeted therapy​

Immunotherapy​

Radiofrequency ablation- exposed to different radio frequency under anesthesia, on tumor tissue and ablative.​

Pancreatic Cancer

Pancreas anatomy and functions- releases insulin and effects those cells.​

Cancer of exocrine cells

Pancreatic Cancer: Epidemiological and Etiological Risk Factors​

Risk factors- anything increases inflammation in body.​Smoking​, Medical conditions​. Family history​, Genetic conditions​. Increased body weight​, Alcohol consumption​

Impact on Overall Health​- Physiological​, Psychosocial​Aging​, Health promotion and disease prevention​

Manifestations​= Jaundice​, Skin itching​, Dark urine​Light colored bowel movements​. Pain- epigastric area​Anorexia​, Weight loss, Nausea and vomiting​

Lab and diagnostic studies​= Liver function testing- AST, ALT may be elevated​

Tumor markers​

Biopsy​

CT scans​

Ultrasound​

Cholangiopancreatography (ERCP)- to diagnose​

Skin Cancer

Epidermis- outer layer

Dermis- middle layer

Subcutanous- inner most layer

Cell damage​

Mutations​

Types= Basal cell​, Squamous cell​, Melanoma​

Skin Cancer: Epidemiological and Etiological Risk Factors​

Risk factors​= Ultraviolet radiation- usually when young​Family history​, Advanced age​

Moles- have checked and evaluate​

Immunosuppression​

Impact on Overall Health​= Physiological​, Psychosocial​Aging​. Health promotion and disease prevention​

Lab testing and diagnostic studies​= Biopsy​

Skin Cancer: Clinical Presentation​

Monitor skin changes-

Asymmetry= The two sides do NOT match

Border,= Are uneven

Color= Two or more colors

Diameter= Larger than 6 mm

Evolution= Changes in size, shape, color, or another trait.

Leukemia

Cancers within the bone marrow that causes an increase production of immature WBCs​

Types;

-Acute Lymphocytic Leukemia (ALL)- common in children, high servival rate​

-Acute Myelogenous Leukemia (AML)- poor prognosis, common in adults​

-Chronic Lymphocytic Leukemia (CLL)- most common in adults in age 50. Most commonly seen​

-Chronic Myelogenous Leukemia (CML)- common after age 50, very uncommon in children.​

Lymphomas

are cancers of lymphocyte cells that overgrow and multiply and causes tumors within the lymph nodes.​

Types:

-Hodgkin’s Lymphoma- most treatable, less common.​

-Non-Hodgkin’s Lymphoma- less treatable​

Leukemia & Lymphomas: Epidemiological and Etiological Risk Factors​

Risk factors​= Immunosuppression​. Exposure to chemotherapy agents or medications​

-Genetic factors (hereditary)​, Ionizing radiation​. Viral infections​

Impact on Overall Health​= Physiological​, Psychosocial, Aging​

Health promotion and disease prevention=

-Expected Findings Leukemia​-Acute leukemia​, Bone pain​, Joint swelling​. Enlarged liver and spleen​. Weight loss​. Fever​.Poor wound healing Manifestations of anemia​Evidence of bleeding​. Headaches, behavior changes, decreased attention​

Expected Findings Lymphoma​- Lymphadenopathy: painless, enlarged lymph node (usually in the neck with HL), ​Other possible manifestations include fever, night sweats, unplanned weight loss, fatigue, and infections.​

-Client may report abdominal fullness and prolonged swelling of lymph nodes.​

Lab testing and diagnostic studies​= CBC with differential​. Coagulation Studies​. Cytogenic Studies​

-Imaging:​ Chest x-ray​, PET​, CT Scan​, Bone Scan . Biopsy of lymph nodes​

Leukemia & Lymphomas: Treatments and Therapies​

Colony Stimulating Medications- help stimulate production of WBC and boost immune function​

Immunotherapy​

Chemotherapy​

Radiation​

Hematopoietic Stem Cell Transplant

Leukemia & Lymphomas: Complications​

Pancytopenia- blood cell count is low​

Thrombocytopenia- low platelet count, cause excessive bleeding.​

Hypoxemia​

Hematopoietic Stem Cell Transplantation (HSCT) related complications​

Failure of stem cells to grow​

Bone marrow transplant must be repeated. Due to rejection or did not work​

Graft-versus-host disease (graft rejection)​

Sinusoidal obstructive syndrome (SOS)​

White Blood Cells and function

Neutrophils​- most abundant type of white blood cell and serve as the immune system's first line of defense.

Lymphocytes​- that form the backbone of your adaptive immune system. They identify and destroy foreign invaders like viruses, bacteria, and cancer cells.

Monocytes​- the largest type of white blood cell and a vital part of your innate immune system. Produced in the bone marrow, they mature into macrophages or dendritic cells to engulf pathogens and remove dead cells.

Eosinophils​-produced in the bone marrow, serves immune system. against parasitic infections and regulate inflammatory and allergic responses.

Basophils​- Formed in the bone marrow, releasing chemicals like histamine and heparin to mediate inflammatory and allergic reactions.

Innate Immunity

Cells- everyone is born with it​ (First line, non-specific)​

Neutrophils: Rapid responders​

Macrophages: Phagocytic cells​

Dendritic Cells: Act as antigen-presenting cells (APCs)​

Natural Killer (NK) Cells: Kill virus-infected and tumor cells​

Mast Cells and Basophils: Release histamine and other mediators​

Adaptive Immunity cells involved?

Get or develop over times.​ (Specific, memory-forming)​

B Cells: Produce antibodies (humoral immunity)​

Helper T Cells (CD4+): Communicator, Activate B cells, cytotoxic T cells, and macrophages​

Cytotoxic T Cells (CD8+): Kill/Destroy infected or abnormal cells​

Memory T and B Cells: Last long time. Long-lived cells that provide faster, stronger responses upon re-exposure to the same antigen.​

Normal WBC range

5,000-10,000/ mm3​

Leukopenia

WBC count less than 4,000/ mm3​

Indicates drug toxicity, autoimmune disease, overwhelming infections, etc.​

Leukocytosis

WBC count greater than 10,000/mm3​

Indicates inflammation, infection, status post splenectomy, trauma, or dehydration, etc.​

Neutropenia

WBC count less than 2,000/mm3​

Indicates severe bacterial infection or viral infection, under going chemotherapy or radiation therapy. Requires protective environment.​

Left Shift

Increase in immature neutrophils (bands) indicating acute infection.Neutrophil production is increased, leading to the presence of more immature cells not capable of phagocytosis. ​​

Human Defenses: Innate Immunity​

First Line of Defense: Barriers​

-Physical- skin, lining of respiratory tract​

-Mechanical- coughing, sneezing​

-Biochemical- chemicals released on surfaces​

Second Line of Defense: Inflammation​

-Acute- cells that are first responders​

-Chronic- cells long-term​

Third line defense- memory cells​

Innate Immunity​

system serves as the body's immediate and non-specific defense mechanism against pathogens and harmful substances.

Unlike adaptive immunity, the innate immune response does not create immunological memory.​​

Acute Inflammation: ​

Four cardinal signs: redness, swelling, heat, and pain in the affected area.​

Blood vessels in the affected region undergo vasodilation​

Occurs immediately and lasts between less than 2 weeks. ​

Subacute inflammation can last up to 6 weeks.

Chronic Inflammation:

can persist for several months or years, less aggressive process.​

The inflammatory process creates physical and chemical barriers ​

Manifestations include malaise, body aches, insomnia, depression, anxiety, weight fluctuations, or gastrointestinal(GI) upset.​

Vascular Response​

Injury to the tissues occur causing constriction to the vessels to reduce loss of blood​

Immune mediators are signaled to dilate blood vessels near injury sites, increasing local blood flow​

Mediators:​ Vasodilation leads to visible redness and warmth in affected areas.​

-Increased blood vessel permeability allows fluid and exudate to move into the interstitial space. Proteins in exudate draw more water, leads to edema​

Cellular Defense​

Immune cells (phagocytes – a type of WBC) also move into the affected tissues and destroy pathogens and consume dead tissue or debris.​

Different types of leukocytes, including neutrophils, macrophages, and lymphocytes, serve specific defensive functions.​

Phases of wound healing:​

Phase 1 - Inflammation: Initial response to injury or infection.​

Phase 2 - Proliferation: Formation of new blood vessels and collagen production.​

Phase 3 - Remodeling: Long-term tissue strengthening and reorganization.​

Healing success depends on factors like damage severity and overall health status.​

Proper nutrition and oxygen supply are crucial for effective tissue repair.​

Nursing considerations: ​Clients with comorbidities that impact the immune system such Diabetes mellitus​

-Clients who are taking immunosuppressant medication- steroids effect wound healing​

-Clients with malnutrition concerns that would delay healing​

What is Adaptive immunity?​

response develops throughout our lifetime as ween counter various pathogens. Varies in everyone.​

Unlike innate immunity, adaptive immunity creates specific responses(memory)to particular threats.​

The system primarily consists of specialized B lymphocytes that activated by Tlymphocytes and antigens​

These activated cells are able to differentiate into plasma cells that produce antibodies and have memory - for years or even a lifetime.​

This immunological memory is the foundation of successful vaccination programs.​

Cell Types of Adaptive Immunity:​B cells, Helper T Cells (CD4+), Cytotoxic T Cells (CD8+), Memory T and B Cells​

Adaptive immunity: Antibody mediated (humoral)​

Antibodies recognize and bind to specific antigens on pathogen surfaces.​

Three key functions of antibodies: neutralizing toxins, preventing cellular entry of pathogens, and activating the complement system.​

B cells that produce antibodies circulating in body fluids (the“humors”) that bind to specific antigens, neutralizing them or marking them for destruction by other immune cells. ​

Memory B cells persist in the body to enable rapid future responses to the same pathogen.​

Adaptive immunity: Cell mediated​

Cytotoxic T cells (CD8+) kill cells harboring intracellular pathogens​

Helper T cells (CD4+) coordinate the immune response by activatingother immune cells though cytokine signaling​

This branch targets pathogens inside cells, such as viruses and somebacteria.​

This immunity is essential for fighting intracellular pathogens likeviruses and certain bacteria.​

Antigen-presenting cells display pathogen fragments to activate T cell responses.​

Passive Immunity

Type of Adaptive immunity

Antibodies are transferred directly from donor to recipient, without the recipient’s immune system being activated. Passes on mother to baby​

Provide immediate defense by neutralizing pathogens or toxins​

Examples: Mother breastfeeding baby or passed through placenta​

Active Immunity

Type of Adaptive immunity

Individual’s immune system encounters an antigen and stages a specific response. Exposure to antigens​

Antigen-presenting cells​

B cells​

Memory B and T cells​

Examples: vaccines or body has been exposed and developed memory cells​.

Types of Hypersensitivity Reactions​

Type I; IgE Mediated

Type II: Mediated by Antibodies that Activate Cellular Cytotoxicity

Type III: Mediated by Immune-Complexes

Type IV: Delayed T Cell Mediated- not dependent on antibodies

Hypersensitivity Reactions; Type I (Immediate Hypersensitivity)​

Allergic reaction​= Mediated by IgE antibodies.​Occurs within minutes of exposure to an allergen.​Causes allergic reactions like hay fever, asthma, anaphylaxis.​Involves mast cell and basophil degranulation releasing histamine.​

Clinical Manifestations:​ Local: hives, itching, redness, swelling​

Systemic: hives everywhere, anaphylaxis shock, asthma response- not being able to breath. ​

Diagnostic Testing:​ Skin prick tests, Food allergy testing, Patch test- determine allergen​. Serum IgE levels​

Radioallergosorbent test (RAST)- when risk is high, blood test to determine-not always 100% correct​

Pulmonary function tests- asthma component to allergen, more in generaland how its impacting respiratory​

Nursing Care and Therapeutic Management:​ Remove allergen (remove trigger such as food or insect stinger) and monitor client closely​

Administer antihistamines, corticosteroids, leukotriene receptor antagonists, and bronchodilators as prescribed.- Epi first and seek medical attention.​

Place patient in trandeleburg during allergic reaction to support blood flow to brain.​ Educate client to avoid allergen, educate about hidden sources of trigger​

Educate client about all medications​. Connect client to appropriate resource such as allergist, immunotherapy​. Client will need to discontinue medications before allergy testing.

Type I Hypersensitivity: Treatments​

Medications​

Antihistamines: Block histamine effects to reduce itching, swelling, and hives (e.g.,diphenhydramine, loratadine, cetirizine, fexofenadine).​

Corticosteroids: Reduce inflammation in severe or persistent cases (topical, oral, or inhaled depending on symptoms). Example: Prednisone.​

Decongestants: Relieve nasal congestion (short-term use).​

Leukotriene receptor antagonists: Help control asthma and allergic rhinitis symptoms(e.g., montelukast).​

Bronchodilators: For asthma, relax airway muscles to improve breathing (e.g., albuterol).​

Emergency Treatment for Anaphylaxis​

Epinephrine: First-line treatment administered immediately via auto-injector (e.g.,EpiPen) to reverse airway constriction and shock.​

Oxygen therapy: To support breathing.​

IV fluids: To maintain blood pressure. Isotonic solution- Normal sailne​

Additional medications: Antihistamines and corticosteroids as adjuncts.​

Immunotherapy (Allergy Shots)​

Anaphylaxis: Epidemiological and EtiologicalRisk Factors​

Triggers​= Insect stings​, Food​, Medications. Other substances​. Exercise​

High-Risk​= Asthma​, Chronic lung disease​

-Medications- Beta blockers​, Alpha adrenergic blockers​

-Mastocytosis- allergic reaction of mast cells overreaction​

What actions to do during allergic reaction?

Administering epinephrine​

Giving oxygen ​

Providing intravenous fluids​

Types of Hypersensitivity Reactions: ​Type II (Cytotoxic Hypersensitivity)​

Transfusion reactions​= Mediated by IgG or IgM antibodies directed against cell surface antigens.​ Occurs within hours or days​. Leads to cell destruction via complement activation or phagocytosis.​

-Examples include hemolytic anemia, Goodpasture’s syndrome, and transfusion reactions.​

Clinical Manifestations:​ Local: lung and kidney damage directly-Goodpasture’s syndrome, coughing up blood or blood in urine.​

-Systemic: Hemolytic transfusion reactions:​ Autoimmune hemolytic anemia​ and Thrombocytopenia​

Diagnostic Testing:​ Direct Coombs test: Detects antibodies attached to red blood cells. Will be elevated if positive.​Blood type and cross match prior to transfusion​

Nursing Care and Therapeutic Management:​ Monitor vital signs closely during transfusions for early signs of reaction.​Assess for symptoms of anemia, bleeding, or organ dysfunction.​

-Educate patients about avoiding known triggers and adhering to treatment.​ Provide emotional support and information about disease management.​ Collaborate with the healthcare team for timely intervention during acute episodes​

Types of Hypersensitivity Reactions:​
Type III​ (Immune Complex-Mediated Hypersensitivity)

Caused by deposition of antigen-antibody complexes in tissues.​ Occurs within 1 to 3 weeks​. Triggers inflammation and tissue damage via complement activation.​

-Examples include systemic lupus erythematosus and rheumatoid arthritis.​

Clinical Manifestations:​ Local: Arthus reaction: joint pain​Systemic: fever, pain, fatigue​

Diagnostic Testing:​ Serum complement levels: Often decreased due to consumption.​ Detection of circulating immune complexes: Various assays available.​

-Antinuclear antibody (ANA) test: Positive in diseases like lupus.​ Tissue biopsy: Shows immune complex deposits and inflammation.​ Urinalysis: To assess kidney involvement.​

Nursing Care and Therapeutic Management:​ Monitor for signs of organ involvement, especially kidney and joints.​

Assess for symptoms like rash, fever, and joint pain.​ Educate patients on medication adherence and recognizing symptom flare-ups.​Provide emotional support and coordinate multidisciplinary care.​

Promote rest and balanced activity to reduce symptoms.​Usually treated with immunosupprents​

Types of Hypersensitivity Reactions: ​Type IV (Delayed-Type Hypersensitivity)

Mediated by sensitized T cells (not antibodies).​ Occurs within days to weeks, Reaction develops over 24–72 hours.​

-Examples include contact dermatitis, tuberculosis skin test reaction, and transplant rejection.​

Clinical Manifestations:​ Generally Localized - rash, stiffening to skin​

Diagnostic Testing:​ Patch testing: Identifies contact allergens by applying patches and observing delayed skin reactions.​

-Tuberculin skin test: Measures induration after 48–72 hours to detect prior exposure to tuberculosis.​

-Biopsy: Shows T cell infiltration, macrophage activation, and tissue damage.​

-Blood tests: May show elevated inflammatory markers.​

Nursing Care and Therapeutic Management:​ Medications: Topical or systemic corticosteroids, immunosuppressants, antihistamines- to suppress reaction​

Educate patients about trigger avoidance and skin care.​Monitor skin integrity and signs of infection.​ Assess for delayed reactions after exposure to allergens or diagnostic tests.​

Provide emotional support for chronic or disfiguring conditions.​Collaborate with the healthcare team for comprehensive management.​

What is HIV/AIDS​?

Retrovirus affecting immune system​, Retroviruses also have an enzyme called reverse transcriptase that allows it to use the host’s DNA to make copies of the virus. ​

Fuses to a host cell and then injects its RNA and converts itinto DNA to replicate itself with the host cell​

New copies can then leave the host cell and infect other host cells, thus spreading the virus​

Targets and destroys CD4 white blood cells (TCells)​

Results in opportunistic infections that can be life-threatening of HIV is not treated​; Tuberculosis​, Fungal infections​, Bacterial infections​, Cancers​

How is HIV/AIDS Spread?

through infected body fluid contact​

Blood​

Semen​

Rectal fluids​

Vaginal fluids​

Breastmilk​

Lifestyle risk factors​= Sexual activities​, Sharing drug needles​Use of drugs/alcohol​, Incarceration​

Viral load​

the number of HIV copies in a milliliter (mL) of blood. Risk of transmission​

A viral load under 40 to 75 copies/mL is considered low, therefore risk of transmission is low. ​

HIV-positive​

After initial infection, a person's viral load is high and the risk of spreading the infection further is increased . ​

As the body produces antibodies, it both lowers the risk of progression and transmission. ​

Treatment can further suppress the viral load to around 200 copies/mL. Although this may prevent HIV from progressing, it is still transmissible. ​

What is AIDS?

If a client who is HIV positive does not receive antiviral treatment, the virus will continue to replicate and the infection will progress to _

HIV/AIDS: Impact on Overall Health

Weakened immune system​

Opportunistic infections and cancers​

Prone to other disorders​= Tuberculosis​, Fungal infection​, Lung cancer​, Hypertension​, Salmonella infection complications​, Dementia​, Herpes​, Eczema​

Development of AIDS – High risk of life-threatening conditions, unable tofight infections​

-Cytomegalovirus (CMV) –typically causes no serious illness except withimmunosuppressed​

-Kaposi sarcoma – caused by human herpesvirus 8 (HHV-8)​

-Lymphoma. Heart failure – due to chronic inflammation/immune response with HIV, also some sideeffects of treatments​

Psychosocial ​, Health Promotion and prevention​

Considerations for aging – higher risk of developing comorbidities with increased age​​

HIV/AIDS:Clinical Presentation​

Initially can be asymptomatic or experience flu-like symptoms; Fever​, Headache​, Rash, Sore throat​

With progression and body unable to fight infections- can take years to progress to this:​ Swollen lymph nodes​, Weight loss​Fever​, Diarrhea​. Cough​

-Low CD4 counts, indicate decline in status and resistance to medication​

HIV/AIDS: Clinical Presentation​ Stages and Diagnostic

Stages​

-Acute infection: risk of infection high, flu-like symptoms, 2-4 weeks of getting​

-Chronic infection: Asymmtomatic and able to pass on, can go for many years.​

-AIDS: Progresses gets worse and life-threatening​

Lab testing and diagnostic studies​=HIV testing​, Viral load testing​. CD4 counts – ongoing monitoring to guide treatment and risk of opportunistic infections.​

-Antigen/antibody testing​, Related conditions testing​

Medication Therapies for HIV

Combination therapy involves 3 to 4 medications together to reduce resistance: Not tested on meds just that combination of these meds are used to help reduce CD4levels​

-Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)​= Block reverse transcriptase enzyme, preventing viral DNA synthesis.​ Examples: Zidovudine (AZT), Lamivudine (3TC), Tenofovir (TDF), Emtricitabine (FTC),Abacavir (ABC).​

-Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)​= Bind directly to reverse transcriptase and inhibit its function.​ Examples: Efavirenz (EFV), Nevirapine (NVP), Etravirine (ETR), Rilpivirine (RPV).​

-Protease Inhibitors (PIs)​= Inhibit HIV protease enzyme, preventing viral protein processing and maturation.​ Examples: Lopinavir/ritonavir (LPV/r), Atazanavir (ATV), Darunavir (DRV).​

-Integrase Strand Transfer Inhibitors (INSTIs)​= Block integrase enzyme, preventing integration of viral DNA into host genome.​ Examples: Raltegravir (RAL), Dolutegravir (DTG), Bictegravir (BIC).​

Fusion Inhibitors​= Prevent HIV from entering host cells by blocking co-receptors or fusion.​ Examples: Maraviroc (CCR5 antagonist), Enfuvirtide (fusion inhibitor).​

Pharmacokinetic Enhancers​= Boost effectiveness of PIs by inhibiting drug metabolism.​Examples: Ritonavir, Cobicistat.​

HIV/AIDS: Roleof the Nurse​

Environmental factors​= Reduce risk of infection. Neutropenic precautions.​ Monitor immune status (CD4 count, viral load) and signs of opportunistic infections.​

Healthcare exposure precautions and prevention​= Exposure to bodily fluids during treatment of a client who has HIV​. Less than 1% from an accidental needlestick, less than 0.1% from direct skin contact with bodily fluid, and 0.1-1% from a human bite ​

Individual factors​= A nurse’s beliefs about sexual activity or drug use should not affect their nursing care of clients who are diagnosed with HIV/AIDS​. Every client should be provided the best possible care by the nurse​

Client education​= Clients need to be educated about preventing the transmission of HIV. ​ They should inform all sexual partners of their status and use barriers, such as condoms​. Educate client about risk reduction, hygiene and avoiding those who are ill.​