Cardiac cycle

 

oxygen therapy

 

cPAP and Bi PAP

 

TBD- To be determined

TBD is a common abbreviation for "To Be Determined" or "To Be Decided," used to indicate that a detail, such as a date, time, location, or specific content, is not yet finalized but is expected to be decided or confirmed later

Fibroids and Cancer

 

Fibroids and Cancer

• Fibroids (also called leiomyomas) are non-cancerous growths of the uterus. They are very common in women of reproductive age.

• In most cases, fibroids do not turn into cancer.

• Rare Cancerous Change

  • In very rare situations, a fibroid-like growth may actually be a cancer called leiomyosarcoma.

  • Research shows this happens in less than 1 in 1,000 cases.

  • Important: leiomyosarcomas usually do not develop from fibroids; they tend to arise independently.

  • Warning Signs to Watch

    Doctors may look more closely if there are:

    • Rapid growth of the mass (especially after menopause).

    • Unusual bleeding.

    • Severe pain or other sudden changes.

    👉 So, to summarize: fibroids almost never turn into cancer. They are benign, but doctors monitor symptoms to rule out rare problems.

  • Feature	Fibroids (Benign)	Uterine Cancer (Malignant – e.g., Leiomyosarcoma / Endometrial cancer)
    Growth	Usually slow, can get larger over years	May grow rapidly, especially after menopause
    Pain	Pelvic pressure or cramping	Can also cause pain, but often with other red flags
    Bleeding	Heavy periods, prolonged periods, spotting between cycles	Postmenopausal bleeding, unpredictable bleeding
    Other Symptoms	Enlarged abdomen, frequent urination, constipation, infertility in some cases	Unexplained weight loss, fatigue, pelvic pain, new bleeding patterns
    Risk	Benign, almost never cancerous	Rare but serious; requires prompt evaluation

    👉 Key point: Fibroids cause symptoms that overlap with cancer, but sudden changes (rapid growth, new bleeding after menopause, or systemic symptoms like weight loss) should raise concern and be checked by a doctor.

  • 🩺 Diagnostic Methods

    1. Pelvic Exam

       • Doctor feels for size, shape, and firmness of the uterus.

       • Fibroids often feel like firm, irregular masses.

       • Cancer suspicion rises if the mass grows quickly or feels unusual.

    2. Ultrasound (Transvaginal or Abdominal)

       • First-line imaging to see the uterus.

       • Fibroids: usually well-defined, round, solid growths.

       • Cancer: may look irregular, with areas that break down (necrosis).

    3. MRI (Magnetic Resonance Imaging)

       • Gives more detail if ultrasound is unclear.

       • MRI can often tell the difference between benign fibroids and malignant leiomyosarcoma, though not 100%.

    4. Endometrial Biopsy / Hysteroscopy

       • If abnormal bleeding is present, doctors may take a tissue sample.

       • Biopsy helps detect cancer in the uterine lining.

    5. Surgery (Myomectomy / Hysterectomy)

       • In some cases, the only way to know for sure is to remove the growth and check it under a microscope.

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    ✅ Key Takeaway

    • Fibroids are common and usually harmless.

    • Cancer (leiomyosarcoma) is rare but serious, so doctors look for warning signs: rapid growth (especially after menopause), abnormal bleeding, or suspicious imaging results.

    • Definitive diagnosis often requires a biopsy or surgical removal.

    🩺 Evaluation Flowchart

    1. Symptoms Appear

    • Heavy bleeding, pelvic pain/pressure, enlarged abdomen, or new post-menopausal bleeding.

    ⬇️

    2. Physical Exam (Pelvic Exam)

    • Doctor checks uterine size and shape.

    • If uterus feels enlarged or irregular → go to imaging.

    ⬇️

    3. Imaging

    • Ultrasound (first step): shows fibroid size, number, location.

    • MRI (if needed): gives detailed view; helps distinguish fibroid vs suspicious mass.

    ⬇️

    4. Red Flag Check

    • Rapid growth (especially after menopause)?

    • Unexplained bleeding?

    • Pain worsening suddenly?
      👉 If YES → further testing.

    • 5. Tissue Sampling

      • Endometrial biopsy (if abnormal bleeding).

      • Hysteroscopy (camera into uterus with biopsy).

      ⬇️

      6. Final Diagnosis

      • Fibroid (benign): Confirmed on imaging or surgical removal.

      • Cancer (leiomyosarcoma or endometrial cancer): Confirmed by pathology (biopsy/surgery).

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      ✅ Summary: Doctors start with symptoms → exam → imaging → biopsy if needed → final diagnosis. Fibroids are benign almost all the time, but suspicious signs trigger deeper tests to rule out cancer.

sitter documentation

  Patient is awake and turning in bed to find a comfortable position. 

“Pt awake; repositioning self in bed for comfort.”

Fibroid Diagnosis process

 If you have mild cramping from a uterine fibroid, doctors usually follow a step-by-step approach to diagnosis and management.

Here’s a simple breakdown:

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1. Diagnosis Process

Doctors want to confirm the fibroid and check its size, number, and location.

A. Medical history & symptom review

• Ask about pain, bleeding patterns, urinary/bowel changes, fertility issues.

• Note if pain is cyclical (period-related) or constant.

B. Physical exam

• Pelvic exam to feel for an enlarged, irregular uterus.

C. Imaging tests

• Pelvic ultrasound (most common first step) – shows fibroid size, shape, and location.

• MRI – for detailed mapping if surgery is considered or diagnosis is unclear.

• Sonohysterography (saline-infusion ultrasound) – to check fibroids inside the uterine cavity.

• Hysteroscopy – direct view of the uterine cavity with a camera, if needed.

D. Lab tests (if symptoms involve heavy bleeding)

• CBC (check for anemia).

• Possibly pregnancy test or hormone levels to rule out other causes.

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2. Management for Mild Pain

If pain is mild and fibroids are not causing major complications, treatment is usually conservative.

A. Watchful waiting (“observation”)

• No immediate surgery.

• Regular follow-up with ultrasound (every 6–12 months).

• Track symptoms.

B. Symptom control

• NSAIDs (ibuprofen, naproxen) for cramps.

• Heat therapy (warm pad on lower abdomen).

• Lifestyle changes: balanced diet, exercise, stress reduction.

C. Hormonal treatments (if bleeding is bothersome)

• Birth control pills or hormonal IUD to reduce heavy flow.

• Progesterone tablets or injections.

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3. Procedures (only if symptoms worsen)

If mild pain becomes moderate/severe or other problems arise (e.g., anemia, pressure symptoms), doctors may suggest:

• Myomectomy – remove fibroid(s) while keeping uterus.

• Uterine fibroid embolization (UFE) – shrink fibroid by blocking its blood supply.

• Endometrial ablation – reduce bleeding (not for large fibroids or future pregnancy).

• Hysterectomy – remove uterus (only in severe cases or if no desire for pregnancy).

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💡 Key point:
For mild cramping from a fibroid, the most common approach is diagnosis via ultrasound followed by symptom management and monitoring, not immediate surgery.

Menstrual Pain Context

 

Pain Score	Description	Menstrual Pain Context
0	No pain	Some people feel only mild discomfort or none at all during periods.
1–3	Mild pain	Slight cramps; able to do normal activities without much trouble.
4–6	Moderate pain	Noticeable cramps; may need rest or pain medication; some difficulty with daily tasks.
7–10	Severe pain	Very strong cramps; may cause nausea, sweating, dizziness; often interferes with school, work, or normal activities (seen in dysmenorrhea).

For many people with a “typical” period, pain is usually in the mild-to-moderate range (about 3–6/10), especially during the first 1–2 days.
If pain is above 7/10 regularly, lasts several days, or affects daily functioning, it’s considered more severe than normal and may require medical evaluation.

Zofran - ondansetron

 Zofran (generic name ondansetron) is primarily indicated for the prevention and treatment of nausea and vomiting.

Main uses include:

Chemotherapy-induced nausea and vomiting (CINV) – given before and sometimes after chemotherapy.

Radiation-induced nausea and vomiting (RINV) – to prevent nausea from radiation therapy.

Postoperative nausea and vomiting (PONV) – used before or after surgery to reduce nausea.

How it works: Zofran is a 5-HT₃ receptor antagonist. It blocks serotonin receptors in the brain and gut that trigger the vomiting reflex.

pT1miN0 R breast

  pT1miN0 R breast

Breakdown of Terms:

pT1mi: p = Pathologic stage (based on what was found during surgery or under the microscope). T1mi = Tumor is 1 millimeter or smaller (microinvasion). "mi" = microinvasion (tiny invasion beyond the ducts or lobules into nearby tissue). N0: No cancer found in the lymph nodes (N = nodes, 0 = none involved). R breast: Cancer is located in the right breast.

What it means overall:

This indicates a very early-stage breast cancer in the right breast, where:

• The invasive tumor is extremely small (1 mm or less),

• No lymph nodes are involved,

• The tumor was confirmed pathologically (via tissue testing).

This is generally considered Stage I breast cancer 

(specifically, Stage IA if there’s no nodal involvement), which often has a very good prognosis.

1. Histologic type (e.g., invasive ductal carcinoma)

1. Hormone receptor status (ER, PR, HER2)

2. Margins

3. Lymphovascular invasion

4. Ki-67 (if available)

Other notes (like DCIS, grade, or BRCA status)

 The pathology report shows an early-stage breast cancer in the right breast, classified as pT1miN0.

 This means the tumor has only microinvasion (1 millimeter or less into nearby tissue) and no cancer was found in the lymph nodes. 

This is a very favorable stage, often called Stage I, and patients with this diagnosis typically have a high chance of successful treatment. 

Treatment decisions will depend on additional test results, such as hormone receptor status (ER, PR, HER2), which guide whether the patient may benefit from hormone therapy, chemotherapy, or targeted therapy.

🔬 What Are ER and PR?

• ER = Estrogen Receptor

• PR = Progesterone Receptor

These are proteins found on some breast cancer cells. If the cells have them, the cancer "feeds" on hormones like estrogen or progesterone to grow.

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✅ ER/PR Positive (ER+ / PR+)

Meaning:

• The cancer has receptors for estrogen and/or progesterone.

• It uses these hormones to grow.

Outcome:

• This is usually a good sign.

• Treatable with hormone (endocrine) therapy, such as:

  • Tamoxifen (for pre-menopausal women)

  • Aromatase inhibitors (for post-menopausal women)

• These treatments block or lower hormone levels, slowing or stopping cancer growth.

• Better long-term outlook with lower recurrence risk.

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❌ ER/PR Negative (ER− / PR−)

Meaning:

• The cancer does not have hormone receptors.

• It does not rely on estrogen or progesterone to grow.

Outcome:

• Hormone therapy will not work.

• Treatment may rely more on:

  • Chemotherapy

  • Targeted therapy (if HER2+)

  • Radiation/surgery

• Sometimes, these cancers may be more aggressive, but newer treatments are improving outcomes.

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🧪 Mixed Results

• Sometimes a tumor might be ER+ but PR− or vice versa.

• Doctors still usually treat it as hormone-responsive, especially if ER+.

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🔄 Summary Table:

Result	Treatment Option	Prognosis
ER+/PR+	Hormone therapy works	Better prognosis
ER−/PR−	No hormone therapy	May need chemo
ER+/PR− or PR+/ER−	Usually still use hormone therapy	Intermediate

🔬 What is Microinvasive Carcinoma?

Microinvasive carcinoma is a very early form of invasive breast cancer.

• It begins as DCIS (Ductal Carcinoma In Situ), which means the cancer is contained inside the milk ducts and has not yet spread.

• In microinvasion, a tiny amount of cancer cells (≤ 1 millimeter) has just started to break out of the duct into nearby breast tissue.

• It is still considered Stage I, specifically T1mi, and is much less advanced than regular invasive cancer.

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✅ What It Means for Treatment and Prognosis:

• It’s often very treatable with an excellent prognosis.

• Doctors will look at other factors like:

  • Hormone receptor status (ER/PR)

  • HER2 status

  • Tumor grade

  • Lymph node involvement (you mentioned N0 = no lymph nodes involved)

• If ER/PR positive, hormone therapy like Tamoxifen might be recommended to reduce recurrence risk.

• Radiation therapy may be used after lumpectomy.

• Chemotherapy is usually not needed unless other aggressive features are present.

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🧾 Summary:

Term	Meaning
Microinvasive carcinoma	Tiny spread (≤1 mm) of cancer outside the duct
Stage	Stage I (early-stage cancer)
Prognosis	Very good, especially if no lymph node spread (N0) and ER/PR+
Common Treatments	Surgery, maybe radiation, possibly hormone therapy (if ER/PR+)

🧠 What the Report Says (in Plain Language):

• DCIS (Ductal Carcinoma In Situ):
  A 3.7 cm area of non-invasive cancer was found.

  • DCIS means cancer cells are inside the milk ducts and have not spread into surrounding breast tissue.

• Microinvasive carcinoma:
  Tiny areas of cancer (measuring between 0.1 to 0.8 mm) have just started to spread outside the ducts.

  • This is called microinvasion and is considered Stage I (T1mi).

• Margins:

  • Margins refer to the edges of the removed tissue.

  • Your anterior and inferior margins are focally positive for DCIS, meaning some cancer cells may be close to or touching the edge of the removed tissue in those areas.

  • This may require additional surgery (like a re-excision) or careful radiation to reduce the risk of recurrence.

• 0/6 LN (Lymph Nodes):

  • All 6 lymph nodes removed were negative, which means no cancer spread to lymph nodes (great news!).

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📋 Summary Table:

Finding	Meaning
DCIS – 3.7 cm	Non-invasive cancer within ducts, relatively large in size
Microinvasion (0.1–0.8 mm)	Tiny areas of invasion beyond the duct, early-stage invasive cancer
Margins focally positive	Cancer cells are close to some edges – may need more surgery/radiation
0/6 Lymph Nodes	No spread to lymph nodes – a very good sign

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✅ What This Means for You:

• Very early invasive cancer with a good outlook.

• May need:

  • Surgery to clear the positive margin

  • Radiation therapy (especially after lumpectomy)

  • Hormone therapy if ER/PR-positive

• No chemotherapy is typically needed unless there are other aggressive features.

microinvasive carcinoma ranging from 0.1-0.8 mm amidst 3.7 cm DCIS with margins for in-situ disease focally positive anterior and inferior, 0/6 LN.

perfusion index

 If the monitor shows a PERF value of 3.85, it typically refers to the Perfusion Index (PI), which is a numerical value provided by pulse oximeters to indicate the strength of blood flow at the sensor site.

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🔍 Understanding Perfusion Index (PI):

• Perfusion Index (PI) ranges from 0.02% (very weak) to 20% (very strong).

• A PI of 3.85% is considered a moderate to good perfusion value.

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✅ Interpretation of 3.85 PI:

• Normal and adequate peripheral perfusion.

• No immediate concern unless symptoms or other vital signs are abnormal.

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📝 Quick PI Reference:

PI Value (%)	Perfusion Strength
< 0.5	Very weak perfusion
0.5 – 1.0	Weak perfusion
1.0 – 3.0	Moderate perfusion
3.0 – 10.0	Good perfusion (normal)
> 10.0	Strong perfusion

So, a reading of 3.85 indicates that the patient likely has adequate blood flow at the sensor site, such as a fingertip. Always confirm with other signs like heart rate, blood pressure, and capillary refill.

Perform Bone Marrow Biopsies or Aspirations (BMS)

 The role of Peds BMS (Pediatric Bone Marrow Specialist or Bone Marrow Service) depends on the context, but generally refers to a specialized team in pediatrics focused on bone marrow-related conditions, particularly in hematology-oncology (blood and cancer disorders in children).

Key Roles of a Pediatric BMS Team:

Diagnosis and Management of Blood Disorders

Leukemia (ALL, AML)

Lymphomas

Aplastic anemia

Sickle cell disease

Thalassemia

Immunodeficiencies

Bone Marrow Transplant (BMT) Services

Evaluate patients who need stem cell or bone marrow transplant

Find donor matches (sibling, unrelated donor, or cord blood)

Manage transplant procedures and post-transplant care

Perform Bone Marrow Biopsies or Aspirations

For diagnosing cancers, infections, or marrow failure

Analyze cell types, counts, and marrow structure

Coordinate Care with Oncology & Genetics Teams

Work with oncologists, immunologists, and geneticists for complex cases

Monitor for complications like graft-versus-host disease (GVHD)

Research and Clinical Trials

Participate in studies for new treatments or transplant techniques

In Summary:

A Peds BMS team plays a critical role in diagnosing, treating, and supporting children with serious blood and immune system diseases, especially those needing bone marrow transplants. They provide highly specialized care that can be life-saving.

EGD (esophagogastroduodenoscopy)

 When an EGD (esophagogastroduodenoscopy)

biopsy shows pathology concerning for B-cell involvement, 

it usually means the pathologist saw abnormal lymphoid cells in the tissue that may be related to a 

B-cell lymphoma, which is a type of blood cancer that starts in B lymphocytes, a kind of white blood cell.

Here’s why this might happen:

1. Lymphoid Infiltrate in the GI Tract

• The stomach and intestines have lymphoid tissue as part of the immune system.

• Sometimes, B-cells grow abnormally in the lining of the GI tract, forming masses or ulcers.

• If these cells look clonal (all the same) or atypical, it raises concern for lymphoma.

2. Most Common: MALT Lymphoma

• A common type of B-cell lymphoma in the stomach is MALT (mucosa-associated lymphoid tissue) lymphoma.

• Often associated with H. pylori infection.

• Chronic infection stimulates B-cells to grow uncontrollably.

3. What Pathologists Look For

• Immunohistochemistry (IHC) tests: show markers like CD20, which is on B-cells.

• Light chain restriction: too many kappa or lambda chains suggest clonal B-cell growth.

• Cell appearance: large, irregular B-cells may indicate high-grade lymphoma.

4. Why It Matters

• B-cell involvement may mean the patient has a form of gastrointestinal lymphoma, needing further tests like CT scan, bone marrow biopsy, or PET scan.

• Early detection is important because some types (like MALT) respond well to antibiotics or immunotherapy.

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