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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 PICC INSERTION 

TIME OUT WAS PERFORMED

1. patient education 
2. discussion plan of care and procedure risk and benefit
3. consent 
4. verified correct patient 
5. correct site
6. correct equitment

 

Trisomy

 Trisomy is a genetic condition where a person has three copies of a chromosome instead of the normal two. Humans usually have 23 pairs of chromosomes (46 in total), but in trisomy, one of those pairs has an extra chromosome—making it 47 total.

For example:

• Trisomy 21 is also called Down syndrome, where there are three copies of chromosome 21.

Trisomy can cause physical, developmental, and health problems, depending on which chromosome is affected. 

T21 stands for Trisomy 21, which is the medical term for Down syndrome.

What is Trisomy 21?

It is a genetic condition where a person has three copies of chromosome 21 instead of the usual two. This extra genetic material affects how the body and brain develop.

Key Features of T21 (Down Syndrome):

• Intellectual disability (mild to moderate)

• Distinct facial features (flat face, almond-shaped eyes, small ears)

• Low muscle tone (hypotonia) in infancy

• Developmental delays

• Higher risk of:

  • Heart defects

  • Hearing and vision problems

  • Thyroid issues

  • Leukemia (increased risk in children)

Causes:

• It usually happens by chance during the formation of reproductive cells.

• Most cases are not inherited.

Diagnosis:

• Can be detected before birth with screening and diagnostic tests (like NIPT, amniocentesis).

• Confirmed after birth with a karyotype test showing 47 chromosomes (an extra chromosome 21).

Support:

People with T21 can live long and fulfilling lives with proper medical care, early therapy, and family support.

Moderate to deep procedural sedation for  Echo

pre procedure plan of care -

1. assess for barrier of learning 
2. access for abuse or neglect 
3. access for pain pre procedure check to be completed 
4. patient education plan of care 
5. patient education discharge care 
6. prepare appropriately for procedure 
7. prevent fall safety precaution

intra procedure plan of care 

1. vital sign 
2. respiratory
3.  oxygen requirement observe 
4. observe skin integrity 
5. infection prevention ( immunocompromised)

post procedure plan of  care 

1. access pain
2. oxygenation status maintain
3. hemostasis to be assess
4. maintain treated 
5. post sedation care