Hodgkins Lymphoma Report
Transcript of Hodgkins Lymphoma Report
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 1/34
Prepared by: Marian S. Jalos
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 2/34
LYMPHATIC SYSTEM
Includes the thymus gland , spleen and a network
of lymphatic vessels , lymph nodes and lymph.
This system circulates interstitial fluid and carries
it into the veins . Along the pathway, lymphatic
system filters and destroys pathogens andremoves other potentially harmful substances.
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 3/34
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 4/34
Malignant Lymphoma
Lymphomasare neoplasm of cells of lymphoid origin.
tumors usually start in lymph nodes but can involve
lymphoid tissue in the spleen , GIT (wall of thestomach),liver and bone marrow.
they are often classified according to the degree of cell
differentiation and the origin of the predominant
malignant cell.can be broadly classified into two categories:
Hodgkin’s disease and Non- Hodgkin’s lymphoma.
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 5/34
HODGKIN’S LYMPHOMA ( HODGKIN’S DISEASE )
Thomas Hodgkin an
English Physician first
Describe the disorder in1832; in 20th century,
realization that the
disease is a lymphoid
malignancy led to it
being renamed Hodgkin
lymphoma.
Background
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 6/34
HODGKIN LYMPHOMA (HODGKINS
DISEASE)
Is a malignantdisease of unknown
etiology that
originates in the
lymphoid system and
involves
predominantly the
lymph nodes.It may occur in
nearly any lymphoid
tissue; spleen, bone
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 7/34
Four Major Classification
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 8/34
EXACT CAUSEPREDISPOSING
CAUSES
UNKNOWN
•Exposure tocarcinogens and
viruses•Genetic and
immune
mechanism•Gender (more
common in man)
RRddd
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 9/34
PATHOPHYSIOLOGY
Epstein-Barr Viruscause mutation in some lymphocytes
Creating malignant cell ( Reed Sternberg cell )
abnormal lymphocytes proliferate
Virus inactivate the immune system „s ability to suppress tumor
Malignant cell release chemicals
( cytokines ,histamine )
Inflammatory symptoms
Pain and fever
Generalized itching and skin rash
Leads to immunologic defect
Cachexia (state of ill health , malnutrition , wasting)
Progressive anemia
Respiratory obstruction death
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 10/34
COMPLICATIONS
o ANEMIA
oINFECTIO
No NAUSEAoDEATH
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 11/34
CLINICAL MANIFESTATIONS
o painless enlargement of lymph nodes ( usually on
one side of the neckoSlight to high fever, night sweats , wt.loss („‟B
symptoms‟‟)
oPruritus ( either local or generalized )
oProgressive anemia
o
Enlargement of lymph nodes in other regions of the body
oEnlargement of mediastinal and retroperitoneal
lymph nodes producing pressure symptoms
-Dyspnea from pressure against the trachea
- dysphagia from pressure against the esophagus
- laryngeal paralysis due to pressure against the
recurrent laryngeal nerve.
- brachial, lumbar, or sacral neuralgias due to
pressure on the nerve.
-Edema of the extremities due to pressure on the
veins- enlar ement of s leen and liver
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 12/34
DIAGNOSTIC TEST
o Biopsy of Lymph node
o chest x- ray
o CT scan
o bone marrow biopsy
o
Liver function test andScan
oLymphangiogram
- reveals size of lymph
node-Detects abdominal lymph
node involvement , which
may not be seen on
tomography
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 13/34
STAGES OF HODGKIN‟S DISEASE
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 14/34
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 15/34
NURSING DIAGNOSIS
oRisk for Ineffective
Airway clearance
oRisk for Impaired GasExchange
oRisk for Infection
oActivity IntoleranceoSelf care deficit
oAlteration In Nutrition
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 16/34
MEDICAL MANAGEMENTRADIOTHERA
PYoDelivery of a lethal dose of ionizing
radiation to tumor cells.
oAn important factor in treatment is the
radiation dose administered.oCOMPLICATIONS of INTENSIVE
RADIOTHERAPY: radiation pneumonitis
and fibrosis , pericarditis , nephritis,
myelitis, hypothyroidism and sterility
o
ACUTE REACTION TO RADIATION :dryness of mouth , loss of taste,
dysphagia , nausea and vomiting , apathy
, skin redness, loss of hair at back of neck
and under areas treated , reduction of
WBC
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 17/34
NURSING INTERVENTIONS
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 18/34
Gas Exchange
Assess respiratory status each shift and prn.Note
quality,rate, pattern, depth,flaring of nostrils,dyspnea on
exertion,evidence of splinting use of accessory muscles and
position for breathing.
Any deviat ion from quiet, effort less breathing indicates
comprom ised vent i lat ion
Keep the neck in midline and place the client in high fowlers
position if respiratory distress developAvoiding unnecessary pressure on the trachea and
posi t ioning for increased lung expansion improve air
exchange
Administer oxygen per physician orders if bloos saturationis consistently less than 90%
Reduces def ic i ts in the blood oxygen level .
Place an endotracheal tube,laryngoscope and bag valve
mask at the bedside for intubation
Ensures that medical and emergency assistance are not
NURSING INTERVENTIONS
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 19/34
Risk for Infection
Restrict visitors or personnel with infections fromcontact with the client
Reduces transm iss ion of pathogens
Practice conscientious hand washing and follow
other principles of medical and surgical asepsisReduces r isk of t ransm itt ing pathogens from one
location to ano ther
Institute infectious disease precautions if normal
WBC are suppressed to dangerous limits.
Protect ive isolat ion technique provide an
env ironmental barr ier against pathogens whi le a
cl ient is highly suscept ib le to disease .
ACTIVITY INTOLERANCE and SELF
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 20/34
ACTIVITY INTOLERANCE and SELF
CARE DEFICIT
Divide care into manageable amounts
Reduces energy expend i tures
Provide rest periods between activities first
Cl ients completes most important or
necessary act iv i t ies whi le energy levels are
highest
Assist client with whatever activities of daily living are independently unmanageable
Reduces the cl ients energy expend i ture
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 21/34
NURSING INTERVENTIONS
Esophagitis – bland soft foods and mildtemperature,anesthetic lozenges, pain medication before
eating if patient unable to eat.
Loss of taste – serve palatable meals
Anorexia – encourage patient to make the effort to eat.
Nausea and Vomiting – anti emetics given to cover peak
time of nausea.
Diarrhea - anti diarrheal medications
Skin reaction (sunburned/tanned appearance of treatment
area) – avoid rubbing , heat,cold applications of lotionLethargy – rest/sleep to keep energy level up; diversional
activities to prevent boredom
Tingling with numbness in hands , toes , weakness in knees
, hands – use a cane for stability
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 22/34
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 23/34
QUESTIONS
1.Which of the following conditions is not
a complication of Hodgkin’s disease?
A. AnemiaB. Infection
C. Myocardial infection
D. infection
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 24/34
2.At the time of diagnosis of
hodgkin‟s disease ,which of thefollowing areas is often involved
A.BackB.Chest
C.Groin
D.Neck
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 25/34
3.According to a standard staging classification
of Hodgkin’s disease , which of the following
criteria reflects stage II? A. Involvement of extra lymphatic organs or
tissues
B. Involvement of single lymph nodes region orstructure
C. Involvement of two or more lymph nodes
region or structure D. Involvement of lymph node or structures on
both sides of diaphragm
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 26/34
4.Which of the following statements is
correct about the rate of cell growthrelations to chemotherapy?
A.Faster growing cells are less
susceptible to chemotherapyB.Non dividing cells are more
susceptible to chemotherapy
C.Faster growing cells are moresusceptible to chemotherapy
D.Slower growing cells are more
susceptible to chemotherapy
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 27/34
5.A nurse is taking the history from a
client who is suspected of havingHodgkin‟s disease . Which of the
following questions should the nurse
ask to support the diagnosis?A.“ do you wake up sweating during the
night?”
B. “ Do you have difficulty breathingwhile lying flat?‟‟
C.“ have you noticed a lump in your
neck?”
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 28/34
6.What is the best advocate approach to a client who
wishes to discontinue chemotherapy because of complications of the treatment and recurrence of her
cancer , but whose husband wants her to continue
treatment?
A. Encourage the client to discuss her
feelings with you
B. Offer to stay with the client when she talks to her
husband and doctor about her wishesC. Inform the client that she has the right to
discontinue therapy
D. Talk to the healthcare team about the conflict
between the client and her husband
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 29/34
7. To which of the following nursingdiagnoses would a nurse give priority for
a client whose blood test reveals a white
blood cell count of 3000/mm³?A.Risk for activity intolerance
B.Impaired gas exchange
C.Impaired tissue integrityD.Risk for infection
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 30/34
8.A nurse is caring for a client whohas just had endotracheal tube
inserted. Which of the following
actions would the nurse take first?A.Inflate the cuff with appropriate
volumeB.Auscultate for bilateral breath
sounds
C.Tape the tube securely in place
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 31/34
9-10.What are the 3 „B SYMPTOMS OF HODGKIN‟S DI
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 32/34
RATIONALE
1.C.myocardial infarction complications of hodgkin‟s
are pancytopenia,nausea,and infection2.D.at the time of diagnosis a painless cervical
lesion is often present.The back,chest,groin area
arent involved.
3.C.Stage II involves two or more lymph node
region.Stage I only involves one lymph node
regions.Stage III involves nodes on both sides of the
diaphragm.Stage IV extralymphatic organ or tissues.
4.C.the faster the cell grows,the more susceptible it
is to chemotherapy and radiation therapy.Slow
growing and non dividing cells are less susceptible
5 C the earliest manifestation of hodgkin‟s
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 33/34
5.C. the earliest manifestation of hodgkin‟s
disease is usually an enlarged, painless
node in the neck.Hodgkin‟s is a cancer
which originates from the lymph tissue. It isusually starts in a single lymph node or in a
chain of nodes. The lymph tissue undergoes
a malignant transformation which includesinflammation.
6.C.adcocacy is defined as the obligation to
look out ,or to speak up, for the rights of others.The best advocacy approach for the
nurse is to inform this client that has the
right to discontinue therapy despite her
7/29/2019 Hodgkins Lymphoma Report
http://slidepdf.com/reader/full/hodgkins-lymphoma-report 34/34
7.C. the normal range for the WBC is
4000-1000µ/ml .Clients exhibiting a low
WBC (leukopenia) are at risk for
infection.
8.A. the first action is to inflate the cuff
so that the tube stays inplace.Afterwards, breath sounds are
auscultated to verify placement.Once
placement is verified,the tube is tape intoplace.
9.The B symptoms are :
Slight to high fe er