Nursing care plan lymphomas

I. Pathophysiology
a. Malignant growth involving reticuloendothelial and
lymphoid system, resulting in accumulation of abnormal
lymphocytes in lymph tissue forming masses; may travel
to distant sites, including the lungs, liver, gastrointestinal
(GI) tract, meninges, skin, and bones
b. Major sites of lymphoid tissue are lymph nodes, spleen,
thymus gland, adenoids and tonsils, and digestive tract.
II. Classification
a. Defined by clinical, immunological, molecular, genetic, and
histological characteristics
b. Based on histological characteristics, lymphomas are divided
into two major categories: Hodgkin’s disease or Hodgkin
lymphoma (HL), with five subtypes, and non-Hodgkin
lymphoma (NHL) with 30 subtypes.
i. HL
1. Slow, insidious onset; superficial lymphadenopathy in
cervical, supraclavicular, or mediastinal lymph nodes,
which are firm, rubbery, and freely movable
2. Spreads in a generally predictable manner to contiguous
lymph nodes via lymphatic channels
ii. NHL
1. Most fall into two broad categories related to the
clinical features: nodular indolent lymphomas and
diffuse, aggressive lymphomas.
2. When normal follicular structure of the nodes remains
intact, the lymphoma is called follicular or nodular,
whereas if malignant cells destroy the follicles, the
lymphoma is considered diffuse.
3. May be separated into two categories—low-grade
lymphomas and aggressive lymphomas, which includes
intermediate-grade and high-grade lymphomas
a. With or without treatment, low-grade lymphomas
can transform into more aggressive lymphomas or
the tumor replaces blood or lymph tissue leading to
multiple systemic dysfunction and death.
b. Intermediate- and high-grade lymphomas tend to be
more responsive to treatment.
c. Further staging is done to determine treatment
options and prognosis.
iii. Stages I to IV reflect the microscopic appearance of
involved lymph nodes and the extent and severity of the
disorder.
iv. May be further classified by letters of the alphabet
(A, B, etc.) according to symptoms present at the time
of diagnosis

III. Etiology (Hu & Hale, 2005)
a. Exact causes are unknown.
b. Several factors have been linked to an increased risk.
i. Age: Risk of NHL generally increases with advancing
age; HL in the elderly population is associated with a
poorer prognosis than in younger clients.
ii. Infection: human immunodeficiency virus (HIV); human
T-lymphocytic virus type 1 (HTLV-1); Epstein-Barr virus
(EBV), one of the etiological factors in mononucleosis;
Helicobacter pylori; hepatitis B or C virus
iii. Medical conditions that compromise the immune system:
HIV; autoimmune diseases; conditions requiring
immunosuppressive therapy, such as following organ
transplant; inherited immunodeficiency diseases; or
treatment with phenytoin
iv. Exposure to toxic chemicals: occupational exposure to
pesticides, herbicides, or benzene and other solvents;
woodworking
IV. Statistics
a. Morbidity: In 2007, 71,380 people were diagnosed with
lymphoma in the United States (Leukemia & Lymphoma
Society, 2006); the 5-year survival rate is 77% to 83%
for HL and 42% to 53% for NHL (Dunleavy et al, 2007);
incidence of NHL is consistently higher than HL, with
NHL the fifth most common cancer in the United States
(Leukemia & Lymphoma Society: Facts 2007–2008).
b. Mortality: In 2001, there were an estimated 26,300 deaths
from NHL (Gajra et al, 2007); mortality rate increases with
age (Dunleavy et al, 2007).
c. Cost: In 2004, projected costs for care were $4.6 billion
(National Cancer Institute [NCI], 2007).

Care Setting
The client receives acute inpatient care on a medical unit for
initial evaluation and treatment and then at the community
level. This plan of care addresses potential complications
that may be encountered in acute care or hospice settings.

Related Concerns
Anemias—iron deficiency, anemia of chronic disease, pernicious,
aplastic, hemolytic,
Cancer,
Adult leukemias,
Psychosocial aspects of care,
Sepsis/septicemia,
Spinal cord injury (acute rehabilitative phase),
Transplantation considerations—postoperative and lifelong,
Upper gastrointestinal/esophageal bleeding,

Nursing Priorities
1. Provide physical and psychological support during extensive
diagnostic testing and treatment regimen.
2. Prevent complications.
3. Alleviate pain.
4. Provide information about disease process, prognosis, and
treatment needs.

Discharge Goals
1. Complications prevented or minimized.
2. Dealing with individual situation realistically.
3. Pain relieved or controlled.
4. Disease process, prognosis, possible complications, and
therapeutic regimen understood.
5. Plan in place to meet needs after discharge.

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