Nursing Care Plan for Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Pathophysiology

Lymphoma refers to cancer of the lymphatic system. This system includes the lymph nodes (glands located throughout the body), spleen, thymus gland and bone marrow. There are two main types of lymphoma: Hodgkin’s and Non-Hodgkin’s lymphoma, and they are classified as such depending on the type of cell involved.  Treatment depends on the type and severity. Lymphoma is characterized by painless, swollen lymph nodes.

Etiology

Lymphoma begins when a disease-fighting white blood cell (lymphocyte) develops a genetic mutation. Doctors are still unclear as to what causes this change, but have found that the mutation causes the cells to multiply rapidly and go on living when normal cells would die. The accumulation of these diseased lymphocytes causes swelling of the lymph nodes.  Certain risk factors increase the chance of developing lymphoma, including being male, over 55, having an impaired immune system or taking immunosuppressants, and certain infections such as Epstein-Barr virus and Helicobacter pylori.

Desired Outome

Maintain adequate ventilation, prevent infection, manage pain and symptoms of side effects related to treatments

Lymphoma (Hodgkin’s, Non-Hodgkin’s) Nursing Care Plan

Subjective Data:

  • Persistent Fatigue
  • Shortness of breath
  • Cough
  • Itching
  • Night sweats
  • Lack of appetite

Objective Data:

  • Swollen, painless lymph glands / nodes
  • Fever, without infection
  • Weight loss

*Symptoms are not always present*


Nursing Interventions and Rationales:

  1. Monitor respiratory status and provide supplemental oxygen as necessary.
    • If lymph nodes of the neck and chest are involved, patient may experience shortness of breath, dyspnea and airway obstruction due to obstruction of the trachea or superior vena cava.
  2. Note changes to the skin color; pallor or cyanosis
    • As the WBCs multiply rapidly, it can reduce the oxygen carrying capacity of the red blood cells, resulting in hypoxemia.
  3. Observe for neck vein distention, headache, dizziness, facial edema, dyspnea and stridor
    • Lymphoma patients are at higher risk for vena cava syndrome in which the superior vena cava is obstructed from enlarged lymph nodes. This constitutes a life-threatening emergency and MD should be notified. Emergency radiation treatment may be ordered.
  4. Assess and manage pain; teach relaxation techniques, administer analgesics as necessary
    • While the enlarged lymph nodes are usually painless, patients may experience pain with radiation or chemotherapy treatments. Management of pain and reduction of stress is essential to patients to promote healing and conserve energy.
  5. Nutrition education; monitor daily weight and caloric intake; encourage patients to eat small frequent meals and increase protein intake.
    • Patients may experience lack of appetite and diminished nutrition. Increasing caloric intake promotes healing, provides fuel for energy and prevents gastric distention. Offer more palatable options frequently.
  6. Provide supportive comfort measures following radiation or chemotherapy treatments.
    • Patients often experience extreme fatigue, nausea and vomiting following treatment. Assist with ADLs, offer ice chips and antiemetics as appropriate for nausea.
  7. Assist with positioning and monitor for skin breakdown
    • Fatigue and impaired nutrition cause muscle weakness. Assist patients to positions of comfort for optimal air exchange and monitor skin for signs of breakdown due to prolonged bed rest.

References

Date Published - Oct 31, 2018
Date Modified - Nov 1, 2018