NURS 301 Nursing Management Patients with Hematologic Disorders.pdf

Chapter 20: Nursing Management Patients with Hematologic Disorders

Lymphoma: neoplasms (abnormal growth of tissue) of lymphoid tissues; usually

derived from B lymphocytes

oUsually start in lymph nodes but can involved lymphoid tissue in the spleen

and GI tract, liver or bone marrow

oOften classified according to degree of cell differentiation and origin of

predominant malignant cell

oHodgkin’s Lymphoma: relatively rare with impressive cure rate

Pathophysiology

Unicentric in origin; originates in single lymph node

Disease spreads by contiguous extension along lymphatic

system

Reed-Sternberg cell: large tumor cell; morphologically unique

and thought to be of immature lymphoid origin

oPathologic hallmark and essential diagnostic criterion for

Hodgkin’s disease

5 sub-types of Hodgkin’s lymphoma

oclassified into four stages I-IV

Risk Factors

More common in men than women and 2 peaks of incidence

oEarly 20’s and other after 50 years of age

Familial pattern

Seen more commonly in patients receiving chronic

immunosuppressive therapy and in woodworkers

Seen in veterans who were exposed to Agent Orange

Clinical Manifestations and Assessment

Begins as painless enlargement of one or more lymph nodes

above the diaphragm

oNodes are painless and rubbery/firm but not hard

Pruritus is common

Painless enlarged cervical lymph nodes

All organs are vulnerable to invasion

oSymptoms result from compression of organs by the tumor

Cough, pulmonary effusion, jaundice, abdominal pain

or splenomegaly/retroperitoneal adenopathy or bone

pain

oHerpes infections are common

“B Symptoms”

ofever without chills, drenching sweats and unintentional

weight loss

oMore common in advanced disease

Mild anemia is most common hematologic finding

Leukocyte count may be elevated or decreased

Platelet count is typically normal

oUnless tumor has invaded the bone marrow

Many manifestations are similar to those occurring with infection

oDiagnostic studies are performed to rule out infectious

origin

Chest X-Ray, CT scan of chest, abdomen and pelvis and PET scan

oAssist with staging

Lab tests

oCBC, platelet count, ESR, lactate dehydrogenase and

liver/renal function studies

Bone marrow biopsy

oSee if marrow involvement

Medial Management

Treatment is determined by the stage of the disease

2-4 months of chemotherapy followed by radiation therapy

ocombination therapy prevents relapse and improve survival

Combination chemotherapy is now standard treatment for

advanced disease

Long-Term Complications

Hypothyroidism, immune dysfunction, dental caries,

cardiomyopathy and secondary malignancies

Risk factors for other cancers should be assessed

oLung cancer is most common secondary malignancy

oBreast cancer in women

Patients should be encouraged to reduce other factors that

increase risk of developing secondary cancers

oTobacco, alcohol and exposure to environmental

carcinogens

oNon-Hodgkin’s Lymphomas

Heterogeneous group of cancers; originate from neoplastic growth of

lymphoid tissue

Thought to arise from a single clone of lymphocytes; cells may

vary morphologically

Lymphoid tissues involved are largely infiltrated with malignant

cells

oSpread of these cells occurs unpredictably

Incidence has increased with immunodeficiency’s or autoimmune

disorders, prior cancer treatment, prior organ transplant, viral

infections and exposure to pesticides, solvents, dyes of defoliating

agents

Clinical Manifestations and Assessment

Symptoms are highly variable

Lymphadenopathy is most common

oIn less aggressive types; can wax and wane

Early-stage disease or types more indolent

oMay be no symptoms and the illness is typically not

diagnosed until it progresses to a later stage

Lymphomatous masses can compromise organ function

oMass in mediastinum: cause respiratory distress

oAbdominal mass: compromise ureters; leading to renal

dysfunction

oSplenomegaly: cause abdominal discomfort, nausea, early

satiety, anorexia and weight loss

Medical Management

Treatment is based on actual classification of the disease, prior

treatment and patient’s ability to tolerate therapy

Nursing Management

Extremely important to know specific disease type, stage of

disease, treatment history and current treatment plan

Regardless of type of treatment all patients experience fatigue

Risk for infection is significant

oTaught to minimize risks for infection, recognize signs of

possible infection

Know tumor location; assessments can be targeted appropriately

Students also viewed