Non-Hodgkin's Lymphoma

What tissues are affected by lymphomas?

Usually start in lymph node but can involve the: -spleen -GI tract -Live -Bone Barrow

Non-Hodgkin's Lymphoma diagnosis

based on histopathology of malignant cells: if indolent = small cells, less aggressive if aggressive = cells are large and immature and distributed spontaneously throughout nodes

An NHL mass in the Spleen can:

cause abdominal discomfort, nausea, early satiety (feeling full when you aren't) --> anorexia & weight loss

What are the two classifications of Lymphomas?

non-hodgkin and hodgkin

What is the incidence of NHL increased with immunodeficient individuals?

Immune system cannot surveil for cancer cells effectively making these people more prone to developing NHL

survival rate of NHL?

69% at 5 years; 59% at 10 years

What is CHOP-BLEO?

A chemotherapy combination used in treating advanced stages of NHL C - cyclophosphamide H - hydroxyldaunorubicin (Adriamycin) O - vincristine (Oncovin) P - prednisone BLEO - bleomycin

Medical management of NHL

(1) Accurate staging is crucial to determine the treatment regimen. (2) Chemotherapy and radiation. (3) Immunotherapy with monoclonal antibodies. (4) Bone marrow transplant.

Non-Hodgkin's Lymphoma nursing considerations

- high risk for infection: teach measures to reduce incidence - survivors should be screened regularly for development of second malignancies (other types of cancer that may arise)

NHL symptoms

Asymptomatic at early stage however, once at stage III/IV: (lymphadenopathy) Swollen, painless lymph nodes in the neck, armpits, or groin Unexplained weight loss Fever Soaking night sweats Coughing, trouble breathing, or chest pain Weakness and tiredness that don't go away Nausea, vomiting, pain, or a feeling of fullness in the abdomen Severe itchiness or skin rash

An NHL mass in the mediastinum can:

cause respiratory distress

How is Non-Hodgkin's Lymphoma staged?

CT scan & bone marrow aspiration

A client with Hodgkin lymphoma is receiving information from the oncology nurse. The client asks the nurse why it is necessary to stop drinking and smoking and stay out of the sun. Which response by the nurse would be best? a. "Avoiding these factors can reduce the risk of Reed-Sternberg cells developing." b. "These behaviors can reduce the effectiveness of your chemotherapy." c. "Engaging in these activities increases your risk of hemorrhage." d. "It's important to reduce other factors that increase the risk of second cancers."

d. "It's important to reduce other factors that increase the risk of second cancers." Explanation: The nurse should encourage clients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight. The presence of Reed-Sternberg cells is the pathologic hallmark and essential diagnostic criterion for Hodgkin lymphoma, so avoiding these behaviors will not reduce the risk of Reed-Sternberg cells developing. There is no evidence that these behaviors will reduce the effectiveness of chemotherapy or increase the risk of hemorrhage, which is not a typical complication of Hodgkin lymphoma.

Non-Hodgkin's Lymphoma

originates from neopastic growth of lymphoid tissue which are largely infiltrated w/ malignant cells such as: - malignant B lymphocytes - NHL is the 6th most common type of cancer

The nurse is caring for a client receiving treatment for non-Hodgkin lymphoma (NHL). Which assessment findings indicate to the nurse that the client is developing multifocal leukoencephalopathy? Select all that apply. a. Altered vision b. Change in speech c. Facial nerve paralysis d. Change in motor coordination e. Peripheral neuropathy

a. Altered vision b. Change in speech d. Change in motor coordination Explanation: The goal of treatment for NHL is to obtain remission of disease by killing as many of the malignant cells as possible. A rare but potentially life-threatening complication is progressive multifocal leukoencephalopathy which may occur in clients with NHL who are severely immunocompromised and treated with chemotherapeutic agents. Symptoms of this complication include confusion, altered vision, change in speech, and a change in motor coordination. Facial nerve paralysis and peripheral neuropathy are not symptoms of this complication.

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? a. Health history, such as bleeding, fatigue, or fainting b. Menstrual history c. Age and gender d. Lifestyle assessments, such as exercise routines

a. Health history, such as bleeding, fatigue, or fainting Explanation: When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.

For a client with Hodgkin lymphoma, who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowler's position to: a. reduce deficits in the blood oxygen concentration. b. detect compromised ventilation. c. increase lung expansion. d. anticipate the need for airway management.

c. increase lung expansion. Explanation: For a client with Hodgkin disease who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse keeps the neck in the midline and places the client in a high Fowler's position if respiratory distress develops. Avoiding unnecessary pressure on the trachea and positioning for increased lung expansion improve air exchange. The nurse administers oxygen, per the physician's orders, to reduce deficits in the blood oxygen concentration. The nurse assesses the client's respiratory status during each shift to detect compromised ventilation. The nurse places an endotracheal tube, a laryngoscope, and a bag-valve mask at the bedside for intubation if the need for the airway management arises.

An NHL mass in the abdomen can:

compromise ureters --> renal dysfunction