Non-Hodgkin Lymphomas: Nursing Care

Nursing Care of Patients with Hematologic and Lymphatic Disorders

Non-Hodgkin lymphomas (NHLs)

• NHLs are a diverse group of blood cancers in the lymphatic system.
• Unlike Hodgkin lymphoma, there is a wide range of subtypes, each with varying characteristics, behaviors, and treatment approaches.
• The incidence of NHL increases with age.
• Most NHLs are diagnosed in people aged 60 or older.
• NHLs are more common than Hodgkin lymphoma.
• NHLs comprise a heterogeneous group, unlike Hodgkin lymphoma.
• The treatment and prognosis vary among different subtypes of NHL, Hodgkin lymphoma generally has a more standardized treatment approach and a higher cure rate.

Nursing Care

• Systematic approach involves: assessment, diagnosis, planning, implementation, and evaluation.
• Encompasses diverse interventions aimed at promoting patient well-being, safety, recovery, while considering specific precautions and educational needs

Data Collection

• Gathering patient information through assessment.
• Includes health history, physical examination, and vital signs
• May involve lab results and diagnostic tests.

Nursing Diagnoses, Planning, and Implementation

• Formulating nursing diagnoses based on assessment data.
• Developing individualized care plans with specific goals and interventions.
• Implementing nursing interventions (medication administration, wound care, patient education).

Evaluation

• Assessing the effectiveness of nursing interventions.
• Comparing patient outcomes to established goals.
• Modifying care plans as needed.

Patient Education

• Providing patients and families with information about their health condition.
• Educating on medications, treatments, and self-care practices.
• Promoting health literacy and empowering patients to actively participate in their care.

Bleeding Precautions

• Implementing measures to minimize the risk of bleeding
• Monitoring coagulation parameters, avoiding intramuscular injections, and minimizing invasive procedures.

Infection Precautions

• Implementing measures to prevent the spread of infections.
• Includes hand hygiene, isolation precautions, and proper use of personal protective equipment (PPE).

Comfort

• Providing interventions to relieve physical and psychological distress.
• Includes pain management, positioning, and supportive environments.

Infection

• Understanding the causes, transmission, and prevention of infections.
• Implementing appropriate interventions to manage infections.

Safety

• Ensuring patient safety by preventing falls, medication errors, and other potential hazards.
• Includes environmental safety measures and patient monitoring.

Cellular Regulation

• Understanding how normal cellular regulation and function plays a role in overall health and well-being.
• Implementing interventions to promote healthy cellular function.

Aplastic Anemia

• A rare but serious blood disorder where the bone marrow fails to produce enough blood cells, resulting in low levels of red blood cells, white blood cells, and platelets.

Pathophysiology

• Damage to the hematopoietic stem cells in the bone marrow results in pancytopenia (deficiency of all three major blood cell lines).
• Bone marrow becomes hypoplastic or aplastic (empty).

Etiology

• Acquired: Idiopathic (unknown cause) is most common, exposure to toxins, medications, infections, autoimmune diseases (e.g., lupus).
• Inherited: Fanconi anemia, dyskeratosis congenita.

Signs and Symptoms

• Fatigue, weakness, and pallor (due to anemia), frequent infections (due to neutropenia).
• Easy bruising or bleeding (due to thrombocytopenia).
• Other symptoms: headache, dizziness, shortness of breath.

Diagnostic Tests

• Complete blood count (CBC) with differential reveals pancytopenia.
• Bone marrow aspiration and biopsy show hypocellular or aplastic bone marrow
• Other tests: reticulocyte count, iron studies, and genetic testing (if indicated).

Therapeutic Measures

• Supportive care: blood transfusions (treat anemia and thrombocytopenia), antibiotics (treat and prevent infections), growth factors (stimulate blood cell production).
• Specific treatments:
  • Immunosuppressive therapy (antithymocyte globulin (ATG), cyclosporine)
  • Hematopoietic stem cell transplantation (HSCT): curative option for eligible patients.

Nursing Management

• Monitor vital signs, CBC, and other lab values; assess for signs of bleeding, infection, and fatigue.
• Provide emotional support to the patient and family

Bleeding Precautions

• Avoid intramuscular injections
• Minimize invasive procedures
• Apply pressure to injection sites
• Use a soft toothbrush
• Avoid activities that may cause injury

Infection Interventions

• Strict hand hygiene
• Monitor temperature and other signs of infection
• Protect from exposure to ill individuals
• Administer antibiotics as prescribed
• Reverse isolation may be necessary

Immune Thrombocytopenic Purpura

• Immune Thrombocytopenic Purpura (ITP) is an autoimmune disorder characterized by low platelet counts, leading to an increased risk of bleeding.
• The body's immune system mistakenly attacks and destroys its own platelets

Pathophysiology and Etiology

• Autoimmune destruction of platelets, antibodies bind to platelets, marking them for destruction by the spleen
• Often idiopathic (unknown cause), but may be triggered by infections, vaccinations, or other drugs.
• Can be acute (often in children, following viral infections) or chronic (more common in adults).

Signs and Symptoms

• Petechiae (small red or purple spots on the skin)
• Purpura (larger areas of bruising), easy bruising.
• Bleeding from the gums or nose.
• Heavy menstrual bleeding in women
• Internal bleeding (rare, life-threatening).

Diagnostic Tests

• Complete Blood Count (CBC): assesses platelet count
• Peripheral blood smear: examines platelet size and morphology
• Antibody tests: detects anti-platelet antibodies
• Bone marrow aspiration and biopsy (rarely needed): rules out other causes of thrombocytopenia.

Therapeutic Measures

• Corticosteroids (e.g., prednisone): suppress the immune system
• Intravenous Immunoglobulin (IVIg): temporarily block the immune response
• Thrombopoietin receptor agonists (e.g., romiplostim, eltrombopag): stimulate platelet production.
• Splenectomy (surgical removal of the spleen): if other treatments fail.
• Platelet transfusions: severe bleeding or prior to invasive procedures.

Nursing Care

• Monitor for bleeding (skin, mucous membranes, urine, stool), assess vital signs and neurological status
• Administer medications as prescribed; provide safe environment to prevent injury; avoid intramuscular injections
• Follow-up appointments and blood tests; educate on the prescribed medication regimen.

Patient Education

• Avoid medications that impair platelet function (e.g., aspirin, ibuprofen), minimize the risk of injury, and recognize and report signs of bleeding.

Hodgkin Lymphoma

• Hodgkin lymphoma is a type of cancer that affects the lymphatic system.
• Characterized by the presence of Reed-Sternberg cells (abnormal, cancerous B-cells).

Pathophysiology

• Cancer of the lymphatic system specifically B lymphocytes
• Characterized by Reed-Sternberg cells (large, abnormal B-cells).
• Leads to the proliferation of lymphocytes and inflammatory cells in lymph nodes.

Etiology

• Exact cause unknown; genetic factors may play a role.
• Epstein-Barr virus (EBV) infection is associated with some cases; weakened immune system can increase risk.

Signs and Symptoms

• Painless swelling of lymph nodes (typically in the neck, armpits, or groin)
• Fever without an infection, night sweats, unexplained weight loss (B symptoms)
• Fatigue, weakness, loss of appetite, itching; coughing, chest pain, or shortness of breath (if the lymph nodes in the chest are affected)

Diagnostic tests and Staging

• Physical Exam: Assess for enlarged lymph nodes or other signs of the disease.
• Biopsy is used for the removal and examination of a lymph node to identify Reed-Sternberg cells.
• Blood Tests: Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and other tests assess overall health.
• Imaging: X-rays, CT scans, MRI, and PET scans to determine the extent of the disease and identify affected areas.
• Uses the Ann Arbor staging system (I-IV) based on the number of affected lymph node regions, presence of symptoms (B symptoms), and the involvement of other organs.

Therapeutic Measures

• Chemotherapy: Uses drugs to kill cancer cells.
• Radiation Therapy: Uses high-energy rays to kill cancer cells.
• Combined modality therapy: Combines chemotherapy and radiation therapy.
• Stem Cell Transplant: Used for patients who relapse or don't respond to initial treatment.
• Targeted Therapy: Uses drugs that target specific molecules involved in cancer growth.

Nursing Management

• Assess symptoms, side effects of treatment, and overall patient well-being.
• Administer medications, monitor lab values, and manage complications.
• Provide supportive care (pain management, nutritional support, and emotional support).

Patient Education

• Educate patients about their condition, treatment plan, and potential side effects, explain the diagnosis, staging, and treatment options.
• Discuss potential side effects of treatment and how to manage them; encourage patients to report new or worsening symptoms.
• Provide information about support groups and; emphasize the importance of follow-up care and regular check-ups after treatment.

Hematologic Disorders

• Hematologic disorders are conditions affecting the blood and its components (red blood cells (RBCs), white blood cells (WBCs), platelets, and clotting factors.
• These disorders can impact oxygen transport, immune function, and hemostasis.

Anemia

• A condition characterized by a deficiency of red blood cells or hemoglobin, resulting in reduced oxygen-carrying capacity.

Causes

• Iron deficiency, vitamin deficiencies (B12, folate), chronic diseases, blood loss, and genetic disorders.

Symptoms

• Fatigue, weakness, pale skin, shortness of breath, and dizziness.

Aplastic Anemia

• A condition in which the bone marrow fails to produce enough blood cells (RBCs, WBCs, and platelets)
• Exposure to certain drugs and infections, autoimmune diseases, and inherited conditions

Consequences

• Pancytopenia (deficiency of all blood cell types), leading to infections, bleeding, and anemia.

Sickle Cell Anemia

• An inherited genetic disorder cause causing red blood cells to become sickle-shaped, leading to chronic anemia, pain, and organ damage.

Mechanism

• Mutation in the hemoglobin gene results in abnormal hemoglobin (HbS), which causes RBCs to become rigid and sickle-shaped, especially under low oxygen conditions.

Complications

• Vaso-occlusive crises, acute chest syndrome, stroke, and organ damage.

Polycythemia

Condition characterized by an abnormally high number of red blood cells

• Types: Polycythemia vera (primary), secondary polycythemia (caused by other conditions

Effects

• Increased blood viscosity, leading to increased risk of blood clots, stroke, and other cardiovascular complications.

Disseminated Intravascular Coagulation (DIC)

• A life-threatening condition involving widespread activation of the blood clotting cascade, leading to both excessive clotting and bleeding.
• Causes: Sepsis, trauma, obstetric complications, and malignancy
• Consequences: organ damage from clotting and severe.

Blood Cell Effects

• Topic encompasses how various factors and disorders impact the different types of blood cells, including their production, function, and lifespan.

Bleeding Disorders

• Conditions that impair the body's ability to form blood clots, leading to excessive bleeding.
• Causes: Platelet disorders, clotting factor deficiencies (e.g., hemophilia), and von Willebrand disease.
• Symptoms: Easy bruising, prolonged bleeding after injury or surgery, and spontaneous bleeding.

WBC Effects

• Pertains to disorders that affect white blood cells, which can result in infections or immune-related problems.

RBC Effects

• Pertains to disorders that affect red blood cells, which can result in problems with oxygen transport

Hemophilia

• Genetic bleeding disorder that impairs the body's ability to make blood clots, which are needed to stop bleeding
• Primarily caused by a deficiency in specific clotting factors, leading to prolonged bleeding

Pathophysiology

• Genetic defect in the clotting factor genes (F8 or F9) resulting in the deficiency or absence of clotting factors VIII (Hemophilia A) or IX (Hemophilia B).
• The Etiology an X-linked recessive genetic disorder

Hemophilia A (Factor VIII deficiency)

• Most common type

Hemophilia B (Factor IX deficiency)

• Also know as Christmas disease
• Can rarely occur from spontaneous genetic mutations
• Signs and Symptoms include prolonged bleeding from cuts or injuries, excessive bruising, bleeding into joints (hemarthrosis), causing pain and swelling

Diagnostic Tests

• Complete Blood Count (CBC) to assess overall blood cell levels with Coagulation studied shown by prolonged Partial thromboplastin time (PTT) in hemophilia
• Clotting factor assays measure levels of factor VIII OR IX

Therapeutic Measures

• Replacement therapy is achieved through the infusion of factor VII or IX concentrate alongside administering Desmopressin (DDAVP) which stimulates factor VII release
• Medical professionals will also perform Antifibrinolytic agents, physical therapy and gene therapy

Nursing Process

• Assessment of bleeding history, assess of possible symptoms such as evaluate the pain
• Monitor laboratory values

Anemia

• The condition is characterized by a deficiency of red blood cells or hemoglobin in the blood, resulting in reduced oxygen-carrying capacity which leads to signs/symptoms due to insufficient O2 to the body tissues is the Nutritional deficiencies.

Common Causes of the resulting anemia

• The microcytic anemia (small red blood cells/low MCV)
• The macrocytic anemia (large red blood cells/high MCV
• Common symptoms of fatigue, pale skin, shortness of breath alongside possible medical diagnosis include complete blood counts, peripheral blood smear

Nursing Process

• Collect data through history taking followed by identifying which problems the patient is facing and how to plan the overall treatment

Sickle Cell Anemia

• The inherited blood disorder that causes misshaped red blood cells.

Etiology of this Genetic Blood Disorder

• The result mutation that leads to a abnormal hemoglobin gene results in the body producing abnormal hemoglobin.
• The pathophysiology of such diseases can present the body with issues

Diagnosing Process

• The medical professional will perform a physical examination and then conduct a Complete Blood Count

Leukemia

• The blood forming issue is characterized through tissue that multiplies due to the abnormal amounts of white blood cells that can overcrowd the normal blood cells and impair the body's ability function
• Viral infections alongside environmental factors contribute to potential causes

Leukemia Infections

• Some potential diagnostic tests can range from Complete Blood Count testing, chromosome analysis followered with genetic testing to find the gene mutation
• Therapeutic measures are designed to primary prevent the infection with the assistance of antibiotics, blood transfusions and growth factor treatments

Nursing

• Frequent assessment of vitals or neurological status
• Administer blood product or medications

Disseminated Intravascular Coagulation

• A life threatening condition that causes the body’s blood to clot and as a result starts clotting issues.
• Diagnosing process includes a fibrinogen level test or a peripheral blood smear.