Chapter 32 Caring for Clients with Disorders of the Lymphatic System-1 PDF

Timby/Smith: Introductory Medical-Surgical Nursing, 13/e Chapter 32: Caring for Clients with Disorders of the Lymphatic System Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of Lymphatic System  Lymphatic System o Lymphatics  Ve...

Timby/Smith: Introductory Medical-Surgical Nursing, 13/e Chapter 32: Caring for Clients with Disorders of the Lymphatic System Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of Lymphatic System  Lymphatic System o Lymphatics  Vessels, transport fluid  Exit capillary walls  Enters interstitial space  Carry lymph to and through lymph nodes o Lymph nodes  Contains lymphs and macrophages  Located in neck, axilla, chest, abdomen, pelvis, groin  Accessory lymphs:  Tonsils, thymus, spleen Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Occlusive, Inflammatory, & Infectious Disorders  Lymphedema o Pathophysiology and Etiology: think of a sponge !!!!!!!!  Accumulated lymphatic fluid from impaired lymph circulation  Causes nonpitting edema (late stage) Arms, legs, genitalia  2 Types: Primary: congenitally acquired, women more than men Secondary: phlebitis, strep infections, burns, insect bites, parasitic infections, or removal of lymph nodes (mastectomy)  Most common cause is parasitic worm Condition know as elephantiasis o Assessment Findings: Signs and Symptoms  Swelling of dependent area, skin is tight (fibro/collagen), firm, shiny, brawny (orange), weeping/oozing, red/warm, pain  See Classifications of Lymphedema Box 32-1, p. 533 look at these Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Occlusive, Inflammatory, & Infectious Disorders (cont’d)  Lymphedema (cont’d) o Diagnostic Testing:  Lymphangiography:  IV dye detects lymph node involvement Reveals degree of blockage o Medical Management:  Treat symptoms, elevation, compression sleeves/stockings, compression garment  Complex decongestive physiotherapy  Mechanical pulsating compression device or pneumatic device (“milks” the lymph) o Nursing Management:  Skin assessment, exercises, elevation, elastic garments, mechanical devices, emotional support Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Occlusive, Inflammatory, & Infectious Disorders (cont’d)  Lymphedema (cont’d) o Pneumatic Devices  Flexitouch  Sequential Compression Device  See Client and Family Teaching 32-1, p. 534 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 A woman undergoing a modified radical mastectomy is at risk for ineffective tissue perfusion and lymphedema. A nursing intervention to prevent compromised flow of lymphatic fluid to the upper extremities includes: A) Assisting the client during periods of ambulation B) Supporting and elevating the arm on the side of the mastectomy C) Administering IM injections in the arm on the side of the mastectomy D) Applying an elastic roller bandage to the affected arm for 24 to 48 hours Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 B) Supporting and elevating the arm on the side of the mastectomy Rationale: Elevation promotes gravity drainage of fluid trapped in the soft tissue Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Occlusive, Inflammatory, & Infectious Disorders (cont’d)  Lymphangitis and Lymphadenitis o Pathophysiology and Etiology:  Inflammation of lymphatic vessels  Causative agent: streptococcal microorganisms o Assessment Findings: Signs and Symptoms  Red streak in arms/legs, fever, lymphadenitis is present, tender/enlarged lymph nodes  Diagnosis made by inspection and palpitation o Medical Management:  Broad-spectrum antibiotic therapy o Nursing Management:  Assist with ADL’s, elevate extremity, provide warmth, monitor temperature and swelling,  Teaching: apply a elastic sleeve and stocking Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Occlusive, Inflammatory, & Infectious Disorders (cont’d)  Infectious Mononucleosis o Pathophysiology and Etiology:  Caused by Epstein-Barr virus (EBV)  Direct contact: saliva and pharyngeal secretions (talk, kiss, cough, sneeze)  Incubation period: 30 – 50 days  Presents itself about 10-14 days later  Produces immunity, virus remains  Ages: 15 – 25 years o Assessment Findings: Signs and Symptoms  Fatigue, fever, sore throat, headache, cervical lymph node enlargement, oozing tonsils, pharyngeal swelling, faint red rash, splenomegaly, hepatomegaly Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Occlusive, Inflammatory, & Infectious Disorders (cont’d)  Infectious Mononucleosis (cont’d) o Diagnostic Findings  Monospot/Monotest: Positive  EBV antibody titer  Heterophile agglutination (1:224 or greater)  CBC: lymphocytosis o Medical Management:  Bed rest, analgesic and antipyretic therapy  Increased fluid intake  Corticosteroids and antibiotics (if indicated) o Nursing Management:  Inspect throat, palpate lymph nodes, encourage liquids (cool) and soft/bland foods, gargle with warm salt water, rest, with- hold blood donations, emotional support, standard precautions Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 The characteristics of infectious mononucleosis include all of the following, except: A) Usual age is 15 to 25 years old. B) The fever is irregular. C) The incubation period is 10 to 14 days after exposure. D) Enlargement of lymph nodes is often generalized. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 C) The incubation period is 10 to 14 days after exposure. Rationale: The normal incubation period of infectious mononucleosis is 30 to 50 days after exposure to the virus and the virus remains in the body for the person’s lifetime. Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Lymphomas: Hodgkin and Non-Hodgkin  Hodgkin Disease o Pathophysiology and Etiology:  Enlargement of lymphoid tissue  Unknown cause, EBV thought to mutate and create malignant cells Reed-Sternberg cells  Release cytokines, causes inflammatory response o Assessment Findings: Signs and Symptoms  Painless, enlarged lymph node  Epigastric pain, fullness  Weight loss, anorexia, fatigue, weakness  Low-grade fever, pruritus, night sweats  Anemia, low platelets  Poor resistance to infection Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Lymphomas: Hodgkin and Non-Hodgkin (cont’d)  Hodgkin Disease (cont’d) o Diagnostic Findings:  Lymph node biopsy  Bone marrow aspiration  CBC: low RBCs, High WBCs  Elevated ESR and liver enzymes  CT, MRI, PET  Bone marrow aspiration: Stage 1 – 4 (See Table 32-2, p. 537) Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Lymphomas: Hodgkin and Non-Hodgkin (cont’d)  Hodgkin Disease (cont’d) o Medical Management:  Localized radiation  Chemotherapy, antineoplastic drugs (See Table 32-3, p. 537)  Antibiotics (secondary infections)  Transfusions  Stem cell transplant o Nursing Management:  See Client and Family Teaching 32-2, p. 539  Asses respiratory status  Infection prevention  Support/protect bony prominences  Assist ADL’s and activity tolerance Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 A client diagnosed with Hodgkin disease is at risk for infection related to immunosuppression and drug or radiation therapy. To assist the client to remain free of infection, the nurse should implement which of the following? A) Divide cares into manageable amounts. B) Restrict visitors with infections from contact with client. C) Avoid drugs administered by parenteral route. D) Keep the neck in midline and place the client in high-Fowler position. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 B) Restrict visitors with infections from contact with client. Rationale: Reducing the number of organisms in the environment and restricting visitors and personnel with an infection reduce the transmission of pathogens to the client. Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Lymphomas: Hodgkin and Non-Hodgkin (cont’d)  Non-Hodgkin Lymphomas o Pathophysiology and Etiology:  Malignant, originate in lymph glands/lymphoid tissue  Lymphosarcoma, Burkitt lymphoma, Reticulum cell sarcoma  Causes:  Genetic link strongly implicated  Environmental triggers: viral agents, chemical herbicides, pesticides, hair dye, immunosuppressive drugs Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Lymphomas: Hodgkin and Non-Hodgkin (cont’d)  Non-Hodgkin Lymphomas (cont’d) o Assessment Findings: Signs and Symptoms  Lymph node enlargement, site dependent  Diffuse rather than localized  2 Classifications: Indolent: asymptomatic, responds to radiation and chemotherapy Aggressive: shorter onset, curable o Diagnostic Findings:  Lymphoid tissue biopsy  Determines staging Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Lymphomas: Hodgkin and Non-Hodgkin (cont’d)  Non-Hodgkin Lymphomas (cont’d) o Medical Management:  Radiation and chemotherapy  Immunotherapy  Monoclonal antibody therapy (MABs)  Bone marrow/stem cell transplant  Autologous or allogenic  Possibilities of graft-versus-host-disease (GVHD) o Nursing Management:  Monitor for adverse signs/symptoms of chemotherapy and radiation  Encourage extra fluid intake (>=2500mL/day) Helps excrete destroyed cells, compensate for any fluid loss due to vomiting. Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Lymphomas: Hodgkin and Non-Hodgkin (cont’d)  Monoclonal Antibody Therapy o Immunotherapy  Eliminate malignant cells and induce remission 1) Human cancer cells injected into mice 2) Mice make lymphocytes, antibodies produced against cancer cells 3) Mouse lymphocytes harvested are fused with laboratory-grown cell creating clones (hybridomas) 4) Administer clones to client, continues producing tumor-fighting antibodies.  Used with chemotherapeutic/radioactive agents  Advantage: target and destroy can cancer cells, spare normal cells. Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Lymphatic System Hodgkin vs Non-Hodgkin Hodgkin Non-Hodgkin 1) Four subtypes 1) 30 subtypes 2) Two peaks of onset 2) Peaks after age 50 years a) Ages 15 – 40 years 3) No Reed-Steinberg cells b) Older than 55 years 4) More common in industrial 3) Reed-Steinberg cells countries; among clients 4) 40% test positive for EBV with immunosuppression 5) B-cell origin 5) B and T-cell origin 6) Starts in lymph nodes 6) Common in abdomen, above clavicle, commonly tonsils; can develop in in neck/chest; 15% below areas other than lymph diaphragm and spread nodes (brain, nasal downward from initial site passages) 7) Orderly growth from one 7) Less predictable growth; node to adjacent nodes, spreads to extranodal more curable sites; less curable Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #4 A client with non-Hodgkin disease is admitted to the hospital. In discussing the client’s care with the nursing assistant, which nursing explanation is most correct in relation to the medical management of the disease? A) Radiation and chemotherapy B) Analgesic and antipyretic therapy C) Corticosteroid therapy D) Complex decongestive physiotherapy Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #4 A) Radiation and chemotherapy Rationale: Non-Hodgkin lymphoma is treated with radiation and chemotherapy or both. Immunotherapy with monoclonal antibodies (MABs) and bone marrow transplants (BMTs) are used to cure lymphomas or extend the lives of clients. Copyright © 2022 Wolters Kluwer · All Rights Reserved