Disorders Associated with Lymph System PDF

**I. Lymphangitis** - **A. Etiology/Pathophysiology:** - Inflammation of one or more lymphatic vessels or channels. - Usually caused by an acute streptococcal or staphylococcal infection in an extremity. - **B. Clinical Manifestations/Assessment:** - Fine red strea...

**I. Lymphangitis** - **A. Etiology/Pathophysiology:** - Inflammation of one or more lymphatic vessels or channels. - Usually caused by an acute streptococcal or staphylococcal infection in an extremity. - **B. Clinical Manifestations/Assessment:** - Fine red streaks from the affected area toward the groin or axilla. - Edema is typically diffuse and not localized. - Accompanying symptoms include chills, fever, local pain, headache, and myalgia. - **Lymphadenopathy** (swollen lymph nodes) may be present. - Septicemia can occur. - **C. Diagnosis:** - Made through visual inspection and palpation. - **D. Medical Management:** - Administration of antimicrobial drugs (oral or IV) to control the infection. - Anti-inflammatory medications to reduce inflammation. - Hot, moist heat soaks or packs for comfort. - **E. Nursing Interventions:** - Keep the affected area clean. - Encourage rest and elevation of the affected extremity to relieve pressure. **II. Lymphedema** - **A. Etiology/Pathophysiology:** - Primary or secondary disorder characterized by the accumulation of lymph in soft tissue and edema. - Causes include: - Obstruction. - Increase in the amount of lymph. - Removal of lymph channels and nodes. - Hereditary factors. - Disturbed lymphatic drainage can result in an inflammatory process. - **B. Clinical Manifestations:** - Massive edema and tightness causing pressure and pain in the affected extremities. - Progresses toward the trunk and can be aggravated by: - Standing. - Pressure. - Obesity. - Warm, humid environments. - **C. Assessment:** - Subjective data: - Complaints of pain and pressure. - Medical history of varicosities, pregnancy, or modified radical mastectomy. - Objective data: - Observation of extremities for edema. - Palpation of distal pulses (e.g., pedal pulses). - **D. Diagnostic Tests:** - Lymphoscintigraphy to differentiate lymphedema from venous disorders. - **E. Medical Management:** - Special massage techniques: - Manual lymph drainage (performed by specially trained personnel). - Mechanical management: - Compression pumps and elastic sleeves or stockings on the affected limb. - Light exercise to increase circulation and improve lymph drainage. - Diet restrictions: - Limiting sodium intake. - **F. Nursing Interventions:** - Increase lymphatic drainage: - Elevation of the extremities while asleep and periodically during the day. - Massage toward the trunk followed by light exercise. - Avoidance of constrictive clothing, shoes, or stockings. - Monitor/prevent infections: - Avoid trauma. - Meticulous skin care. - Daily inspection of the skin for cuts and cracks. - Application of lotion to prevent dryness. - Emotional support: - Address body image disturbances. - Emphasize that the disorder need not prevent engaging in routine activity. - **G. Prognosis:** - No cure for the disorder, but signs and symptoms can be controlled. **III. Hodgkin's Lymphoma** - **A. Etiology/Pathophysiology:** - Malignant disorder characterized by painless, progressive enlargement of lymphoid tissue. - Affects males twice as frequently as females. - Two age populations: - 15-35 years of age: Thought to be a viral infection that turns into an infectious/inflammatory process and eventually a neoplasm. - Peak at 50 years of age. - Cause is unknown but thought to be an immune disorder (T-cell disease). - Risk factors: - History of mononucleosis (Epstein-Barr virus). - Congenital immune deficiency syndrome. - Immunosuppressive drugs after organ transplantation. - History of diminished or delayed exposure to infections. - Occupational toxins. - Genetic predisposition. - HIV presence increases the incidence of Hodgkin\'s lymphoma. - Lymphoid tissue enlargement is first noticed in the cervical nodes and spleen. - Characterized by abnormal or atypical cells called **Reed-Sternberg cells**. - These cells are large, abnormal multinucleated cells in the lymph nodes. - They increase in number, replacing normal cells. - **B. Clinical Manifestations:** - Painless enlargement of lymph nodes in the cervical, axillary, or inguinal areas. - Unexplained rapid weight loss (B symptom, worse prognosis). - Fever (B symptom, worse prognosis). - Night sweats (B symptom, worse prognosis). - Fatigue. - Pruritus. - Pain in lymph nodes after alcohol ingestion. - Anemia and leukocytosis with respiratory tract infections. - **C. Assessment:** - Subjective: - Fatigue. - Appetite loss. - Pruritus (often severe). - Pain at the site with small amounts of alcohol ingestion. - Bone pain later in the disease course. - Objective: - Cervical and supraclavicular lymph node enlargement. - Splenomegaly, hepatomegaly, and abdominal tenderness. - Excoriation of the skin and evidence of scratching from pruritus. - Cough or dyspnea with enlargement of chest nodes. - Difficulty swallowing with pain behind the sternum. - **D. Diagnostic Tests:** - Peripheral (Lab) blood studies: - Anemia. - Increased WBCs. - Abnormal ESR (indicator of inflammation). - Low iron level in blood due to increased uptake in the liver and spleen. - Abnormal liver enzymes (leukocyte alkaline phosphatase elevated and hypoalbuminemia). - Hypercalcemia. - Presence of Reed-Sternberg cells. - Radiographic examination: - CXR may reveal a mediastinal mass. - CT or MRI can detect retroperitoneal involvement. - CT scan/ultrasound reveals splenomegaly or hepatomegaly. - Lymph node biopsy, including laparoscopy for retroperitoneal nodes. - PET, CT, bone scans, and bone marrow biopsy aid in staging and metastasis assessment. - Liver, lungs, and bone are the primary areas of metastasis. - **E. Medical Management:** - Treatment depends on the staging process. - The stage of Hodgkin\'s lymphoma must be established before selecting a treatment plan. - Clinical Staging for Hodgkin\'s Disease: - Stage I: Abnormal single lymph nodes, regional or single extranodal site. - Stage II: Two or more lymph nodes on the same side of the diaphragm, or localized involvement of extranodal site and one or more lymph node regions on the same side of the diaphragm. - Stage III: Two or more abnormal lymph node regions on both sides of the diaphragm; may be accompanied by spleen involvement, subdivided into upper abdominal (Stage III1) and lower abdominal nodes (Stage III2). - Stage IV: Diffuse and disseminated involvement of one or more extralymphatic tissues and/or organs, with or without lymph node involvement. - Staging Designations: - A: absence of symptoms. - B: presence of symptoms (sweats, fever, weight loss). - S: involvement of the spleen. - E: single extra nodal involvement. - X: bulky disease ( \>1/3 Mediastinum or nodal mass \> 10CM). - Combination therapy: \* Chemotherapy and radiation used together. \* Used in high-risk cases for relapse. \* Used in general forms (Stage III and IV). \* Advances enable some stage IIIB and IV to be cured with high-dose chemo and stem cell transplant. - Early stages: two to four cycles of chemotherapy (ABVD). \* doxorubicin (Adriamycin). \* bleomycin (Blenoxane). \* vinblastine (Velban). \* dacarbazine (DTIC-DOME). - Advanced stages of Hodgkin's lymphoma can have the following regimes: - ABVD for up to eight cycles. - Stanford V: mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, prednisone. - BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone. - If disease relapses then high-dose chemotherapy and then stem cell transplant (SCT). - **F. Nursing Interventions:** - Planned according to staging level. - Monitor/control side effects of therapy: - Knowledge of side effects of radiotherapy or chemotherapy (nausea, vomiting, diarrhea, GI ulcerations, fatigue, anemia). - Provide education and emotional support to deal with side effects. - Maintain patient comfort - focus on skin integrity. - Provide soothing baths with an antipruritic medication (as ordered). - Control fever and perspiration (antipyretics, linen changes). - Maintain meticulous skin care. - Teach/assess understanding of disease process and treatment regimen. - Explain extensive tests to decrease anxiety and ineffective coping. - Understanding the disease is important for self-care and retaining independence. - Provide psychological support: - Encourage verbalization of feelings/concerns. - Assist with stress management. - Involve the patient with community resources. - Nutritional considerations: - Avoid excess weight loss; encourage high calorie, nutritious foods. - Avoid undernourished condition. - **G. Prognosis:** - Staging of the disease is important for the prognosis. - Earlier stage cancers have a higher survival rate. - Stage I or II with proper treatment has a 90% survival rate. - Stage III has a 5-year survival rate of 80%. - Stage IV survival rate is 65%. **IV. Non-Hodgkin's Lymphoma (NHL)** - **A. Etiology/Pathophysiology:** - Group of malignant neoplasms of primarily B or T cell origin, affecting people of all ages. - B-cell lymphomas constitute about 85% of all NHLs. - Third type is NK natural killer cells. - These attack virus-infected or tumor cells. - Suspected causes include: - Previous human T-cell leukemia/lymphoma. - Epstein-Barr Virus. - Immunocompromised patients linked to immunosuppressive agents. - More common in men older than 60 years of age, in the white population. - Farming communities due to exposure to pesticides and herbicides. - Risk factors for NHL include: - Age (65-74). - EBV (Epstein-Barr virus), HIV, Helicobacter pylori, and Hepatitis C. - Weakened immune system. - No hallmark pathologic feature, but all NHLs involve lymphocytes arrested in various stages of development. - **B. Clinical Manifestations:** - Painless lymphadenopathy in the cervical area. - Fever, sweats, chills. - Weight loss. - Anemia. - Pruritus. - Fatigue. - Susceptibility to infection. - Pressure symptoms in the involved areas. - Abdominal distention due to swollen lymph nodes, liver, or spleen. - Chest pressure, shortness of breath (SOB), cough if in the chest. - Pleural effusion, bone fractures, and paralysis. - Bone lesions. - **C. Assessment:** - Subjective: - Complaints of fatigue, malaise, and anorexia. - Objective: - Examination of the abdomen for splenomegaly. - Lymphadenopathy. - Fever, night sweats, and weight loss. - **D. Diagnostic Tests:** - Biopsies of lymph node, liver, and bone marrow to establish cell type and pattern. - PET scans, CT, MRI, and chest x-rays are common tests. - Common lab tests include CBC, immunohistochemistry, flow cytometry, DNA/genetics. - Staging is used to help guide therapy (same as Hodgkin's lymphoma). - **E. Medical Management:** - Accurate staging is crucial to determine the treatment regimen. - Chemotherapy (same medications as Hodgkin's but adding methotrexate). - Immunotherapy with monoclonal antibodies to target cancer cells rather than normal cells. - rituximab (Rituxan). - ibritumomab (Zevalin) used for refractory NHL. - Bone marrow transplant or peripheral stem cell transplant. - Radiation: - Chest wall mediastinum axilla and neck (mantle field). - Abdomen, paraaortic area, spleen, and less common pelvis. - **F. Nursing Interventions:** - Supportive care of the patient during radiation and chemotherapy. - Similar to Hodgkin's lymphoma. - Teach/assess understanding of the treatment regimen. - Frequently reassess knowledge. - Explanations of the extensive diagnostic workup and importance of staging. - Monitor for complications. - **G. Prognosis:** - Influenced by staging. - 5-year survival rate is 70%. - 10-year survival rate is 60%. - Relapse in the first 2 years worsens prognosis. This study guide covers the key points from the provided document, and is organized to help you understand the differences and similarities between the disorders of the lymphatic system discussed.