Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Understanding Lymphoma:
- Provide comprehensive education to the patient and family about lymphoma, differentiating between Hodgkin’s and Non-Hodgkin’s types. Ensure they grasp the nature of the disease, potential causes, and its impact on the lymphatic system.
Treatment Options and Risks:
- Educate the patient about available treatment modalities, including chemotherapy, radiation therapy, and immunotherapy. Discuss potential side effects, risks, and benefits associated with each treatment option to facilitate informed decision-making.
Symptom Management:
- Equip the patient with knowledge and skills to manage symptoms related to lymphoma and its treatment. This includes addressing pain, fatigue, nausea, and other side effects. Provide strategies for maintaining a good quality of life during and after treatment.
Psychosocial Support:
- Address the psychosocial aspects of living with lymphoma. Offer resources for emotional support, coping mechanisms, and counseling services. Encourage open communication about fears, concerns, and expectations related to the diagnosis and treatment.
Follow-up Care and Monitoring:
- Emphasize the importance of regular follow-up appointments, monitoring, and surveillance after completing treatment. Educate the patient on signs of recurrence or complications that should prompt immediate medical attention. Foster a sense of empowerment in managing their health.

Pathophysiology of Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Abnormal Cell Growth:
- Lymphoma originates in the lymphocytes, a type of white blood cell, where genetic mutations lead to uncontrolled and abnormal cell growth. This results in the formation of tumors within the lymphatic system.
Lymph Node Involvement:
- Both Hodgkin’s and Non-Hodgkin’s lymphomas affect lymph nodes, causing them to enlarge and become palpable. In Hodgkin’s lymphoma, specific abnormal cells called Reed-Sternberg cells are present, while Non-Hodgkin’s lymphoma comprises various subtypes with diverse cell characteristics.
Spread to Surrounding Tissues:
- Lymphoma can extend beyond the lymph nodes, infiltrating other tissues and organs of the lymphatic system, such as the spleen and bone marrow. Non-Hodgkin’s lymphoma, in particular, can involve extranodal sites, leading to a wider range of potential locations for tumor growth.
Disruption of Immune Function:
- As lymphocytes play a crucial role in the immune system, the presence of lymphoma can compromise normal immune function. This may result in an increased susceptibility to infections and a decreased ability to combat other diseases.
Potential Systemic Effects:
- In advanced stages, both types of lymphoma can have systemic effects on the body, leading to symptoms such as fever, night sweats, and unintentional weight loss. The abnormal lymphocyte growth can also affect the production of normal blood cells in the bone marrow, causing anemia, thrombocytopenia, or leukopenia.

Etiology of Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Genetic Factors:
- Genetic predisposition can contribute to the development of lymphoma. Certain inherited genetic mutations or a family history of lymphoma may increase the risk. However, the majority of cases occur sporadically, without a clear familial pattern.
Immune System Dysfunction:
- A compromised immune system, whether due to conditions like HIV/AIDS or immunosuppressive therapy following organ transplantation, can elevate the risk of lymphoma. The immune system plays a crucial role in controlling abnormal cell growth, and its impairment may allow lymphoma to develop.
Viral Infections:
- Some viral infections have been linked to an increased risk of lymphoma. For example, Epstein-Barr virus (EBV) is associated with Hodgkin’s lymphoma, while human T-cell lymphotropic virus (HTLV-1) is linked to certain types of Non-Hodgkin’s lymphoma.
Environmental Factors:
- Exposure to certain environmental factors, such as certain chemicals and pesticides, has been suggested as potential contributors to lymphoma development. However, the specific causative agents and their mechanisms are not always well-defined.
Age and Gender:
- Lymphoma can occur at any age, but the risk increases with age, especially in individuals over 60. Some subtypes of lymphoma may also show variations in incidence based on gender, with Hodgkin’s lymphoma more common in young adults and Non-Hodgkin’s lymphoma having a higher prevalence in males.

Desired Outcome for Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Remission of Disease:
- Achieve complete remission of lymphoma through effective treatment modalities, including chemotherapy, radiation therapy, and immunotherapy.
Preservation of Organ Function:
- Ensure the preservation of organ function and integrity by targeting and eliminating cancerous cells without significant damage to surrounding healthy tissues.
Symptom Relief:
- Alleviate and manage symptoms associated with lymphoma, such as enlarged lymph nodes, fatigue, fever, night sweats, and unexplained weight loss, to improve the overall quality of life for the individual.
Prevention of Relapse:
- Implement strategies and follow-up care to minimize the risk of disease relapse. This may involve ongoing surveillance, maintenance therapy, or other preventive measures tailored to the specific subtype and stage of lymphoma.
Psychosocial Support:
- Provide comprehensive psychosocial support to the patient and their caregivers throughout the treatment process. This includes addressing emotional and psychological well-being, coping mechanisms, and facilitating a support network to enhance the overall resilience of the individual.

Lymphoma (Hodgkin’s, Non-Hodgkin’s) Nursing Care Plan

Subjective Data:

Persistent Fatigue
Shortness of breath
Cough
Itching
Night sweats
Lack of appetite

Objective Data:

Swollen, painless lymph glands / nodes
Fever, without infection
Weight loss

*Symptoms are not always present*

Nursing Assessment for Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Medical History:
- Obtain a detailed medical history, including any previous cancer diagnoses, treatments, and family history of cancer, to identify potential risk factors and genetic predispositions.
Symptom Assessment:
- Conduct a thorough assessment of lymphoma-related symptoms, such as painless swollen lymph nodes, unexplained weight loss, night sweats, fatigue, and recurrent fevers. Document the severity and duration of symptoms.
Physical Examination:
- Perform a comprehensive physical examination, with a focus on palpating lymph nodes, assessing their size, tenderness, and consistency. Examine other relevant areas, such as the spleen, liver, and skin.
Laboratory Tests:
- Order and interpret laboratory tests, including a complete blood count (CBC), blood chemistry panels, and specific markers for lymphoma, such as lactate dehydrogenase (LDH) and beta-2 microglobulin.
Imaging Studies:
- Coordinate imaging studies such as computed tomography (CT) scans, positron emission tomography (PET) scans, and magnetic resonance imaging (MRI) to evaluate the extent of disease, identify affected lymph nodes, and assess organ involvement.
Bone Marrow Biopsy:
- If indicated, schedule a bone marrow biopsy to evaluate the involvement of lymphoma in the bone marrow and determine disease staging.
Psychosocial Assessment:
- Assess the patient’s emotional well-being, coping mechanisms, and support systems. Identify potential stressors related to the diagnosis and treatment, and provide appropriate referrals for psychosocial support.
Educational Assessment:
- Evaluate the patient’s understanding of the diagnosis, treatment options, and potential side effects. Provide education on self-care, symptom management, and the importance of follow-up appointments.

Implementation for Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Collaborative Treatment Planning:
- Collaborate with the multidisciplinary healthcare team, including oncologists, radiation therapists, and hematologists, to develop an individualized treatment plan based on the type and stage of lymphoma.
Chemotherapy Administration:
- Administer chemotherapy as per the prescribed regimen, ensuring adherence to safety protocols and closely monitoring for potential side effects. Provide education on the expected course of treatment and possible adverse reactions.
Supportive Care:
- Implement supportive care measures to manage symptoms and enhance the patient’s overall well-being. This includes addressing pain, fatigue, and nutritional needs. Collaborate with nutritionists, pain management specialists, and other relevant healthcare providers.
Monitor and Manage Complications:
- Monitor for treatment-related complications, such as neutropenia, infections, and anemia. Implement strategies to prevent and manage complications promptly, including the administration of growth factors or blood transfusions as needed.
Psychosocial Support:
- Facilitate access to psychosocial support services, such as counseling, support groups, or palliative care, to address the emotional and psychological impact of lymphoma. Encourage open communication and provide resources for coping with stress and anxiety.
Patient Education:
- Educate the patient and their caregivers about the importance of adhering to the treatment plan, recognizing and reporting side effects, and maintaining a healthy lifestyle. Provide information on potential long-term effects of treatment and survivorship care.

Nursing Interventions and Rationales

Monitor respiratory status and provide supplemental oxygen as necessary.

If lymph nodes of the neck and chest are involved, patient may experience shortness of breath, dyspnea and airway obstruction due to obstruction of the trachea or superior vena cava.

Note changes to the skin color; pallor or cyanosis

As the WBCs multiply rapidly, it can reduce the oxygen carrying capacity of the red blood cells, resulting in hypoxemia.

Observe for neck vein distention, headache, dizziness, facial edema, dyspnea and stridor

Lymphoma patients are at higher risk for vena cava syndrome in which the superior vena cava is obstructed from enlarged lymph nodes. This constitutes a life-threatening emergency and MD should be notified. Emergency radiation treatment may be ordered.

Assess and manage pain; teach relaxation techniques, administer analgesics as necessary

While the enlarged lymph nodes are usually painless, patients may experience pain with radiation or chemotherapy treatments. Management of pain and reduction of stress is essential to patients to promote healing and conserve energy.

Nutrition education; monitor daily weight and caloric intake; encourage patients to eat small frequent meals and increase protein intake.

Patients may experience lack of appetite and diminished nutrition. Increasing caloric intake promotes healing, provides fuel for energy and prevents gastric distention. Offer more palatable options frequently.

Provide supportive comfort measures following radiation or chemotherapy treatments.

Patients often experience extreme fatigue, nausea and vomiting following treatment. Assist with ADLs, offer ice chips and antiemetics as appropriate for nausea.

Assist with positioning and monitor for skin breakdown

Fatigue and impaired nutrition cause muscle weakness. Assist patients to positions of comfort for optimal air exchange and monitor skin for signs of breakdown due to prolonged bed rest.

Evaluation for Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Treatment Response Assessment:
- Evaluate the patient’s response to the prescribed treatment through imaging studies, laboratory tests, and clinical assessments. Assess changes in the size of lymph nodes, resolution of symptoms, and normalization of laboratory parameters.
Monitoring for Complications:
- Regularly monitor for treatment-related complications, such as infection, anemia, and other adverse effects. Evaluate the effectiveness of interventions implemented to prevent or manage complications.
Functional Status and Quality of Life:
- Assess the patient’s functional status and quality of life throughout the treatment course. Consider physical, emotional, and social aspects to determine the impact of lymphoma and its treatment on the patient’s overall well-being.
Psychosocial Well-being:
- Evaluate the patient’s psychosocial well-being, addressing emotional and psychological aspects. Utilize standardized tools, patient interviews, and feedback to assess mental health, coping strategies, and the need for additional support services.
Survivorship Care Planning:
- Collaborate with the patient to develop a survivorship care plan that addresses long-term follow-up, surveillance for recurrence, and ongoing healthcare needs. Evaluate the patient’s understanding of survivorship care and their ability to manage post-treatment challenges.

References

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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Impaired Immunity: Lymphoma can affect the immune system. This diagnosis addresses the potential for compromised immunity.
Risk for Infection: Lymphoma treatment and compromised immunity increase the risk of infections. This diagnosis emphasizes infection prevention.
Anxiety: Patients with lymphoma may experience anxiety about their diagnosis and treatment. This diagnosis addresses their emotional well-being.

Transcript

Hey guys, let’s talk about the care plan for lymphoma. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of lymphoma, also subjective and objective data included in the care plan, as well as nursing interventions and rationales.

So lymphoma is defined as cancer of the lymphatic system including the lymph nodes, spleen, thymus gland, and bone marrow. There are two types of lymphoma: Hodgkin’s and non-Hodgkin’s lymphoma. They are classified as such, depending on the type of cell involved. Treatment depends on the type and the severity of lymphoma is characterized by painless, swollen lymph nodes.

Lymphoma begins when a disease-fighting white blood cell or lymphocyte develops a genetic mutation. Doctors are unclear of what causes this change, but have found that the mutation causes the cells to multiply rapidly and continue to live when a normal cell would die. The accumulation of the diseased lymphocytes causes the swelling of the lymph nodes. Certain risk factors increase the chance of developing lymphoma, including being male over the age of 55, having an impaired immune system, and certain infections like Epstein BARR virus, as well as H pylori.

The desired outcome is to maintain adequate ventilation, prevent infection and manage pain and symptoms of the side effects related to treatments. Let’s take a look at some of the subjective and objective data that your patient with lymphoma may present with. Now, remember subjective data are going to be things that are based on your patient’s opinions or feelings, and with lymphoma, your patient may complain of persistent fatigue, shortness of breath, cough, itching, night sweats, and lack of appetite.

Objective or measurable data includes swollen, painless lymph glands or nodes, fever without infection and weight loss. Keep in mind that lymphoma symptoms are not always going to be present.

Nursing interventions are a super important part of a care plan, so let’s take a look at those next. First, monitor your patient’s respiratory status. If lymph nodes of the neck and chest are involved, the patient may experience shortness of breath, dyspnea, an airway obstruction due to obstruction of the trachea, or the superior vena cava. Note changes in your patient’s skin color, including pallor or cyanosis. As the white blood cells multiply rapidly, it can reduce the carrying capacity of the red blood cells resulting in hypoxemia. Lymphoma patients are at a higher risk for vena cava syndrome in which the superior vena cava is obstructed from enlarged lymph nodes. So, observe for neck vein distension, headache, dizziness, facial edema, dyspnea, and stridor.This constitutes a life threatening emergency and the provider should be notified immediately. Emergency radiation treatment may be ordered for this issue.

While enlarged lymph nodes are usually painless, patients may experience pain with radiation and chemotherapy treatments, so management of pain and reduction of stress is essential to patients to promote healing and conserve their energy. Teach relaxation techniques and administer analgesics as necessary. Patients with lymphoma may experience a lack of appetite and diminished nutrition, so increasing caloric intake promotes healing, provides fuel for energy, and prevents gastric distension. Encourage patients to eat small/ frequent meals and increase their protein intake. Monitor your patient’s daily weight as well as their caloric intake. Be sure to provide supportive comfort measures to your patient following chemo or radiation treatment, as patients oftentimes, experience fatigue as well as nausea and vomiting following these treatments. Assist with their ADL’s, offer ice chips and anti-emetics as appropriate for nausea. Finally, fatigue and impaired nutrition cause muscle weakness. Assist patients to positions of comfort for optimal air exchange and monitor skin for signs of breakdown due to this prolonged bed rest.

Here is a look at the completed care plan for lymphoma. We love you guys. Now, go out and be your best self today and as always, happy nursing!