Hodgkin’s Lymphoma

Hodgkin’s Lymphoma Nursing Care Plans Diagnosis and Interventions

Hodgkin’s Lymphoma NCLEX Review Care Plans

Nursing Study Guide on Hodgkin’s Lymphoma

In Hodgkin’s Lymphoma (also called Hodgkin’s Disease), the lymphatic system is compromised, thereby resulting to the proliferation of invasive abnormal, cancer cells.

The lymphatic system is composed of a network of lymph nodes whose primary function is to transport lymph, a fluid that flows around the lymphatic system.

In turn, it carries away unwanted toxins or waste for elimination.

Another function of this system is on the production and transport of white blood cells (called lymphocytes) throughout the body.

It acts as the “highway” for these infection-fighting cells to reach injury sites as part of the self-repair mechanism of the body.

Given the role of the lymphatic system, the cells in Hodgkin’s lymphoma will invade otherwise healthy tissues interconnected by this network.

Common age group affected by this type of cancer is among people aged 20 to 40 years old, and those 55 years old and above.  

Hodgkin’s disease has become more manageable because of the advances in the diagnosis and treatment of this condition.

Signs and Symptoms of Hodgkin’s Lymphoma

  • Painless swelling of lymph nodes – commonly on the neck, armpit or groins
  • Persistent fatigue
  • Fever
  • night sweats
  • Unexplained weight loss
  • Sever itching
  • Chest pain – often associated with shortness of breath or cough
  • Increased sensitivity and/or pain in the lymph nodes after drinking alcohol

Causes and Risk Factors of Hodgkin’s Lymphoma

The cause of Hodgkin’s Disease is unknown. However, it is stipulated that stressors affecting the lymphocytes causes the condition.

Epstein-Barr Virus or EBV infections has been pointed out that may cause DNA changes in the B-lymphocytes.

In some cases, the infection leads to the development of Reed-Sternberg cells, which are cancer cells distinct to Hodgkin’s disease.

These cells crowd the lymphatic system rapidly, thereby causing the manifestations of the disease.

The type of cells and their behavior determine the subtype used for diagnosing the condition and are enumerated below:

  • Nodular sclerosing – the most common type and accounts for 60-80% of cases; characterized by fibrous scars (sclerosed) on the lymph nodes; commonly located in the chest and neck areas
  • Mixed Cellularity – accounts for 25% of cases; common in older adults; commonly located in the abdomen
  • Lymphocyte-depleted – extremely rare; accounts for less than 1% of cases; commonly diagnosed on older patients or people with HIV infection.
  • Lymphocyte-rich – accounts for 5% of cases; more commonly diagnosed in men
  • Nodular lymphocyte predominant – less common and affects about 5% of Hodgkin lymphoma patients; commonly diagnosed in middle-aged adults; characterized by “popcorn-like” Reed-Sternberg cells

The following risk factors may play a role in the development of this condition:

  • Epstein-Barr Virus/Mononucleosis – Epstein-Barr Virus (EBV) is the primary agent responsible for the condition, Mononucleosis. People who had this disease is correlated with an increased risk for Hodgkin’s Disease
  • Age – The condition can be diagnosed at any age. However, it is more common in early adulthood (early 20’s) and late adulthood (age 55 and above).
  • Gender – occurs more often in males than in females
  • Family history – Having younger siblings and/or identical twin with the disease is a risk factor.
  • Weakened immune system – Patients with HIV infection, have autoimmune disease, or those on immunosuppressive drugs are considered at risk for developing Hodgkin’s Disease.

Complications of Hodgkin’s Lymphoma

  1. Weakened immune system. Because of the origin of the condition, the body is unable to produce enough normal leukocytes to fight for opportunistic infections that may likewise cause severe illness.
  2. Infertility. Chemotherapy and radiation are the usual treatment options. Since the nature of these treatment not only destroys abnormal cells but also normal cells, infertility may set-in as secondary effect.
  3. Secondary cancers. Patients who had Hodgkin’s disease are at risk for developing secondary cancers (e.g. leukemia) in the future, first due to abnormalities in cell production and second, as compounding effect attributed to chemotherapy and radiation.

Diagnosis of Hodgkin’s Lymphoma                                                

  • Physical Exam – to assess presence of enlarged lymph nodes in the body particularly the neck, armpit and groin areas.
  • Blood Tests – include CBC, Erythrocyte sedimentation rate, Lactate dehydrogenase, Serum creatinine, Alkaline phosphatase, HIV test (including screening for Hepatitits B and C), and serum levels of cytokines (interleukin [IL]-6, IL-10 and soluble CD25 (IL-2 receptor) to assess for tumor burden and disease progression.
  • Imaging – X-rays of the chest for initial assessment of mediastinal masses; CT scans particularly of the abdomen, chest and pelvis to visualize enlarged lymph nodes; PET scans to aide in staging of the disease.
  • Lymph node biopsy – done to diagnose the specific subtype of Hodgkin’s Disease
  • Bone marrow aspiration – indicated for those with advanced-stage disease, those with generalized and systemic manifestations, or with high susceptibility for the disease.

The staging for Hodgkin’s Disease utilizes the Ann Arbor classification as follows:

  •  Stage I: A single lymph node or extra-nodal site
  • Stage II: 2 or more lymph node areas on the same side of the diaphragm
  • Stage III: Lymph node areas on both sides of the diaphragm
  • Stage IV: Disseminated or multiple involvement of extra-nodal organs

Treatment for Hodgkin’s Lymphoma

According to the World Health Organization, Hodgkin’s lymphoma is potentially treatable. Listed below are the treatment options for the disease:

  1. Radiation Therapy. This involves using highly focused beams of radiation to target cancer in specific areas of the body. Examples are IFRT or Involved-field radiation wherein organs/areas with cancer is the focal point of application.
  2. Induction Chemotherapy. A variety of initial chemotherapy protocols are administered, one commonly used protocol for Hodgkin’s disease is the ABVD (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine).
  3. Salvage Chemotherapy – This involves the use of chemotherapy drugs administered to patients on the later or more advanced stages of the disease. An example is the ICE regimen (Ifosfamide, Carboplatin, and Etoposide).
  4. Hematopoietic stem cell transplantation. After high doses of chemotherapy are administered, new, healthy stem cells are infused to replace the necessary blood cells lost.

Nursing Care Plans for Hodgkin’s Lymphoma

Nursing Care Plan 1

Nursing Diagnosis: Risk for Ineffective Breathing Pattern secondary to Hodgkin’s Lymphoma

Desired Outcome: The patient will maintain effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Administer the prescribed medications (e.g. bronchodilators, steroids, or combination inhalers / nebulizers)Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Perform chest physiotherapy such as percussion and vibration, if not contraindicated. Nebulization using sodium chloride (NaCl) may also be done, as ordered by the physician. Steam inhalation may also be performed.To facilitate clearance of thick airway secretions.

Nursing Care Plan 2

Nursing Diagnosis: Activity intolerance related to persistent fatigue as evidenced by verbalization of unrelieved fatigue, overwhelming lack of energy, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To allow the patient to pace activity versus rest.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan 3

 Nursing Diagnosis: Risk for Infection secondary to chemotherapy/radiotherapy

Desired Outcome: The patient will be able to avoid the development of an infection.

InterventionsRationales
Assess vital signs and observe for any signs of infection as well as for any signs of respiratory distress.Sepsis or infection of the blood may be evidenced by fever accompanied by respiratory distress.
Observe the color of the sputum.Greenish or yellowish pulmonary secretions may indicate the development of an infection.
Obtain a sputum sample for culture if infection is suspected.To confirm the presence of an infection and its causative agent.
Teach the patient how to perform proper hand hygiene, covering the mouth when coughing, and oral care.To maintain patient’s safety. To prevent spreading airborne or fluid borne pathogens and reduce the risk of contamination.

Nursing Care Plan 4

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to decrease food intake secondary to ongoing chemotherapy for Hodgkin’s lymphoma  as evidenced by weight loss, nausea & vomiting, poor muscle tone and lack of appetite

 Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight gain.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.  
Help the patient to select appropriate dietary choices to follow a high caloric diet.Patients tend to expend a significant amount of energy by overusing respiratory muscles to breathe. High caloric diet may help provide the energy he/she needs and combat fatigue and weight loss.  
Instruct the patient to avoid carbonated beverages and gas-producing food.To reduce abdominal distention which can hinder the optimal expansion of the diaphragm.
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed cancer and chemotherapy/ radiotherapy treatment.  

Other possible nursing diagnoses:

  • Fatigue
  • Anticipatory Grieving
  • Acute Pain

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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