Hodgkin’s Lymphoma (HL) is a type of cancer originating in the lymphatic system, specifically affecting lymphocytes. This nursing diagnosis focuses on identifying and managing symptoms, preventing complications, and supporting patients through treatment.
Causes (Related to)
Hodgkin’s Lymphoma can affect patients in various ways, with several factors contributing to its development and progression:
- Genetic predisposition
- Compromised immune system
- Previous Epstein-Barr virus infection
- Family history of lymphoma
- Age (bimodal distribution: 15-35 and over 55 years)
Risk Factors include:
- Autoimmune conditions
- HIV/AIDS
- Immunosuppressive therapy
- Family history of blood cancers
Environmental factors including:
- Exposure to certain chemicals
- Radiation exposure
- Environmental toxins
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Persistent fatigue
- Night sweats
- Unexplained weight loss
- Pruritus (itching)
- Bone pain
- Loss of appetite
- Alcohol-induced lymph node pain
Objective: (Nurse assesses)
- Painless, enlarged lymph nodes
- Fever
- Splenomegaly
- Hepatomegaly
- B symptoms (fever, night sweats, weight loss)
- Decreased breath sounds if mediastinal involvement
- Pallor
- Tachycardia
Expected Outcomes
- The patient will maintain adequate nutrition and hydration
- The patient will report decreased fatigue
- The patient will demonstrate proper infection prevention measures
- The patient will maintain an optimal comfort level
- The patient will verbalize understanding of the disease process and treatment
- The patient will show improved blood counts during treatment
- The patient will maintain weight within the normal range
Nursing Assessment
Monitor Vital Signs
- Check temperature, pulse, respiratory rate, and blood pressure
- Monitor for signs of infection
- Assess for B symptoms
Assess Physical Status
- Evaluate lymph node changes
- Monitor for respiratory distress
- Check for skin changes
- Assess for bleeding
- Monitor for signs of infection
Evaluate Nutritional Status
- Monitor weight
- Track food and fluid intake
- Assess for nausea/vomiting
- Check for mucositis
- Monitor laboratory values
Check for Complications
- Monitor for tumor lysis syndrome
- Assess for treatment side effects
- Watch for signs of infection
- Check for bleeding
- Monitor organ function
Review Psychosocial Status
- Assess coping mechanisms
- Evaluate support system
- Monitor anxiety levels
- Check understanding of disease/treatment
- Assess for depression
Nursing Care Plans
Nursing Care Plan 1: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to immunosuppression from disease process and treatment as evidenced by decreased WBC count and neutropenia.
Related Factors:
- Compromised immune system
- Chemotherapy effects
- Malnutrition
- Invasive procedures
Nursing Interventions and Rationales:
- Implement neutropenic precautions
Rationale: Prevents exposure to pathogens - Monitor temperature and vital signs
Rationale: Early detection of infection - Educate about hand hygiene and infection prevention
Rationale: Reduces risk of infection
Desired Outcomes:
- The patient will remain free from infection
- The patient will demonstrate proper infection-prevention techniques
- The patient will maintain a normal temperature
Nursing Care Plan 2: Fatigue
Nursing Diagnosis Statement:
Fatigue related to disease process and treatment effects as evidenced by verbalized exhaustion and decreased activity tolerance.
Related Factors:
- Anemia
- Treatment side effects
- Poor nutrition
- Sleep disturbances
Nursing Interventions and Rationales:
- Plan activities during peak energy periods
Rationale: Maximizes energy utilization - Encourage adequate rest periods
Rationale: Prevents exhaustion - Monitor activity tolerance
Rationale: Prevents overexertion
Desired Outcomes:
- The patient will report improved energy levels
- The patient will maintain a balanced activity/rest schedule
- The patient will perform ADLs independently
Nursing Care Plan 3: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than body requirements related to disease process and treatment side effects as evidenced by weight loss and decreased appetite.
Related Factors:
- Nausea/vomiting
- Altered taste sensation
- Mucositis
- Decreased appetite
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition - Provide small, frequent meals
Rationale: Improves food tolerance - Administer antiemetics as ordered
Rationale: Controls nausea/vomiting
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will demonstrate an improved appetite
- The patient will achieve optimal nutritional status
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to diagnosis and treatment process as evidenced by expressed concerns and increased tension.
Related Factors:
- Uncertain prognosis
- Treatment concerns
- Changed health status
- Financial concerns
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety levels - Educate about disease/treatment
Rationale: Increases sense of control - Facilitate coping strategies
Rationale: Helps manage stress
Desired Outcomes:
- The patient will report decreased anxiety
- The patient will utilize effective coping mechanisms
- Patient will verbalize understanding of treatment plan
Nursing Care Plan 5: Risk for Bleeding
Nursing Diagnosis Statement:
Risk for Bleeding related to thrombocytopenia secondary to disease process and treatment as evidenced by decreased platelet count.
Related Factors:
- Bone marrow suppression
- Chemotherapy effects
- Disease process
- Coagulation disorders
Nursing Interventions and Rationales:
- Monitor for bleeding signs
Rationale: Early detection of complications - Implement bleeding precautions
Rationale: Prevents injury - Educate about bleeding prevention
Rationale: Promotes safety
Desired Outcomes:
- The patient will remain free from bleeding
- Patient will demonstrate an understanding of precautions
- The patient will maintain safe platelet levels
References
- Ally F, Gajzer D, Fromm JR. A Review of the Flow Cytometric Findings in Classic Hodgkin Lymphoma, Nodular Lymphocyte Predominant Hodgkin Lymphoma and T Cell/Histiocyte-Rich Large B Cell Lymphoma. Clin Lab Med. 2023 Sep;43(3):427-444. doi: 10.1016/j.cll.2023.04.011. Epub 2023 Jun 23. PMID: 37481321.
- Fraga M, Sánchez-Verde L, Forteza J, García-Rivero A, Piris MA. T-cell/histiocyte-rich large B-cell lymphoma is a disseminated aggressive neoplasm: differential diagnosis from Hodgkin’s lymphoma. Histopathology. 2002 Sep;41(3):216-29. doi: 10.1046/j.1365-2559.2002.01466.x. PMID: 12207783.
- Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
- O’Malley DP, Dogan A, Fedoriw Y, Medeiros LJ, Ok CY, Salama ME. American Registry of Pathology Expert Opinions: Immunohistochemical evaluation of classic Hodgkin lymphoma. Ann Diagn Pathol. 2019 Apr;39:105-110. doi: 10.1016/j.anndiagpath.2019.02.001. Epub 2019 Feb 6. PMID: 30802809.
- Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Wang HW, Balakrishna JP, Pittaluga S, Jaffe ES. Diagnosis of Hodgkin lymphoma in the modern era. Br J Haematol. 2019 Jan;184(1):45-59. doi: 10.1111/bjh.15614. Epub 2018 Nov 8. PMID: 30407610; PMCID: PMC6310079.
