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Lymphoma

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Overview

  1. Cancer of the lymphatic system affecting lymphocytes
  2. Impairs immune response

Nursing Points

General

  1. Classified by Type
    1. Hodgkin’s Lymphoma
      1. Presence of Reed-Sternberg cells
    2. Non-Hodgkin’s Lymphoma
      1. Absence of Reed-Sternberg cells
      2. 90% of Lymphomas
  2. Tumors may form in/around the lymph nodes
  3. Lymphocytes affected – can travel/metastasize through lymphatic system

Assessment

  1. Painless swelling of lymph nodes
  2. Persistent fatigue
  3. Fever
  4. Night sweats
  5. Shortness of breath
  6. Unexplained weight loss
  7. Enlarged liver or spleen
  8. Risk for Infection

Therapeutic Management

  1. Official diagnosis with lymph node biopsy
    1. Hold pressure over biopsy site
  2. Chemotherapy
  3. Radiation
  4. Lymph node removal
  5. Monitor for s/s metastasis (high risk)

Nursing Concepts

  1. Infection Control
    1. Neutropenic Precautions
    2. Monitor for s/s Infection
  2. Clotting
    1. May have risk for bleeding, especially after surgery or biopsy
  3. Cellular Regulation
    1. Chemotherapy Precautions

Patient Education

  1. Bleeding Precautions
  2. Infection Precautions
  3. Oral Hygiene

Reference Links

Study Tools

Video Transcript

This lesson will cover lymphoma. Now, this is very similar to leukemia in that they are both cancers affecting white blood cells. But we want to help differentiate it for you and break it down.

Where Leukemia is cancer of the Bone Marrow affecting all White Blood Cells – Lymphoma is a cancer of the Lymphatic System and it primarily affects Lymphocytes only. Remember that the purpose of the lymphatic system is to participate in our immune system – these green nodes and vessels are showing our lymphatic system in the body. It helps circulate white blood cells throughout the body to fight infections or clean up dead cells. It helps bring toxins and waste products to the liver or spleen for processing. It’s basically the clean-up crew of our body. When our lymphatic system is affected and cancerous, it no longer functions properly, therefore our immune response is severely impaired. Now, there are many types, but they fit into two umbrella categories – they’re either Hodgkin’s or Non-Hodgkin’s. When they do the lymph node biopsy and look at the cells under the microscope – they may see what are called Reed-Sternberg cells. If they DO see them, it’s considered Hodgkin’s Lymphoma. If there are NO Reed-Sternberg cells, then it’s Non-Hodgkin’s Lymphoma. So if you see Reed-Sternberg cells in a question, you know you’re dealing with Hodgkin’s Lymphoma, which is more treatable and tends to be less severe at diagnosis than Non-Hodgkin’s.

So, in lymphoma, tumors can form in and around the lymph nodes like the one you see here. So already you can see how there’s not only gonna be an issue with function, but you may be able to even feel this tumor on some of the more superficial lymph nodes. These cancerous cells can also travel throughout the lymphatic system to any place in the body or just exist within the lymphatic circulation. To diagnoses lymphoma, we need to biopsy the lymph nodes – usually they’ll choose the swollen one plus one on either side of that circulation. Make sure you hold pressure and watch for bleeding after a lymph node biopsy.

So like I said, one of the primary things you’ll see is enlargement of the lymph nodes. This could be because of a tumor, but also because of the overproduction of abnormal malignant lymphocytes. In fact, fun fact – the supraclavicular lymph nodes, which aren’t actually even shown here – if those are enlarged, it is almost ALWAYS indicative of malignancy. We may also see enlargement of the liver and spleen because that’s where all these built up waste products go to try to be removed. Because of the effect on the immune system, these patients are at risk for infection, so we want to protect them and implement infection precautions. They will also present with flu-like symptoms, fever, night sweats, persistent fatigue, and shortness of breath, as well as unexplained weight loss. Again, these are kind of non-specific so it’s important to do a thorough assessment so that we can connect the dots between these general malaise-like symptoms and the enlarged lymph nodes, liver, and spleen.

Managing Lymphoma is similar to Leukemia – we will do chemotherapy and radiation. We could also remove affected lymph nodes, especially if there are large tumors. But the other thing we need to keep in mind with Lymphoma is its high likelihood for metastasis. Because the lymphatic system circulates throughout the whole body, these cancerous cells have a high risk of moving and setting up shop in other organs. These are the most common sites for metastasis of lymphoma cells. The brain, bones, skin, liver, stomach and small intestine, and the testicles in males. So it’s important that we monitor for any signs that these organs may be affected as well.

Priority nursing concepts for a patient with Lymphoma are going to be infection control, clotting, and cellular regulation. We want to prevent infection and use strict hand hygiene, they may have some anemia or have other blood cells affected, and they can bleed from their biopsy site, so we need to monitor for that as well. And we want to support them through their chemotherapy treatments and monitor for signs of metastasis. In the Oncology Important Points lesson we’ll talk in a little bit more detail about caring for a patient getting chemotherapy. Also, check out the care plan attached to this lesson to see more detailed nursing interventions and rationales for a patient with lymphoma.

So let’s review. Lymphoma is a cancer of the lymphatic system that affects lymphocytes. It’s either Hodgkin’s type or Non-Hodgkin’s based on the presence or absence of Reed-Sternberg cells. It presents with flu-like symptoms plus enlargement of the lymph nodes, liver, or spleen. Lymphoma has a high metastatic risk because these cells circulating throughout the body. Patients are at high risk for infection because it affects the immune system. So we want to use good hand hygiene and implement infection control precautions for these patients.

So those are the basics of Lymphoma. Don’t miss all the resources attached to this lesson to get a big picture of how to care for these patients. Now, go out and be your best selves today. And, as always, happy nursing!

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