{ "name": "Lymphoma", "slug": "lymphoma", "url": "https://nursingplex.com/care-plans/lymphoma", "category": "Hematologic & Lymphatic", "summary": "Lymphatic malignancy; treatment side effects, infection risk and body-image support.", "nursing_diagnoses": [ "Risk for infection", "Fatigue", "Disturbed body image" ], "overview": [ "Lymphoma is cancer of the lymphatic system, divided into Hodgkin lymphoma — identified by Reed-Sternberg cells, common in young adults, and highly curable — and the far larger and more varied group of non-Hodgkin lymphomas, which range from indolent follicular disease to aggressive diffuse large B-cell lymphoma.", "The classic presentation is painless, rubbery, enlarging lymphadenopathy, most often cervical or supraclavicular, together with the 'B symptoms' that drive staging and prognosis: unexplained fever above 38 °C, drenching night sweats and loss of more than 10% of body weight over six months. Pruritus and alcohol-induced node pain are characteristic of Hodgkin disease.", "Treatment is chemotherapy, often with radiation and immunotherapy such as rituximab. Nursing care therefore blends the myelosuppression management of any cytotoxic regimen with attention to the long-term survivorship issues that matter enormously in a young, curable population: fertility, secondary malignancy, cardiac and pulmonary toxicity, and thyroid dysfunction after neck radiation." ], "key_facts": [ { "label": "Hallmark node", "text": "Painless, firm, rubbery, mobile lymph node — most often cervical or supraclavicular." }, { "label": "B symptoms", "text": "Fever >38 °C, drenching night sweats, >10% weight loss in 6 months; their presence upstages the disease." }, { "label": "Hodgkin marker", "text": "Reed-Sternberg cells on excisional lymph node biopsy confirm Hodgkin lymphoma." }, { "label": "Late effects", "text": "Doxorubicin cardiotoxicity, bleomycin pulmonary fibrosis, secondary cancers, infertility, hypothyroidism after neck radiation." }, { "label": "Splenectomy note", "text": "Asplenic patients need pneumococcal, meningococcal and Hib vaccination and lifelong infection vigilance." } ], "nursing_priorities": [ "Complete accurate staging and support the patient through diagnostic procedures.", "Prevent infection during myelosuppression.", "Manage chemotherapy side effects: nausea, mucositis, fatigue, neuropathy.", "Monitor for organ toxicity from specific agents.", "Maintain nutrition against B symptoms and treatment effects.", "Address fertility, body image and long-term survivorship early." ], "assessment": { "subjective": [ "A lump the patient noticed that does not hurt and has not gone away", "Drenching night sweats requiring a change of bedding", "Unexplained fevers and severe generalized itching", "Fatigue disproportionate to activity", "Pain in enlarged nodes after drinking alcohol", "Worry about fertility, appearance and returning to work or school" ], "objective": [ "Firm, painless, rubbery lymphadenopathy; hepatosplenomegaly", "Documented fever, night sweats and quantified weight loss", "Pallor, petechiae or infection during myelosuppression", "Cough, dyspnea or superior vena cava syndrome from mediastinal mass", "Elevated LDH and ESR, anemia and abnormal biopsy or PET-CT findings", "Peripheral neuropathy after vinca alkaloids; declining ejection fraction after anthracyclines" ], "related_factors": [ "Malignant proliferation of lymphocytes with nodal and organ infiltration", "Cytokine-driven fever, sweats and hypermetabolism", "Myelosuppression and mucosal injury from chemotherapy and radiation", "Splenic involvement or splenectomy with reduced immune surveillance", "Airway or vascular compression by bulky mediastinal disease" ] }, "goals": [ "The client will remain free of infection through each treatment cycle.", "The client will maintain weight within 5% of baseline.", "The client will report fatigue and nausea managed to a tolerable level.", "The client will show no evidence of cardiac or pulmonary toxicity on surveillance testing.", "The client will state fertility options and long-term follow-up requirements.", "The client will complete the planned treatment cycles on schedule." ], "interventions": [ { "title": "1. Supporting diagnosis and staging", "points": [ "Prepare the patient for excisional lymph node biopsy, bone marrow biopsy and PET-CT, explaining each in plain terms.", "Care for the biopsy site: monitor for bleeding, infection and, after bone marrow biopsy, apply pressure and observe for hematoma.", "Document node size, location, mobility and consistency with a consistent method so response can be tracked.", "Record B symptoms explicitly, since they alter staging and treatment intensity." ] }, { "title": "2. Infection prevention during treatment", "points": [ "Monitor CBC with differential and calculate the ANC before each cycle.", "Teach and enforce hand hygiene, oral care and avoidance of sick contacts during nadir, typically 7–14 days post-cycle.", "Report fever of 38 °C or above at once; obtain cultures and start antibiotics within an hour.", "Administer growth factors and prophylactic antimicrobials as ordered.", "For asplenic patients, verify vaccination status and teach lifelong fever precautions and antibiotic standby." ] }, { "title": "3. Managing treatment side effects", "points": [ "Give scheduled antiemetics before and after each cycle rather than waiting for nausea.", "Assess the oral mucosa daily and provide bland rinses; treat pain before meals.", "Assess for peripheral neuropathy at each visit — numbness, tingling, foot drop, constipation from autonomic effects — and report early since dose reduction may be needed.", "Prepare the patient for alopecia in advance: discuss wigs, scarves and scalp care before hair loss begins.", "Monitor infusion reactions closely during rituximab, especially the first dose, and premedicate as ordered." ] }, { "title": "4. Monitoring organ toxicity", "points": [ "Track cumulative anthracycline dose and support baseline and serial echocardiograms or MUGA scans.", "Assess for heart failure signs: dyspnea, orthopnea, edema, weight gain.", "Assess breath sounds and exertional dyspnea for bleomycin pulmonary toxicity and report a dry cough or new crackles.", "Monitor thyroid function after neck irradiation and teach hypothyroid symptoms.", "Protect irradiated skin: mild soap, no rubbing, no heat or ice, no fragranced products, and sun protection." ] }, { "title": "5. Nutrition and energy", "points": [ "Weigh at every visit and act on a downward trend before it becomes cachexia.", "Provide high-calorie, high-protein small frequent meals and supplements between meals.", "Manage taste alteration with plastic utensils, tart flavors and cold foods when tolerated.", "Encourage light regular activity such as walking, which reduces cancer-related fatigue more effectively than rest." ] }, { "title": "6. Survivorship and psychosocial care", "points": [ "Discuss sperm banking or oocyte preservation before the first cycle — after treatment starts the window closes.", "Address body image openly, particularly in adolescents and young adults.", "Provide a written survivorship plan listing agents received, cumulative doses and required lifelong surveillance.", "Screen for anxiety, depression and fear of recurrence at follow-up visits and refer as needed.", "Connect the patient with young-adult cancer support networks." ] } ], "patient_teaching": [ "Call for fever of 38 °C or higher, chills, sore throat, cough or burning with urination during treatment.", "Report new numbness or tingling in hands or feet promptly; it can be reduced by adjusting the dose.", "Report new shortness of breath, a dry cough, swelling of the ankles or rapid weight gain.", "Ask about fertility preservation before your first treatment.", "Keep every follow-up appointment and scan; long-term surveillance matters even years after cure.", "Protect irradiated skin from sun and heat and use only approved products.", "Stay active with light daily walking — it genuinely helps treatment fatigue." ] }