Lymphoma Nursing Care Plans

Lymphoma is a cancer of the lymphocytes, the white blood cells that run the immune system. It covers distinct entities defined by clinical, histologic, immunologic, molecular, and genetic features, split into two major groups: Hodgkin's disease and non-Hodgkin's lymphoma. On the floor, two problems demand your attention first: airway compromise from enlarged nodes, and the heavy psychosocial and educational load these patients carry.

Nursing Priorities

1. Symptom management.
2. Psychosocial support.
3. Patient education and health teaching.

Nursing Assessment

Assess for these subjective and objective findings:

• Verbalization of the problem
• Actual or perceived limitations from disease or therapy
• Altered relationship with a significant other
• Statements reflecting misconception, or requests for information
• Inaccurate follow-through on instruction, or preventable complications developing

Contributing factors to watch:

• Altered body structure or function from drugs, surgery, disease, or radiation (loss of sexual desire, disrupted sexual response)
• Tracheobronchial obstruction from enlarged mediastinal nodes or airway edema (Hodgkin's and non-Hodgkin's); superior vena cava syndrome (non-Hodgkin's)
• Lack of exposure or recall, information misinterpretation, unfamiliarity with resources, cognitive limitations

Nursing Goals

• The patient verbalizes understanding of the reasons behind any sexual problems and identifies lifestyle stressors that contribute.
• The patient discusses concerns about body image and desirability with a partner.
• The patient maintains an effective respiratory pattern, free of dyspnea, cyanosis, or distress.
• The patient verbalizes understanding of the condition, prognosis, and potential complications, and the link between disease signs and symptoms.
• The patient initiates necessary lifestyle changes.

Nursing Interventions and Actions

1. Promoting an Effective Breathing Pattern

Enlarged lymph nodes can compress the airway, and superior vena cava syndrome can swell and compress the veins draining the head and neck. Both threaten breathing, and superior vena cava syndrome is an oncologic emergency.

1. Assess respiratory rate, depth, and rhythm. Note dyspnea, accessory muscle use, nasal flaring, and altered chest excursion. Tachypnea, dyspnea, and accessory muscle use signal progressing respiratory involvement that needs prompt intervention.

2. Monitor skin color for pallor and cyanosis (nailbeds, ear lobes, lips). WBC proliferation cuts the blood's oxygen-carrying capacity, producing hypoxemia.

3. Assess the respiratory response to activity. Note dyspnea, air hunger, and increased fatigue, and schedule rest periods. Lower cellular oxygenation drops activity tolerance, and rest reduces oxygen demand.

4. Watch for neck vein distension, headache, dizziness, periorbital and facial edema, dyspnea, and stridor. Non-Hodgkin's patients are at risk for superior vena cava syndrome, which can deviate the trachea and obstruct the airway. This is an oncologic emergency.

5. Monitor ABGs and oximetry. Measures respiratory function and the effectiveness of therapy.

6. Position for comfort, usually head of bed elevated or sitting upright leaning forward with weight on the arms and feet dangling. Maximizes lung expansion, decreases work of breathing, and reduces aspiration risk.

7. Reposition and assist with turning periodically. Aerates all lung segments and mobilizes secretions.

8. Teach and assist with deep breathing, pursed-lip, or abdominal diaphragmatic breathing. Improves gas diffusion and small-airway expansion, and gives the patient some control over breathing, which lowers anxiety.

9. Encourage energy-saving techniques (rest before and after meals, shower chair, sitting for care). Reduces fatigue and dyspnea and conserves energy for cellular regeneration.

10. Promote bedrest during acute or prolonged exacerbation. Worsening hypoxia may require stopping activity to prevent more serious compromise.

11. Encourage expression of feelings and acknowledge that they are normal. Anxiety raises oxygen demand, and hypoxemia worsens distress, which feeds back into more anxiety.

12. Provide a calm, quiet environment. Promotes relaxation and lowers oxygen demand.

13. Support family and caregivers and encourage them to express feelings. This complication frightens families because it can mark end-stage disease, especially in hospice. Keeping them informed lowers their anxiety and keeps it from transmitting to the patient.

14. Provide supplemental oxygen. Maximizes available oxygen and reduces hypoxemia.

15. Administer analgesics and tranquilizers as indicated. Lowering the physiologic response to pain and anxiety reduces oxygen demand and limits respiratory compromise.

16. Assist with respiratory adjuncts (IPPB, incentive spirometer) as appropriate. Promotes full aeration and prevents atelectasis.

17. Assist with intubation and mechanical ventilation. May be needed to support breathing until airway edema resolves in acutely ill patients.

18. Prepare for emergency radiation therapy when indicated. The treatment of choice for superior vena cava syndrome.

2. Health Teaching and Patient Education

Cognitive limitations and a fast-changing treatment landscape make it hard for these patients to stay informed. Tailored teaching lets them take part in decisions, manage symptoms, stick to medications, and catch complications early.

1. Identify signs and symptoms that need further evaluation: cough, fever, chills, malaise, dyspnea (pneumonitis); weight gain, slow pulse, low energy, cold intolerance (hypothyroidism); moderate fever, chest pain, dry cough, dyspnea, rapid pulse (pericarditis); dyspnea, fatigue, chest pain, dizziness or syncope (cardiomyopathy). Prompt action limits the progression of complications.

2. Discuss complications tied to the specific regimen. Radiation and some chemotherapy agents can cause pneumonitis, hypothyroidism, pericarditis, and cardiomyopathy.

3. Emphasize ongoing medical followup. Treatment raises the risk of secondary malignancies (thyroid, myeloid leukemia, non-Hodgkin's lymphoma). Yearly Pap smears are recommended for female patients because Hodgkin's cells can appear on the cervix.

4. Recommend regular moderate exercise with adequate rest, and discuss energy conservation. Fatigue rides along with the disease, the treatment, and any developing complications, so balancing activity with rest protects the patient's ability to do ADLs.

5. Review infection prevention and the signs that need evaluation. Lymphoma carries a complex deficiency in cellular immunity before and after therapy, and herpes zoster is common.

6. Identify financial needs and community resources. Survival rates are good, but dyspnea, chronic fatigue, and trouble concentrating can limit work, and the diagnosis itself can affect a patient's ability to get loans or insurance.