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Lymphoma- nursing management

NURSING MANAGEMENT

 

Nursing Assessment

  • Obtain health history, focusing on fatigue, fever, chills, night sweats, swollen lymph nodes, and history of illness or therapy causing immunosuppression.
  • Evaluate splenomegaly, hepatomegaly, lymphadenopathy.
  • Assess the vital signs of the patient regularly.
  • Monitor the support system received by the patient.
  • Assess any break in skin or mucosal integrity due to the therapy.
  • Assess the psychological state of the patient.
  • Assess the CBC and other investigations regularly.

Nursing Diagnosis

  • High risk for Infection related to altered immune response because of lymphoma and leukopenia caused by chemotherapy or radiation therapy
  • Impaired Tissue Integrity related to high-dose radiation therapy
  • Impaired Oral Mucous Membrane related to high-dose radiation therapy
  • Anxiety and fear of the unknown and possible death
  • Risk for ineffective breathing pattern/airway clearance related to airway obstruction: enlarged mediastinal nodes and/or airway edema

Nursing Interventions

Minimizing Risk of Infection

  • Care for patient in protected environment with strict hand washing observed.
  • Avoid invasive procedures, such as urinary catheterization, if possible.
  • Assess temperature and vital signs, breath sounds, LOC, and skin and mucous membranes frequently for signs of infection.
  • Notify health care provider of fever greater than 101° F (38.3° C) or change in condition.
  • Obtain cultures of suspected infected sites or body fluids.

Maintaining Tissue Integrity

  • Avoid rubbing, powders, deodorants, lotions, or ointments (unless prescribed) or application of heat and cold to treated area.
  • Encourage patient to keep treated area clean and dry, bathing area gently with tepid water and mild soap.
  • Encourage wearing loose-fitting clothes.
  • Advise patient to protect skin from exposure to sun, chlorine, and temperature extremes.

Preserving Oral and GI Tract Mucous Membranes

  • Encourage frequent small meals, using bland and soft diet at mild temperatures.
  • Teach patient to avoid irritants, such as alcohol, tobacco, spices, extreme food temperatures.
  • Administer or teach self-administration of pain medication or antiemetic before eating or drinking, if needed.
  • Encourage mouth care at least twice per day and after meals using gentle flossing, soft toothbrush or toothette, and mild mouth rinse.
  • Assess for ulcers, plaques, or discharge that may be indicative of superimposed infection.
  • For diarrhea, switch to low-residue diet and administer antidiarrheals as ordered.

Fears verbalized/identified; maintain realistic hope

  • Identify previous coping mechanisms, if possible.
  • Encourage patient to use them as appropriate.
  • Explain all procedures and rationale for these in terms patient and family can understand.
  • Assist family in supporting patient.
  • Use services from behavioral medicine, chaplain as needed.

Maintain a pattern airway

  • Assess/monitor respiratory rate, depth, rhythm.
  • Note and reports of dyspnea and/or use of accessory muscles, nasal flaring, altered chest excursion.
  • Place patient in position of comfort, usually with head of bed elevated or sitting upright leaning forward (weight supported on arms), feet dangling.
  • Reposition and assist with turning periodically.
  • Instruct in/assist with deep-breathing techniques and/or pursed-lip or abdominal diaphragmatic breathing if indicated.
  • Provide supplementary Oxygen.
  • Assist with respiratory treatment, eg. Incentive spirometer, if appropriate.
  • Assist with intubation and mechanical ventilation, if required.

Patient Education and Health Maintenance

  • Teach patient infection precautions.
  • Encourage frequent follow-up visits for monitoring of CBC and condition.
  • Teach patient about risk of infection.
  • Teach patient how to take medications as ordered, and instruct about possible adverse effects and management.
  • Explain to patient that radiation therapy may cause sterility; men should be given opportunity for sperm banking before treatment; women may develop ovarian failure and require hormone replacement therapy.
  • Reassure patient that fatigue will decrease after treatment is completed; encourage frequent naps and rest periods.
  • Provide patient and family with information about resources in the community and other support groups.

Evaluation: Expected Outcomes

  • Remains afebrile with no signs or symptoms of infection
  • Skin intact without erythema or swelling
  • Oral mucosa intact, patient eating
  • Patient indicates understanding of procedures and situation as condition permits
  • Maintain a normal/effective respiratory pattern, free of dyspnea, cyanosis, or other signs of respiratory distress

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