1. Timby/Smith: Introductory Medical-Surgical Nursing, 11/e
Chapter 32: Caring for Clients With Disorders of the Lymphatic System

2. Lymphatic System

3. Occlusive, Inflammatory, and Infectious Disorders
Lymphedema
Pathophysiology and Etiology: accumulation of lymphatic fluid from impaired lymph circulation
Types: primary or secondary
Assessment Findings: swelling of affected area; skin is tight, firm, shiny, brawny; weeping or oozing
Medical Management
Symptomatic; elevation; compression sleeve or stocking, complex decongestive physiotherapy
Nursing Management
Skin assessment, exercises; elevation; elastic garments; mechanical devices, emotional support

4. Question
A woman undergoing a modified radical mastectomy is at risk for ineffective tissue perfusion and lymphedema. A nursing intervention to prevent compromised flow of lymphatic fluid to the upper extremities includes: A) Assisting the client during periods of ambulation B) Supporting and elevating the arm on the side of the mastectomy C) Administering IM injections in the arm on the side of the mastectomy D) Applying an elastic roller bandage to the affected arm for 24 to 48 hours

5. Answer
B) Supporting and elevating the arm on the side of the mastectomy Rationale: Elevation promotes gravity drainage of fluid trapped in the soft tissue.

6. Occlusive, Inflammatory, and Infectious Disorders—(cont.)
Lymphangitis and Lymphadenitis
Pathophysiology and Etiology: streptococcal microorganisms
Assessment Findings: red streaks; fever; tender, enlarged lymph nodes
Medical Management: broad-spectrum antibiotic therapy
Nursing Management
Assist with ADLs; elevate extremity; provide warmth
Monitor temperature, swelling
Teaching: elastic sleeve and stocking application

7. Occlusive, Inflammatory, and Infectious Disorders—(cont.)
Infectious Mononucleosis
Pathophysiology and Etiology: Epstein-Barr virus; direct contact
Assessment Findings
Fatigue, fever, sore throat, headache, cervical lymph node enlargement, oozing tonsils, pharyngeal swelling
Diagnostic Findings
Epstein-Barr virus antibody titer; heterophil agglutination

8. Occlusive, Inflammatory, and Infectious Disorders—(cont.)
Medical Management
Bed rest; analgesic and antipyretic therapy
Increased fluid intake
Corticosteroids; antibiotics
Nursing Management
Inspect throat; palpate lymph nodes; encourage fluids; soft, bland foods; cool liquids
Emotional support
Teaching: rest; withhold donating blood

9. Question
The characteristics of infectious mononucleosis includes all of the following, except: A) Usual age is 15 to 25 years old. B) The fever is irregular. C) The incubation period is 10 to 14 days after exposure. D) Enlargement of lymph nodes is often generalized.

10. Answer
C) The incubation period is 10 to 14 days after exposure. Rationale: The normal incubation period of infectious mononucleosis is 30 to 50 days after exposure to the virus and the virus remains in the body for the person’s lifetime.

11. Lymphomas Hodgkin’s Disease
Pathophysiology and Etiology: Reed-Sternberg cells
Assessment Findings
Painless lymph node enlargement
Epigastric pain, fullness
Weight loss, anorexia, fatigue, weakness
Low-grade fever, pruritus, night sweats
Anemia, thrombocytopenia
Poor resistance to infection

12. Nursing Process: The Client With Hodgkin’s Disease
Assessment
History: symptoms, mononucleosis; physical assessment: lymph nodes
Diagnosis and Planning
Risks: ineffective airway clearance; impaired gas exchange; infection; impaired skin integrity
Interventions
Assess respiratory status, administer oxygen, prepare for intubation, infectious disease precautions, support and protect bony prominences

13. Lymphomas—(cont.) Hodgkin’s Disease—(cont.) Diagnostic Findings
CBC, blood chemistry tests, CT, MRI, lymphangiography, chest radiography
Laparotomy, bone marrow aspiration, biopsy
Staging: I to IV
Medical Management
Localized radiation
Chemotherapy, antineoplastic drugs, antibiotics
Transfusions; stem cell transplant

14. Question
A client diagnosed with Hodgkin’s disease is at risk for infection related to immunosuppression and drug or radiation therapy. To assist the client to remain free of infection, the nurse should implement which of the following? A) Divide cares into manageable amounts. B) Restrict visitors with infections from contact with client. C) Avoid drugs administered by parenteral route. D) Keep the neck in midline and place the client in high- Fowler’s position.

15. Answer
B) Restrict visitors with infections from contact with client. Rationale: Reducing the number of organisms in the environment and restricting visitors and personnel with an infection reduce the transmission of pathogens to the client.

16. Lymphomas—(cont.) Non-Hodgkin’s Lymphomas
Pathophysiology and Etiology: malignant diseases that originate in lymph glands
Causes: genetic link, environmental triggers
Classifications: indolent or aggressive
Assessment Findings
Lymph node enlargement
Lymphoid tissue biopsies; additional tests for staging

17. Lymphomas—(cont.) Non-Hodgkin’s Lymphomas—(cont.) Medical Management
Radiation, chemotherapy, immunotherapy; monoclonal antibody therapy (MAB)
Bone marrow transplant
Stem cell transplants
Autologous; allogenic
Nursing Management
Chemotherapy and radiation therapy
Encourage extra fluid intake

18. Monoclonal Antibody (MAB) Therapy

19. Question
A client with non-Hodgkin’s disease is admitted to the hospital. In discussing the client’s care with the nursing assistant, which nursing explanation is most correct in relation to the medical management of the disease? A) Radiation and chemotherapy B) Analgesic and antipyretic therapy C) Corticosteroid therapy D) Complex decongestive physiotherapy

20. Answer
A) Radiation and chemotherapy Rationale: Non-Hodgkin’s lymphoma is treated with radiation and chemotherapy or both. Immunotherapy with monoclonal antibodies (MABs) and bone marrow transplants (BMTs) are used to cure lymphomas or extend the lives of clients.