Exam 14: Lymphatic Disorders
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| Lymphangitis | Inflammation of one or more lymphatic vessels or channels.
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| Lymphangitis: Caused by | acute streptococcal or staphylococcal infection in an extremity.
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| Lymphangitis: Manifestations | Fine red streaks from the affected area in the groin or axilla.
Usually not localized, and edema is diffuse.
Chills, fever, and local pain accompany headache and myalgia.
Lymphadenopathy (swollen lymph nodes).
Septicemia may occur.
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| Lymphangitis: Diagnosis | Made by visual inspection and palpitation.
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| Lymphangitis: Medical Management | (1) Administration of penicillin or other antimicrobial drugs controls the infection.
(2) Hot, moist- heat-soaks or packs for comfort.
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| Lymphedema | Primary or secondary disorder characterized by the accumulation of lymph in soft tissue and edema.
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| Lymphedema: Causes | (a) Obstruction.
(b) Increase in the amount of lymph.
(c) Removal of the lymph channels and nodes.
(d) May be hereditary.
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| Lymphedema: Fun Fact | If lymphatic drainage is disturbed, an inflammatory process may result.
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| Lymphedema: Clinical Manifestations | Massive edema and tightness cause pressure and pain in the affected extremities.
Progresses toward the trunk and aggravated by pressure, obesity or warmth.
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| Lymphedema: Subjective data | (a) Complaints of pain and pressure.
(b) Medical history of varicosities, pregnancy, or modified radical mastectomy is important.
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| Lymphedema: Objective Data | (a) Observations of the extremities for edema.
(b) Palpation of distal pulses (e.g., pedal pulses)
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| Lymphedema: Dx Tests | Lymphangiography is used to differentiate lymphedema from venous disorders.
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| Lymphedema: Medical Management | Fluid management (Diuretics not recommended).
Prevention of complications (mechanical management, compression pumps & elastic sleeves or stockings).
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| Lymphedema: Nursing Interventions | Increase lymphatic drainage.
Monitor/prevent infections.
Emotional support.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma) | Neoplastic disorder of lymphoid tissue (a neoplasm of the immune system).
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Causes | unknown, but a viral source (herpes-like virus) is suspected.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Clinical Manifestations | Painless lymphadenopathy in the cervical area.
Fever.
Weight loss.
Anemia.
Pruritus.
Susceptibility to infection.
Pressure symptoms in the involved areas.
Pleural effusion, bone fractures, and paralysis.
Bone lesions.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Subjective Data | Complaints of fatigue, malaise and anorexia.
Fever and diaphoresis.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Objective | (a) Examination of the abdomen for splenomegaly.
(b) Lymphadenopathy.
(c) Weight loss
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Bone scan may reveal | fractures, lesions, and tumor infiltration.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): CBC Show | increased RBCs, WBCs, platelets, ESR and anemia.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Chemistry | increased calcium and alkaline phosphatase.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Coombs' Test | reveals a positive result for antiglobulin (reveals an autoimmune process causing anemia).
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): CXR | to reveal mediastinal nodes
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): CT Scan of chest, ABD and pelvis | to identify tumors.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Gallium Scan | Nuclear Medicine scan to search for tumors - gallium accumulates in inflamed and abnormal tissue
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Biopsies of lymph nodes, liver, and bone marrow are performed | for specific evidence of a pathological condition.
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| Malignant lymphoma (Non-Hodgkin’s Lymphoma): Medical Management | (1) Accurate staging is crucial to determine the treatment regimen.
(2) Chemotherapy and radiation.
(3) Immunotherapy with monoclonal antibodies.
(4) Bone marrow transplant.
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| Chemotherapy agents used for Lymphoma | (a) cyclophosphamide (Cytoxan).
(b) vincristine (Oncovin).
(c) prednisone.
(d) doxorubicin (Adriamycin).
(e) bleomycin.
(f) methotrexate.
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| Radiation & Lymphoma | Commonly receive radiation to the chest wall, mediastinum, axillae, and neck (known as the "mantle field").
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| Monoclonal antibody therapy - rituximab (Rituxan) | Immunotherapy to eliminate malignant cells and induce remission.
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| Bone marrow transplant: Autologous | From yourself
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| Bone marrow transplant: Allogenic | From someone else
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| Hodgkin's disease | Malignant disorder characterized by painless, progressive enlargement of
lymphoid tissue.
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| Hodgkin's disease: Two age populations | (a) 15-35 years of age: Thought to be a viral infection that turns into an infectious/inflammatory process and eventually a neoplasm.
(b) Peak at 50 years of age.
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| Hodgkin's disease: Causes | unknown but thought to be an immune disorder (T-cell disease).
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| Reed-Sternberg cells | large, abnormal multinucleated cells in the lymph nodes of Hodgkin’s lymphoma
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| Hodgkin's disease: Clinical Manifestations | (1) Anorexia.
(2) Weight loss.
(3) Malaise.
(4) Extreme pruritus.
(5) Low-grade fever.
(6) Night sweats.
(7) Anemia, leukocytosis followed by respiratory infections.
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| Hodgkin's disease: Subjective data | (a) Malaise.
(b) Appetite loss.
(c) Pruritus is often severe.
(d) Bone pain occurs later in the disease's course.
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| Hodgkin's disease: Objective data | Cervical and supraclavicular lymphadenopathy.
Splenomegaly, hepatomegaly, and abdominal tenderness.
Excoriation of skin and evidence of scratching from pruritus.
Edema of the face and neck may be noticed.
Weight and nutritional status are recorded.
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| Hodgkin's disease: CBC | shows anemia, increased WBCs, increased ESR (shows an inflammatory process).
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| Hodgkin's disease: CXR | may reveal a mediastinal mass.
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| Hodgkin's disease: Lymphangiograms | can detect retroperitoneal node involvement.
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| Hodgkin's disease: CT scan/ultrasound | reveals splenomegaly or hepatomegaly
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| Hodgkin's disease: Lymph node biopsy | includes laparoscopy for retroperitoneal nodes is performed.
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| hallmark of the presence of Hodgkin's disease. | The presence of Reed-Sternberg Cells
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| Hodgkin's disease: medical Management (stage I & II) | Radiation therapy for stages I and II (localized).
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| Hodgkin's disease: medical Management (stage III & IV) | Chemotherapy and radiation therapy for stages III and IV (generalized forms); advances in treatment now enable some stage IIIB and stage IV diseases to be cured with high-dose chemotherapy and bone marrow or peripheral stem cell transplantation.
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| Traditional Regimen for Hodgkin's Disease (MOPP) | 1) Mechlorethamine (Mustargen).
2) Vincristine (Oncovin).
3) Procarbazine (Matulane).
4) Prednisone.
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| Oncologist Regimen for Hodgkin's Disease (ABVD) | 1) doxorubicin (Adriamycin).
2) bleomycin (Blenoxane).
3) vinblastine (Velban).
4) dacarbazine (DTIC-DOME).
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| Biological response modifier (Neupogen) | (a) Stimulates proliferation and differentiation of neutrophils.
(b) Used to decrease infection in patients receiving antineoplastics that suppress neutrophil production.
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| Hodgkin's disease: Stage I | Abnormal single lymph nodes, regional or single extranodal site
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| Hodgkin's disease: Stage II | a. Two or more lymph nodes on the same side of the diaphragm.
b. Localized involvement of extranodal site and one or more lymph node regions of the same side of diaphragm.
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| Hodgkin's disease: Stage III-1 | Abnormal lymph node regions on both sides of diaphragm.
May be accompanied by spleen involvement.
Now subdivided into lymphatic involvement of the upper abdomen in the spleen (Splenic, celiac, and portal nodes).
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| Hodgkin's disease: Stage III-2 | lower abdominal nodes in the periaortic, mesenteric and iliac regions (Stage III2)
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| Hodgkin's disease: Stage IV | Diffuse and disseminated involvement of one or more extralymphatic tissues and/or organs-with or without lymph node involvement; the extranodal site is identified as H, Hepatic; L. lung; P, pleural; M, marrow; D, dermal; O, osseous.
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| Blood products should be administered with caution | older adults are at increased risk of developing congestive heart failure.
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