Chapter 29 White blood cell disorders Lymphomas
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| Malignant Lymphoma | • Proliferation of lymphocytes, histocytes, and precursors or derivatives
• Hodgkin and non-Hodgkin
• Malignancies of lymphoid tissue
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| • Hodgkin lymphoma | – Develops in a single lymph node or chain of nodes, spreads to adjoining cells
– Reed–Steinberg cells
– Immune system impairment
- Reed-Sternberg Cells
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| • Pathophysiology of Hodgkin lymphoma | – Etiology unknown
– Contributing factors
• Epstein–Barr virus
• Genetic factors
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| – Manifestations of Hodgkin lymphoma | • Painlessly enlarged lymph nodes in cervical or subclavicular region
• Persistent fever
• Night sweats
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| – Classic “B” Symptoms of Hodgkin lymphoma | • Fatigue, malaise
• Weight loss (>10% of normal body weight)
• Pruritus
• Anemia
• Enlarged spleen
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| • Non-Hodgkin lymphoma | – Does not contain Reed–Steinberg cells
– Etiology unknown
– Viral infections can play a role
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| Manifestations of Non-Hodgkin lymphoma | • Early, similar to Hodgkin disease – Classic “B” symptoms
• Fever, night sweats, fatigue, and weight loss are less common
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| • Prognosis of Non-Hodgkin lymphoma determined by | – Stage of disease
– Presence of systemic manifestations
– Factors such as age
- Prognosis good when localized to one or two node regions
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| – Diagnostic tests for Lymphoma | – CBC
– Erythrocyte sedimentation rate (ESR)
– Chemistry studies of major organ function
– Chest x-ray– CT scans of chest, abdomen, and pelvis
– PET or gallium scans
– Biopsy of lymph node and bone marrow
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| • Staging of Lymphoma | – Ann Arbor Staging System (Stage I, II, III, IV)
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| Stage I of Lymphoma | • Involvement of a single lymph node region or lymphoid structure
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| Stage II of Lymphoma | • Involvement of two or more lymph node regions on the same side of the
diaphragm
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| Stage III of Lymphoma | • Involvement of lymph node regions or structures on both sides of the
diaphragm
• III1: limited to upper abdomen
• III2: involvement of lower abdominal nodes
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| Stage IV of Lymphoma | • Involvement of an extranodal site
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| Nursing Diagnoses for Lymphoma | • Fatigue
• Nausea
• Disturbed Body Image
• Sexual Dysfunction
• Risk for Impaired Skin Integrity
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