At the end our case presentation staff will be able :
– To understand pathophysiology of NHL.
– To know the management of the patient.
– To identify nursing role in caring for patient with NHL.
What is Non- Hodgkin Lymphoma ?
Is cancer that begins in cells of the immune system. The immune system fights infections and other diseases.
Because lymphatic tissue is in many parts of the body, Hodgkin lymphoma can start almost anywhere. Usually, it’s first found in a lymph node.
The lymphatic system is part of the immune system. The lymphatic system includes the following:
Lymph vessels: The lymphatic system has a network of lymph vessels. Lymph vessels branch into all the tissues of the body.
Lymph: The lymph vessels carry clear fluid called lymph. Lymph contains white blood cells, especially lymphocytes such as B cells and T cells.
Lymph nodes: Lymph vessels are connected to small, round masses of tissue called lymph nodes. Groups of lymph nodes are found in the neck, underarms, chest, abdomen, and groin. Lymph nodes store white blood cells. They trap and remove bacteria or other harmful substances that may be in the lymph.
Other parts of the lymphatic system: Other parts of the lymphatic system include the tonsils, thymus, and spleen. Lymphatic tissue is also found in other parts of the body including the stomach, skin, and small intestine.
•The cause of NHL is unknown.
•Exposures to viruses & immunosuppression Are thought to related to NHL.
•Some believe that both Hodgkin disease & NHL result from an immune defect or from the activation of an oncogentic virus .
Non-Hodgkin lymphoma cells
Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell divides to make copies of itself
The new cells divide again and again, making more and more abnormal cells. The abnormal cells don’t die when they should. They don’t protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Patient Name: Mohammed Abed Al-thubaiti
Hospital Record NO: 10773307
Age: 6 years old
Nationality : Saudi
Date of admission: 30 /10 /2010
Admitted from : OPD
Diet : Normal oral Diet
Attending physician : DR. Hala
Admitting diagnosis & Final
Diagnosis : NHL
Reason for coming to hospital:
Patient referred from KFH in
Condition in Taif was acute
fever and bone pain for 2 weeks
&loss of appetite and sore throat
previous hospitalization :
Surgical History: Right
tonsillectomy on 2-6-2010.
Medical history: Nil
ADM & final Dx : NHL (Non-Hodgkin lymphoma)
– Obtain healthy history focusing on fatigue, fever, chills ,Night sweats, swollen lymph nodes & chemotherapy causing immunosuppression.
– Evaluate splenomegaly, hepatomegaly, lymphadenopathy.
Signs & Symptoms:
Swollen, painless lymph nodes in the neck, armpits, or groin.
Unexplained weight loss.
Soaking night sweats.
Coughing, trouble breathing, or chest pain.
Weakness and tiredness that don’t go away.
On 15/8/2010 he did CT –Abdomen , Pelvic, chest with contrast
– Marked regression as regard the size & extent of previous noted lymphoadenopathy, lung cystic lesions
– No ascites or pleural effusion
– Mild hepatomegaly
– Marked splenomegaly
Patient admitted for chemotherapy 7th days, if there is no complication noted , he’ll discharge.
MEDICATION RECEIVED BY THE PATIENT
Chemotherapy for high-grade lymphomas is given into a vein (intravenously). Usually, a combination of several drugs is given over a few days and this is followed by a gap of a few weeks. This allows your body to recover from any side effects before the next treatment.
The most commonly used chemotherapy for high-grade lymphomas is a combination of four drugs called CHOP|. CHOP is a combination of the chemotherapy drugs:
doxorubicin (doxorubicin hydrochloride)
Some people with particular types of lymphoma have a lumbar puncture| done at the start of chemotherapy. This is to check if there are lymphoma cells in the spinal fluid. If lymphoma cells are found, you will be advised to have chemotherapy directly into the spinal fluid on several occasions until the lymphoma cells are gone.
your doctors may decide to give several doses of a chemotherapy drug directly into the spinal fluid to prevent lymphoma cells from growing there.
This patient received :
MTX 12mg + hydrocortisone 24 mg + cytosar 36 mg
NAME OF THE MEDICATION
Cyclophosphamide (brand names Cytoxan, Neosar in the US, cytoxan or procytox in Canada)
A chemotherapy agent used in the treatment of Non-Hodgkin’s lymphoma (NHL) and other forms of cancer. This drug is an alkalizing agent, disrupting cancer growth.
200 mg IV
Q 12 hr* 3 days
Short Term Side Effects: Common: nausea and vomiting , diarrhea, menstrual irregularity, alopecia (hair loss),fatigue
Long Term Side Effects: hair loss (alopecia).
Encourage the patient to drink fluid up to 2 liters a day to prevent urinary tract damage.
NAME OF THE MEDICATION
NAME OF THE MEDICATION
Generic Name: Doxorubicin
Other Brand Name: Rubex
It functions as an antineoplastic, cytotoxic drug, meaning that it is toxic to rapidly growing cells, such as tumors.
This drug is used for both Hodgkin’s and Non-Hodgkins Lymphomas.
Common side effects include pain at the IV site, nausea, neutropenia and leukopenia (low blood counts), alopecia (hair loss), and the development of sores on the body
The most serious side effects are long term. These include heart problems and secondary cancers, especially leukemia.
it should only be injected into a vein, not an artery. Nurses should monitor patients closely during administration to ensure that there is no swelling or redness at the injection site, which could indicate damage
NAME OF THE MEDICATION
Brand Names: Oncovin, VCR, Vincasar Pfs
administered for the treatment of acute leukemia, neuroblastoma, thyroid cancer, and lymphoma. It functions as an alkylating agent, meaning it prevents the replication of tumor cells by damaging the DNA
Vincristine is given intravenously (IV).
The most common side effect of vincristine use is hair loss. Less common side effects include low blood counts, constipation, nausea, abdominal pain, mouth sores, unusual bleeding and/or bruising, bone pain, and blood in the stool or urine.
it should be given through a vein only.
We can give VCR without pre chemo medication.
Nursing role in Administration chemotherapy
– Ensuring that patients receive their treatment safely and competently.
Patients also need advice to ensure that the risks of toxicity are minimized and education to ensure that, where toxicity occurs, patients know exactly what to do and how to manage it, there by minimizing the impact and risks from toxicity.
They also need support to help them cope with treatment and to minimize psychological morbidity from it.
Nursing care plan
High risk of infection related to immune response because of lymphoma & leukopenia caused by chemotherapy
To minimize risk of infection
Assess temperature & vital signs q 4 HR
Monitor for any signs of infection
Hand washing & Reinforce good personal hygiene habits
Avoid invasive procedures such as urinary catheterization
a febrile , no sign of infection
imbalance nutrition less than body requirement R/T adverse effects of therapy
emaciated, loss of appetite
promoting the nutrition
NSG Intervention :
Administer anti emetics before chemotherapy as order
Encourage the patient to eat small , frequent meals ,diet high protien high calorie
Encourage fluid intake
Monitor weight weekly
Tolerated small frequent meals
Patient health education:
– avoid crowds,
– avoid infected visitors particularly children with colds,
– wash the hands frequently;
– when an infection occurs, report it to a physician immediately;
– avoid direct contact with pets to limit the risk of infections from licks, scratches, or bites;
– do not change the cat litter or clean a birdcage.
– Maintain a high-calorie and high-protein diet.
– Take sips of grapefruit juice, orange juice, or ginger if nausea persists.
– Drink at least 2 L of fluid a day unless on fluid restriction.
– Perform frequent mouth care with a soft toothbrush and avoid commercial mouthwashes.