CAYANAN, Nikki Marielle V.

REMULAR, Eunice Ritchel

TEJANO, Athena Kayana Linda
BSN IV Caritas Christi Therese 15
St. Paul College of Ilocos Sur
Member: SPUS

The lymphatic system is a system of capillaries,

vessels, nodes and other organs that transport
a fluid called lymph from the tissues as it
returns to the bloodstream. The lymphatic
tissue of these organs filters and cleans the
lymph of any debris, abnormal cells, or
pathogens. The lymphatic system also
transports fatty acids from the intestines to the
circulatory system.

Lymph (lymph fluid) is a clear, yellowish fluid that

carries white blood cells (lymphocytes), antibodies and
nutrients throughout the body. The lymph flows through the
network of lymph nodes and vessels.
Lymphocytes are a type of white blood cell important to
the body's immune system.
There are 2 types:
B cells (B lymphocytes) make antibodies to fight an infection
T cells (T lymphocytes) regulate the immune system
Lymphocytes start to develop in the bone marrow. The B cells
and T cells mature in different places:
B cells bone marrow or lymphatic organs
T cells thymus

Lymph vessels
There are 3 main types of lymph vessels:
lymphatic capillaries microscopic, closedended tubes where fluid from body tissues
enters the lymphatic system
lymph vessels tubes that move lymph to and
from the lymph nodes
collecting ducts tubes that return lymph to
the bloodstream

Lymph nodes are small, bean-shaped organs that

filter lymph. Lymph nodes vary in size, but are usually
less than 2.5 cm (1 inch) across. There are many
lymph nodes throughout the body. The number of
lymph nodes varies from one part of the body to
another.
Lymph nodes contain 2 types of white blood cells that
fight invading micro-organisms:
lymphocytes attack viruses, bacteria and other
micro-organisms
macrophages engulf and destroy foreign substances,
damaged cells and bits of broken cells

Lymph nodes are located in groups in the

following major locations:
neck cervical nodes
chest (thoracic) cavity thoracic and
mediastinal nodes
armpit axillary nodes
abdominal cavity para-aortic (peri-aortic)
and mesenteric nodes
groin inguinal nodes

The main functions of the lymph nodes are to:

filter harmful particles, such as bacteria, viruses and
foreign substances, from the lymph before returning
it to the bloodstream
activate the immune system
If a large number of particles are filtered through a
lymph node or group of nodes, they may swell and
become tender to the touch. For example, a sore
throat may cause the lymph nodes under the jaw and
in the neck to swell.

The spleen is the largest lymphatic organ. It is

located in the upper-left abdomen. The spleen:
makes, stores and removes lymphocytes
filters the blood
stores red blood cells
destroys old red blood cells
The thymus is located in the chest behind the
breastbone (sternum). It is where T lymphocytes
mature and multiply.
The tonsils are 2 small masses of lymphatic tissue
in the throat that contain lymphocytes.

The adenoids are actually a single, small

mass of lymphatic tissue in the back of the nose
(nasopharynx) that contains lymphocytes.
Although they are often called adenoids there is
only one adenoid. The adenoid is also
sometimes called the pharyngeal tonsil. The
adenoids are present in infants and children,
and start to shrink just before puberty. They are
usually absent in adults.

Bone marrow is soft, spongy tissue in the

centre of certain bones. It contains
immature blood cells called stem cells.
Stem cells develop into:
Red blood cells deliver oxygen to the
body
white blood cells (including lymphocytes)
protect the body from infection
platelets help blood to clot

The main functions of the lymphatic

system are to:
move excess fluid from tissues and
return it to the bloodstream
help defend the body against disease
provide an alternate route for
transporting hormones, nutrients and
waste products

Lymphoma is a group of malignant

neoplasms that affects the lymphatic
system resulting in the proliferation of
lymphocytes. Lymphomas can be classified
as Hodgkins disease or non Hodgkins
lymphoma.

Non-Hodgkin's lymphoma
Hodgkin's lymphoma

Non-Hodgkin's lymphoma
also called non-Hodgkin lymphoma, is cancer that
originates in your lymphatic system, the disease-fighting
network spread throughout your body. In non-Hodgkin's
lymphoma, tumors develop from lymphocytes a type
of white blood cell.
Non-Hodgkin's lymphoma is more common than the
other general type of lymphoma Hodgkin lymphoma.
Many different subtypes of non-Hodgkin's lymphoma
exist. The most common non-Hodgkin's lymphoma
subtypes include diffuse large B-cell lymphoma and
follicular lymphoma.

Non-Hodgkin's lymphoma
Medications that suppress your
immune system.
Infection with certain viruses
and bacteria.
Chemicals
Older age.

Pathophysiology and Etiology

Etiology is unknown
Characterized by appearance of
Reed-Sternberg multinucleated giant
cell in tumor. Generally spreads via
lymphatic channels, involving lymph
nodes, spleen and ultimately
extralymphatic sites
May also spread via bloodstream to
such as GI tract, bone marrow, skin,
upper air passages, and other organs

Clinical Manifestations
Fatigue, fever, chills, night sweats,
painless swelling of lymph nodes
(generally unilateral), pruritus, weight
loss.
Wide variety of symptoms may occur if
there is pulmonary involvement,
superior vena cava obstruction, hepatic
or bone involvement, and involvement
of other structures.

Diagnostic Evaluation:
Lymph Node Biopsy detects characteristic Reed-sternberg
giant cell, helping to confirm diagnosis.
Complete blood count and Bone Marrow Aspiration and
Biopsy determine whether there is bone marrow
involvement.
X-rays, CT scan, and MRI detect deep nodal involvement.
Lymphangiogram detects size and location of deep nodes
involved, including abdominal nodes, which may not be
readily seen by CT scan.
Liver function test and liver biopsy determine hepatic
involvement.
Gallium-67 detects areas of active disease; determines
aggressiveness of disease.
Surgical staging (laparotomy with splenectomy, liver
biopsy, multiple lymph node biopsies) may be done in
selected patients.

Pharmacologic Interventions:
Chemotherapy may be used in
combination with radiation.
Initial treatment often begins with a
specific four-drug regimen known as
MOPP (Mustargen, Oncovin,
procarbazine, and prednisone).
Three or four drugs may be given in
intermittent or cyclical courses, with
periods of treatment to allow recovery
from toxicities.

Surgical Interventions:
Autologous or allogeneic bone
marrows or stem cell
transplantation.

Nursing Interventions:
To protect the skin receiving radiation,
avoid rubbing, powders, deodorants,
lotions, or ointments (unless prescribed) or
application of heat or cold.
Encourage patient to keep clean and dry,
and to bathe the area affected by radiation
gently with tepid water and mild soap.
Encourage wearing loose-fitting clothes
and to protect skin from exposure to sun,
chlorine, and temperature extremes.

Nursing Interventions:
To protect oral and gastro-intestinal tract
mucous membranes, encourage frequent, small
meals, using bland and soft diet at mild
temperatures.
Teach the patients to avoid irritants such as
alcohol, tobacco, spices, and extremely hot or
cold foods.
Administer or teach self-administration of pain
medication or antiemetic before eating or
drinking, if needed.

Nursing Interventions:

Encourage mouth care at least twice per

day and after meals using a soft toothbrush
or toothete 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 anti-diarrheals as ordered.

Nursing Interventions:

Teach patient about risk of infection.

Advice patient to monitor temperature
and report any fever or other sign of
infection promptly.
Explain to patient that radiation
therapy may cause sterility.

Complications
Adverse effects of radiation or
chemotherapy
Dependent on location and
extent of malignancy, but may
include splenomegaly,
hepatomegaly, thromboembolic
complications, spinal cord
compression

Nursing Diagnosis:
Impaired tissue integrity related
to high dose radiation therapy
Impaired oral mucous
membrane related to high dose
radiation therapy

Hodgkin's lymphoma
formerly known as Hodgkin's disease is a cancer of the
lymphatic system, which is part of your immune system.
In Hodgkin's lymphoma, cells in the lymphatic system grow
abnormally and may spread beyond the lymphatic system. As
Hodgkin's lymphoma progresses, it compromises your body's
ability to fight infection.
Hodgkin's lymphoma is one of two common types of cancers
of the lymphatic system. The other type, non-Hodgkin's
lymphoma, is far more common.
Advances in diagnosis and treatment of Hodgkin's lymphoma
have helped to give people with this diagnosis the chance for
a full recovery. The prognosis continues to improve for people
with Hodgkin's lymphoma.

Hodgkin's lymphoma
Your age
A family history of lymphoma
Your sex
Past Epstein-Barr infection
A weakened immune system

Pathophysiology and Etiology:

Association with defective or altered immune system;
higher incidence in patients receiving
immunosuppression for organ transplant, in HIV- positive
people, and with some viruses (HTLV-1 and EpsteinBarr). Other risk factors include family history, male
gender, white ethnicity, autoimmune diseases such as
rheumatoid, arthritis, history of Helicobacter gastritis ( for
gastric B-cell lymphoma), history of Hodgkins
lymphoma, history of radiation therapy, diet high in
meats and fat exposure to certain pesticides.
Arise from malignant transformation of lymphocyte at
some stage during development; level of differentiation
and type of lymphocyte influences course of illness and
prognosis
Incidence rises steadily from age 40

Clinical Manifestations
Common symptoms include painless
enlargement of lymph node (generally
unilateral), fever, chills, night sweats, weight
loss, unexplained pain in chest, abdomen,
or bones. Unlike Hodgkins lymphoma, is
more likely to be advanced disease at
presentation
Various systems may occur with pulmonary
involvement, superior vena cava
obstruction, hepatic or bone involvement

Diagnostic Evaluation:
Lymph node biopsy to detect type.
CBC, bone marrow aspirate, and biopsy to
detect bone marrow involvement
X-rays, CT scan, positron-emission tomography
scan, Gallium scan and MRI to detect deep nodal
involvement
Liver function test, liver scan to detect liver
involvement
Lumbar puncture to detect CNS involvement
Surgical staging (laparotomy with splenectomy,
liver biopsy, multiple lymph node biopsies)

Management:
The NCCN guidelines for non-Hodgkins lymphomas
describe a variety of regimens, using radiation therapy,
chemotherapy, monoclonal antibodies, radioimmune
therapy, and hematopoietic stem cell transplant. Precise
diagnosis and staging is needed to assure appropriate
treatment
Radiation therapy is generally palliative not curative.
Chemotherapy: various regimens available, including
CHOP regimen of cyclophosphamide (Cytoxan),
doxorubicin (Adriamycin), vincristine (Oncovin) and
prednisone (Orasone) or BACOP regimen of bleomycin
(Blenoxane), doxorubicin (Adriamycin),
cyclophosphamide (Cytoxan),vincristine (Oncovin) and
prednisone

Monoclonal antibody therapy: rituximab

(Rituxan) may be given alone or with
chemotherapy to patients with CD20
positive lymphomas
Radioimmune therapies, such as Yttium90-labeled ibritumomab tiuxetan (Zevalin)
have been effective for patients with certain
lymphomas who do not respond to rituxan
Autologous or allogeneic bone marrow or
stem cell transplantation

Complications:
Depend on the location and
extend of malignancy but may
include splenomegaly,
hepatomegaly, thromboembolic
complications, spinal cord
compression

Nursing Diagnosis:
Risk for infection related to altered
immune response because of
lymphoma and leukopenia caused by
chemotherapy or radiation therapy.