Ch 32 Flashcards by Brandie Alnobani

A network of vessels, known as lymphatics

Lymphatic system

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Transport lymph

Lymphatics

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Watery fluid derived from plasma that exits the walls of capillaries and enters interstitial spaces

Lymph

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The lymphatic vessels carry lymph to and through the ___

Lymph nodes

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Where are lymph nodes primarily located (6)

Neck
Axilla
Chest
Abdomen
Pelvis
Groin

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Accumulation of lymphatic fluid that results from impaired lymph circulation

Lymphedema

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Secondary lymphedema develops (2)

Complication of other disorders (repeated phlebitis & strep, burns, insect bites, and parasitic infections
Consequence of treatment (mastectomy, radiation)

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Wordwide the most common cause of lymphedema is a

Parasitic work, mosquitos transmit parasite resulting in ephantiasis

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S&S ion lymphedema

Skin swells & becomes firm, tight & shiny

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A special exam in which an IV dye and radiography are used to detect lymph node involvement, reveals the degree & extent of blockages in the lymph system

Lymphangiography

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Treatment of lymphedema

Treatment usually symptomatic
Compression garment with PROXIMAL TO DISTAL compression gradation

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Complex decongestive physiotherapy includes (4)

1.distal to proximal massage of Demario’s areas to facilitate lymphatic drainage into collateral vessels
2. Application of compression dressing to relieve edema by reducing excess volume of fluid in interstitial space
3.active exercise to promote lymphatic circulation and maintain functional use of limb
4. Care & maintenance of skin & makes that are vulnerable to secondary complications

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A ____ is applies to the arm & trunk. The alternating filling & emptying “milks” the lymph toward the duct, leading to venous drainage

Mechanical pulsating compression device or pneumatic device

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Grade 1 of lymphedema

2cm but not more than 4cm

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Grade 2 (moderate) of lymphedema

4cm but not more than 8cm

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Grade 3 (severe) of lymphedema

8cm greater than unaffected limb. Involved the entire limb or is accompanied by infection or cellulitis

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Client family teaching, use of a compression garment
SATA (5)

1.purchase 2 compression garments so that one can be worn while the other is washed & dried
2.change garment in morning & evening bc it becomes stretched after 12 hrs
3.limit time NOT worn to NO MORE than 30 to 60 minutes, to prevent recuperation of tissue & stretched skin
4.wash removed garment in soap & water each day to prolong elasticity & remove perspiration, bacteria & dead skin cells
5. Air dry out of direct sun to preserve longevity of garment (don’t put in dryer)

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Inflammation of lymphatic vessels

Lymphangitis

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When inflammation of lymphatic vessels affects the lymph nodes near the lymphatics

Lymphadenitis

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What commonly causes lymphangitis & lymphandentitis

Strep virus

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S&S of lymphangitis & lymphadentitis

Red streaks follow the course of the lymph channels & extend up arm or leg.
Fever

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S&S when lymphandentis is present

Lymph nodes along the lymphatic channels are enlarged & tender in palpation

Treatment for lymphangitis & lymphadenitis

Broad spectrum antibiotic

Nursing management for lymphangitis & lymphandenitis
SATA (5)

1.inspect area & note response to ABT
2. Assistance for discomfort w ADLs
3.elevation to reduce swelling
4.warmth to promote comfort & enhance circulation
5.notify if area becomes enlarged, more lymph nodes become involved, temp stays elevated

In severe cases with persistent swelling, the nurse teaches the client how to

Apply an elastic sleeve or stocking

A viral disease that’s affects the lymphoid tissues such as tonsils and spleen

Mono

What other organs can mono also involve

Brain, meninges & liver

What virus causes mono

Epstein Barr virus

Incubation period for mono

30-50 days

Epstein Barr virus is believed to trigger ___ in approximately ___ of people with disease

Hodgkin lymphoma 40%

S&S of mono (8)

Fatigue Fever Sore throat Headache Cervical lymph node enlargement Tonsils ooze white or greenish gray Faint red rash on hands ir abdomen Liver & spleen may be enlarged

Test to diagnose mono

Positive slide agglutination Monospot Monotest Monosticon

Withhold donating blood for how long after recovering from mono

At least 6 months

A group of cancers that affect the lymphatic system

Lymphomas

A malignancy that produces enlargement of lymphoid tissue, the spleen & the liver with invasion of other tissues such as bone marrow & lungs

Hodgkin disease

What condition is purexia(elevated temp) & splenomegaly(enlarged spleen) found in?

Hodgkin disease

Causes mutations in some lymphocytes, creating malignant cells

Reed sternberg cells

Which lymphoma has reed sternberg cells

Hodgkin

Early symptoms of hodgkins include

Painless enlargement of one or more lymph nodes

Which lymph nodes are first to be infected in Hodgkin disease

Cervical lymph nodes

As nodes enlarge they press on adjacent structures such as

Esophagus or bronchi

As retroperitoneal nodes enlarge there is a sense of

Fullness in stomach & epigastric pain

Stage 1 of Hodgkin

Single lymph node region

Stage 2 of Hodgkin

Two or more lymph node regions on one side of diaphragm

Stage 3 of Hodgkin

Lymph node regions on both sides of the diaphragm but extensions is limited to the spleen

Stage 4 of Hodgkin

Bilateral lymph nodes affected and extensions include spleen plus one or more of the following: bones,bone marrow, lungs, liver, skin, GI structures, or other sites

The b designation is given to clients with any of the following symptoms (3)

1.Unexplained loss of more than 10% if body weight in the 6 months before diagnosis 2.unexplained fever w temp above 100.4 3.drenching night sweats

Treatment of hodgkins

Transfusions prescribed to control anemia. If resistance develops, autologous bone marrow or peripheral stem cells are harvested, followed by HIGH DOSES of chemo that destroy the bone marrow

Drug combinations of Hodgkin

ABVD Doxorubicin (Adriamycin) Bleomycin Vinblastine Dacarbazine

A group of 30 sub classifications of malignant disease that originate in the lymph glands & other lymphoid tissue

Non hodgkins

Causes of NHL

Environmental triggers (viral agents, chemical herbicides, pesticides, hair dye) Administration of immunosuppressive drugs to prevent transplant rejection

NHL is classified as (2)

1.indolent (relatively asymptomatic at diagnosis & disorder relatively responsive to radiation & chemo 2. Aggressive (condition has a shorter onset with acute symptoms)

Nursing management for NHL

Encourage >2500 ml of fluids a day to facilitate excretion of cells destroyed by therapy & compensate for fluids that are lost due to vomiting

Nutrition of Hodgkin & NHL

N/V may accompany radiation & chemo Must maintain food & fluid intake Offer clear liquids (carbonated beverages,water,ice pops, flavored gelatin) until nausea subsides Thereafter, small, frequent low fat meals to prevent nausea, improve nutritional intake & reduce weight loss