Ch 32 Flashcards
A network of vessels, known as lymphatics
Lymphatic system
Transport lymph
Lymphatics
Watery fluid derived from plasma that exits the walls of capillaries and enters interstitial spaces
Lymph
The lymphatic vessels carry lymph to and through the ___
Lymph nodes
Where are lymph nodes primarily located (6)
Neck
Axilla
Chest
Abdomen
Pelvis
Groin
Accumulation of lymphatic fluid that results from impaired lymph circulation
Lymphedema
Secondary lymphedema develops (2)
Complication of other disorders (repeated phlebitis & strep, burns, insect bites, and parasitic infections
Consequence of treatment (mastectomy, radiation)
Wordwide the most common cause of lymphedema is a
Parasitic work, mosquitos transmit parasite resulting in ephantiasis
S&S ion lymphedema
Skin swells & becomes firm, tight & shiny
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
Treatment of lymphedema
Treatment usually symptomatic
Compression garment with PROXIMAL TO DISTAL compression gradation
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
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
Grade 1 of lymphedema
2cm but not more than 4cm
Grade 2 (moderate) of lymphedema
4cm but not more than 8cm
Grade 3 (severe) of lymphedema
8cm greater than unaffected limb. Involved the entire limb or is accompanied by infection or cellulitis
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)
Inflammation of lymphatic vessels
Lymphangitis
When inflammation of lymphatic vessels affects the lymph nodes near the lymphatics
Lymphadenitis
What commonly causes lymphangitis & lymphandentitis
Strep virus
S&S of lymphangitis & lymphadentitis
Red streaks follow the course of the lymph channels & extend up arm or leg.
Fever
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
