Test 2 Study Guide Flashcards
What is the primary assessment for a client with Lymphatic disease?
Skin integrity- Pitting => firm, tight, shiny => thickened, rough, discolored; brawny (orange) => Weeping, oozing => ulcers, infection (from poor perfusion: tissue is nutrition impaired). Red, warm, painful.
Classification of Lymphedema
Grade I (Mild): Circumference of affected limb is 2 cm, but not more than 4 cm larger than the unaffected limb; patient is asymptomatic.
Grade II (Moderate): Circumference of affected limb is 4 cm, but not more than 8 cm larger than the unaffected limb; patient experiences symptoms such as heaviness in the limb, pain, and limited movement.
Grade III (Severe): Circumference of affected limb is 8 cm greater than the unaffected limb, involves the entire limb, or is accompanied by infection or cellulitis (inflammation of connective tissue in or close to the skin).
What are the signs and Symptoms of a person with Hodgkin’s disease?
Malignancy that produces enlargement of lymphoid tissue, spleen, and liver with invasion of other tissues (ie. bone marrow, lungs);
Early symptoms: painless enlargement of one or more lymph nodes (starts with cervical) that start to press on adjacent structures (esophagus or bronchi);
Retroperitoneal nodal enlargement: sense of stomach fullness, epigastric pain;
Common: marked wt loss, anorexia, fatigue, weakness, low-grade fever, pruritus, night sweats;
Less Common: marked anemia, thrombocytopenia (leading to a tendency to bleed), poor resistance to infection, staph skin infections, resp tract infections.
Hodgkin’s Lymphoma
Four Subtypes;
Two peaks of onset: [15,40] yrs and >55 yrs;
Reed-Sternberg cells;
40% of affected clients test pos to EBV;
B-cell origin;
Usually starts in lymph nodes above the clavicle, commonly in the neck and chest; 15% are below the diaphragm; spreads down-ward from initial site;
More orderly growth from one node to adjacent nodes;
More curable
Non-Hodgkin’s Lymphoma
Thirty subtypes;
Peaks after age 50;
No Reed-Sternberg cells;
More common in industrial countries; common among patients with immunosuppression;
B- and T-cell origin;
Common in abdomen, tonsils; can develop in areas other than lymph nodes (ie. brain, nasal passages);
Less predictable growth; spreads to extranodal sites; less curable
What can a nurse help a client with lymphadenitis has developed persistent swelling?
Inflammation of the lymph nodes;
Patient ed: application of elastic sleeve or stocking
Why would a patient with Hodgkin’s develop anemia?
Low rbc’s and elevated leukocytes common; spleen enlargement = dec function
With a diagnosis of lymphangitis. What interventions would the nurse institute?
Inflammation of lymphatic vessels;
Red streaks follow the course of the lymph channels and extend up the arm or leg;
Fever may be present;
Inspect area, note patient response to antibiotics, assistance with ADLs, elevate (to reduce swelling), warmth (comfort; inc circulation);
Notify physician: affected area appears to become enlarged, additional lymph nodes become involved, body temp remains elevated
A client had a left radical mastectomy with an axillary node dissection, What should the nurse inform the client is the reason for the edema?
Lack of lymph nodes in the armpit and scar tissue can inhibit lymphatic draining leading to edema.
What foods or liquids would be best to offer a client with infectious mono would hel woth food?
Soft, bland foods; cool liquids; gargling with warm salt water.
What are the signs and symptoms along with incubation period for infectious mononucleosis?
Usual Age: [15,25] yrs
Incubation Period: [30,50] days
S/S: fever- irregular, usually about 2 weeks;
sore throat- marked, whitish-gray exudate;
adenopathy (enlarged lymph nodes)- most commonly anterior and posterior cervical chains; often generalized;
Splenomegaly (enlargement of spleen)- ~50%
Hepatomegaly (enlargement of liver)- ~10%
What is the cell mediated response?
Immune response that T-cell lymphocytes perform; T-cells survey proteins in the body, actively analyze the surface features, respond to non-self by attacking the invading antigen.
Antigen -> nonspecific defenses -> Immune response (specific defences) -> activation of T cells (Helper T cells stimulate this activation) -> Production of memory T cells and cytotoxic T cells -> Maturation and migration of cytotoxic T cells -> Physically attack the antigen.
What type of immunity to measles develops after the initial infection?
Naturally acquired active immunity
In which type of client is a vaccine more likely to be less effective and why?
Elderly. The amount of antibody produced in response to most foreign antigens dec with age (=dec immune response)
What is the function of the thymus gland?
Programs T lymphocytes to become regulator or effector T cells.
