I.

Reflecting on practice: Care of a client with

lymphangitis and lymphadenitis

II.

Reflecting on Practice: Client Profile and Case Study

XY 3 year old female presents to her primary care physician with

a chief complaint of a neck mass that has been present and
getting worse over 4 days. The mass started as a small lump that
has enlarged to the size of a walnut and is now becoming painful,
and warm to touch with overlying redness. She has had 2 days of
fever up to 104 degrees (40 degrees C). She is also complaining
of a runny nose, cough and sore throat for 1 week. Her appetite
for solid foods is down but she is drinking fluids well and her urine
output is normal. She has not been as active as usual and has not
slept well due to the fever. No one at home has been ill but she
does attend pre-school and several children have been ill recently
with sore throats and URI symptoms. Her history is negative for
recent skin infection, skin rash, weight loss, dental problems or
cavities, nausea, vomiting or diarrhea. There is no exposure to
cats or other animals. Her past medical history, family history and
social history are unremarkable. There is no culture swab done
due to lack of financial resources

Celebrating Practice
As a nurse you need to inspect the present condition. Vital signs
should be monitored. Provide TSB during hyperthermia and
administered analgesics for pain as prescribed. Elevation reduces
swelling and Warmth promotes comfort and enhances circulation.
Notify the physician if the affected area appears to enlarge,
additional lymph nodes become involve of temperature remains
elevated.

Lymphangitis most often results from an acute streptococcal

infection of the skin. Less often, it is caused by a staphylococcal
infection. The infection causes the lymph vessels to become
inflamed.

Correcting Practice
The nurse should explain about the disease process and how it
occurs. The main option to treat the disease is to maintain
hygienic measures to prevent the spread of infection in other
area. As a nurse you need also to promote confidentiality about
the information gathered to gain trust.
Complete recovery is expected if antibiotic treatment is begun at an early stage of
the infection. However, if untreated, it can be a very serious and even deadly
disease. If that goes untreated it can spread, causing tissue damage. Extensive
tissue damage would need to be repaired by plastic surgery. Spread of the infection
into the bloodstream could be fatal.

Understanding Self
As a nurse, you need to give assistance if the discomfort
interferes the patient. Administer medications as prescribed in
right time to alleviate patients discomfort especially during pain
occurs. Discuss the affecting factors together with the mother.

Understanding others
The nurse should deal with the S.O and talk about the treatment
of lymphangitis and lymphadenitis. Discuss also the possible

complications if left untreated. Since, XYs motheris in denial

stages she always denies that she never leave her child alone at
home and cant accept that her daughter is sick. As a nurse,
youto need provide emotional support.

Understanding Profession
Because of the serious nature of this infection, treatment would begin immediately
even before the bacterial culture results were available. The only treatment is to
give very large doses of an antibiotic, usually penicillin, through the vein. Growing
streptococcal bacteria are usually eliminated rapidly and easily by penicillin. The
antibiotic clindamycin may be included in the treatment to kill any streptococci
which are not growing and are in a resting state. Alternatively, a "broad spectrum"
antibiotic may be used which would kill many different kinds of bacteria.

Analgesics can be used to control pain, and anti-inflammatory

medications can help to reduce inflammation and swelling. Hot,
moist compresses also help to reduce inflammation and pain.
As a health worker, we must educate the public, particularly the
pediatric age group, to seek immediate medical attention if they
present with unusual redness or swelling, red streaks which are
getting worse and traveling proximally in the arms or legs,
increasingly painful or having fever. It is a potential treatable
condition, but occasionally complications may set in. We should
explain every procedure performed.
Challenging Assumptions
Complete recovery is expected if antibiotic treatment is begun at an early stage of
the infection. However, if untreated, it can be a very serious and even deadly
disease. If that goes untreated can spread, causing tissue damage. Extensive tissue

damage would need to be repaired by plastic surgery. Spread of the infection into
the bloodstream could be fatal.

III.

Client Assessment Database: Summary of Significant Findings

Gordons Functional Health

Pattern

Subjective Data:

Activity and rest

Dili katarongugtulog as
verbalized

Painand Discomfort
Sigelangughilaktungodsakasa
kit as verbalized

Health
Assessme
nt or
Physical
Examinati
on
Objective
Data:

Restless
Irritable

Swelling
lymph
nodes.
Fever
40oC

Food and fluid

Dili gnhanmukaon as
verbalized

Loss of
appetite
Complain

Laborator
y and
Diagnosti
cs Studies

Therapeutic
Manageme
nt

Nursing
Care
Managemen
t

Laborator
y Findings

Medical or
Surgical
Manageme
nt

Nursing
Diagnosis

Fatigue
Provide well
ventilated
environmen
t.

Hypertherm
ia
Administer
analgesics
as
prescribed
for pain.
Perform
TSB for
fever.
Imbalanced
nutrition:
Less than

Safety
Patient S.O is leaving
her daughter at home
alone.

of pain
during
swallowing
.
Weight
loss

Respiratory
Respiratory rate is in
normal range.

24 breaths
per
minute.

Administer
food
supplement
s.

body
requirement
s

Objective Data

Subjective Data

Di ganahan mu kaonas
verbalized
Sigelangughilak as
verbalized by the mother
Luya kayo as
verbalized

Fever 40 degrees Celsius

Chills
Swelling Lymph nodes
Weight loss
Pain
Restless
Irritable

V. Care Maps/Care Pathways:

Part I and II
Part I. Nursing Diagnostic Reasoning: Analysis of Data

Step 1: Identify abnormal findings and client strengths

Step 2. Identify cue clusters

-

Dilignhan
mu kaon
as
verbalized
Weight
loss

Sigelanghi
lak as
verbalized
Swelling of
lymph
nodes
Pain

luyakaayoangi
yanglawas as
verbalized
Fever 40
degrees Celsius
Restless
irritable

Step 3 Draw insights and Inference

Weight loss it is
caused by inability to
ingest food due to
loss of appetite and
can be a symptom of
an underlying
medical disorder.

Pain is caused by
inflammatory
response by a
localized infection.

Fever is caused by the

pathogens entering
the patients body. It is
also due to increased
heat which is the
result of the
inflammation process.

Step 4 List possible nursing diagnosis

Imbalanced
Nutrition : Less than
body requirements
related to inability
to ingest foods s/t
pain swallowing

Pain r/t swelling

of lymph nodes

Hyperthermia
related to increased
body temperature
s/t inflammatory
process

Step 5 Check for defining characteristics: Major and Minor

Major: Patient is
unable to swallow
solid foods.

Major:
Swelling
of lymph nodes is
present.

Minor: NONE

Minor: NONE

Major: Body
temperature of 40
degree Celsius. Skin is
warm to touch.
Patient is
experiencing chills.
Minor: NONE

Step 6 Confirm or rule out diagnosis

Confirm because it
meets the one are of
defining characteristics
but need to collect
more additional
information.

Nursing Actions:

Accept diagnosis because it

meets the defining
characteristics.

This diagnosis meets the

defining characteristics

Nursing Actions:

Nursing Actions:

INDEPENDENT

INDEPENDENT

INDEPENDENTStep

7 Document Conclusion:
Monitor or recordKey Nursing
Assess and
Diagnosis/ Probl
the characteristics
monitor clients

Evaluation of
of the pain, noted
temperature. Note
Part II.
Clinical Care
Pathways
nutritional
status
the report verbal,
for the presence of
nonverbal cues, and
and weight loss.
chills.
Step 1: Key Nursing Diagnoses (Wellness, Risk, Actual, and Collaborative
Nursing
Tell the mother to give
the hemodynamic
Apply Tepid
Problems)
the child to eat small
Imbalanced
meals but often.
Nutrition
than
Assess less
causative
body
requirements
factors
contributing
r/ttoinability
to
imbalanced
swallow food

nutrition

EducateNutrition
the patient
Imbalanced
the
lessS.O
thanregarding
Body
importance
Requirements
r/tof
Inability
to swallow
eating
healthy food.
food

COLLABORATIVE
Monitor laboratory
values that indicate
nutritional wellbeing/deterioration

response
Pain(grimacing,
r/t swelling crying,
of lymph
nodes
anxiety,
sweating,
clutching his chest,
rapid breathing,
blood pressure /
heart frequency
change).
Pain
swelling
of
r/t
Instruct
patient
S.O
lymphtonodes
report pain
immediately.
Provide a quiet,
slow activity, and
comfortable action (
bed linen, dry / not
crossed, rubbing his
back).

COLLABORATIVE
Administer

Hyperthermia
r/t
Sponge Bath.
increased
body patient
Encourage
temperature
to increase fluid
intake.
Adjust and monitor
environmental
Hyperthermia r/t
factors.
increased body
temperature
COLLABORATIVE

Administer
analgesics as
prescribed by
the physician
Provide
cooling
blanket, if chill
occurs.

CLIENT OUTCOMES

CLIENT OUTCOMES

CLIENT OUTCOMES

After 1-2days of nursing

intervention, the patient
S.O will verbalize and
demonstrate selection of
foods or meals that will
achieve a cessation of
weight loss.

Within 1-2 days of

providing nursing
interventions, the
patient will be report
reduced pain to a
tolerable level.

After 1-2 days of

giving nursing
interventions, the
patient will reduce
temperature within
normal range and be
free of chills.