Nursing management
NURSING INTERVENTIONS
 Monitor respiratory status
 Note changes to skin color
 Observe for neck vein
distension, headache, dizziness,
facial edema, dyspnes, stridor
 Assess and manage pain
 Nutrition education - instruct
the patient to increase caloric
intake like banana, avocado,
salmon, eggs, etc..
- monitor daily weight, caloric
intake
 Provide supportive comfort
measures following
chemotherapy/radiation
- assist ADLs
-offer ice chips, antiemetics
as ordered
 Assist with positioning/monitor
skin breakdown
RATIONALE
 If lymph nodes-neck/chest
involved, patient may
experience SOB, dyspnea,
airway obstruction
 Note pallor or cyanosis.
WBC’s multiply rapidly can
reduce carrying capacity of
RBC that may result in
hypoxemia
 Vena cava syndrome -
superior vena cava is obstructed
from enlarge lymph nodes. Life
threatening emergency, notify
the physician.
 Patients may experience
pain from radiation and chemo.
Pain management/reduction of
stress promotes
healing/conserves energy
 Increasing caloric intake
promotes healing, provides
energy, prevents gastric
distention.
 Patients experience fatigue,
nausea and vomiting.
 Fatigue and impaired nutrition
can cause muscle weakness.
Nursing diagnosis:

1. Ineffective breathing pattern

2. Imbalanced nutrition
3. Pain
4. Sexual dysfunction
5. Deficient knowledge
6. Risk for infection

Sexual dysfunction

Related to altered body structure or function (drugs, surgery, disease

process, radiation [loss of sexual desire, disruption of sexual response
pattern])

NURSING INTERVENTIONS RATIONALE

Let the patient describe problem in Provides more accurate picture of

own words. patient experience with which to
develop plan of care.

Know the importance of sex to Because lymphomas often affect

individual, partner and patient’s
motivation for change.
the relatively young who are in
their productive years, these people
may be affected more by these
problems and may be less
knowledgeable about the
possibilities of change.

Weigh knowledge of patient and Helps analyze areas of concern,

SO regarding sexual function and misconception, and actual problems
effects of current situation and related to therapy side effects.
condition.

Identify preexisting and current Patient may be concerned about

stress factors that may be affecting other issues, such as job, financial,
the relationship. and illness-related problems.

Deficient knowledge
May be related to

 Lack of exposure/recall
 Information misinterpretation
 Unfamiliarity with information resources
 Cognitive limitations

NURSING INTERVENTIONS RATIONALE

Discuss potential complications Possible side effects and long-term

relative to specific therapeutic physical complications of radiation
regimen. (direct or indirect) and
some chemotherapy agents include
pneumonitis, hypothyroidism,
pericarditis, cardiomyopathy.

Following treatment, there is

Emphasize need for ongoing
medical follow-up.
increased risk of secondary
malignancies (thyroid,
myeloid leukemia, non-Hodgkin’s
lymphoma) in addition to other
complications listed. Note:
Yearly Pap smears are
recommended for female patients
because Hodgkin’s cells may be
found on the cervix.

Ineffective breathing pattern

Risk factors may include

Tracheobronchial obstruction: enlarged mediastinal nodes and/or airway
edema (Hodgkin’s and non-Hodgkin’s); superior vena cava syndrome
(non-Hodgkin’s)

NURSING INTERVENTIONS RATIONALE

Assess and monitor respiratory rate,
depth, rhythm. Note reports of
dyspnea and use of accessory
muscles, nasal flaring, altered chest
excursion.
Place patient in position of comfort, Maximizes lung expansion,
usually with head of bed elevated
or sitting upright leaning forward
(weight supported on arms), feet
dangling.
Reposition and assist with turning
periodically.
Instruct and assist with
deep-breathing techniques,
pursed-lip or abdominal
diaphragmatic breathing if
indicated.
Monitor and evaluate skin color,
noting pallor, development of
cyanosis (particularly in nailbeds,
ear lobes, and lips).
Assess respiratory response to
activity. Note reports of dyspnea
or ”air hunger,” increased fatigue.
Schedule rest periods between
activities.
Identify and encourage
energy-saving techniques (rest
periods before and after meals, use
of shower chair, sitting for care).
Promote bedrest and provide care
as indicated during acute and
prolonged exacerbation.
Changes (such as tachypnea,
dyspnea, use of accessory muscles)
may indicate progression of
respiratory involvement and
compromise requiring prompt
intervention.
decreases work of breathing, and
reduces risk of aspiration.
Promotes aeration of all lung
segments and mobilizes secretions.
Helps promote gas diffusion and
expansion of small airways.
Provides patient with some control
over respiration, helping to
reduce anxiety.
Proliferation of WBCs can reduce
oxygen-carrying capacity of the
blood, leading to hypoxemia.
Decreased cellular oxygenation
reduces activity tolerance. Rest
reduces oxygen demands and
minimizes fatigue and dyspnea.
Aids in reducing fatigue and
dyspnea, and conserves energy for
cellular regeneration and
respiratory function.
Worsening respiratory involvement
and hypoxia may necessitate
cessation of activity to prevent
more serious respiratory
compromise.

Encourage expression of feelings.
Acknowledge reality of situation
and normality of feelings.
Provide calm, quiet environment.
Pain
Related to treatment (radiation, chemotherapy)
NURSING INTERVENTIONS
 Assess the level of pain by
using pain scale of 1 to 10
 Provide divertional technique
like watch TV, reading books or
short conversation.
 Instruct and demonstrate deep
breathing technique.
 Place the patient in a
comfortable position
Imbalance nutrition
Related to loss of appetite due to disease process or treatment
NURSING INTERVENTIONS
 Assess for malnutrition like
weight loss, appearance, etc..
- weigh the patient daily
 Discuss eating habits including
Anxiety increases oxygen demand,
and hypoxemia potentiates
respiratory distress and cardiac
symptoms, which in turn escalates
anxiety.
Promotes relaxation, conserving
energy and reducing oxygen
demand.
RATIONALE
 To have a baseline and to be
able to identify what kind of
intervention necessary
 This technique may reduce
the patient’s pain by diverting
the attention
 Deep breathing helps relax
you. Learning deep breathing
reduces muscle tension thereby
lessening pain.
 To help alleviate pain
RATIONALE
 To establish baseline
parameter
 foodpreferences, intolerance
and aversion
 Encourage client to choose food
or have family member to bring
food that seems appealing
 Promote pleasant relieving
environment including
socialization
 Evaluate total daily food intake
 Appeals to client tasks, and
enhances intake
 Stimulates the appetite of
the client
 This promotes comfort to
thepatient and encourages a
goodeating habit
 Reveals possible cause
of malnutrition changes that
could
be made in client’s intake.