Hodgkin's disease

Is a malignant lymphoma of the reticuloendothelial system that results in an accumulation of dysfunctional, immature lymphoid-derived cells.

The disease generally spreads by lymphatic channels, involving lymph nodes, spleen, and ultimately (through the bloodstream) to extra lymphatic sites, such as gastrointestinal tract, bone marrow, skin, upper air passages, and other organs.

It is most common in patient ages 20 to 40 and in those older than age 60.
It’s cause is unknown.

Assessment:
Fatigue,
fever,
chills,
night sweats,
painless swelling of lymph nodes (generally unilateral),
pruritus,
weight loss.

Wide variety of symptoms may occur if there is pulmonary involvement, superior vena cava obstruction, hepatic or bone involvement, and involvement of other structures.

Diagnostic Evaluation:

Lymph node biopsy detects characteristic Reed-sternberg giant cell, helping to confirm diagnosis.

Complete blood count and bone marrow aspiration and biopsy determine whether there is bone marrow involvement.

X-rays,
CT scan,
MRI detect deep nodal involvement.

Lymphangiogram
detects size and location of deep nodes involved, including abdominal nodes, which may not be readily seen by CT scan.

Liver function test and liver biopsy determine hepatic involvement.

Gallium-67 detects areas of active disease; determines aggressiveness of disease.
Surgical staging (laparotomy with splenectomy, liver biopsy, multiple lymph node biopsies) may be done in selected patients.

Pharmacologic Interventions:

Chemotherapy may be used in combination with radiation.
Initial treatment often begins with a specific four-drug regimen known as MOPP (Mustargen, Oncovin, procarbazine, and prednisone).
Three or four drugs may be given in intermittent or cyclical courses, with periods of treatment to allow recovery from toxicities.

Surgical Interventions:
Autologous or allogeneic bone marrows or stem cell transplantation.

Nursing Interventions:
To protect the skin receiving radiation, avoid rubbing, powders, deodorants, lotions, or ointments (unless prescribed) or application of heat or cold.
Encourage patient to keep clean and dry, and to bathe the area affected by radiation gently with tepid water and mild soap.
Encourage wearing loose-fitting clothes and to protect skin from exposure to sun, chlorine, and temperature extremes.
To protect oral and gastro-intestinal tract mucous membranes, encourage frequent, small meals, using bland and soft diet at mild temperatures.
Teach the patients to avoid irritants such as alcohol, tobacco, spices, and extremely hot or cold foods.
Administer or teach self-administration of pain medication or antiemetic before eating or drinking, if needed.
Encourage mouth care at least twice per day and after meals using a soft toothbrush or toothete and mild mouth rinse.
Assess for ulcers, plaques, or discharge that may be indicative of superimposed infection.
For diarrhea, switch to low-residue diet and administer anti-diarrheals as ordered.
Teach patient about risk of infection. Advice patient to monitor temperature and report any fever or other sign of infection promptly.
Explain to patient that radiation therapy may cause sterility.