CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
INTRODUCTION
Lymphoma is a cancer of the lymphatic system, an essential part of the
immune system. In children, it is one of the most common types of cancer,
classified mainly into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma
(NHL). HL is characterized by the presence of Reed-Sternberg cells , while
NHL includes a diverse group of lymphatic cancers without these cells. Early
diagnosis and appropriate treatment are crucial, as pediatric lymphomas are
often aggressive but respond well to therapy.
NURSING ASSESSMENT II
* General appearance: Fatigue, pallor, signs of distress
* Vital signs: Fever may indicate infection or tumor activity
* Palpation of lymph nodes
* Respiratory assessment: Due to possible mediastinal mass
* Abdominal assessment: Look for organomegaly
* Psychosocial assessment: Child’s emotional response and coping
LABORATORY AND DIAGNOSTIC PROCEDURES
CBC (Complete Blood Count): May show anemia, leukocytosis, or
thrombocytopenia.
ESR (Erythrocyte Sedimentation Rate): Elevated in inflammatory
conditions and malignancy.
LDH (Lactate Dehydrogenase): Elevated in rapidly growing tumors.
Lymph Node Biopsy: Confirms diagnosis and distinguishes HL from
NHL.
Bone Marrow Aspiration/Biopsy: Checks for marrow involvement.
CT Scan/MRI/PET Scan: Locates tumor sites and stages disease.
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
SUMMARY OF INTRAVENOUS FLUID
D5 0.3% NaCl w/ 10 mEq KCl/L at 60 mL/hr: For hydration and electrolyte
balance.
Purpose: Maintain fluid volume, correct mild dehydration and electrolyte loss.
SUMMARY OF MEDICATION
Chemotherapeutic agents (e.g., Vincristine)
Antibiotics (for infections due to immunosuppression)
Antiemetics (e.g., Ondansetron)
Pain relievers (e.g., Acetaminophen)
DRUG STUDY
1. Chemotherapeutic Agent
BRAND NAME: Oncovin
GENERIC NAME: Vincristine
CLASSIFICATION: Vinca alkaloid antineoplastic
DOSAGE/FREQUENCY/ROUTE: 1.5 mg/m² IV once weekly
MECHANISM OF ACTION: Inhibits microtubule formation, arresting cell
division in metaphase.
INDICATION: Acute lymphoblastic leukemia, lymphoma
CONTRAINDICATION: Demyelinating conditions, hypersensitivity
ADVERSE REACTIONS: Neurotoxicity, constipation, alopecia, jaw pain
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
NURSING RESPONSIBILITIES: Monitor for neurotoxicity (foot drop, tingling),
bowel function, ensure proper IV administration to avoid extravasation.
2. Antibiotic
BRAND NAME: Cefuroxime (Zinacef)
GENERIC NAME: Cefuroxime
CLASSIFICATION: Second-generation cephalosporin antibiotic
DOSAGE/FREQUENCY/ROUTE: 30 mg/kg/day divided every 12 hours IV
MECHANISM OF ACTION: Inhibits bacterial cell wall synthesis, leading to cell
lysis
INDICATION: Bacterial infections in immunocompromised patients
CONTRAINDICATION: Allergy to cephalosporins
ADVERSE REACTIONS: Diarrhea, rash, eosinophilia, hypersensitivity reactions
NURSING RESPONSIBILITIES: Assess for allergy, monitor WBC count, watch
for superinfection and GI symptoms.
3. Antiemetic
BRAND NAME: Zofran
GENERIC NAME: Ondansetron
CLASSIFICATION: Serotonin 5-HT3 receptor antagonist
DOSAGE/FREQUENCY/ROUTE: 4 mg IV every 8 hours
MECHANISM OF ACTION: Blocks serotonin receptors in the GI tract and CNS
to prevent nausea
INDICATION: Chemotherapy-induced nausea and vomiting
CONTRAINDICATION: Hypersensitivity, congenital long QT syndrome
ADVERSE REACTIONS: Headache, dizziness, QT prolongation, constipation
NURSING RESPONSIBILITIES: Monitor ECG, assess nausea level before and
after administration, monitor bowel function.
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
4. Pain Reliever
BRAND NAME: Tylenol
GENERIC NAME: Acetaminophen
CLASSIFICATION: Non-opioid analgesic, antipyretic
DOSAGE/FREQUENCY/ROUTE: 10–15 mg/kg/dose orally every 4–6 hours PRN
MECHANISM OF ACTION: Inhibits prostaglandin synthesis in CNS to reduce
pain and fever
INDICATION: Mild to moderate pain, fever
CONTRAINDICATION: Severe hepatic impairment, hypersensitivity
ADVERSE REACTIONS: Hepatotoxicity (in overdose), rash, GI upset
NURSING RESPONSIBILITIES: Monitor liver function (AST/ALT), assess pain or
fever response, educate parents about safe dosing.
ANATOMY AND PHYSIOLOGY
The lymphatic system includes lymph nodes, spleen, thymus, and lymphatic
vessels. It filters harmful substances and supports immune response.
Flow Chart (text form):
Lymphatic Organs → Produce and store lymphocytes → Lymph fluid
transports cells → Detects and destroys pathogens and abnormal cells →
Cancer disrupts this balance (e.g., lymphoma)
MEDICAL MANAGEMENT
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
* Chemotherapy (e.g., ABVD for HL, CHOP for NHL)
* Radiation therapy (for localized disease)
* Hematopoietic stem cell transplant (for refractory cases)
* Supportive care: Transfusions, antibiotics, nutritional support
NURSING MANAGEMENT
* Monitor for infection, bleeding, and anemia
* Manage side effects of chemotherapy (nausea, fatigue, alopecia)
* Provide emotional support and age-appropriate education
* Encourage hydration and balanced nutrition
* Ensure safe administration of medications and fluids
DISCHARGE PLAN
**D** – Diet: Encourage high-protein, high-calorie meals
**I** – Instruction: Educate about signs of infection, medication adherence,
follow-up care
**S** – Safety: Neutropenic precautions, avoid crowded places
**C** – Care: Central line care, wound monitoring
**H** – Hygiene: Oral care, daily bathing to prevent infections
**A** – Activity: Allow rest with gentle activity
**R** – Referral: Support groups, oncology follow-up
**G** – Guidance: Continuous family counseling and child support
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
NURSING CARE PLAN
NCP 1:
A – Assessment:
Patient reports tiredness, decreased play activity, pale appearance, and
desire to rest most of the time.
D – Nursing Diagnosis:
Fatigue related to disease process and effects of chemotherapy as evidenced
by verbalization of tiredness and decreased activity.
P – Planning (Goals):
Patient will verbalize reduced fatigue within 3 days.
Patient will demonstrate increased participation in quiet activities.
Vital signs will remain within normal range during rest and mild
exertion.
Caregiver will verbalize understanding of fatigue management.
Hemoglobin levels will be maintained or improved.
I – Interventions:
Independent:
Allow frequent rest periods throughout the day.
Encourage age-appropriate quiet activities.
Monitor energy levels and activity tolerance.
Promote a calm, restful environment.
Educate family on signs of overexertion.
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
Dependent:
Administer prescribed hematinics if anemic.
Collaborate with dietitian to provide high-iron, high-protein meals.
Monitor lab values like hemoglobin and hematocrit.
Administer blood transfusions as ordered.
Administer IV fluids or medications as per orders for hydration and
energy support.
E – Evaluation:
Patient reports improved energy level.
Patient engages in quiet activities without distress.
Hemoglobin levels are within target range.
Family demonstrates understanding of fatigue care.
Patient requires fewer rest breaks over time.
NCP 2:
A – Assessment:
Patient is neutropenic, with CBC showing low WBC count, currently on
chemotherapy.
D – Nursing Diagnosis:
Risk for infection related to compromised immune system from
chemotherapy.
P – Planning (Goals):
Patient will remain free of infection during hospitalization.
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
Caregiver will demonstrate understanding of infection prevention
measures.
No signs of fever or abnormal vital signs will be present.
Skin and mucous membranes will remain intact.
White blood cell count will be monitored and maintained.
I – Interventions:
Independent:
Monitor for signs of infection (fever, chills, redness).
Maintain strict hand hygiene before and after patient contact.
Teach caregivers about infection control at home.
Ensure patient is in a clean and isolated environment.
Avoid exposure to people with infections.
Dependent:
Administer prescribed antibiotics if infection is suspected.
Monitor WBC count and report significant changes.
Provide neutropenic diet as ordered.
Administer granulocyte colony-stimulating factor (G-CSF) as
prescribed.
Administer antipyretics for fever as ordered.
E – Evaluation:
Patient remains afebrile.
No signs of infection observed.
WBC levels remain stable or improve.
Caregivers verbalize understanding of infection precautions.
Patient maintains intact skin and mucosa.
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
NCP 3:
A – Assessment:
Patient complains of abdominal and lymph node tenderness; may be post-
biopsy or experiencing tumor-related pain.
D – Nursing Diagnosis:
Acute pain related to lymphoma process or invasive procedures as evidenced
by verbal report of pain (e.g., 7/10).
P – Planning (Goals):
Patient will report pain relief within 30 minutes of intervention.
Patient will show nonverbal signs of comfort.
Pain level will be managed to <3/10 during hospital stay.
Family will verbalize knowledge of pain management strategies.
Sleep and feeding patterns will improve.
I – Interventions:
Independent:
Assess pain level using age-appropriate pain scale.
Provide comfort measures such as repositioning and warm compresses.
Offer distraction techniques (toys, games, music).
Encourage expression of pain in developmentally appropriate ways.
Educate caregivers on signs of pain and how to comfort the child.
Dependent:
Administer prescribed analgesics (e.g., acetaminophen, opioids).
Monitor for side effects of pain medications.
Collaborate with physician for pain regimen adjustments.
CASE STUDY ON LYMPHOMA
RICO, PRINCE REYMARK L. BSN 2 SET A
Administer topical agents as ordered for localized pain.
Provide pharmacologic sedation during procedures if indicated.
E – Evaluation:
Patient reports pain reduced to tolerable level.
Patient is observed engaging in normal activities.
Pain medication effectively relieves symptoms without side effects.
Family demonstrates understanding of pain management.
Patient sleeps and eats more comfortably.
REFERENCES:
* [https://www.cancer.org/cancer/lymphoma-in-children.html](https://
www.cancer.org/cancer/lymphoma-in-children.html)
* [https://www.cdc.gov/cancer/lymphoma/](https://www.cdc.gov/cancer/
lymphoma/)
*
[https://www.ncbi.nlm.nih.gov/books/NBK459455/](https://www.ncbi.nlm.nih.
gov/books/NBK459455/)
* [https://www.nhlbi.nih.gov/health/lymphoma](https://www.nhlbi.nih.gov/
health/lymphoma)
* Pediatric Nursing Care Plans, Gulanick & Myers
