Nursing Care Plan for Lymphomas: A Comprehensive Guide
A resource for nursing students
Table of Contents
Introduction to Lymphoma Nursing Care
Lymphoma is a type of cancer that originates in the lymphatic system, which is part of the body’s immune system. As nurses caring for patients with lymphoma, understanding the comprehensive nursing care plan is essential for providing quality care. This lymphoma nursing care plan follows focusing on clear, evidence-based interventions.
Lymphomas are broadly categorized into two main types:
- Hodgkin Lymphoma (HL): Characterized by the presence of Reed-Sternberg cells
- Non-Hodgkin Lymphoma (NHL): A diverse group of lymphomas that do not contain Reed-Sternberg cells
As nursing professionals, our role encompasses assessment, implementing interventions, patient education, and providing emotional support throughout the treatment journey. This comprehensive lymphoma nursing care plan provides a structured approach to addressing the complex needs of patients diagnosed with lymphoma.
Nursing Assessment for Lymphoma
A thorough nursing assessment forms the foundation for effective care planning for patients with lymphoma. Consider the following key assessment areas:
Physical Assessment:
- Lymph node enlargement (cervical, axillary, inguinal)
- Hepatosplenomegaly
- Respiratory status and effort
- Skin assessment for pallor, petechiae, ecchymosis
- Vital signs including temperature patterns
Symptom Assessment:
- B symptoms: fever, night sweats, weight loss
- Fatigue levels and impact on ADLs
- Pain: location, intensity, character
- Pruritus (itching)
- Appetite changes and nutritional intake
Laboratory and Diagnostic Findings:
- Complete blood count (CBC) with differential
- Erythrocyte sedimentation rate (ESR)
- Lactate dehydrogenase (LDH) levels
- Results of imaging studies (CT, PET scans)
- Biopsy results confirming lymphoma type
Psychosocial Assessment:
- Emotional response to diagnosis
- Support system availability
- Coping mechanisms
- Spiritual needs
- Financial concerns related to treatment
1. Risk for Infection
NANDA Definition:
At increased risk for being invaded by pathogenic organisms related to immunosuppression from lymphoma and/or chemotherapy treatment.
Assessment Findings:
- Neutropenia (neutrophil count < 1500/mm³)
- Compromised immune function due to disease process
- Bone marrow suppression from chemotherapy
- Presence of indwelling catheters or vascular access devices
- Malnutrition or poor nutritional status
Expected Outcomes:
- Patient will remain free from signs and symptoms of infection
- Patient will demonstrate knowledge of infection prevention measures
- Patient will maintain temperature within normal range
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Monitor temperature, vital signs, and assess for signs of infection q4h or as indicated | Early detection of infection allows for prompt intervention, especially important during neutropenic periods |
| Implement neutropenic precautions when ANC < 1000/mm³: private room, restricted visitors, no fresh flowers/plants | Reduces exposure to potential pathogens during periods of severe immunocompromise |
| Practice meticulous hand hygiene and ensure all staff and visitors comply | Hand hygiene is the most effective method to prevent transmission of pathogens |
| Administer prophylactic antibiotics, antivirals, or antifungals as prescribed | May be indicated to prevent opportunistic infections during severe immunosuppression |
| Educate patient on neutropenic diet precautions and food safety | Reduces risk of foodborne infections during immunocompromised periods |
Evaluation:
- Monitor for presence/absence of infection indicators (fever, chills, localized signs)
- Assess laboratory values (WBC, ANC, CRP) to evaluate immune function
- Evaluate patient’s adherence to and understanding of infection prevention measures
2. Impaired Gas Exchange
NANDA Definition:
Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane related to mediastinal lymph node enlargement or pulmonary involvement.
Assessment Findings:
- Dyspnea or shortness of breath
- Tachypnea
- Abnormal arterial blood gases (decreased PaO2, increased PaCO2)
- Reduced oxygen saturation
- Mediastinal mass (particularly in Hodgkin lymphoma)
- Use of accessory muscles for breathing
Expected Outcomes:
- Patient will demonstrate improved respiratory parameters (normal rate, rhythm, depth)
- Patient will maintain oxygen saturation > 95% on room air or prescribed oxygen
- Patient will report decreased dyspnea
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Assess respiratory status q4h or as indicated (rate, rhythm, depth, use of accessory muscles) | Detects early changes in respiratory status allowing for prompt intervention |
| Monitor and document oxygen saturation via pulse oximetry | Provides objective measurement of oxygenation status |
| Position patient in semi-Fowler’s or high Fowler’s position (30-45°) | Promotes lung expansion and reduces pressure from mediastinal masses |
| Administer supplemental oxygen as prescribed | Improves oxygenation and relieves respiratory distress |
| Encourage deep breathing exercises and incentive spirometry q2h while awake | Promotes alveolar expansion and prevents atelectasis |
Evaluation:
- Monitor respiratory rate, rhythm, and effort for improvement
- Assess oxygen saturation values for stabilization or improvement
- Evaluate patient’s subjective reports of breathing comfort
- Review arterial blood gas results if available
3. Acute Pain
NANDA Definition:
Unpleasant sensory and emotional experience arising from actual or potential tissue damage related to lymphadenopathy, hepatosplenomegaly, or treatment effects.
Assessment Findings:
- Self-reported pain using valid pain scale
- Facial grimacing, guarding behavior
- Pain localized to areas of lymphadenopathy
- Abdominal pain related to hepatosplenomegaly
- Bone pain from bone marrow involvement or growth factor medications
- Mucositis pain from chemotherapy
Expected Outcomes:
- Patient will report pain at acceptable level (≤ 3/10 or patient-defined goal)
- Patient will demonstrate effective use of pharmacological and non-pharmacological pain management strategies
- Patient will maintain functional ability despite pain
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Conduct comprehensive pain assessment using appropriate scale q4h and as needed | Provides baseline and ongoing evaluation of pain characteristics and effectiveness of interventions |
| Administer prescribed analgesics according to appropriate schedule and PRN protocol | Maintains therapeutic blood levels of medications for effective pain control |
| Apply heat/cold therapy to painful areas as appropriate | Non-pharmacological intervention that can reduce pain and inflammation |
| Teach relaxation techniques, guided imagery, and distraction methods | Complementary approaches that can modify pain perception and enhance coping |
| Reposition patient q2h and provide supportive devices (pillows, etc.) | Reduces pressure on painful areas and improves comfort |
Evaluation:
- Monitor pain scores regularly to evaluate effectiveness of interventions
- Assess for side effects of pain medications
- Evaluate patient’s ability to participate in self-care and daily activities
- Document patient’s satisfaction with pain management regimen
4. Imbalanced Nutrition: Less than Body Requirements
NANDA Definition:
Inadequate intake or absorption of nutrients to meet metabolic needs related to disease process or treatment effects.
Assessment Findings:
- Weight loss of ≥5% of body weight
- Decreased appetite or early satiety
- Nausea and vomiting from chemotherapy
- Mucositis affecting oral intake
- Altered taste sensation from treatment
- Serum albumin and protein levels below normal range
Expected Outcomes:
- Patient will maintain or improve weight status
- Patient will consume adequate calories and protein daily
- Patient will demonstrate improved or stabilized nutritional laboratory values
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Monitor daily weights and intake/output | Provides objective data regarding nutritional status and fluid balance |
| Administer antiemetics 30-60 minutes before meals and as scheduled | Prevents or reduces nausea and vomiting, improving oral intake |
| Provide small, frequent meals (6-8 per day) with high-protein, high-calorie options | Easier for patients with early satiety to manage and maximizes nutritional intake |
| Consult with dietitian for individualized nutrition plan | Ensures specialized nutritional needs are addressed with appropriate interventions |
| Implement oral care protocol before and after meals | Reduces taste alterations and discomfort from mucositis, improving oral intake |
Evaluation:
- Monitor weight trends over time
- Assess caloric and protein intake compared to calculated requirements
- Evaluate laboratory values (albumin, prealbumin, transferrin)
- Monitor patient’s tolerance of oral intake and preferred foods
5. Risk for Bleeding
NANDA Definition:
At risk for a decrease in blood volume that may compromise health related to thrombocytopenia from bone marrow suppression or disease involvement.
Assessment Findings:
- Thrombocytopenia (platelet count < 150,000/mm³)
- Petechiae, ecchymoses, or purpura
- Prolonged bleeding from venipuncture sites
- Epistaxis or gingival bleeding
- Hematuria, hematemesis, or melena
- Bone marrow involvement affecting platelet production
Expected Outcomes:
- Patient will remain free from bleeding episodes
- Patient will demonstrate knowledge of bleeding precautions
- Patient will maintain skin integrity without new bruising or petechiae
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Monitor platelet counts and implement bleeding precautions when < 50,000/mm³ | Risk of spontaneous bleeding increases significantly with platelets < 50,000/mm³ |
| Avoid invasive procedures when possible; apply pressure to venipuncture sites for 5-10 minutes | Minimizes trauma and allows for adequate clot formation at puncture sites |
| Administer platelet transfusions as prescribed, typically for counts < 10,000/mm³ or active bleeding | Replaces platelets to improve clotting ability and prevent spontaneous bleeding |
| Provide soft toothbrush and recommend electric razor for shaving | Reduces risk of trauma to mucous membranes and skin |
| Test all excretions for occult blood | Allows early detection of internal bleeding |
Evaluation:
- Monitor for presence/absence of bleeding from any site
- Assess skin and mucous membranes for new petechiae or bruising
- Evaluate platelet count response to interventions
- Document patient’s adherence to bleeding precautions
6. Fatigue
NANDA Definition:
An overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work related to disease process, anemia, or treatment effects.
Assessment Findings:
- Verbalization of overwhelming lack of energy
- Inability to maintain usual routines
- Decreased performance
- Anemia (hemoglobin < 12 g/dL for women, < 13 g/dL for men)
- Lethargy or listlessness
- Increased need for rest
Expected Outcomes:
- Patient will report improved energy levels
- Patient will demonstrate effective energy conservation techniques
- Patient will maintain participation in valued activities despite fatigue
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Assess fatigue levels using validated fatigue scale | Provides objective measurement of fatigue and helps evaluate effectiveness of interventions |
| Monitor hemoglobin and hematocrit values; administer prescribed blood transfusions or erythropoiesis-stimulating agents | Anemia treatment can improve oxygen-carrying capacity and reduce fatigue |
| Help patient identify high-priority activities and plan rest periods around them | Energy conservation techniques help patients participate in valued activities |
| Encourage light to moderate physical activity as tolerated | Regular exercise paradoxically improves energy levels and reduces cancer-related fatigue |
| Implement sleep hygiene measures to improve sleep quality | Better sleep quality can reduce fatigue and improve daytime functioning |
Evaluation:
- Monitor fatigue levels using assessment scale
- Assess hemoglobin and hematocrit values
- Evaluate patient’s ability to participate in daily activities
- Document effectiveness of energy conservation techniques
7. Disturbed Body Image
NANDA Definition:
Confusion in mental picture of one’s physical self related to treatment effects, changes in appearance, and changes in function.
Assessment Findings:
- Verbalization of negative feelings about body
- Alopecia from chemotherapy
- Weight changes
- Visible lymphadenopathy
- Avoidance of social situations
- Refusal to look at affected body parts
Expected Outcomes:
- Patient will verbalize acceptance of changes in appearance
- Patient will utilize adaptive strategies to cope with body changes
- Patient will engage in social activities despite changes in appearance
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Assess patient’s perception of and emotional response to body changes | Establishes baseline understanding of patient’s body image concerns |
| Provide anticipatory guidance about expected changes (hair loss, weight changes) | Preparation for changes can reduce distress when they occur |
| Connect patient with resources for wigs, scarves, hats, or cosmetic programs | Practical interventions can improve confidence in appearance |
| Encourage expression of feelings about changed appearance | Acknowledging feelings helps in the adaptation process |
| Refer to support groups or counseling as appropriate | Peer support and professional guidance facilitate coping with body image changes |
Evaluation:
- Monitor patient’s verbalization about body image
- Assess patient’s willingness to view and care for affected body parts
- Evaluate level of social engagement and activities
- Document use of adaptive strategies and resources
8. Anxiety
NANDA Definition:
Vague uneasy feeling of discomfort or dread accompanied by an autonomic response related to uncertainty about prognosis, treatment outcomes, and fear of recurrence.
Assessment Findings:
- Expressed concerns or worries about treatment or prognosis
- Restlessness or irritability
- Sleep disturbances
- Increased heart rate, respiratory rate, or blood pressure
- Difficulty concentrating
- Verbalization of feeling overwhelmed
Expected Outcomes:
- Patient will report decreased anxiety
- Patient will demonstrate effective coping strategies for managing anxiety
- Patient will verbalize understanding of treatment plan and what to expect
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Assess anxiety levels using validated tools | Provides objective measurement of anxiety and helps evaluate intervention effectiveness |
| Create a calm, quiet environment; reduce unnecessary stimuli | Environmental factors can influence anxiety levels |
| Provide accurate information about treatment, procedures, and what to expect | Uncertainty often increases anxiety; information can reduce fear of the unknown |
| Teach relaxation techniques (deep breathing, progressive muscle relaxation, guided imagery) | These techniques activate the parasympathetic nervous system and reduce physiological arousal |
| Administer prescribed anti-anxiety medications as appropriate | Pharmacological intervention may be necessary for significant anxiety that interferes with function |
Evaluation:
- Monitor anxiety levels using assessment scale
- Assess physiological indicators of anxiety (heart rate, blood pressure)
- Evaluate patient’s use and effectiveness of coping strategies
- Document patient’s understanding of information provided
9. Impaired Skin Integrity
NANDA Definition:
Altered epidermis and/or dermis related to radiation dermatitis, graft-versus-host disease, or treatment effects.
Assessment Findings:
- Erythema or redness in radiation fields
- Dry desquamation (flaking, peeling)
- Moist desquamation (weeping, exposed dermis)
- Pruritus (itching)
- Dermatological manifestations of graft-versus-host disease
- Skin dryness or rash from targeted therapies
Expected Outcomes:
- Patient will demonstrate intact or improving skin integrity
- Patient will perform appropriate skin care regimen independently
- Patient will report manageable levels of skin-related discomfort
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Assess skin condition daily, with special attention to treatment areas | Allows early detection of skin changes and prompt intervention |
| Implement gentle skin care: mild soap, lukewarm water, pat dry (not rub) | Minimizes trauma to compromised skin |
| Apply prescribed topical agents to radiation fields per protocol | Radiation oncology departments have specific protocols for skin care during radiation |
| Instruct patient to avoid sun exposure on treatment areas | Skin in radiation fields is more susceptible to sun damage |
| Use pressure-reducing surfaces for patients with limited mobility | Prevents pressure injury development in compromised skin |
Evaluation:
- Monitor skin condition for improvement or deterioration
- Assess patient’s adherence to skin care regimen
- Evaluate effectiveness of interventions for managing skin-related symptoms
- Document skin changes using standardized assessment tools
10. Ineffective Coping
NANDA Definition:
Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources related to psychological impact of diagnosis and treatment.
Assessment Findings:
- Verbalization of inability to cope or ask for help
- Ineffective problem solving
- Inappropriate use of defense mechanisms
- High levels of distress
- Destructive behavior toward self or others
- Inability to meet basic needs
Expected Outcomes:
- Patient will identify and use effective coping strategies
- Patient will verbalize decreased feelings of being overwhelmed
- Patient will utilize appropriate support resources
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Assess current coping strategies and their effectiveness | Identifies baseline functioning and areas for improvement |
| Establish therapeutic relationship with active listening and non-judgmental approach | Creates safe space for patient to express feelings and concerns |
| Help identify situations that trigger distress and develop specific coping strategies | Targeted interventions for specific stressors are more effective than general approaches |
| Connect patient with resources (psycho-oncology services, social work, support groups) | Professional support services provide specialized interventions for cancer-related distress |
| Teach problem-solving techniques and stress management strategies | Provides practical tools to manage challenges related to diagnosis and treatment |
Evaluation:
- Monitor patient’s self-reported coping efficacy
- Assess for decreased distress and improved function
- Evaluate patient’s use of support resources
- Document adaptive behaviors and coping strategies utilized
11. Risk for Spiritual Distress
NANDA Definition:
At risk for an impaired ability to experience and integrate meaning and purpose in life through connections with self, others, art, music, literature, nature, and/or a power greater than oneself related to life-threatening illness.
Assessment Findings:
- Questioning meaning of illness or existence
- Expression of lack of hope, purpose, or peace
- Anger toward God or higher power
- Withdrawal from religious practices that were previously important
- Feelings of abandonment
- Request for spiritual support or counseling
Expected Outcomes:
- Patient will express feeling of spiritual well-being or peace
- Patient will engage with sources of spiritual strength
- Patient will verbalize meaning and purpose despite illness
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Assess spiritual beliefs, practices, and needs using appropriate assessment tools | Establishes baseline understanding of patient’s spiritual framework and needs |
| Create environment conducive to spiritual practices (privacy, respect for rituals) | Facilitates continued engagement with spiritual practices during hospitalization |
| Listen actively to spiritual concerns without imposing own beliefs | Therapeutic presence and listening are powerful interventions for spiritual distress |
| Refer to chaplain, spiritual advisor, or religious leader as appropriate | Professional spiritual care providers offer specialized support aligned with patient’s beliefs |
| Support activities that have brought meaning and purpose in the past | Reconnecting with sources of meaning promotes spiritual well-being |
Evaluation:
- Monitor patient’s expressions of spiritual well-being or distress
- Assess engagement with spiritual practices and resources
- Evaluate statements about finding meaning and purpose
- Document effectiveness of spiritual support interventions
12. Deficient Knowledge
NANDA Definition:
Absence or deficiency of cognitive information related to lymphoma, its treatment, self-care requirements, and follow-up care.
Assessment Findings:
- Verbalization of lack of information or misunderstanding
- Inaccurate follow-through of instructions
- Inappropriate behaviors
- Questions regarding disease process, treatment, or self-care
- Anxiety about health management requirements
- Expressed desire for information
Expected Outcomes:
- Patient will verbalize accurate understanding of lymphoma and its treatment
- Patient will demonstrate appropriate self-care behaviors
- Patient will identify signs and symptoms requiring medical attention
Nursing Interventions:
| Interventions | Rationale |
|---|---|
| Assess current knowledge level and preferred learning methods | Tailoring education to baseline knowledge and learning preferences improves effectiveness |
| Provide information about lymphoma type, stage, treatment plan, and expected effects | Foundational knowledge helps patient participate in care decisions and prepares for treatment |
| Teach self-care strategies for managing treatment side effects | Empowers patient to manage symptoms and improves quality of life during treatment |
| Provide written materials to reinforce verbal teaching | Written resources serve as reference after discharge and reinforce retention |
| Use teach-back method to verify understanding | Confirms comprehension and identifies areas needing clarification |
Evaluation:
- Assess patient’s verbal explanation of key concepts
- Monitor demonstration of self-care activities
- Evaluate patient’s ability to identify when to seek medical attention
- Document areas of understanding and ongoing educational needs
Home Care Advice for Lymphoma Patients
Maintaining a Safe Home Environment
Creating a safe environment is essential for lymphoma patients, especially during periods of immunosuppression:
- Clean high-touch surfaces daily with disinfectant (doorknobs, light switches, remotes)
- Remove fresh flowers and plants during severe neutropenia periods
- Maintain good air quality; consider HEPA filters if recommended
- Avoid home renovation projects during active treatment
- Keep pets clean and up-to-date on vaccinations; delegate pet waste cleanup to others
Nutrition and Food Safety
Proper nutrition and food safety practices are crucial for lymphoma patients:
- Follow neutropenic diet guidelines if prescribed (avoiding raw foods, unwashed produce)
- Ensure thorough cooking of all meats, eggs, and seafood
- Wash hands thoroughly before food preparation
- Store foods at proper temperatures; discard leftovers after 2-3 days
- Focus on protein-rich foods to support healing and immune function
- Stay hydrated with 8-10 cups of fluid daily unless restricted
Medication Management
Proper medication management is critical for treatment success:
- Create a medication schedule and use pill organizers if helpful
- Keep an updated list of all medications, including over-the-counter drugs and supplements
- Understand the purpose, dosage, and potential side effects of each medication
- Check with healthcare provider before taking any new medications or supplements
- Store medications according to instructions (some require refrigeration)
When to Seek Medical Attention
Know when symptoms require prompt medical evaluation:
- Fever ≥ 100.4°F (38°C) — seek immediate medical attention during neutropenia
- Unusual bleeding or bruising
- Shortness of breath or difficulty breathing
- Severe pain unrelieved by prescribed medications
- Persistent nausea, vomiting, or inability to eat or drink for 24 hours
- New rash, especially if painful or blistering
Infection Prevention
Preventing infections is paramount for lymphoma patients:
- Practice thorough hand hygiene with soap and water or alcohol-based sanitizer
- Avoid crowds and individuals with known infections
- Wear mask in public settings during periods of severe immunosuppression
- Avoid raw or undercooked foods and unpasteurized products
- Practice good dental hygiene with soft toothbrush
Activity and Rest
Balancing activity and rest promotes recovery:
- Engage in light physical activity as tolerated and approved by healthcare provider
- Schedule activities during times of peak energy
- Balance activity with planned rest periods
- Prioritize activities and delegate tasks when needed
- Gradually increase activity level as strength improves
Emotional Support and Coping
Strategies for emotional well-being during lymphoma treatment:
- Connect with support groups specific to lymphoma patients
- Practice stress reduction techniques (meditation, deep breathing)
- Maintain a journal to process thoughts and feelings
- Communicate needs clearly with family and caregivers
- Consider professional counseling if experiencing persistent distress
Remember: Each lymphoma patient’s care needs are unique. Always follow specific recommendations from your healthcare team.