Lippincott Certification Review Medical-Surgical Nursing

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Chapter 8

●● Laboratory testing includes clotting factor assays, which will reveal the type and severity of disease. ●● Additional laboratory testing includes a complete blood count (CBC); PT, which often remains normal; and PTT, which may be prolonged by two to three times normal. ●● Treatment typically consists of replacement of deficient clotting factors (VIII or IX); however, patients can develop antibodies to factor concentrates, which reduces their effectiveness. ●● Tranexamic acid and epsilon aminocaproic acid inhibit fibrinolysis and can be used to stabilize clots. ●● Desmopressin (DDAVP) can be used to induce a transient rise in factor VIII. ●● The monoclonal antibody emicizumab has been found to mimic the function of factor VIII and is considered a breakthrough in hemophilia treatment. ●● Nursing interventions ●● During bleeding episodes, administer clotting factors or plasma as ordered. ●● Prevent trauma and limit activity when bleeding occurs. ●● Minimize injections and apply pressure for at least 10 minutes to puncture sites. ●● Monitor vital signs and be alert for hemodynamic changes. ●● Administer analgesics and cold packs for joint pain; promote joint mobility when bleeding is controlled. ●● Teach the patient and family about the disease process, monitoring, treatment, and genetic testing. Hodgkin Lymphoma ●● Description ●● Hodgkin lymphoma is a malignant B lymphocyte cell line disease of the lymph system that primarily affects those between ages 15 and 30 and those older than age 55. ●● The malignant cell associated with Hodgkin lymphoma is the Reed–Sternberg cell, a giant, morphologically unique cell that is usually an abnormal type of B lymphocyte. ●● Although the cause is unknown, this cancer is associated with viral infections (EBV) and prolonged immunosuppression; a genetic and environmental association may also exist. ●● It is among the most treatable of adult cancers and has a better prognosis than malignant or non-Hodgkin lymphoma. ●● Signs and symptoms ●● This cancer is characterized by greatly enlarged, painless, movable lymph nodes in the cervical or supraclavicular area. ●● The patient may also experience fever, night sweats, severe pruritus, and weight loss (referred to as “B” or systemic symptoms). ●● Symptoms resulting from compression by the enlarged lymph nodes depend on the area involved. ●● Diagnosis and treatment ●● Laboratory testing may include an immunohistochemistry, a blood test that can detect cells that are found on the surface of Reed–Sternberg cells.

●● Lymph node biopsy showing Reed–Sternberg cells supports the diagnosis. ●● Staging is done after the initial diagnosis of Hodgkin lymphoma is confirmed.

●● The stage of disease is determined by biopsies of distant lymph nodes, bilateral bone marrow biopsies, lymphangiography, computed tomography scan or magnetic resonance imaging of the thorax and abdomen, positron emission tomography, chest x-ray, a CBC, and serum alkaline phosphatase. ●● A splenectomy is usually done during staging. ●● Hodgkin lymphoma has four stages (see Staging lymphomas , page 125). ●● Generally, all stages of Hodgkin lymphoma are treated with a combination of chemotherapy and radiation. ●● Autologous stem cell transplantation and immunotherapy are used for disease resistant to standard treatment. ●● Nursing interventions ●● Provide supportive care related to the adverse effects of radiation therapy and chemotherapy (see Nursing implications in oncology care , pages 348–354). ●● Provide psychological support to help the patient cope with the diagnosis, treatment, and effects of treatment. ●● Provide education to the patient and their family regarding the diagnosis of Hodgkin lymphoma and its treatment. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.