Hodgkin’s Disease Nursing Care Plan Notes


  • 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.

Hodgkin’s Disease

Causes/ Risk Factors

The cause of Hodgkin’s disease is unknown. Many researchers have suspected an infectious component. Some of the early symptoms include fever, chills, and leukocytosis, as if a viral infection were present. Gene fragments similar to those of a murine leukemia virus have been found in Hodgkin’s tissue. In particular, higher than usual Epstein-Barr antibodies have been found in many Hodgkin’s patients, and a small increase in Hodgkin’s incidence has been found in people who have had the Epstein-Barr–induced disease, infectious mononucleosis. Some people who have reduced immune systems, such as those with AIDS and organ transplant patients, are also at a higher risk for Hodgkin’s disease.

  • 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, and 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.
Primary Nursing Diagnosis
  • Risk for infection related to impaired primary and secondary defenses
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.
Medical Management
  • Chemotherapy followed by radiation therapy is used in early-stage disease
  • Combination chemotherapy alone is now the standard treatment for more advanced disease.
  • When Hodgkin’s does recur, the use of high doses of chemotherapeutic medications, followed by autologous bone marrow or stem-cell transplantation, can be very effective.
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.
Documentation Guidelines
  • Response to staging: Emotional and physical response to diagnostic testing, healing of incisions,signs of ineffective coping,response to diagnosis,ability to participate in planning treatment options,response of significant others
  • Response to treatment:Effects of chemotherapy or radiation therapy,or both; response to treatment of symptoms,presence of complications (weight loss,infection,skin irritation)
  • Emotional state:Effectiveness of coping, presence of depression, interest in group support or counseling,referrals mad
Discharge and Home Healthcare Guidelines

Although they are cured of the disease,patients who survive Hodgkin’s disease continue to have immune defects that persist throughout life. Defects include transiently depressed antibody production, decreased polymorphonuclear chemotaxis, decreased antigen-induced T-cell proliferation,and changes in delayed hypersensitivity. Coupled with the sometimes lingering aftereffects of radiation and chemotherapy, the patient needs to maintain infection vigilance even after remission is obtained. Teach the patient lifelong strategies to avoid infection. Patients may have other complications for up to 25 years after mantle radiation therapy, including hypothyroidism, Graves’disease, and thyroid cancer. Irradiation can also cause pulmonary and pericardial fibrosis and coronary artery changes,and it may increase the risk for the development of solid tumors such as lung cancer,breast cancer,and others. Explain the presenting symptoms of the disorder,provide written information for the patient,and encourage yearly physicals to maintain follow-up. Because infertility may be a complication of chemotherapy, men may want to think of sperm banking before treatments, although many have sperm dysfunction at diagnosis.