Primary Nursing Diagnosis

Risk for infection related to impaired primary and secondary defenses

OUTCOMES. Immune status; Knowledge: Infection control; Risk control; Risk detection; Nutritional status; Tissue integrity: Skin and mucous membranes; Treatment behavior: Illness or injury

INTERVENTIONS. Infection control; Infection protection; Surveillance; Nutritional management; Medication management; Teaching: Disease process


Treatment begins with accurate classification and staging. Clinical staging is determined by initial biopsy, history, physical examination, and radiologic findings. Pathological staging involves a more extensive surgical assessment of possible sites for spread. Owing to continued improvement in radiologic staging, a staging laparotomy (thorough abdominal exploration, splenectomy, liver biopsy, bone marrow biopsy, and multiple lymph node samplings) is performed infrequently.

In general, radiation is used for early, less extensive disease. A combination of radiation and chemotherapy is used for stages IIB, IIIA, and B. Combination chemotherapy with drugs such as doxorubicin, bleomycin, vinblastin, and dacarbazine (ABUD) is used for stage IV (see Phar-macologic Highlights). External beam radiation is the most effective single agent in the treatment of Hodgkin's disease and may be given after three to four courses of chemotherapy. Stages I and IIA Hodgkin's disease are routinely treated with external beam radiation therapy. Mantle therapy (radiation to the chest wall, mediastinum, axilla, and neck—the region known as the mantle field) is done for supradiaphragmatic sites. Radiation-protective shields are used to block irradiation to unaffected areas. These shields are custom fit for each patient, based on his or her physical configurations. Surgery is not used as a treatment modality in Hodgkin's except in the role of staging. A dietary consultation may be needed to help the patient maintain weight and to help support healing.

If the disease does not respond to standard treatment, bone marrow transplantation may be offered, either as part of a clinical trial or outside of a clinical trial. The patient's own bone marrow is removed and stored. Then very high doses of chemotherapy, sometimes in combination with radiation therapy, are administered to eradicate the cancer. High doses also destroy bone marrow. The stored marrow is administered intravenously to the patient, and bone marrow cells

428 Hodgkin's Disease enter the bloodstream and return to the bone. The transplanted marrow produces new red and white blood cells. In another type of transplant, peripheral blood stem cell transplant (PBSCT), only the stem cells (immature cells from which all blood cells develop) are removed and the rest of the blood is returned to the body. Stem cells are then frozen until they are returned to the patient after treatment is finished.

Pharmacologic Highlights

General Comments: Typically, chemotherapy Is given in six or more cycles of treatment. Common side effects are alopecia, nausea, vomiting, fatigue, myelosuppres-sion, and stomatitis. Patients who are receiving chemotherapy are administered antinausea drugs, antiemetics, and pain medicines as needed to help control adverse experiences.

Medication or Drug Class





Varies with drug

Three common

Chemotherapy is used for stage

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