Risk for infection related to impaired primary and secondary defenses
Treatment is based on classification of the cell and staging of the disease. Some of the indolent types of NHL do well with only supportive therapy. The disease process may be slow enough that treatment is saved until the disease takes a more aggressive path. Most patients with intermediate-grade and high-grade lymphomas receive combination chemotherapy.
Radiation is effective for many patients with stage I or II NHL. Radiation is delivered to the chest wall, mediastinum, axilla, and neck (the region known as the mantle field). Most patients, however, are at stage III or IV at diagnosis. Surgery has limited use in the treatment ofNHL. It may be part of the diagnostic and staging process, but diagnostic laparotomy is much less common than in Hodgkin's disease. A therapeutic splenectomy may be performed for severe spleen enlargement. Gastric or bowel resection may be done if the patient has a primary gastrointestinal lymphoma or has obstructions from bulky nodes. Stem cell transplantation may be considered for patients who have relapsed, are at high risk for relapse, or have tried conventional therapy without success.
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
592 Lymphoma, Non-Hodgkin's
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