NSG210 Week 09 Lecture: Non-Hodgkin Lymphoma

Course: NSG210 Medical-Surgical Nursing, Fall 2026 Week: 09 (Oct 19-23), lecture Oct 21, Alterations in Protection Exam: Exam 3

Source: lecture deck raw/nsg210_wk09_nonHodgkinLymphoma.pptx (8 slides, no speaker notes; pictures are decorative). The deck is short, so the textbook section adds most of the detail: Hinkle Ch. 30, section VI.B nsg210-hinkle-ch30-hematologic-neoplasms.

Objectives (slide 1)

1. Discuss the signs and symptoms of non-Hodgkin lymphoma (NHL)
2. Discuss medical and nursing management

Lymphomas (slide 2)

• Cancers of lymphoid cells; usually start in lymph nodes but can involve the spleen, GI tract, liver, or bone marrow
• Classified by how differentiated the cells are and which cell type predominates
• Two broad groups: Hodgkin lymphoma and non-Hodgkin lymphoma
• NHL: most are malignant B lymphocytes (textbook: 85% B cell); the involved tissue is heavily infiltrated with malignant cells

Epidemiology and Risk (slide 3)

• 6th most common cancer in the US (textbook: 7th)
• Incidence rises with each decade; median age at diagnosis 66
• Risk factors: immunodeficiency or autoimmune disease, prior cancer treatment, organ transplant, viral infection (Epstein-Barr virus, HIV), pesticides and certain chemicals
• Survival: 69% at 5 years, 59% at 10 years

Signs and Symptoms (slide 4)

• Early stage: may have no symptoms
• Stage III or IV: lymph node swelling is noticeable (textbook: painless, in the neck, armpit, or groin)
• About one third have B symptoms: recurrent fever, drenching night sweats, unintentional weight loss of 10% or more
• Masses can press on organs:
  • Mediastinal mass: respiratory distress
  • Abdominal mass: ureter compression, leading to kidney problems
  • Enlarged spleen: abdominal discomfort, nausea, early fullness, anorexia, weight loss

Diagnosis (slide 5)

• Diagnosis is by examining the malignant cells under the microscope (lymph node biopsy)
• Indolent (slow-growing) types tend to have small cells
• Aggressive types have large or immature cells spread diffusely through the nodes
• Staging: CT scan and bone marrow biopsy

Medical Management (slide 6)

• Based on type, stage, prior treatment, and ability to tolerate therapy
• Radiation and chemotherapy

Textbook adds: the aggressive form is treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone). The goal is remission. Watch for tumor lysis syndrome 12-72 hours after starting treatment, and screen for hepatitis B before rituximab. Drug side effects are in nsg210-week-09-cancer-lecture.

Nursing Management (slides 7-8)

• Most care for Hodgkin and NHL patients is outpatient
• High infection risk: teach how to lower risk, recognize signs of infection, and when to call the provider
• Survivors need regular screening for second cancers
• ACS recommendations for survivors: no smoking, normal BMI, better nutrition (fruits and vegetables), at least 150 minutes of aerobic activity a week. Many survivors do not follow them

Likely Exam Points

• Most NHL is B cell
• B symptoms: fever, drenching night sweats, weight loss of 10% or more
• Mediastinal mass can cause respiratory distress
• Diagnosis is by lymph node biopsy; staging by CT and bone marrow biopsy
• Priority nursing concern: infection prevention and teaching
• Survivors: screen for second cancers