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1

C E R V I C A L

L Y M P H A D E N O P A T H Y

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Introduction

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Cervical

lymphadenopathy is anenlargement of

the cervical lymphnodes .

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Lymphadenopathy is a term meaning"disease of the lymph nodes ." It is, however,almost synonymously used with"sw ollen/enlarged lymph node s". It could be

due to infection , auto-immune dis ea s e,or malignancy .Inflammation of a lymph node iscalled lymphadeniti s . In practice, thedistinction between lymphadenopathy andlymphadenitis is rarely made. (Inflammationof lymph channels is called lymphangiti s .)

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Type s:Localized lymphadenopathy : due to localized spotof infection e.g. an infected spot on the scalp willcause lymph nodes in the neck on that same side toswell up

Generalized lymphadenopathy : due to generalizedinfection all over the body e.g. influenza

persistent generalized lymphadenopathy (PGL) : persisting for a long time, possibly without an apparentcause

Dermatopathic lymphadenopathy : lymphadenopathy associated with skin disease.

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Cau s e s:Enlarged lymph nodes are acommon symptom in a number of

infectious

and malignantdis ea s e s. It is a recognizedsymptom of very many diseases,of which some are as follows :

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Reactive : acute infection (e.g. bacterial , or viral), orchronic infections ( tuberculous lymphadenitis , cat-

scratch disease ).

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The most distinctive symptom of bubonic plague isextreme swelling of one or more lymph nodes that bulgeout of the skin as "buboes." The buboes often becomenecrotic and may even rupture.

Infectious mononucleosis is an acute viral infection, thehallmark of which is marked enlargement of the cervicallymph nodes .

It is also a symptom of cutaneous anthrax , measles and Human Africantrypanosomiasis , the latter two giving lymphadenopathy inlymph nodes in the neck.

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Toxoplasmosis , a parasitic disease , gives ageneralized lymphadenopathy ( Pirin ge r-Kuchinka lymphad e nopathy ).

Plasma cell variant of Castleman's disease -associated with HHV-8 infectionand HIVinfection.

Mesenteric lymphadenitis after viralsystemic infection (particularly in the GAL T in the appendix) can commonly present likeappendicitis.

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Tumoral : Primary : Hodgkin lymphoma , non-

Hodgkin lymphoma , hairy cellleukemia , give lymphadenopathy in allor a few lymph nodes. [4]

Secondary : metastasis , Virchow'sNode , Neuroblastoma .

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Autoimmune etiology : systemic lupus

erythematosus , rheumatoidarthritis all giving a

generalized lymphadenopathy.

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Immunocompromi s ed etiology : AIDS.Generalized lymphadenopathy is an earlysign of infection with humanimmunodeficiency virus (HIV), the virus thatcauses acquired immunodeficiencysyndrome (AIDS). "Lymphadenopathysyndrome" has been used to describe thefirst symptomatic stage of HIVprogression,preceding a diagnosis of AIDS.

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DEMOGRAPHIC

DATA

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NAME: Mrs .LymphaAGE: 37 y/o

S EX: FemaleRELIGION: Roman CatholicCIVILS TATUS : MarriedNATIONALITY: F ilpino

ADDRESS : P1 Carulay Echague IsabelaB IRTH DATE: August 29, 1973DATE OF ADMISS ION: August 21, 2011TIME OF ADMISS ION: 2:45 pmATTENDING PHYS ICIAN: Dr. Jade MalvarCHIEF COMPLAINT: Submandibular MassADMITTING DIAGNOS IS : Thyroductal CystsFINAL DIAGNOS IS : Cervical Lymph AdenopathyS URGICAL PROCEDURE: Thyroglossalduct cyst excision

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Nursing Hi

story

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Pre s ent Medical

His tory

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Pa s t MedicalHis tory

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According to the patient she has not yetexperienced any serious health problem. She

was just hospitalized at Ilagan District Hospitaltwice because she had undergone CesareanSection by the year 2000 with her 1 st baby and

last 2001with her 2nd

child. She has an allergyto sea foods such as seashells and Daing .According to the patient she also

experiences common coughs and colds andshe manages it by over the counter drugs suchas Neozep.

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Family Hi s tory

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HTNAS THMA

DM TB CAPaternal

Maternal

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Gordons

Functional HealthPattern

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Before hospitalization : Health is important to her too. Napaka healthconscious ko as verbalized by the patient. Ang

kalusugan ang pinakamahalaga sa bawat tao lalo na sagaya kong nagtratrabaho at naghahanap buhaypatient adds. She immediately consulted a doctor if she observed something unusual to her so that shewill be aware of any health problem she s sufferingand to avoid any problem so it won t lead to a moreserious one.

23HEALTH PERCEPTION HEALTH MANAGEMENT

PATTERN

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According to her 5 years ago herhealth rating is 10 but as of now her

health rating is 8 and 5 years fromnow her heath rating then is 6 because habang tumatanda ang tao

mas lalong nagiging prone sa sakitshe says.

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I learned that it s a good idea to be always awarewhen it comes to our health. Health seems to bereally important to her because she immediatelydecided to undergo operation.When it comes to the effect of the illness to her ADL

she says sa awa ng diyos hindi naman naapektohanang pang araw araw kong gawain . She drinksoccasionally but doesn t smoke. She complies

properly with management and treatment by takingmedicine and cooperating with the health care team.

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NUTRIT IONAL-ME TABOLIC

PATT E

RNBefore hospitalization :

Few days after she noticed her palpable mass, everytime sheeat,she observed feeling of fullness on her throat whenever sheswallow. Parang hindi bumababa ang mga kinakain ko she said. She eatthree times a day.Her breakfast usually comprises of fried rice and eggand sometimes frozen products such as tocino.Her lunch and dinnerusually comprises of vegetables such as pinakbet and meat such as

adobong manok and baboy.She consumes 2-3 cups of rice per meal anddrinks 5-8 glasses of water per day.She is also a fond of eating streetfoods such as kwek kwek and fishball,this served already as hersnacks according to her.She as an allergy to seafoods suchs as seashelland daing

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Few weeks after she noticed the submandibularmass, she also observed that she was having adifficulty swallowing her food but this did notalter her dietary intakeDuring hospitalization :

Upon admission, patient was placed onDAT. Seven hours prior to surgery, the patient ison NPO status. DA T was ordered when patient

was fully awake. Due to the incision under herchin patient was hesitant to chew her food. Thiscaused a minimal change in her intake. Patientconsumes only of her usual intake

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ELIMINAT IONPATT ERN

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During hospitalization :Her bowel and bladder habits were the same,never defecate that day(on the day of surgery).Patient did not defecate on the day of surgery.

No known problems on bowel andbladder habits such asincontinence,hematuria,retention andnocturia.No known history of laxatives andanti diarrhreals used.

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ACT IVITY-EXE RCISE PATT ERN

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Before hospitalization : Our client is a working mom.She usedher time wisely. She wakes up early in

the morning to prepare the needs of herkids,sends them to school,and goes toher office everyday as a secretary to a

pharmaceutical company.T

his servedalready as her daily routine according toher.

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During hospitalizationShe can still perform activities of daily living such as grooming and

eating,she is ambulatory and canmove freely. During her postoperative status, she can do thesame thing with a minimal assistancewith her SO because she is hesitantto move her head.

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SLEE P-REST PATT ERN

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Before hospitalization : She sleeps at 9pm andawakes at 5am.She has nodifficulty in falling asleepand remaining asleep.

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During hospitalization :The night before surgery she cannot sleep in anormal pattern because of unfamiliarity toenvironment and due to hospital routinessuch as giving medications and vital signsmonitoring.

Patient also mentioned being anxious/afraid of the upcoming surgery. Kahit sinonaman kakabahan pag nalalamang operahan .She sleeps at interval with a total of 5- 6

hours/day.

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Our client is a college graduate in a degree of Bachelor of Science in E lementary Education

but she failed to pass the board exam. Beforeconsultation she does not understand howshe understand how she can manage and cureher submandibular mass.She did not evenknow how she acquired such condition.During her consultation :

She already understand the course of her condition on how does she acquired andthe approach to removed as explained by herphysician.

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SELF -PERCEPT ION/

SE

LF

CONCE

PT

PATT ERN

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Before hospitalization : She viewed herself as a supportive and loving mother

.She find her kids to be the source of her pride and joy especially

when life gets too chaotic. She can t imagine life without herloved ones. She also considered her husband as one of thegreatest blessing she had. He is the reason why I am happy withmy life [Laughing] she added.

With regard to her body image, pt. felt worried about thegrowing mass on her chin that is why she sought consultationDuring hospitalization :

Self-perception-self concept pattern was the same butthis time, she proved again that whatever life gives, her loved

ones will always be there that cares and supports. This increasesher self-esteem and self-worth, accdg. to her.

With regard to her body image, after surgery patient hasno problem with the appearance of incision under her chin sincefor her, hindi naman nakikita .

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SEX UALLY AND

REPRODUCT IVEPATT ERN

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Our client s menarche is when she was 13y/o,she was second year H.S that time. She got

married when she was 25y/o, now, she smarried for 12 years. They were blessed with

two lovely children. Obstetrical datais :T-2,P-O,A-

0,L-2.(G2P2).Now that she is 37y/o, she is stillsexually active, they used withdrawal method as

a form of control. Have also other method of birth control such as pills, condoms and depot.,

according to her.She underwent CS twice. The first and

second was due to Oligohydramnios.

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COPING-ST RESSTOLERANCE

PATT ERN

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Whenever she is stress, she simply

diverts her attention by having funwith her kids and sometimes socialized

went out to with her officemates.Being alone and reflecting in silence

and listening to old songs is alsobeneficial for her. Her support system

includes her husband and children.

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VALUE-BELIE F PATT ERN

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T heir family is a Roman Catholic.

She believed that God is the sourceof our strength and health. They goto church every Sunday. They donot believe to any quack doctors

and superstitious beliefs.Only God

can cure all the ailments, accordingto her.

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Thank YOu