Lymphadenopathy
Lymphadenopathy: Excerpt from Nursing: Interpreting Signs and Symptoms
Lymphadenopathy—enlargement of one or more lymph nodes—may result from increased production of lymphocytes or reticuloendothelial cells or from infiltration of cells that aren't normally present. This sign may be generalized (involving three or more node groups) or localized. Generalized lymphadenopathy may be caused by an inflammatory process, such as bacterial or viral infection, connective tissue disease, an endocrine disorder, or neoplasm. Localized lymphadenopathy most commonly results from infection or trauma affecting a specific area. (See Areas of localized lymphadenopathy, page 374, and Causes of localized lymphadenopathy, page 375.)
normally, lymph nodes are discrete, mobile, soft, nontender and, except in children, nonpalpable. (However, palpable nodes may be normal in adults.) Nodes that are more than ⅜9 (1 cm) in diameter are cause for concern. They may be tender, and the skin overlying the lymph node may be erythematous, suggesting a draining lesion. Alternatively, they may be hard and fixed, tender or nontender, suggesting a malignant tumor.
History and physical examination
Ask the patient when he first noticed the swelling and whether it's located on one side of his body or both. Are the swollen areas sore, hard, or red? Ask the patient if he has recently had an infection or other health problem. Also ask if a biopsy has ever been done on any node because this may indicate a previously diagnosed cancer. Find out if the patient has a family history of cancer.
Palpate the entire lymph node system to determine the extent of lymphadenopathy and to detect other areas of local enlargement. Use the pads of your index and middle fingers to move the skin over underlying tissues at the nodal area. If you detect enlarged nodes, note their size in centimeters and whether they're fixed or mobile, tender or nontender, and erythematous or not. Note their texture: Is the node discrete, or does the area feel matted? If you detect tender, erythematous lymph nodes, check the area drained by that part of the lymph system for signs of infection, such as erythema and swelling. Also, palpate for and percuss the spleen.
Medical causes
Acquired immunodeficiency syndrome (AIDS).Besides lymphadenopathy, findings with AIDS include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and a cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous).Lymphadenopathy, malaise, headache, and fever may develop with cutaneous anthrax, along with a lesion that progresses into a painless, necrotic-centered ulcer.
Brucellosis.With brucellosis, generalized lymphadenopathy usually affects cervical and axillary lymph nodes, making them tender. It usually begins insidiously with easy fatigability, malaise, a headache, backache, anorexia, weight loss, and arthralgia; it may also begin abruptly with chills, a fever that usually rises in the morning and subsides during the day, and diaphoresis.
Cytomegalovirus infection (CMV).CMV causes generalized lymphadenopathy occurs in the immunocompromised patient and is accompanied by fever, malaise, rash, and hepatosplenomegaly.
Hodgkin's disease.The extent of lymphadenopathy with Hodgkin's disease reflects the stage of malignancy—from stage I involvement of a single lymph node region to stage IV generalized lymphadenopathy. Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and an unexplained fever (usually up to 101º F [38.3º C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Kawasaki syndrome.Cervical lymphadenopathy is a characteristic sign of Kawasaki syndrome, a potentially life-threatening illness. Affected individuals present with a high, spiking fever, along with other diagnostic signs including erythema, bilateral conjunctival injection, and swelling in the peripheral extremities. Kawasaki syndrome isn't contagious, however the cause remains unknown and the disease typically affects children under age 5. Prompt detection and treatment with I.V. gamma globulin is essential in preventing serious complications, such as coronary artery dilations and aneurysms.
Leptospirosis.Lymphadenopathy is uncommon in leptospirosis, a rare disease. More common findings include a sudden onset of a fever and chills, malaise, myalgia, a headache, nausea and vomiting, and abdominal pain.
Leukemia (acute lymphocytic).With acute lymphocytic leukemia, generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and a low-grade fever. The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
Leukemia (chronic lymphocytic).With chronic lymphocytic leukemia, generalized lymphadenopathy appears early, along with fatigue, malaise, and a fever. As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease.Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans. As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, an intermittent headache, a fever, chills, and aches. He may go on to develop arthralgia and, eventually, neurologic and cardiac abnormalities.
Monkeypox.Lymphadenopathy is the one symptom that clearly distinguishes monkeypox from smallpox. Humans infected with monkeypox usually develop cervical or inguinal lymphadenopathy, along with other characteristic symptoms such as fever, chills, throat pain, muscle aches, and rash. This rare viral disease acquired its name after being discovered in laboratory monkeys; however, many other animals can carry this disease. Although the monkeypox virus is similar to smallpox, the smallpox vaccine is only used in limited circumstances to protect certain at-risk individuals against the disease.
Mononucleosis (infectious).With infectious mononucleosis, characteristic, painful lymphadenopathy involves cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Typically, prodromal symptoms—such as a headache, malaise, and fatigue—occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, a sore throat, and temperature fluctuations with an evening peak of about 102º F (38.9º C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Mycosis fungoides.Lymphadenopathy occurs in stage III of mycosis fungoides, a rare, chronic malignant lymphoma. It's accompanied by ulcerated brownish red tumors that are painful and itchy.
Non-Hodgkin's lymphoma.Painless enlargement of one or more peripheral lymph nodes is the most common sign of non-Hodgkin's lymphoma, with generalized lymphadenopathy characterizing stage IV. Dyspnea, a cough, and hepatosplenomegaly occur, along with systemic complaints of a fever of up to 101° F (38.3º C), night sweats, fatigue, malaise, and weight loss.
Plague (Yersinia pestis).Signs and symptoms of the bubonic form of plague, a bacterial infection, include lymphadenopathy, a fever, and chills.
Rheumatoid arthritis.Lympha-
denopathy is an early, nonspecific finding in rheumatoid arthritis and is associated with fatigue, malaise, a continuous low-grade fever, weight loss, and vague arthralgia and myalgia. Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis.With sarcoidosis, generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common. Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, a cough, substernal chest pain, and arrhythmias. About 90% of patients have an abnormal chest X-ray at some time during their illness. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Sjögren's syndrome.Lymphadenopathy of the parotid and submaxillary nodes may occur in Sjögren's syndrome, a rare disorder. Assessment reveals cardinal signs of dry mouth, eyes, and mucous membranes, which may be accompanied by photosensitivity, poor vision, eye fatigue, nasal crusting, and epistaxis.
Syphilis (secondary).Generalized lymphadenopathy occurs in the second stage of syphilis and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp. A palmar rash is a significant diagnostic sign. Headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, and low-grade fever may occur.
Systemic lupus erythematosus (SLE).With SLE, generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud's phenomenon, and joint pain and stiffness. Pleuritic chest pain and a cough may appear with systemic findings, such as a fever, anorexia, and weight loss.
Tuberculous lymphadenitis.Lymphadenopathy that occurs with tuberculous lymphadenitis may be generalized or restricted to superficial lymph nodes. Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by a fever, chills, weakness, and fatigue.
Waldenström's macroglobulinemia.
Lymphadenopathy may appear along with hepatosplenomegaly in Waldenström's macroglobulinemia. Associated findings include retinal hemorrhage, pallor, and signs of heart failure, such as jugular vein distention and crackles. The patient shows a decreased level of consciousness, abnormal reflexes, and signs of peripheral neuritis. Weakness, fatigue, weight loss, epistaxis, and GI bleeding may also occur. Circulatory impairment occurs because of increased blood viscosity.
Other causes
Drugs.Phenytoin may cause generalized lymphadenopathy.
Immunizations.Typhoid vaccination may cause generalized lymphadenopathy.
Nursing considerations
▪ If the patient is uncomfortable, provide an antipyretic, tepid sponge bath, or a hypothermia blanket.
▪ Expect to obtain blood for routine blood work, platelet and white blood cell counts, liver and renal function studies, erythrocyte sedimentation rate, and blood cultures.
▪ Prepare the patient for other diagnostic tests, such as chest X-ray, computed tomography, liver and spleen scan, lymph node biopsy, or lymphography, to visualize the lymphatic system.
▪ If tests reveal infection, check your facility's policy regarding infection control and isolation precautions.
Patient teaching
▪ Explain to the patient all diagnostic tests or procedures.
▪ Teach the patient ways to prevent infection.
▪ Explain the signs and symptoms of infection the patient should report.
▪ Explain the reasons for any isolation precautions.
▪ Stress the importance of a healthy diet and rest.
Pictures
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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