Lymphadenopathy
Lymphadenopathy: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
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.)
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 ⅜"(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, and tender or nontender, suggesting a malignant tumor.
History
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.
Physical assessment
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. 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
Besides lymphadenopathy, acquired immunodeficiency syndrome (AIDS) findings include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous)
With cutaneous anthrax, lymphadenopathy, malaise, headache, and fever may develop along with a small, elevated, itchy lesion resembling an insect bite that progresses into a painless, necrotic-centered ulcer.
Chronic fatigue syndrome
Lymphadenopathy may occur with incapacitating fatigue, sore throat, low-grade fevers, myalgia, cognitive dysfunction, and sleep disturbances. The patient may also experience arthralgia with arthritis, headache, and memory deficits.
Cytomegalovirus infection
Generalized lymphadenopathy is accompanied by fever, malaise, and hepato-splenomegaly in a patient infected with cytomegalovirus. The patient also develops a pruritic rash of small, erythematous macules that progresses to papules and then to vesicles.
Hodgkin’s disease
In Hodgkin’s disease, the extent of lymphadenopathy 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 unexplained fever (usually to 101° F [38.3° C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Leukemia
In acute lymphocytic leukemia, generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and low fever. The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
In chronic lymphocytic leukemia, generalized lymphadenopathy appears early, along with fatigue, malaise, and 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, and intermittent headache, fever, chills, and aches. He may go on to develop arthralgia and, eventually, neurologic and cardiac abnormalities.
Mononucleosis (infectious)
Patients with mononucleosis develop painful lymphadenopathy that involves the cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Typically, prodromal symptoms — such as headache, malaise, and fatigue — occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, sore throat, and temperature fluctuations with an evening peak of about 102° F (38.9° C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
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, cough, and hepatosplenomegaly occur, along with systemic complaints of fever to 101° F (38.3° C), night sweats, fatigue, malaise, and weight loss.
Rheumatoid arthritis
Lymphadenopathy is an early, nonspecific finding of rheumatoid arthritis that’s associated with fatigue, malaise, continuous low 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
Generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common in sarcoidosis. 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, cough, substernal chest pain, and arrhythmias. 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.
Syphilis
Localized lymphadenopathy and a painless ulcer (canker) with an indurated border and relatively smooth base at the site of sexual exposure characterize a primary syphilis infection. The ulcer is usually single, but more than one may be present. In the second stage of syphilis, generalized lymphadenopathy occurs 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 fever may occur.
Systemic lupus erythematosus
Generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud’s phenomenon, and joint pain and stiffness associated with systemic lupus erythematosus (SLE). Pleuritic chest pain and cough may appear with systemic findings, such as fever, anorexia, and weight loss.
Tuberculous lymphadenitis
With tuberculous lymphadenitis, lymphadenopathy 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 fever, chills, weakness, and fatigue.
Other causes
Drugs
Phenytoin may cause generalized lymphadenopathy.
Immunizations
Typhoid vaccination may cause generalized lymphadenopathy.
Special considerations
If the patient has a fever above 101° F (38.3° C), don’t automatically assume that the temperature should be lowered. A patient with a bacterial or viral infection must tolerate the fever, which may assist recovery. Provide an antipyretic if the patient is uncomfortable. Tepid sponge baths or a hypothermia blanket may also be used.
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 scheduled diagnostic tests, such as chest X-ray, 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.
Pediatric pointers
Infection is the most common cause of lymphadenopathy in children. The condition is commonly associated with otitis media and pharyngitis.
Provide an antipyretic if the child has a history of febrile seizures.
Patient counseling
Explain the importance of avoiding crowds and washing hands properly to prevent infection. Teach the patient the signs and symptoms of infection he needs to report to the health care provider. If isolation is required, explain its purpose and associated interventions to the patient and his family. Encourage the patient to eat a healthy diet and get plenty of rest.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, 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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Lymphadenopathy (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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