Max is a 60-year-old living in Iowa. For the 27 years, he has been working in the agricultural industry, particularly in the management of corn production
Recently he began to feel weak during work and tired easily. During the night he woke up sweating, and he often felt unusually warm during the day. Max was also surprised that, in spite of eating regularly, his weight was declining and his work pants were now too large for him. Upon physical examination, his physician noted his inguinal lymph nodes were swollen although Max said they were not sore. Subsequent laboratory tests confirmed follicular, non-Hodgkin lymphoma. Chemotherapy in conjunction with rituximab was immediately initiated.
What are the key cellular differences between non-Hodgkin lymphoma and Hodgkin lymphoma?
The early manifestations of non-Hodgkin lymphoma and Hodgkin lymphoma in lymphatic tissue appear differently. In terms of lymphatic presentation, how would these two diseases appear clinically?
What are the pharmacologic properties of rituximab, and what is its mechanism of action on malignant cells?
Outline the structure of lymph node parenchyma including the areas where B and T lymphocytes reside. Where did Max's lymphoma arise?
In non-Hodgkin disease, there is a malignant transformation of either B or T lymphocytes. The key feature of Hodgkin disease is the presence of the Reed-Sternberg cellâ€"a cell not found in non-Hodgkin disease.
Non-Hodgkin disease is multicentric in nature and often presents with painless, generalized lymphadenopathy with nonnodal concentration, or with several nodes involved. Hodgkin disease begins as a single enlarged node or within a local group. Typically HL begins in nodes above the diaphragm in the younger population. In elderly individuals, it may initially present in nodes below the diaphragm.
Rituximab is a pharmaceutic monoclonal antibody (MOA). It acts by recognizing and binding to the CD20 antigen found on the majority of B-cell lymphomas. After binding, the toxic effect of the MOA destroys the malignant cell.
The parenchyma consists of a cortex, paracortex, and medulla. In the cortex, B cells are found in the primary follicles and secondary follicles. Within the secondary follicles are immunologically active germinal centers. B cells also surround the germinal centers in regions called mantle zones. T cells are also present in lymph nodes and are concentrated in the in the deeper region of the cortex known as the paracortex.
Max's follicular lymphoma involved the centroblasts and centrocytes in the germinal centers of the lymph nodes.
You might also like to view...
The nurse is assessing a female patient who has become rapidly and exceedingly anxious because her fingernail polish is chipped. What type of anxiety should the nurse conclude that the patient is exhibiting?
a. Signal anxiety b. General anxiety c. Anxiety traits d. Panic disorder
When caring for an older patient having surgery, the nurse avoids shaving the patient. Which body system is the nurse supporting by using this intervention?
1. integumentary 2. sensory-perceptual 3. respiratory 4. cardiovascular
An older cognitively impaired adult patient is being discharged to a daughter's home. The nurse knows continued success of the patient's bladder training for urinary incontinence primarily rests on the
a. patient's ability to follow instructions. b. severity of the impairment of the urinary sphincter. c. patient's ability to sense the need to uri-nate. d. daughter's ability to support the training.
To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility?
a. Evidence-based practice to reduce the prevalence of pressure sores b. Implementation of informatics at the bedside c. Staff-manager conferences to review reporting of adverse medical events d. Patient councils to review food, recreation, and nurse-patient relations