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CERVICAL LYMPHADENOPATHY

Introduction

Cervical lymphadenopathy is an enlargement of the cervical lymph nodes.

 Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy. Inflammation of a lymph node is called lymphadenitis. In practice, the distinction between lymphadenopathy and lymphadenitis is rarely made. (Inflammation of lymph channels is calledlymphangitis.)

Types:
Localized lymphadenopathy : due to localized spot of infection e.g. an infected spot on the scalp will cause lymph nodes in the neck on that same side to swell up Generalized lymphadenopathy : due to generalized infection all over the body e.g. influenza
persistent generalized lymphadenopathy (PGL) : persisting for a long time, possibly without an apparent cause

Dermatopathic lymphadenopathy : lymphadenopathy associated with skin disease.

Causes:
Enlarged lymph nodes are a common symptom in a number of infectious and malignant diseases. It is a recognized symptom of very many diseases, of which some are as follows:

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

scratch disease).

The most distinctive symptom of bubonic plague is extreme swelling of one or more lymph nodes that bulge out of the skin as "buboes." The buboes often become necrotic and may even rupture. Infectious mononucleosis is an acute viral infection, the hallmark of which is marked enlargement of the cervical lymph nodes. It is also a symptom of cutaneous anthrax, measles and Human African trypanosomiasis, the latter two giving lymphadenopathy in lymph nodes in the neck.

Toxoplasmosis, a parasitic disease, gives a generalized lymphadenopathy (PiringerKuchinka lymphadenopathy). Plasma cell variant of Castleman's disease associated with HHV-8 infection and HIV infection. Mesenteric lymphadenitis after viral systemic infection (particularly in the GALT in the appendix) can commonly present like appendicitis.

 Tumoral: Primary: Hodgkin lymphoma, nonHodgkin lymphoma, hairy cell leukemia, give lymphadenopathy in all or a few lymph nodes. [4] Secondary: metastasis, Virchow's Node, Neuroblastoma.

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Autoimmune etiology: system ic lupus erythematosus, rheumatoid arthritis all giving a generalized lymphadenopathy.

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Immunocompromised etiology: AIDS. Generalized lymphadenopathy is an early sign of infection with human immunodeficiency virus(HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). "Lymphadenopathy syndrome" has been used to describe the first symptomatic stage of HIV progression, preceding a diagnosis of AIDS.

DEMOGRAPHIC DATA

NAME: Mrs .Lympha AGE: 37 y/o SEX: Female RELIGION: Roman Catholic CIVIL STATUS: Married NATIONALITY: Filpino ADDRESS: P1 Carulay Echague Isabela BIRTH DATE: August 29, 1973 DATE OF ADMISSION: August 21, 2011 TIME OF ADMISSION: 2:45 pm ATTENDING PHYSICIAN: Dr. Jade Malvar CHIEF COMPLAINT: Submandibular Mass ADMITTING DIAGNOSIS: Thyroductal Cysts FINAL DIAGNOSIS: Cervical Lymph Adenopathy SURGICAL PROCEDURE: Thyroglossalduct cyst excision

Nursing History

Present Medical History

 1 month PTA, the patient observed that she has a palpable mass on her submandibular midline tsaka parang namamaga as verbalized by the patient . She asked for consultation immediately at De Vera Medical Hospital at EENT department and they advised her to take sultamicillin 750mg BID for three (3) weeks. She noticed that it slightly become responsive but didn t disappear. So 1 week PTA she again sought for a second option. Dr. Malvar suggested for her to undergo ultrasound and they found out that it is a cyst (3cm). Initial diagnosis of thyroductal cyst was made and the doctor recommended an elective excision. 1 day PTA, the patient decided to undergo surgery and was therefore confined at Callang General Hospital and Medical Center on August 21 for scheduled thyroglossalduct cyst excision.

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Past Medical History

 According to the patient she has not yet experienced any serious health problem. She was just hospitalized at Ilagan District Hospital twice because she had undergone Cesarean Section by the year 2000 with her 1st baby and last 2001with her 2nd child. She has an allergy to sea foods such as seashells and Daing . According to the patient she also experiences common coughs and colds and she manages it by over the counter drugs such as Neozep.

Family History

HTN
Paternal

ASTHMA

DM TB CA

Maternal

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Gordon s Functional Health Pattern

HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN

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Before hospitalization: Health is important to her too. Napaka health conscious ko as verbalized by the patient. Ang kalusugan ang pinakamahalaga sa bawat tao lalo na sa gaya kong nagtratrabaho at naghahanap buhay patient adds. She immediately consulted a doctor if she observed something unusual to her so that she will be aware of any health problem she s suffering and to avoid any problem so it won t lead to a more serious one.

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According to her 5 years ago her health rating is 10 but as of now her health rating is 8 and 5 years from now her heath rating then is 6 because habang tumatanda ang tao mas lalong nagiging prone sa sakit she says.

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I learned that it s a good idea to be always aware when it comes to our health. Health seems to be really important to her because she immediately decided to undergo operation. When it comes to the effect of the illness to her ADL she says sa awa ng diyos hindi naman naapektohan ang pang araw araw kong gawain . She drinks occasionally but doesn t smoke. She complies properly with management and treatment by taking medicine and cooperating with the health care team.

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NUTRITIONAL-METABOLIC PATTERN
Before hospitalization: Few days after she noticed her palpable mass, everytime she eat,she observed feeling of fullness on her throat whenever she swallow. Parang hindi bumababa ang mga kinakain ko she said. She eat three times a day.Her breakfast usually comprises of fried rice and egg and sometimes frozen products such as tocino.Her lunch and dinner usually comprises of vegetables such as pinakbet and meat such as adobong manok and baboy.She consumes 2-3 cups of rice per meal and drinks 5-8 glasses of water per day.She is also a fond of eating street foods such as kwek kwek and fishball,this served already as her snacks according to her.She as an allergy to seafoods suchs as seashell and daing

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Few weeks after she noticed the submandibular mass, she also observed that she was having a difficulty swallowing her food but this did not alter her dietary intake During hospitalization: Upon admission, patient was placed on DAT. Seven hours prior to surgery, the patient is on NPO status. DAT was ordered when patient was fully awake. Due to the incision under her chin patient was hesitant to chew her food. This caused a minimal change in her intake. Patient consumes only of her usual intake

ELIMINATION PATTERN

Before hospitalization:
Our client defecates every morning,brown in color,cylindrical in shape and consistency was formed and moist. She urinates 6-8 times per day.This are all normal based on her pattern.Patient sometimes experiences constipation and diarrhea and she manages it by water therapy alone.

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 and bladder habits such as incontinence,hematuria,retention and nocturia.No known history of laxatives and anti diarrhreals used.

ACTIVITY-EXERCISE PATTERN

Before hospitalization:
Our client is a working mom.She used her time wisely. She wakes up early in the morning to prepare the needs of her kids,sends them to school,and goes to her office everyday as a secretary to a pharmaceutical company.This served already as her daily routine according to her.

During hospitalization
She can still perform activities of daily living such as grooming and eating,she is ambulatory and can move freely. During her post operative status, she can do the same thing with a minimal assistance with her SO because she is hesitant to move her head.

SLEEP-REST PATTERN

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Before hospitalization: She sleeps at 9pm and awakes at 5am.She has no difficulty in falling asleep and remaining asleep.

During hospitalization:
The night before surgery she cannot sleep in a normal pattern because of unfamiliarity to environment and due to hospital routines such as giving medications and vital signs monitoring. Patient also mentioned being anxious/ afraid of the upcoming surgery. Kahit sino naman kakabahan pag nalalamang operahan . She sleeps at interval with a total of 5-6 hours/day.

COGNITIVE PERCEPTUAL PATTERN

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Our client is a college graduate in a degree of Bachelor of Science in Elementary Education but she failed to pass the board exam. Before consultation she does not understand how she understand how she can manage and cure her submandibular mass.She did not even know how she acquired such condition. During her consultation: She already understand the course of her condition on how does she acquired and the approach to removed as explained by her physician.

SELF-PERCEPTION/ SELF CONCEPT PATTERN

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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 her loved ones. She also considered her husband as one of the greatest blessing she had. He is the reason why I am happy with my life [Laughing] she added. With regard to her body image, pt. felt worried about the growing mass on her chin that is why she sought consultation During hospitalization: Self-perception-self concept pattern was the same but this time, she proved again that whatever life gives, her loved ones will always be there that cares and supports. This increases her self-esteem and self-worth, accdg. to her. With regard to her body image, after surgery patient has no problem with the appearance of incision under her chin since for her, hindi naman nakikita .

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SEXUALLY AND REPRODUCTIVE PATTERN

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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 s married for 12 years. They were blessed with two lovely children. Obstetrical datais:T-2,P-O,A0,L-2.(G2P2).Now that she is 37y/o, she is still sexually 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-STRESS TOLERANCE PATTERN

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Whenever she is stress, she simply diverts her attention by having fun with her kids and sometimes socialized went out to with her officemates .Being alone and reflecting in silence and listening to old songs is also beneficial for her. Her support system includes her husband and children.

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VALUE-BELIEF PATTERN

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Their family is a Roman Catholic. She believed that God is the source of our strength and health.They go to church every Sunday. They do not believe to any quack doctors and superstitious beliefs.Only God can cure all the ailments, according to her.

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