Burkitt’s Lymphoma: Case Study for NSB026 Nursing Practice Capstone

This case study presents a patient diagnosed with Burkitt’s Lymphoma, complicated by a pre-existing HIV diagnosis and a history of cholecystectomy. The patient presented with severe abdominal pain and nausea. The study details the patient's assessment, including pain management challenges, chest discomfort, dry mouth, headaches, and anxiety. The pathophysiology of Burkitt’s Lymphoma, particularly its association with HIV and chromosomal translocations, is discussed. Clinical interventions, including pain management with Fentanyl and Tramadol, antiemetics, and chemotherapy with cyclophosphamide and prednisone, are outlined. The evaluation section notes improved kidney function and the effectiveness of HAART therapy. The study concludes that while initial medications provided relief, the patient's long-term survival depends on the success of malignancy treatment and the improvement of her overall health and immune system status. References to relevant medical literature are included to support the analysis and interventions.

Case Study on Burkitt’s Lymphoma

The presentation of the Case
The initial sign with which the patient came was with sharp
abdominal pain that was accounted as 7/10 and also have the
incidence of neausea
The patient also had the history of cholesectomy and she was
diagnosed with HIV from past one year
It was recorded that she was underweight and was also slim
built
The BP was recorded to be 110/70 at the time of her
admisssion
The patient was initially put on PCA Fentanyl, 10mcg which
did not help in pain alleviation and proved to be ineffective.
Then a combination of Fentanyl, PRN and Tramadol was

Assessment of the Patient
The patient was been assessed to have a constant pain and Hydromorphone was given to
her with the dose of 3mg daily initially to sooth her from the pain. The Burkiit Lymphoma
is a form of tumor that occurs in sporadic, AIDS and endemic forms is a classic for of
example for human malignency.
She also had discomfort in the chest and also had the complaint of dry mouth
She also reported for having a minor form of headache and episodes of depression and
anxiety. The pathogenesis of the disease includes the specific form of changes in the
cellular genes for the translocation of the chromosome deregulations for the expression of
the c-myc oncogene that are been complemented in various cases for the action of the
ocogenic virus and the Epstien Barr virus (Jarzyna et al., 2017).
The patient was been administered with cyclophosphamide
The sample of the lymph nodes reported that the patient was suffering from Burkitt’s
Lymphoma. The Burkiit Lymphoma is a form of tumor that occurs in sporadic, AIDS and
endemic forms is a classic for of example for human malignency.

Assessment Contd.
It has been seen that the patient is suffering from expansions of
the lymph nodes that acted as the tumor in the patient that
confirmed the incidences of the Burkiit Lymphoma
It has also been observed that the patient had the past history of
AIDS that confirms the increased occurrence of the Burkiit
Lymphoma
However, the incidence rate of this form of disease is found
higher on the cases of the children and in the adolescents whoa
are aged sixteen years or below. The incidence of this type of
disease that have affected the patient is seen very less amongst
the adult population.

Literature supporting the disease
The primary form of the Burkitt Lymphoma that are been generated in the thyroid
glands is a uncommon form of the pathological entity that have a few form of the
isolated cases that are reported in the patients who are adults (Dunleavy et al.,
2013).
This is a highly aggressive form of the malignency that have arised from the cells of
the B- lymphiod cells. It is presented usually in a rapid form of the expanding the
thyroid mass that causes the comprehensive form of the symptoms.
BL should be promptly recognized because its management is quite different from
the treatment of other neoplasms of the thyroid gland. Moreover, this disease is
quite curable if diagnosed early and treated appropriately (Molyneux et al., 2015).
The BL should be very much promptly be recognized because there its
managements are quite the different form of the treatment of the other form of the
neoplasms of the thyroid glands that actually curable if they are being diagnosed
very early and can be thus treated in an appropriate manner.

Pathophysiology of the patient
As the patient has been diagnosed with HIV, it can be interpreted that the
manifestation of the tumor is due to the fact that burkitts lymphoma is the
line of effect after HIV infection and is the result of translocation mutation
that activates a key oncogene.
The acute abdominal pain that the patient is suffering from can be due to the
intussusceptions and bowel obtsruction that is t direct result of burkitts
lymphoma (Dunleavy et al., 2013).
Another patient priority that needs to be discussed ere is the resultant
vomiting after extensive chemotherapy, which can be sue to the fact that the
chemotherapeutic agents increase serotonin and 5-HIAA in the blood which in can
activate the emesis receptors (Molyneux et al., 2015).
Now the anxiety that the patient is going through is the result of cancer diagnosis which is
a very common phenomenon in cancer patients.

Clinical Interventions
 Medical interventions included:
10mg Fentanyl for severe the pain of 7/10. The minimal
amount effected for changing it to 100mg Tramadol, PRN
100mg subcutaneous Fentanyl given dropping the pain down
to 6/10.
Stat dose of aprepitant were given and dose of IV
palonosetron was given after which the patient vomited after
the aprepiton.
Hydromorphone was been administered with the dose of 3mg
daily
Cyclophosphamide was administered as 200mg per day with
60mg of Prednisone

Evaluation
The output of the urine have heavily increased that indicated a
comparative form of the better functioning of the kidney of the
patient
The therapy of the HAART was very much effective in the initial
stage and by reducing the AIDS virus for spreading further
The initial form of medications provided her some sort of relief,
however, her survival depends totally on the course of her
malignancy
The treatment of the chemotherapy aims for the betterment for
the overall form of health and the status of her immune system for
achieving a longer lifespan for the patient.

Table for the References
Jarzyna, D., Jungquist, C. R., Pasero, C., Willens, J. S., Nisbet,
A., Oakes, L., . . . Polomano, R. C. (2011). American society for
pain management nursing guidelines on monitoring for opioid-
induced sedation and respiratory depression. Pain
Management Nursing, 12(3), 118-145.e10.
doi:10.1016/j.pmn.2011.06.008
This article highlights the role nurses play in
identifying patients who are at risk for …….. It
supports the interventions of …. by demonstrating…..
Dunleavy, K., Pittaluga, S., Shovlin, M., Steinberg, S.
M., Cole, D., Grant, C., ... & Wilson, W. H. (2013).
Low-intensity therapy in adults with Burkitt's
lymphoma. New England Journal of
Medicine, 369(20), 1915-1925.
This article highlights the low form f intensity
of the therapy that are given to the patients
O’Hayre, M., Inoue, A., Kufareva, I., Wang, Z.,
Mikelis, C. M., Drummond, R. A., ... & Guo, F.
(2016). Inactivating Mutations in GNA13 and
RHOA in Burkitt’s Lymphoma and Diffuse
Large B cell Lymphoma: A Tumor Suppressor
Function for the Gα13/RhoA Axis in B
Cells. Oncogene, 35(29), 3771.
This article highlights the main causes of the
disease and how it effects the B cells of the
body

References
Dunleavy, K., Pittaluga, S., Shovlin, M., Steinberg, S. M., Cole, D., Grant, C., ... &
Wilson, W. H. (2013). Low-intensity therapy in adults with Burkitt's
lymphoma. New England Journal of Medicine, 369(20), 1915-1925.
Gutzeit, C., Nagy, N., Gentile, M., Lyberg, K., Gumz, J., Vallhov, H., ... & Scheynius,
A. (2014). Exosomes derived from Burkitt’s lymphoma cell lines induce
proliferation, differentiation, and class-switch recombination in B cells. The Journal
of Immunology, 192(12), 5852-5862.
Molyneux, E., Schwalbe, E., Chagaluka, G., Banda, K., Israels, T., Depani, S., ... &
O'Brien, S. (2017). The use of anthracyclines in the treatment of endemic Burkitt
lymphoma. British journal of haematology, 177(6), 984-990.
O’Hayre, M., Inoue, A., Kufareva, I., Wang, Z., Mikelis, C. M., Drummond, R. A., ...
& Guo, F. (2016). Inactivating Mutations in GNA13 and RHOA in Burkitt’s
Lymphoma and Diffuse Large B cell Lymphoma: A Tumor Suppressor Function for
the Gα13/RhoA Axis in B Cells. Oncogene, 35(29), 3771.