Lippincott Certification Review Medical-Surgical Nursing


Multiple Myeloma

●● Administer blood through a filter (only with normal saline solution). ●● Infuse it slowly (2 to 4 hours/unit). ●● Observe for reactions, and record vital signs at least hourly and at the end of the transfusion (see Guide to immediate transfusion reactions , page 129). ●● Platelet transfusions may be prescribed. ●● Platelets should not be refrigerated. ●● The nurse must: ●● Verify the provider order. ●● Ensure appropriate IV access. ●● Educate the patient regarding the procedure. ●● Take baseline vital signs before transfusion. ●● Premedicate with steroids or antihistamines, as prescribed, to prevent reactions. ●● Administer platelets through a filter (only with normal saline solution). ●● A 6-unit IV bolus of platelets should be infused over 20 to 30 minutes. ●● Observe for reactions, and record vital signs at least hourly and at the end of the transfusion (see Guide to immediate transfusion reactions , page 129). ●● WBC transfusions, though rarely used, must be infused within 24 hours of collection; the process for WBC transfusions is similar to that for RBC transfusions. ●● Nursing interventions ●● Follow infection control procedures if the WBC count is low, also known as neutropenia —place a severely neutropenic patient in a private room with no flowers, plants, or fresh fruits; avoid unnecessary invasive procedures; limit patient contact with infected personnel or visitors; and teach hand hygiene techniques to the patient, family, and visitors. ●● Educate the patient about use of personal protective equipment (high quality mask) when in public places to decrease risk of respiratory infections (COVID-19, influenza, etc.). ●● For a patient with a low platelet count, monitor blood counts and take precautions to prevent bleeding— avoid parenteral injections, limit venipuncture, and advise the patient to use an electric razor for shaving and a soft toothbrush for brushing teeth. ●● Prevent or manage stomatitis (oral/GI mucosa breakdown) by inspecting the oral cavity daily and encouraging oral care with prescribed mouth rinses on a regular basis. ●● Teach the patient how to care for an indwelling vascular access device and how to detect signs of infection. ●● Educate patients undergoing chemotherapy about the side effects, adverse effects, and length of treatment. ●● Provide supplemental feedings as prescribed. ●● Conserve the patient’s energy, but promote independence. ●● Provide emotional support to the patient and family, and encourage them to verbalize feelings. Multiple Myeloma ●● Description ●● Multiple myeloma is a malignancy of plasma cells found in bone marrow; these cells are an important part of the immune system that make antibodies. ●● Malignant plasma cells produce an increased amount of a specific nonfunctional immunoglobulin. ●● Overgrowth of malignant cells can impair formation of all types of blood cells leading to anemia, thrombocytopenia, and/or leukopenia.

●● Myeloma cells also speed up osteoclast activity, causing weakling of bones and increased risk for fractures. ●● This type of cancer is slightly more common in men, and the rate for Black males is double that of White males. ●● Risk for multiple myeloma increases with age; most cases are diagnosed after age 65, and the average age of diagnosis is 75. ●● Other risks include radiation exposure, family history, obesity, and occupational exposure in petroleum related industries. ●● Signs and symptoms ●● Severe bone pain, confusion, weakness, dizziness, weight loss, fractures, renal failure, frequent infections, and skeletal deformities. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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