Lippincott Certification Review Medical-Surgical Nursing

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Chapter 8

●● Anemia, leukopenia, and thrombocytopenia—with resulting bleeding, infection, shortness of breath, weakness, and protein in blood and urine—may also occur. ●● Increased bone breakdown may cause hypercalcemia. ●● Diagnosis and treatment ●● Serum and urine protein electrophoresis showing immunoglobulin or beta 2 -microglobulin are indicative of multiple myeloma; urine studies may contain M protein, an immunoglobulin; urine may also have increased levels of calcium. ●● X-rays, computed tomography scans, and magnetic resonance imaging may show bone deterioration and damage. ●● Bone marrow aspiration and biopsy reveal an increased number of immature plasma cells. ●● Chemotherapy suppresses plasma cell growth, and radiation therapy may be used to treat bone lesions and relieve pain. ●● Radiation therapy may be used to damage myeloma cells and stop growth. ●● Patients with multiple myeloma may also receive interferon to slow the growth of the myeloma cells and thalidomide (Thalomid) to inhibit angiogenesis. ●● Newer targeted therapies for multiple myeloma include monoclonal antibodies (elotuzumab [Empliciti], daratumumab [Darzalex]), proteasome inhibitors, nuclear export inhibitors, and bispecific T-cell engagers. ●● Autologous bone marrow transplantation is not a cure but may put the patient into remission for a period; allogenic transplantation carries a higher risk of serious complications but produces longer-lasting remissions. ●● Plasmapheresis is sometimes used to temporarily remove the high-myeloma protein and thereby improve symptoms. ●● Hypercalcemia may be managed with a diuretic, hydration, or a phosphate. ●● Nursing interventions ●● Educate the patient and family about diagnostic and treatment procedures and adverse effects. ●● Assess the patient for pain, and administer prescribed analgesics as ordered. ●● Implement safety measures to prevent fractures of affected bones; direct the patient not to walk without assistance; have the patient use devices, such as splints or braces, to prevent injury and reduce pain. ●● Encourage the patient to drink plenty of fluids, or administer IV fluids, to dilute calcium, prevent dehydration, and prevent renal precipitates. ●● Assess the patient for signs and symptoms of infection and bleeding, and take measures to prevent their occurrence. Polycythemia Vera ●● Description ●● Polycythemia vera has recently been reclassified a myeloproliferative neoplasm; this type of cancer is characterized by over production of RBCs. ●● Along with increased RBCs, WBCs and platelets are often elevated. ●● In the early phase and for 10 or more years, hematocrit is elevated; in later stages, the bone marrow becomes fibrotic, with the resulting inability to produce as many cells, while the spleen resumes its embryonic function of hematopoiesis and enlarges. ●● The disease may eventually progress to myeloid metaplasia with myelofibrosis or acute myelogenous leukemia. ●● The median age at onset is 65, and the median survival is between 15 and 20 years after diagnosis. ●● Death results from thrombosis, hemorrhage, or complications of acute myelogenous leukemia. ●● Signs and symptoms ●● Patients typically have a ruddy complexion. ●● Splenomegaly.

●● Symptoms of increased blood volume or increased blood viscosity include headache, dizziness, tinnitus, fatigue, paresthesia, blurred vision, angina, claudication, dyspnea, thrombophlebitis, and hypertension. ●● Pruritus, gout, and burning in the fingers and toes may also occur. ●● Complications include stroke, myocardial infarction, thrombotic events, and bleeding related to dysfunctional platelets. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.