Multiple Myeloma: Complication, Treatment, Nursing Intervention pdf ppt file download link

 MULTIPLE MYELOMA

Multiple myeloma is a malignant disorder of bone marrow caused by a type of white blood cell called a plasma cell.

Pathophysiology 

• Proper aetiology unknown; environmental and genetic causes, such as chronic exposure to low levels of ionizing radiation and agricultural exposure to herbicides, may role apart.
• Plasma cells are activated to secrete antibodies (or immunoglobulins). In the case of multiple myeloma, the plasma cells are abnormal and they develop and proliferate in the bone marrow. These cells also cause bone lesions as well as interfere with the development of RBCs, WBCs, and platelets.
• Plasma cells develop osteoclast-activating factor cause extensive bone loss, pathologic fractures and severe pain.
• Abnormal immunoglobulin disturbs renal and platelet function.

Clinical Manifestation

• Sever and constant bone pain caused by bone lesions and pathologic fractures; location frequently affected thoracic and lumbar vertebrae, ribs, pelvis, skull and proximal long bones.
• Weakness and fatigue caused by anaemia related to crowding of marrow by plasma cells.
• Renal impairment and proteinuria
• Electrolytes imbalance; hypercalcemia and hyperuricemia

Diagnostic Evaluation

• Bone marrow examination 
• CBC and blood smear examination reflect anaemia 
• Urine and serum examination for the presence of abnormal immunoglobulin.
• Skeletal X-rays-osteolytic lesions.

Treatment

• Immunotherapy
• Chemotherapy
• Corticosteroids
• Bone marrow transplant
• Radiation therapy

Complications

• Pathologic fractures and spinal cord compression
• Recurrent infection.
• Electrolyte imbalance.
• Pyelonephritis and Kidney failure
• Haemarroahge 
• Thromboembolic complications related to hyperviscosity

Nursing Diagnosis

• Chronic and acute pain leads to the destruction of bone and pathologic fracture.
• Impaired physical activity related to pain and possible fracture.
• Anxiety-related to poor prognosis.

Nursing Interventions

Controlling Pain

• Observe the presence, intensity and location of the pain.
• Administer analgesic regularly to control pain 
• Encourage relaxation methods, such as music, relaxation breathing, distraction and imagery.
• Adjust dosage of analgesics

Promoting Mobility

• Educate patient to use back brace for the lumbar lesion. 
• Physiotherapy consultation if needed.
• Assist the patient with measures to avoid injury and reduce the risk of fracture

Relieving Anxiety

• Maintain trusting, supporting communication with the patient and his significant others.
• Promote the patient to review the medical condition and prognosis with the health care provider.
• Provide comfort measures 

Patient Education

• Encourage the patient about the complications of infection caused by impaired antibody production and chemotherapy
• Encourage  patient to take proper medication as per prescribed 
• Encourage the patient to reduce the risk of fractures. Use appropriate assistive devices.
• Suggest to the patient to report new onset of pain, location, and intensity immediately.
• Advise patient to maintain fluid intake 2 to 3 L/day to prevent dehydration.

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