Question

The client is a 77-year-old male client with multiple myeloma. The client was diagnosed 4 years ago. He has a past medical history of hypertension, hyperlipidemia, and chronic obstructive pulmonary disease; he has a 40-pack year smoking history but quit smoking three years ago. He has presented today with complaints of increased bone pain in the lumbar spine region, shortness of breath, and poor appetite with nausea. He states he needs some help with “this awful back pain.” He is the primary caregiver for his spouse who has dementia.

Medications

Medication:	Dose:	Route:
Prednisone	30 mg daily	Oral
Sennekot	2 capsules daily	Oral
Lisinopril	40 mg daily	Oral
Simvastatin	40 mg daily	Oral
Oxycontin SR	60 mg BID	Oral
Oxycontin IR	5 mg as needed	Oral

Diagnostics

	Result
Hemoglobin(13.5 -17.5 g/dL)	10.8
Hematocrit (40-45%)	34
WBC (4-11 x103/L)	4.0
Platelets (150-400 x103/L)	145
Creatinine (0.6-1.4 mg/dL)	2.1
Blood Urea Nitrogen (8-23 mg/dL)	37
Calcium (8.0-10.5 mEq/dL)	11.8

1. What are the relevant findings in the case presentation?

2. What are your expectations from the collaboration with the dietitian, case manager, oncologist, and pharmacist in your case study?

Answer 1

His hemoglobin count is 10.8 which is below than normal range. This means patient has mild anemia and his hematocrit level also low, may be white blood cell disorder. This also cause anemia. WBC count is in normal range. Platelets count is relatively okay, but need to evaluate it. Creatinine level is 2.1 is high, this is a sign of kidneys are not working properly.
BUN is 37 is high also indicate kidney is not working properly. Calcium level is 11.8 is high, need to evaluate parathyroid disease.

Dietitian must consider the hemoglobin level of the patient and include hemoglobin increasing foods. Reduce high protein food to reduce the level of creating and BUN. Reduce high calcium food to reduce calcium levels.  Oncologist and Case manager must consider his current situation. He has shortness of breath and less appetite with nausea.  Pharmacist controls medicines and give advise for how to take tablet and its dosage.