Question

Please help me the 3 NANDA nursing diagnosis, interventions, rationales, goals, evaluations of this patient.

. John King, 60 years of age, is a male patient who is admitted with the diagnosis of multiple myeloma. He presents with a spinal fracture of the fifth lumbar vertebrae. The patient is scheduled for a vertebroplasty of the spinal fracture. The patient is to remain on bed rest and should be log rolled. Osteolytic lesions are seen in x-rays of the skull, vertebrae, and ribs. The patient has hypercalcemia. The patient’s uric acid level is elevated. The patient has orders for zoledronic acid (Zometa), thalidomide (Thalomid), allopurinol (Zyloprim), calcitonin, ibuprofen, and Vicodin.

Answer 1

Ans) 3 NANDA Nursing diagnosis care plan for patient with multiple myeloma:

1) Risk of infection related to Inadequate secondary defenses: alterations in mature WBCs (low granulocyte and abnormal lymphocyte count), increased number of immature lymphocytes; immunosuppression, bone marrow suppression (effects of therapy/transplant)

2) Self care deficit related to activity intolerance

3) knowledge deficit related to treatment regime/discharge instructions.

Nursing expected outcome:

• Identify actions to prevent/reduce risk of infection.
• Demonstrate techniques, lifestyle changes to promote safe environment, achieve timely healing.
• Meeting client's daily needs
• Assisting in self care activities
• Knowledge specific to the disease condition, treatment regime.

Nursing intervention with rationale:

• Assessment of the patient general condition- to obtain the patient's baseline data to plan care

• Put patient in isolation ( Use of PPE by health care providers & visitors). Restrictions to the visitors- To protect the patient from potential sources of pathogens or infection.

• Require good hand washing protocol for all personnel and visitors.- Prevents cross-contamination and reduces risk of infection.

• Avoid using indwelling urinary catheters and giving I.M. injections.- These can provide an avenue for infection.

• Skin care interventions- Reduces risk of infection

• Avoid use of aspirin containing antipyretics- causes gastric bleeding.

• Provide nutritious diet, high in protein and calories, avoiding raw fruits, vegetables, or uncooked meats-Proper nutrition enhances immune system. Minimizes potential sources of bacterial contamination.

•Prepare for and assist with leukemia-specific treatments such as chemotherapy, radiation, and/or bone marrow transplant- Leukemia is usually treated with a combination of these agents, each requiring specific safety precautions for patient and care providers.

• Handle patient gently. Keep linens dry and wrinkle-free- Prevents sheet burn and skin excoriation.

Inspect oral mucous membranes. Provide good oral hygiene. Use a soft toothbrush, sponge, or swabs for frequent mouth care- The oral cavity is an excellent medium for growth of organisms and is susceptible to ulceration and bleeding.

• Change IV tubing according to your facility’s policy. Use strict sterile technique- IV sites can harbor infection. Additional measure to avoid infection.

• Promote good perianal hygiene. Examine perianal area at least daily during acute illness. Provide sitz baths, using Betadine or Hibiclens if indicated. Avoid rectal temperatures, use of suppositories- Promotes cleanliness, reducing risk of perianal abscess; enhances circulation and healing. Perianal abscess can contribute to septicemia and death in immune compromised patients.