Question

1. 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. (Learning Objective 5) a. What nursing management should the nurse provide the patient? b. Explain the indication and action of the various medications ordered to treat the patient's symptoms. 2. Susan Clare, age 38, is admitted to the medical oncology unit with acute myeloid leukemia (AML). She has many areas of ecchymosis and petechiae on her skin, as well as generalized pallor. She states she has lost 15 pounds in the last 2 months, and often has a low-grade fever. On physical assessment, you find her liver and spleen to be enlarged on palpation. (Learning Objective 3) a. What laboratory results would you anticipate due to her ecchymosis and petechia? b. Why would it be important to inspect her gums and teeth? c. Why is her liver enlarged?

Answer 1

2. a. AML is a defect of Hematopioectic cells which affect myeloid cells. It affects the normal blood cells especially erythrocytes and platelets. so ecchymosis and petechiae are commonly seen in AML patients. The reason is the low platelet count. So the laboratory test of Complete Blood count to reveal platelet level, RBC level, different types of WBC cells, and coagulation studies to know the blood clotting factors and fibrinogen level were anticipated.

b. It is necessary to keep the mouth and oral cavities to be kept clean. Because gingivitis, bleeding and swelling of gums are common in a leukemia patient. Cancer treatment further worsens the oral cavities. So inspecting of oral cavities help to reduce the risk of oral infection and complication.

c. Leukemic cells can spread to the liver through lymph nodes. The infiltered myeloid cells are accumulated in the liver causes enlargement of the liver.