Walden University - NURS 6550N6550 week 11 ihuman
Primary Diagnosis: Plasma Cell Leukemia: Plasma cell leukemia (PCL) is an aggressive form of multiple myeloma characterized by high levels of abnormal plasma cells cir
...
Walden University - NURS 6550N6550 week 11 ihuman
Primary Diagnosis: Plasma Cell Leukemia: Plasma cell leukemia (PCL) is an aggressive form of multiple myeloma characterized by high levels of abnormal plasma cells circulating in the peripheral (circulating) blood (University of Arkansas for Medical Sciences, 2019).
Status/Condition:
• Guarded
Code Status:
• Full Code
Allergies:
• NKDA
Admit to Unit:
• Med-Surg oncology unit
Activity Level:
• Up as tolerated
Diet:
• Regular diet, high protein
IVF:
• 0.9% NS at 75ml/hr: Prevention of renal failure with adequate hydration and avoidance of nephrotoxic agents and dye contrast studies (Ferri, 2019).
Critical Drips:
• Initial treatment therapy should be initiated promptly for this patient’s new diagnosis of PCL with the oncologist.
Respiratory:
• Monitor O2 saturations, oxygen therapy as needed per protocol
Medications:
• Zofran 4mg IVP Q6H PRN nausea
• Tylenol 650 mg Q4H PRN fever/pain
• Fentanyl 50 mcg IVP Q4H for severe pain
• Bortezomib: The proteosome inhibitor bortezomib has shown clinical activity in both primary and secondary PCL (Fernandez de Larrea et al., 2013). 1.3 mg/m¬≤/dose IV/SC twice weekly for 2 weeks (Days 1, 4, 8, and 11) followed by a 10-day rest period (Days 12-21) (Medscape, n.d.).
Nursing Orders:
• Vital signs Q4H
• Monitor intake and output
• Braden scale skin assessment shiftily
• Notify if BP <100, HR >100 or temp >101.2
Follow Up Lab tests :
• CBC daily
• BMP: monitor renal function and electrolytes
• LFT to evaluate hepatic involvement
• Bone marrow biopsy
• Urine protein electrophoresis (PEP): The hallmark of myeloma is the finding of a paraprotein on serum or urine protein electrophoresis or immunofixation electrophoresis (Papadakis & McPhee, 2018).
• Abdominal CT: radiograph films of painful areas often demonstrate punched-out lytic lesions (Ferri, 2019).
• CXR: evaluate shortness of breath
Diagnostic testing:
• CBC with differential revealed:
o WBC: 32,000 elevated
o RBC: low at 3.3
o H/H 8.2/22, normocytic anemia
o Platelets: 45 thrombocytopenia
• Peripheral blood smear revealed:
o Plasma cell present
o anemia
Consults:
• Hematology/oncology: plasma cell leukemia, recurrent myeloma
Patient Education and Health Promotion:
• Follow up with your oncologist per their recommendations.
• Continue medications prescribed unless told otherwise by your physician
• Follow a healthy, high protein diet
• The prognosis of PCL patients is poor and median survival is only two to seven months after relapse of multiple myeloma (Rajkumar, 2019).
• Get plenty of rest
• Eat five to six small meals or snacks each day instead of three big meals to help manage nausea.
• Call your doctor if you think you have an infection. Besides fever, other signs of infection include: redness, swelling, rash, chills, cough, earache, headache, stiff neck, bloody or cloudy urine, painful or frequent need to urinate, or sinus pain (National Cancer Institute, 2018).
Discharge planning and required follow-up care:
• Follow up with hematology/oncology per their recommendations
• Follow up with primary care provider within 1 week of discharge
References:
Fernández de Larrea, C., Kyle, R. A., Durie, B. G., Ludwig, H., Usmani, S., Vesole, D. H., . . . International Myeloma Working Group. (2013, April). Plasma cell leukemia: Consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112539/
Ferri, F. F., & Ferri, F. F. (2019). Ferris clinical advisor 2019: 5 books in 1. Philadelphia, PA: Elsevier.
Medscape. (n.d.). Bortezomib. Retrieved from https://reference.medscape.com/drug/velcade-bortezomib-342256
National Cancer Institute. (2018, September). Chemotherapy and You. Retrieved from https://www.cancer.gov/publications/patient-education/chemotherapy-and-you.pdf
Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2018). Current medical diagnosis & treatment (57th ed.). New York, NY: McGraw Hill.
Rajkumar, S. V. (2019). Plasma cell leukemia. Retrieved from https://www.uptodate.com/contents/plasma-cell leukemia?search=plasma%20cell%20leukemia&source=search_result&selectedTitle=1~26&usage_type=default&display_rank=1
[Show More]
.png)
