Multiple Myeloma

  1. General information
    1. A neoplastic condition characterized by the abnormal proliferation of plasma cells in the bone marrow, causing the development of single or multiple tumors composed of abnormal plasma cells. Disease disseminates into lymph nodes, liver, spleen, and kidneys and causes bone destruction throughout the body.
    2. Cause unknown, but environmental factors thought to be involved
    3. Disease occurs after age 40; affects men twice as often as women
    4. Pathophysiology
      1. Bone demineralization and destruction with osteoporosis and a negative calcium balance
      2. Disruption of erythrocyte, leukocyte, and thrombocyte production
  2. Medical management
    1. Drug therapy
      1. Analgesics for bone pain
      2. Chemotherapy (melphalan [Alkeran] and cyclophosphamide [Cytoxan]) to reduce tumor mass; may intensify the pancytopenia to which these clients are prone; requires careful monitoring of laboratory studies
      3. Antibiotics to treat infections
      4. Gammaglobulin for infection prophylaxis
      5. Corticosteroids and mithramycin for severe hypercalcemia
    2. Radiation therapy to reduce tumor mass and for palliation of bone pain
    3. Transfusion therapy
  3. Assessment findings
    1. Headache and bone pain increasing with activity
    2. Pathologic fractures
    3. Skeletal deformities of sternum and ribs
    4. Loss of height (spinal column shortening)
    5. Osteoporosis
    6. Renal calculi
    7. Anemia, hemorrhagic tendencies, and increased susceptibility to infection
    8. Hypercalcemia
    9. Renal dysfunction secondary to obstruction of convoluted tubules by coagulated protein particles
    10. Neurologic dysfunction: spinal cord compression and paraplegia
    11. Laboratory tests
      1. Radiologic: diffuse bone lesions, widespread demineralization, osteoporosis, osteolytic lesions of skull
      2. Bone marrow; many immature plasma cells; depletion of other cell types
      3. CBC: reduced Hgb, WBC, and platelet counts
      4. Serum globulins elevated
      5. Bence-Jones protein: positive (abnormal globulin that appears in the urine of clients with multiple myeloma and other bone tumors)
  4. Nursing interventions
    1. Provide comfort measures to help alleviate bone pain.
    2. Encourage ambulation to slow demineralization process.
    3. Promote safety as clients are prone to pathologic and other fractures.
    4. Encourage fluids: 3000-4000 ml/day to counteract calcium overload and to prevent protein from precipitating in the renal tubules.
    5. Provide nursing care for clients with bleeding tendencies and susceptibility to infection.
    6. Provide a supportive atmosphere to enhance communication and reduce anxiety.
    7. Provide client teaching and discharge planning concerning
      1. Crucial importance of long-term hydration to prevent urolithiasis and renal obstruction
      2. Safety measures vital to decrease the risk of injury
      3. Avoidance of crowds or sources of infection if leukopenic