VII.
RISK FACTORS FOR MULTIPLE MYELOMA
Risk Factors Rationale
Your risk of multiple myeloma increases as you
Increasing age.
age, with most people diagnosed in their mid-60s.
Some changes with genes and chromosomes are
linked with multiple myeloma, including the number
Genes
of chromosomes you have. About half of people
with the disease are missing chromosome 13.
Family history If patient has a parent, brother, or sister who has
multiple myeloma, the odds of getting the disease
may be higher. This is likely because of an inherited
gene.
Obesity: It's possible that it has to do with how obesity affects
how certain hormones behave and also with insulin
resistance, which is when the body can't
process sugar properly.
Contact with chemicals: If you work in certain industries, like oil and
agriculture, you have a higher risk of multiple
myeloma. This may be because you're more likely to
come into contact with certain hazardous chemicals.
Contact with pesticides and fertilizers may also raise
your risk.
Black Race Black people are more likely to develop multiple
myeloma than are people of other races.
Personal history of a monoclonal gammopathy Multiple myeloma almost always starts out
of undetermined significance (MGUS) as MGUS, so having this condition increases your
risk.
IX. DIAGNOSTIC AND LABORATORY TEST
Lab #: 1724048560
Clinician: Receno, Pia Angela M.D.
Date Requested: 12-07-2017
Test Name Result Unit Reference Range
Hematology
CBC and Platelet
White Blood Cells H 10.63 X10^9/L 3.98-10.04
Red Blood Cells L 3.19 X10^12/L 3.93-5.22
Hemoglobin L 88.00 g/L 112.00-157.00
Hematocrit L 0.28 Vol Fraction 0.34 – 0.45
MCV 87.80 fl 79.40 – 94.80
MCH 27.60 Pg 25.60 – 32.20
MCHC L 31.40 % 32.20 – 35.50
RBC Distribution W. H 16.90 % 11.60 – 14.60
Platelet Count H 581.00 X10^9/L 150.00 – 450.00
Mean Platelet Volume 9.90 fl 6.50 – 12.00
Differential Count
Neutrophils H 72.90 % 34.00 – 71.00
Lymphocytes L 13.90 % 19.00 – 52.00
Monocytes H 13.10 % 5.00 – 12.00
Eosinophils L 0.10 % 1.0-7.00
Basophils 0.00 % 0.0-1.0
Test Name Result Unit Reference Range
CHEMISTRY
Creatinine 78.00 umo/L 45.00 – 84.00
Ionized Calcium 1.24 umo/L 1.10 – 1.35
Interpretation:
The laboratory result (Complete blood count) shows that there is a decrease in number of Red
Blood cells with a value of 3.19 (3.93 – 5.22) including haemoglobin and haematocrit with a value of
88.00g/L (112.0 – 157.0) and 28% (34 – 45%). There is also a decrease in the number of Lymphocytes
with a value of 13.90% (19.00 – 52.00) and Eosinophils with a value of 0.10% (1.0 – 7.0). There is an
increase in number of WBC 10.63(3.98 – 10.04), RBC Distribution Width with a value of 16.90 % (11.60
– 14.60), Platelet count with a value of 581.0 (150 - 450), Neutrophils with 72.90% (34.0 – 71.0) and
monocytes with a value of 13.10 (5.0 – 12.0). Lastly, there is a decrease in the number of MCHC with a
value of 31.40% (32.20 – 35.50).
Multiple myeloma triggers an overgrowth of plasma cells in the bone marrow. Plasma cells are
white blood cells that produce and secrete antibodies. Too many of these cells in the bone marrow crowd
and decrease the number of normal blood-forming cells. This response causes a low red blood cell count.
Thus, there is low levels of RBCs, Hb, and HCT.
Nursing Implication:
Educating patients on the need for adequate hydration; prompt recognition of the signs of spinal-
cord compression and hypercalcaemia; management of fatigue; psychosocial support of the patient and
family; and provision of relevant, high-quality, up-to-date information at all stages of their disease.
Monitor every 2 weeks or more frequently if necessary. Follow dose medication prior to doctor’s order.
Lab #: 1940501
Clinician: Leano, Bevy Lynn Calina
Date Requested: 06-25-2019 17:33.00
Test Name Result Unit Reference Range
Hematology
CBC and Platelet
White Blood Cells L 2.9 X10^9/L 3.98-10.04
Differential Count
Neutrophils L 32 % 56.00 – 65.00
Lymphocytes H 53 % 25.0 – 35.0
Monocytes 8 % 2.00 – 8.00
Eosinophils H6 % 1.0-5.00
Basophils 1 % 0.0-1.0
RBC COUNT L 3.0 10^6/uL 4.3 – 5.5
Hemoglobin L 9.9 g/dl 12.0 – 16.0
Hematocrit L 31.1 % 37.0 – 45.0
Blood Indices
MCV H 104.7 fL 82.0 – 98.0
MCH 33.3 Pg 26.0 – 34.0
MCHC 31.8 g/dl 31.0 – 37.0
RBC Distribution W. 14.6 %
Platelet Count 212.0 10^/uL 150.0 – 450.0
Mean Platelet Volume 10.0 fL
Interpretation:
The laboratory result (Complete blood count) shows that there is a decrease in number of Red Blood cells
with a value of 3.0 (4.3 – 5.5) including hemoglobin and hematocrit with a value of 9.9g/L (12.0 – 16.0)
and 31% (37 – 45%). There is also a decrease in the number of White Blood Cells with a value of
2.9(3.98 – 10.04); Decrease in Neutrophils with a value of 032% (56.0 – 65.0%). On another hand, There
is an increase in number of Lymphocytes with a value of 53% (25.0 – 35.0), Eosinophils with a value of
6% (1.0 – 5.0%) and MCV with a value 104.7fl (82.0 – 98.0).
X. Drug Study
Brand Name: Zovirax
Generic Name: Acyclovir
Doctor’s Order: Give Acyclovir 200 mg
Date Ordered: 11/24/17
Drug Class: Antivirals
Mechanism of Action: Acyclovir (9-2-hydroxymethyl guanine) is a nucleoside analog that selectively
inhibits the replication of herpes simplex virus types 1 and 2 (HSV-1, HSV-2) and varicella-zoster virus
(VZV). After intracellular uptake, it is converted to acyclovir monophosphate by virally-encoded
thymidine kinase. This step does not occur to any significant degree in uninfected cells and thereby lends
specificity to the drug's activity. The monophosphate derivative is subsequently converted to acyclovir
triphosphate by cellular enzyme
Contraindication: Hypersensitivity
Nursing Implications:
Monitor I&O renal function test if ordered, electrolyte levels
Check food tolerance, vomiting.
Assess Intravenous site for phlebitis(heat, pain, red streaking over vein)
Evaluate cutaneous lesions.
Be alert to neurologic effects: headache, lethargy, confusion, agitation, hallucinations, seizures
Assure adequate ventilation.
Provide analgesics and comfort measures; esp. exhausting to elderly.
Encourage fluids
Generic Name: Aspirin
Doctor’s Order: Give Asa/Aspirin 80mg
Date Ordered: 11/24/17
Drug Class: Non-steroidal Anti-inflammatory drug (NSAID) – Acetylsalic acid (ASA)
Mechanism of Action: Reduction of Inflammation (also antipyretic effect); analgesic(prostaglandin
inhibitor); anti-platelet (blocks formation of thromboxane A2 reducing platelet aggregation and
vasoconstriction of coronary arteries)
Contraindication: Hypersentsitivity to salicylates or NSAIDs
Side effects: - A high incidence of gastro-intestinal irritation with slight asymptomatic blood loss;
Bronchospasm; Increased bleeding time; Possible skin reactions in hypersensitive patients.
Nursing Implications:
Assess patient for signs of bleeding (petechiae. Ecchymosis, bloody or black stools, bleeding
gums).
Drink adequate fluids while taking aspirin
Advise patient to avoid alcohol when prescribed high doses of aspirin
Discontinue aspirin use of ringing or buzzing in ears or unrelieved GI discomfort
Generic Name: Candesartan
Doctor’s Order; Give Candesartan
16 mg #30 tabs
½ tabs OD
Date Ordered: 1/22/18
Drug Class: Cardiovascular agent; angiotensin II receptor antagonist
Mechanism of Action: blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by
selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular
smooth muscle and the adrenal gland.
Contraindications: Known sensitivity to candesartan or any other angiotensin II (AT1) receptor
antagonist (e.g., losartan, valsartan); primary hyperaldosteronism;
Adverse Effects: Body as a Whole: Fatigue, peripheral edema, back pain, arthralgia. CV: Chest
pain. GI: Nausea, abdominal pain, diarrhea, vomiting. CNS: Headache, dizziness. Respiratory: Cough,
sinusitis, upper respiratory infection, pharyngitis, Rhinitis. Urogenital: Albuminuria.
Nursing Implications:
Monitor BP as therapeutic effectiveness is indicated by decreases in systolic and diastolic BP
within 2 wk with maximal effect at 4–6 wk.
Monitor for transient hypotension in volume/salt-depleted patients; if hypotension occurs, place
in supine position and notify physician.
Monitor BP periodically; trough readings, just prior to the next scheduled dose, should be made
when possible.
Lab tests: Periodically monitor BUN and creatinine, serum potassium, liver enzymes, and CBC
with differential.
Generic Name: Trimetazidine
Doctor’s Order: Give Trimetazidine 35mg
#60 tabs
1 tab 2x/day
Drug Class: Anti-antiginal drug
Mechanism of Action: Improves myocardial glucose utilization through stopping of fatty acid
metabolism by limitation of intracellular acidosis, correction of disturbances of transmembrane ion
exchanges and prevention of excessive production of free radicals.
Indication: w/ heart failure
Contraindications: Parkinson's disease, parkinsonian symptoms, tremors, restless leg syndrome and
other movement related disorders. Severe renal impairment (CrCl <30 mL/min). Lactation.
Side effects: Dizziness, headache, rashes, abdominal pain, nausea, vomiting and diarrhea
Nursing Implications:
Assess for hypersensitivity to trimetazidine, with heart failure
Administer drug after patient has eaten with full glass of water
Encourage patient to continue efforts at smoking cessation
Provide safety measures if lethargy occurs
Generic Name: Pregabalin
Doctor’s order: Give Pregabalin 75mg
Date ordered: 1/13/18
Drug Class: Analgesic, anticonvulsant
Mechanism of Action: Binds to calcium channels in CNS tissues which regulate neurotransmitter
release. Does not bind to opioid receptors
Contraindications: contraindicated with known pregabalin hypersensitivity or with product specific
ingredient hypersensitivity.
Side effects: dizziness, sleepiness, trouble concentrating, blurry vision, dry mouth, weight gain, swelling
of your hands or feet
Nursing Implications
Monitor for weight gain, peripheral edema, and S&S of heart failure, especially with concurrent
thiazolidinedione (e.g., rosiglitazone) therapy.
Lab tests: Baseline and periodic kidney function tests; periodic platelet counts; CPK if
rhabdomyolysis is suspected.
Monitor diabetics for increased incidences of hypoglycemia.
Withhold drug and notify physician if rhabdomyolysis is suspected
Supervise ambulation especially when other CNS drugs are used concurrently.
Generic Name: Dexamethasone
Doctor’s Order: Give Dexamethasone 4mg
Date ordered: 1/13/18
Drug Class: Anti-inflammatory glucocorticoid
Mechanism of Action: Suppresses inflammation and the normal immune response. Has numerous
intense metabolic effects.
Contraindications: active untreated infectious (except for certain forms of meningitis)
Side effects: headache, dizziness, spinning sensation, nausea and vomitting
Nursing Implications:
Monitor intake and output ratios and daily weights
Observe patient for appearance of pheripheral edema, steady weight gain, crackles or dyspnea.
Generic Name: Acetylcysteine
Doctor’s order: Give Acetylecystine 600 mg
Date ordered: 1/4/19
Drug Class: Mucokinetics/Expectorant
Mechanism of Action: Decreases viscosity of respiratory tract secretions and promote their removal by
breaking disulphide bonds. In acetaminophen overdose. It protects the liver from injury by restoring
glutathione levels by acting as alternate substrate for acetaminophen metabolism.
Contraindications: Hypersensitivity
Side effects: Mild fever, hypotension, nausea and vomiting. Dyspnea, wheezing, generalized urticarial,
stomatitis
Nursing Implications
During IV infusion, carefully monitor for fluid overload and signs of hyponatremia (i.e., changes
in mental status).
Monitor for S&S of aspiration of excess secretions, and for bronchospasm (unpredictable);
withhold drug and notify physician immediately if either occurs.
Lab tests: Monitor ABGs, pulmonary functions and pulse oximetry as indicated.
Have suction apparatus immediately available. Increased volume of respiratory tract fluid may be
liberated; suction or endotracheal aspiration may be necessary to establish and maintain an open
airway. Older adults and debilitated patients are particularly at risk.
Nausea and vomiting may occur, particularly when face mask is used, due to unpleasant odor of
drug and excess volume of liquefied bronchial secretion
Generic Name: Penicillin V
Doctor’s Order: Give Penicillin VK 500 mg
Drug Class: Anti-ineffective, antibiotic
Mechanism of Action: Interferes with bacteria cell wall synthesis during active multiplication, causing
cell wall death and resultant bactericidal activity against susceptible bacteria.
Contraindications: Allergies to penicillins, cephalosporins, or other allergens, renal disorders
Side effects: CNS: Lethargy, hallucinations, seizures. GI: gastritis, sore mouth, furry tongue, vomiting,
diarrhea, abdominal pain
Nursing Implications
Monitor for allergic reactions. Have emergency equipment available
Empty stomach with full glass of water
Monitor CBC, BUN, creatinine
