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St. Luke'S College of Nursing

The document describes a case of a 63-year-old female farmer presenting with six months of generalized musculoskeletal pain and weakness. Physical examination and laboratory findings reveal lytic bone lesions, plasma cell infiltration on bone marrow biopsy, and positive results for multiple myeloma. The patient is started on a chemotherapy protocol to treat the multiple myeloma.

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fleur harrison
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67 views4 pages

St. Luke'S College of Nursing

The document describes a case of a 63-year-old female farmer presenting with six months of generalized musculoskeletal pain and weakness. Physical examination and laboratory findings reveal lytic bone lesions, plasma cell infiltration on bone marrow biopsy, and positive results for multiple myeloma. The patient is started on a chemotherapy protocol to treat the multiple myeloma.

Uploaded by

fleur harrison
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ST.

LUKE’S COLLEGE OF NURSING


1st Semester
School Year: 2020-2021
LEVEL 3 RLE
NCM 112

12nd CASE: MULTIPLE MYELOMA (MM)

Case Presentation:

A 63-years-old female, farmer presents with history of six months of generalized musculoskeletal pain that has gradually increased. She has been treated with oral and
intramuscular analgesics without improvements. He also reports an onset of weakness, myalgia, anorexia, and a presence of abscess in left gluteal area. The patient is
hospitalized in a Provincial Hospital where he receives antibiotic coverage for seven days with no improvements. The musculoskeletal pain persists and limits
ambulation for this reason, she is transferred to St. Luke’s Medical Center charity ward.

Past medical history

Hypertension for over a year; currently managed with atenolol, 100 mg a day. Two months ago, history of a stroke without neurologic damage or motor deficit.
Pneumonia in two occasions that required antibiotic coverage and hospitalization for more than 21 days.

Present

At hospitalization it presents vital signs Heart Rate: regular 71 bpm, Respiratory Rate: 18 rpm, Temperature: 37°C, O2 Sat: 98%, Weight: 600 Kg, Height: 5 feet and 2
inches. At physical examination we find a female alert and oriented, cooperative. Poorly nourished with pale and thin skin, with facies of chronic disease and overall
clinical. Her gait is slow, with ambulation difficulty due to musculoskeletal pain. The left gluteal area presents an abscess in resorption with scarce purulent material.
The rest of the physical examination is normal

1 TLC Lesson 1
Laboratory findings:

Kidney ultrasound findings:

The Right kidney measures 121 mm × 64.8 mm. The left kidney measures 118 mm × 68 mm. Kidney parenchyma is normal and corticomedullary relation is normal.
Evidence of moderate urinary stasis at the pyelocaliceal region of the left kidney with lithiasis of 7 mm. Bladder without abnormalities

2 TLC Lesson 1
Lateral x-ray of the skull: Multiple well circumscribed lytic lesions with a diameter between 0.5 cm to 2.5 cm. The rest of the study was without abnormalities.

Bacterial culture of abscess: Positive to Acinetobacter baumannii sensitive to imipenem and tigecycline

Bence-Jones protein: Negative Urine analysis: Presence of high concentration of calcium oxalate crystals. Bone marrow biopsy: Plasma cell infiltration of more than
10%.

CHEMOTHERAPY PROTOCOL

3 TLC Lesson 1
LEARNING PACKETS

I. PHYSICAL EXAMINATION/CONTRAPTIONS

II. PATHOPHYSIOLOGY

III. CORRELATE DOCTOR’S ORDER TO LABORATORY RESULTS TO PT’S S/SX (PATHOPHY)

IV. NCP

V. DRUG STUDY OF MEDICATIONS ON BOARD AND OTHER MEDICATIONS RELATED TO THE DEASE

VI. DISCHARGE HEALTH TEACHINGS ABOUT THE DISEASE AND ITS COMPLICATIONS

4 TLC Lesson 1

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