Philippine Christian University

MARY JOHNSTON COLLEGE OF NURSING

415 Morga Street, Tondo, Manila 1012, Philippines

A CASE PRESENTATION ON:

CELLULAR ABERRATION (MULTIPLE MYELOMA)

Submitted By:

Angeles, Angelica E.

Serquina, Johniza Hope G.

BSN-II, Class 2022

Submitted To:

Ms. Gladys T. Cruz

Clinical Instructor

5 December 2020
I. INTRODUCTION
Multiple myeloma is the second most prevalent blood cancer after non-Hodgkin's Lymphoma. It
represents only 1% of all cancers but contributes to 2% of all cancer deaths. Multiple myeloma is
still classified as a non-curable disease and its management involves chemotherapy, radiotherapy
and- bone marrow transplantation with the aim of prolonging survival. Multiple myeloma is a
rare type of cancer that affects bone marrow and alters the blood’s plasma cells. Plasma cells are
a type of white blood cell and are responsible for recognizing foreign infections and making
antibodies to fight them. Multiple myeloma leads to an accumulation of cancer cells in the bone
marrow. Eventually, the cancer cells overtake healthy blood cells, and the body becomes unable
to produce disease-fighting antibodies. Instead, it creates harmful proteins that damage the
kidneys and cause other signs and symptoms. Knowing the most common signs and symptoms
of multiple myeloma may help in detecting it before it becomes advanced but is wasn’t always
easy to detect. There might not be any of the symptoms during the cancer’s earliest phases. As
the cancer advances, symptoms vary greatly. One person’s experience can be completely
different from another’s. Multiple myeloma affects more than one area of your body. Symptoms
include bone pain and easily broken bones. And may experience frequent infections and fevers,
excessive thirst, increased urination, nausea, weight loss, constipation

Multiple myeloma also called plasma cell myeloma is a neoplasm of plasma cells which usually
present with fatigue, bone pain, and recurrent infections. Although the incidence rates in men are
approximately 50% higher than rates in women for all racial/ethnic groups, with the exception of
Filipinos, where women have an 80% excess, it is stated that Myeloma also occurs commonly in
people at least at age 60. In this study we will be describing demographic data, nursing history,
Gordon’s functional health pattern, physical assessment, risk factors, pathophysiology,
diagnostic and laboratory test, drug study, nursing theories, conceptual paradigm, nursing care
plan and health teachings. We will also be discussing how the client was diagnosed and treated
for having multiple myeloma for almost 3 years. This is for the awareness of multiple myeloma
in races with lowest incidence rates which is very important.

The client that we have is a 61-year old survivor of Multiple Myeloma. With this case study that
we had, we would like to take this opportunity to learn from our client’s experience of having the
cancer. We want to gain and impart understanding of the case so that once we encounter the
same scenario we would be able to apply knowledge and wisdom gained from this study and
evaluate ourselves from doing so. In this case study, it explains what myeloma is, and how it
develops within the body. Learning as much as possible about multiple myeloma will help us be
more involved in making decisions about treatment. And in connection to that, we are to conduct
important information and assessment that will help us build interventions and health teachings
towards the client. And in collaboration with the client, the client must also be accountable to
any given health teachings.

II. DEMOGRAPHIC DATA

Name: R.M.F

Age: 61 years old

Sex: Female

Address: Siblot Tramo, San Nicolas, Pangasinan

Birthdate: June 23, 1959

Occupation: Housewife

Civil Status: Married

Religion: Christian-Methodist

Nationality: Filipino

Educational Attainment: College Graduate

III.NURSING HISTORY
 History of Present Illness
The client is a 61 year-old, female, with multiple myeloma. Prior to diagnosis of the disease, last
July 2017, she was admitted in the hospital due to severe back pain, body malaise and fatigue.
She was diagnosed with rheumatoid arthritis and took her medication up until September. The
family noticed that she is not getting well and continue to experience body malaise,
unexplained/radiating pain in the back, polyuria and weight loss. She stated that she cannot move
freely at that time so they decided to admit her at Manila Med. Decreased Hgb was noted.
Workups were done for possible etiology of anemia, but despite transfusion, client was sill
anemic. Client was then referred to a hematologist on November 2017 where BMA was done
and was diagnosed with multiple myeloma, stage 4. She was misdiagnosed in the hospital she
was admitted to so the doctor ordered to stop taking her previous medication (rheumatoid
arthritis) and started to do chemotherapy. She underwent treatment with Bortezomib (Velcade)
(It works by slowing or stopping the growth of  cancer cells.) for 16 cycles and Thalidomide [used
to treat a certain type of cancer (multiple myeloma)] 50mg OD. Client was referred to AP for
stem cell harvest and transplant, hence admission. Client started chemotherapy from December
2017 to April 2018. Repeat test showed that client is already in remission hence was advised fit
for BMT. She underwent stem cell harvest 2 months PTA (last week of April – 1 st week of May
2018) June 29, 2018, she underwent BMT. According to her daughter, post BMT client
continued her chemotherapy for 2 years every 21 days to make sure there is no rejection. Meds
taken that time was Lenelidomide (It works by slowing or stopping the growth of cancer cells. It
is also used to treat anemia in patients with certain blood/bone marrow disorders) As far as the
client can remember, her last chemotherapy was on August 2020.
 Past Medical History:
The client is complete in vaccines and has no known allergies. Stated that she had a removal of
left ovary (oophorectomy) when she was 21 years old. (1970s) Admitted to the hospital for
almost 1 month last July 2017 due to back pain and fatigue. October 2017, s/p VATS, right
oophorectomy. (+) Hypertension since Jan 2018.
 Family History:
The patient has reported that on her maternal side there is a history of cancer (leukemia, throat
CA) and hypertension while on her paternal side, there is a history of heart failure. There were
no reported history of other diseases such as diabetes mellitus, tuberculosis or asthma.
 Social History:
The patient is a housewife and living with her husband, 3 children and 3 grandchildren. She is a
certified “plantita” who loves to collect different kinds of plants. Denies vices. No travel history
for the past 5 years.

IV. GORDON’S FUNCTIONAL HEALTH PATTERN

1. Health Perception- Health Management Pattern
 Before our client was admitted, she describes her health as good. She eats healthy foods
like fruits and green leafy vegetables. Doesn’t smoke nor drink alcohol. But when she
was admitted because of severe back pain, she described her health as poor. She claimed
that she has no appetite since then up until she was diagnosed with cancer.
 The last time she had a face to face check-up with her doctor was on February 2020.
Because of pandemic, she just had a phone call with the doctor to check her current
status. All her cancer related medications were already stopped.
 Since she has hypertension since 2018, to maintain her good health, the client is currently
taking her maintenance which are Trimetazidine and Nebivolol and by eating healthy
foods made by her daughters.
2. Nutrition- Metabolic Pattern
 Usual food intake before was 5 meals per day including snacks. Eats everything
especially fresh fruits and vegetables (kamote and kangkong tops). Drinks 10-12 glasses
of water and takes vitamins for her immune system. No difficulty in swallowing, no food
restrictions and allergies.
 During her admission, client was taking her food through NGT. After she recovered she
went back to the usual eating habits but with food restrictions. (fruits with thin skin like
grapes and apples, fatty foods and high in salt) Client is also not allowed to eat fresh
foods e.g kinilaw. Good thing, she is allowed to eat her favorite fruits which are orange
and bananas. She also stated that she drinks more than 10-12 glasses a day and takes
vitamin C for immune system.
3. Elimination Pattern
 Client normally voids 10 times a day and produces yellow urine prior to admission. She
defecates once a day. Does not experience urinary incontinence and no history of Urinary
Tract Infection.
 During the confinement, she was catheterized because she has a difficulty of moving. She
also wore a diaper where she can defecate. She stated that when she was in the hospital,
skin condition is not good. Dry. But no edema and lesions were noted.
 As of the moment, client has good skin condition. Weight came back to normal. (45kg-
66kg) Voids more than 10 times a day and produces yellow to white urine and defecates
once a day.
4. Activity-Exercise Pattern
 Patient is a housewife. Does all the chores in the house before admission like washing of
their clothes, cooking the food, cleaning the house, watering the plants and going to the
market. Because of her condition, she was forbidden to do extraneous activity. Her way
of exercising right now is walking every morning for 30 minutes, sweeping the backyard
and cooking their food if capable enough to do so.
5. Sleep Rest Pattern
 Usual sleeping pattern is from 8pm to 5:30am. No difficulty in sleeping. Sleeping ritual is
after she watch the news, she will get her urinal before going to bed because she wakes
up in between her sleep to void. In the hospital, she has more sleeping time because she
feels weak. She also told me that she experienced hallucination because of the effect of
the medications. The dream she cannot forget is when she saw heaven while she was
sleeping.
6. Cognitive Perceptual Pattern
 Patient is able to read and write. No hearing problems noted, has good memory and no
vision problem. But during her admission, she was not able to write and most of the
decision making was passed to her eldest daughter. She is not well oriented about what is
happening around her and experienced hallucinations. Now, she noticed that she cannot
hear and see clearly because her physician told her that it has an effect on the medication
she is taking. With the help of using a glasses, she can clearly see the things around her.
7. Self-Perception Pattern
 In cancer patients, it’s common to experience alopecia. In my client’s case, she
mentioned that she experienced the stage where she cried while looking herself in the
mirror without hair. According to her, she felt ashamed that time but later on, she learned
to accept it. Now, her normal hair came back and even her physical body.
8. Role Relationship Pattern
 While doing the interview, client is alert and cooperative. Expresses ideas and feelings
clearly. Makes and maintain eye contact and conversation. Living together with her
 husband and 4 children. Her 2 other children are working as a health worker in abroad
and in Manila. They are the one who give them financial support to use in their daily
needs. Husband works as a farmer and the client as a housewife.
 Client’s eldest child together with the 2nd daughter are the decision makers during her
hospitalization. They are also the one who took care of her because the others are
working and still studying.
 While we are having the interview, the client mentioned me the PCSO’s help during her
admission in the hospital. She applied there and asked for a hospitalization expenses. It
was a big help in their financial needs.
9. Sexuality-Reproductive Pattern
 Since client is already 61 years old, she is already in menopause stage. As far as she
remember, her 1st menstruation (menarche) happened when she was in 3rd year high
school. She had a left and rigjht oophorectomy last 1970 and 2017 respectively.
 When she was undergoing the therapy, she had a blood transfusion (4 bags of O+ blood)
and underwent bone marrow transplant.
10. Coping Stress Management Pattern
 Client’s stress is tolerable. She can manage it. Because of her grandchildren, her stress
fades right away. Now, her family is experiencing another health problem because her
daughter is positive with COVID 19. I can see that the client is anxious but she assured
me while we are talking that she fully trust God on what is happening in her family.
 Her family is her core and rock. She mentioned that she needs to stay strong because
when she was sick they showed how strong their faith to God.
11. Values and Beliefs
 Client is a Methodist. She is an active church goer but when she got sick, she stopped
going to church. Now that she is recovering, she attends the service initiated by her sister-
in-law because she cannot still mingle with many people because her immune system is
still low.
 While listening to her story (somewhat testimony), I can’t help but to cry because her
faith in God is the one who healed her. She never questioned God about her condition. In
fact, she has a big faith and trust to Him. She mentioned that if ever God will get her, she
 is very willing to accept it. She also told me that she dreamt about heaven and it was so
beautiful.

V. PHYSICAL ASSESSMENT
 General Survey: Client is alert, oriented and cooperative. Speech is clear, without
slur or stutter. Expresses ideas and feelings clearly. Makes eye contact and maintains
conversation appropriately while sitting on the chair with legs crossed and shoulder
slightly slouched forward. Clothes is clean and appropriate for season.
 Skin, Hair, Nails: Skin is brown in color. Warm and dry to touch. Turgor is intact
with immediate recoil of skin and over the clavicle. Hair is black with scattered gray
streaks, short and straight. No scalp lesions or flaking noted. Fingernails are well
trimmed; immediate capillary refill of two (2) seconds. No clubbing or beau's lines.
 Head and Neck: Head symmetrically round, hard and smooth, without lesions or
bumps. Face is oval, smooth and symmetric. Bilateral temporomandibular joints with
full ROM. No lymph nodes noted.
 Eyes: Eyes are symmetrical. Conjunctiva and sclera moist and smooth. Eyebrows
sparse with equal distribution. Wears glasses because complains blurred vision
without glasses. Denies itching, excessive tearing, discharge, and redness. PERRLA.
 Ears: Bilateral auricles without deformity, lumps or lesions. Bilateral auditory canals
contain scant amount of dark brown cerumen. Denies pain, discharge or trauma to
ears.
 Nose: External structure without deformity, asymmetry, or inflammation. Nares
patent. Frontal and maxillary sinuses nontender.
 Mouth, Throat, Nose and Sinuses: Lips dark brown in color, smooth and moist. No
lesions or ulcerations. Bucal mucosa and gums pink and moist without inflammation,
bleeding or discoloration. Teeth are clean with no decay. White with shiny enamel
and smooth surfaces and edges. Wears crown and some teeth are with pasta. Last
dental examination 6 mos ago. Total no. of teeth: 30. Tongue midline when
protruded. Tonsils present, without exudate, edema, ulcers or enlargement. Nose
external structure without deformity, asymmetry, or inflammation. Nares patent.
Frontal and maxillary sinuses nontender.
  Thorax and Lungs: Thorax expands symmetrical without retraction. Clear to
auscultation anterior and posterior bilaterally. Respirations are even, unlabored and
regular. Respiratory rate: 18, no reports of dyspnea.
 Abdomen: Abdomen round and symmetric, without masses, lesions, pulsations or
peristaltic waves. Abdomen free of hair. Stretchmarks are observed.
 Upper Extremities: Equal in size and symmetric. Skin brown in color; warm and dry
to touch, without edema, bruising or lesions. Radial and brachial pulses 2+ and equal
bilaterally. Observed a 5 inches flat scar in the right lateral aspect of 3rd to 6th rib.
 Lower Extremities: Symmetric in size and shape. Skin intact, brown in color, warm
and dry to touch without edema. Varicose veins were observed in both legs.
VI. RISK FACTORS

Factors that may increase your risk of multiple myeloma include:

Risk Factors Rationale

Your risk of multiple myeloma increases as
Increasing age.  you age, with most people diagnosed in their
mid-60s.

Genes Some changes with genes and chromosomes are

linked with multiple myeloma, including the
number 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 Multiple myeloma almost always starts out
gammopathy of undetermined significance as MGUS, so having this condition increases
(MGUS) your risk.

VII. PATHOPHYSIOLOGY

Multiple myeloma begins in the bone marrow—the soft, spongy tissue that fills the center of
bones. The bone marrow is where blood cells such as red blood cells, white blood cells, and
platelets are made. Patients with multiple myeloma develop an excessive number of abnormal
plasma cells in their bone marrow. The cancerous plasma cells multiply, building up in the
marrow and crowding out normal, healthy blood cells. To understand further, monoclonal
myeloma plasma cells proliferate and overproduce M protein (abnormal IgG, IgM, or IgA, or
rarely IgE or IgD); these cells also produce abnormal light chain proteins (κ or λ), cytokines that
stimulate osteoclasts and suppress osteoblasts, and angiogenesis factors that promote new blood
vessel formation. This process leads to an excessive M protein level, which causes
hyperviscosity; light chain proteins that cause end-organ damage, especially in the kidneys; and
bone lesions that cause bone pain, osteoporosis, and hypercalcemia. Bone marrow infiltration
leads to anemia, and immunologic alterations contribute to recurrent infections. Multiple
myeloma almost always starts out as a relatively benign condition called monoclonal
gammopathy of undetermined significance (MGUS). MGUS, like multiple myeloma, is marked
by the presence of M proteins — produced by abnormal plasma cells — in your blood. However,
in MGUS, the levels of M proteins are lower and no damage to the body occurs. It is not
completely understood how MGUS develops into multiple myeloma. An elevated M protein
level (1.5 g per dL [15g per L ] or greater), non-IgG MGUS , and an abnormal free light chain
ratio increase the risk of multiple myeloma, if all three risk factors are present.

VIII. DIAGNOSTIC AND LABORATORY TESTS

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

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).

Nursing Implication

Client teaching about maintaining adequate nutrition; eating healthy diet, foods rich in fibre;
Routine blood work; Taking iron supplements as prescribed by the doctor. Taking the colour of
the stools into considerations and monitoring the intake and output. Lastly, monitor for possible
vitamin B12 deficiency; fatigue, headache, palpitations, and dyspnea, and neurological
symptoms such as dysesthesia and hypoesthesia may also be present.

IX. 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 (AT 1) 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

Brand Name: Nebivolol

Doctor’s Order: 2.5 mg, OD

Drug Class: Beta blockers

Mechanism of Action: Binds to and blocks the beta-1 adrenergic receptors in the heart, thereby
decreasing cardiac contractility and rate. This leads to a reduction in cardiac output and lowers
blood pressure.

Contraindications:

 diabetes
 low blood sugar
 complete heart block
 second degree atrioventricular heart block
 sick sinus syndrome
 slow heartbeat
 sudden and serious symptoms of heart failure called acute decompensated heart failure
 peripheral vascular disease
 bronchospasm
 liver problems
 severe liver disease
 blood circulation failure due to serious heart condition
 pregnancy
 chronic kidney disease stage 4 (severe)
 chronic kidney disease stage 5 (failure)
 kidney disease with likely reduction in kidney function

Side effects:

 headache.
  tiredness.
 weakness.
 dizziness.
 diarrhea.
 nausea.
 stomach pain.
 difficulty falling asleep or staying asleep.

Generic Name: Pregabalin

Doctor’s order: Give Pregabalin 75mg, ODHS

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: 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

Generic Name: Febuxostat

Brand Name: Atenurix

Doctor’s Order: Give Febuxostat, 40 mg, OD at 8am

Drug Class: Xanthine Oxidase Inhibitors

Mechanism of Action: The primary mechanism of action of febuxostat evaluated in trials was

the inhibition of xanthine oxidase, evidenced by the increase in serum and urine xanthine
concentrations, decrease in serum and urine uric acid levels, and lack of significant reduction in
total purine synthesis.

Contraindications: Febuxostat is contraindicated in patients being treated with azathioprine or

mercaptopurine. Patient with severe rash, cardiac disease, mortality, myocardial infarction,
stroke, Hepatic disease, Dialysis, renal failure, and renal impairment

Side effects:

Common reactions to febuxostat include:

 nausea, rash, joint pain, gout flares, and liver problems.

Other important, but less common side effects include:

 stroke, heart attack, anemia, hepatitis, hypersensitivity, and weight loss.

Nursing Implications

 Assess for joint pain and swelling, especially during early therapy. Changing serum uric a
cid levels from mobilization of urate from tissue deposits may cause gout flares. Use prop
hylactic NSAID or colchicine therapy for up to 6 mo. If a gout flare occurs, continue febu
xostat therapy and treat flare concurrently.
 Monitor for signs and symptoms of MI and stroke.
  Lab Test Considerations: Monitor serum uric acid levels prior to, 2 wk after intitiating, an
d periodically thereafter. If serum uric acid levels are ≥6 mg/dL after 2 wk of daily 40 mg 
therapy, increase dose to 80 mg daily.

Drug Name: Velcade

Drug classification: Proteasome Inhibitors.

Indication for use: This medication is used to treat certain types of cancer (such as multiple
myeloma, mantle cell lymphoma). It works by slowing or stopping the growth of cancer cells. And is
preferred treatment option for treatment of patients with relapsed or refractory myeloma.

Side effects: Dizziness, lightheadedness, nausea, vomiting, loss of appetite, diarrhea, constipation,

tiredness, weakness, or pain/redness at the injection site may occur. Nausea, vomiting,
and diarrhea can be severe. 

Nursing Implications

 Monitor for and report S&S of neuropathy (e.g., hyperesthesia, hypoesthesia, paresthesia,
discomfort or neuropathic pain).
 Monitor postural vital signs for orthostatic hypotension.
 Monitor I&O and assess for S&S of dehydration or electrolyte imbalance if vomiting
and/or diarrhea develop.
 Lab tests: Frequent CBC with platelet count; baseline and periodic LFTs; frequent blood
glucose in diabetics.

Drug Name: Thalidomide

Drug Classification: immunomodulatory agent, and an antiangiogenic agent.

Indication for use: Thalidomide is used to treat a certain type of cancer (multiple myeloma). It
reduces the formation of blood vessels that feed tumors.
Side effects: fever; low blood cell counts; headache, dizziness, drowsiness, weakness, tired
feeling; anxiety, agitation, confusion; numbness, tremors, muscle weakness; nausea, loss of
appetite, constipation; weight gain or loss;

Nursing Implications

 Lab tests: Monitor WBC with differential prior to therapy and periodically thereafter.
 Monitor carefully for and immediately report S&S of peripheral neuropathy. Discontinue
drug and notify prescriber if peripheral neuropathy is suspected.

Drug Name: Lenelidomide

Drug Classification: immunomodulatory agent and an antiangiogenic agent

Indication for use: in combination with dexamethasone is indicated for the treatment of adult
patients with multiple myeloma (MM). It is indicated as maintenance therapy in adult patients
with MM following autologous hematopoietic stem cell transplantation (auto-HSCT).

Side Effects: Gastrointestinal effects (diarrhea, abdominal pain);Fatigue, weakness, decrease

appetite; Low red blood cell or white cell count; Shortness of breath; Cough; Insomnia; Muscle
spasms; Back pain; Fever; Rash
Nursing Implications

 Assess for signs of deep venous thrombosis and pulmonary edema (dyspnea, chest pain,
arm, or lefg swelling)
 Assess for skin rash. Discontinue lenalidomide if rash occurs; may cause stevens Johnson
syndrome or toxic epidermal necrolysis
 Monitor for signs and symptoms of tumor flare

X. NURSING THEORIES
 Ida Jean Orlando- Deliberative Nursing Process
Ida J. Orlando was one of the first nursing theorists to write about the nursing process based on
her own research. She proposed that “patients have their own meanings and interpretations of
situations and therefore nurses must validate their inferences and analyses with patients before
drawing conclusions.” In short, her deliberative nursing process theory focuses on the interaction
between the nurse and patient, perception validation, and the use of the nursing process to
produce positive outcomes or patient improvement. What the nurse and the patient say and do
affects them both. 

To further understand why this theory was used in a client with multiple myeloma, the
deliberative nursing process has five stages: assessment, diagnosis, planning, implementation,
and evaluation. In the assessment stage, the student nurse conducted a holistic assessment of the
patient’s needs and current situation. This was completed by asking the patient about what she
feels and looking into records that was provided to us. The student nurse used a nursing
framework to collect both subjective and objective data about the client. In diagnosis stage we
used the nurse’s clinical judgment regarding health issues. The diagnosis can then be confirmed
using the similarities found in the patient's assessment to the distinguishing features, associated
factors, and risk factors. Each of the problems found in the diagnosis is solved by the planning
stage. A particular purpose or outcome was provided to each problem, and nursing strategies
were given to each target or outcome to help achieve the goal. By the end of this stage, the
student nurse had a nursing care plan. The student nurse started using the nursing care plan in the
implementation stage. And finally, the student nurse looked at the patient's progress towards the
targets set in the nursing care plan in the evaluation stage. Changes to the nursing care plan will
be made depending on how well (or poorly) the patient is doing towards the objectives/goals. If
any new problems are identified in the evaluation stage, they can be addressed, and the process
starts over again for those specific problems.

We chose this theory because we believe that using her theory assures that patient will be treated
as individual and that she will have active and constant input into her own care. The advantages
of using this theory in this study is that it prevents inaccurate diagnosis or ineffective plans
because the student nurse has to constantly explore her reaction with the intervention. Lastly, it
guides the student nurse to evaluate her care in terms of objectively observable patient outcome.
  Afaf Ibrahim Meleis- Transitions Theory

One of the transitions of the client that needs validation are transition experience, and
environmental conditions that expose the client to potential damage, problematic or extended
recovery, or delayed unhealthy coping. A healthy transition, according to Meleis et al., is
characterized by both process and outcome indicators. The process indicators inherent in healthy
transitions, according to Meleis et al., are feeling connected and interacting, location and being
situated, and developing confidence and coping. The nursing therapeutics described by Meleis et
al incorporate nursing assessment, role supplementation, creating a healthy environment, and
mobilizing resources. And in the case of the client in cancer survivorship, transition is a turning
point with a variable time period one passes through after treatment. It is the client’s experience
with degrees of liminality, changes, and challenging consequences. In understanding more of this
theory in accordance to the patient’s case, it helps identify patient needs for targeted nursing
interventions that can bridge safe passage to cancer survivorship. And just as it states in the
theory, nurses often are the primary caregivers of people undergoing transitions associated with
health problems. Transitions both result in change and are the result of change. Person,
transitions involve a process of movement and changes in fundamental life patterns, which are
manifested in patient. Transitions cause changes in identities, roles, relationships, abilities, and
patterns of behavior. The daily lives of client, environments, and interactions are shaped by the
nature, conditions, meanings, and processes of their transition experiences. The nurses tend to be
involved in preparing client for impending transitions and to be those “who facilitate the process
of learning new skills related to client' health and illness experiences” (Meleis et al., 2000, p. 13).
And so,

We chose this theory because by using this theory there is guidance towards the student nurse
role in transition period of the patient; that the student nurse will help the patient complete
healthy transition through the means of health teachings.

 Nola Pender’s Health Promotion Model

WHO states that health promotion is the fundamental strategy in healthcare that implies changes
in behaviour and adoption of patterns that promote good health – Among the many models of
health related quality of life, Pender’s Health promotion behaviour model helps to identify
factors influenced the decisions and actions of individuals that were made to prevent disease and
promote a healthy lifestyle. And in the case of the patient undergoing transitions, improving and
protecting health is the major role of a student nurse; student nurse focused mainly on recovering
health and later stages, more attention towards health promotion
The Health Promotion Model was designed by Nola J. Pender to be a “complementary
counterpart to models of health protection.” It defines health as a positive dynamic state rather
than simply the absence of disease. Health promotion is directed at increasing a patient’s level of
well-being. The health promotion model describes the multidimensional nature of persons as
they interact within their environment to pursue health. Pender’s model focuses on three areas:
individual characteristics and experiences, behavior-specific cognitions and affect, and
behavioral outcomes. The theory notes that each person has unique personal characteristics and
experiences that affect subsequent actions. The set of variables for behavior specific knowledge
and affect have important motivational significance. The variables can be modified through
nursing actions. Health promoting behavior is the desired behavioral outcome, which makes it
the end point in the Health Promotion Model. These behaviors should result in improved health,
enhanced functional ability and better quality of life at all stages of development. The final
behavioral demand is also influenced by the immediate competing demand and preferences,
which can derail intended actions for promoting health.
We chose this theory because through the model, it will help assist student nurse in
understanding the major determinants of health behaviors as a basis for behavioral counseling to
promote healthy lifestyle of the patient. Pender’s theory encourages scholars to look at variables
that have been shown to impact health behavior. Although the client already has good healthy
lifestyle, there is a transition on how the patient must adapt to these changes. The model can be
used as a foundation to structure nursing protocols and interventions. In practices, nurses should
focus on understanding and addressing the variables most predictive of given health behaviors.

XI. CONCEPTUAL PARADIGM

 INPUT PROCESS OUTPUT

 Demographic Data  Assessment  Evaluation

 History of Present  Nursing Diagnosis
Illness  Planning
 Subjective and  Nursing
Objective Data Interventions
 Physical  Health Teachings
Examination
 XII. NURSING CARE PLAN

ASSESSMENT (HOPE)

SUBJECTIVE:“Dipa ako masyado lumalabas at nakikisalamuha ngayon kasi sabi ng doctor,

dipa kaya ng immune system ko. Atska may COVID, high risk ako.” verbalized by the client.

OBJECTIVE: Hx of BMT, Diagnosed with multiple myeloma,Unstable WBC

NURSING DIAGNOSIS: Risk for Infection related to external factors

GOALS AND OUTCOMES: After the 2 weeks communication and intervention, the client will
be able to:

 Maintain good personal and oral hygiene

 Show no evidence of skin breakdown.
 State infection risk factors.
 Identify signs and symptoms of infection.
 Remain free from all signs and symptoms of infection.

INTERVENTION:

Intervention Rationale
Minimize client’s risk for infection by: Hand washing is the single best way to avoid
-Washing hands before and after providing spreading pathogens.
care (interaction)
 - Emphasizing personal hygiene. Limits potential sources of infection
and secondary overgrowth.
Monitor WBC count as ordered. Report Elevated total WBC counts indicate infection.
elevations/depressions. Markedly decreased WBC count may indicate
decreased production resulting from extreme
debilitation or severe lack of vitamins and
amino acids. Any damage to bone marrow
may supress WBC formation.
Educate patient the importance of washing Hand washing prevents spread of pathogens
hands before and after meals and after using to other objects and food.
bathroom, bedpan, or urinal.
Instruct patient to turn every 2 hours. Provide To help prevent venous stasis and skin
or teach the proper skin care, particularly over breakdown.
bony prominences,
Arrange for protective isolation if client has These measures protect patient from
compromised immune system. Monitor flow pathogens in environment.
and number of visitors.
Teach patient about: These measures allow patient to participate
-good hand washing technique. in care and help patient modify lifestyle to
-factors that increase risk. maintain optimum health level.
-infection signs and symptoms.

EVALUATION:

After the 2 weeks communication and intervention, goal was partially met.

 Client demonstrate appropriate personal and oral hygiene.

 Client’s WBC count and deferential remains unknown because her schedule for follow up
check-up and diagnostic and laboratory test will be on the 15th of January.
 Client’s skin doesn’t exhibit signs of breakdown.
 Client lists risk factors for infection.
 Client lists signs and symptoms of infection.
 Client remains free from signs and symptoms of infection.
ASSESSMENT (HOPE)

SUBJECTIVE: “Ngayon, alam mo medyo humina pandinig ko kasi sabi ng doctor saakin ganon
daw kasi yung effect ng gamot.”

OBJECTIVE: Hx of chemotherapy, lots of drug intake, often ask to repeat the questions

NURSING DIAGNOSIS: Disturbed sensory perception (auditory) related to altered sensory

reception; transmission or integration.

GOALS AND OUTCOMES: After the 2 weeks communication and intervention, the client will
be able to:

 Remain oriented to time, place and person.

 Show interest in external environment.
 Compensate for auditory loss by using signing, gestures, lipreading, or other measures.
 Plan to use community resources to assist with auditory deficit.

INTERVENTION:

Intervention Rationale
Allow client to express feelings about hearing Giving client a chance to talk about hearing
loss. Convey willingness to listen, but don’t loss enhances acceptance of loss.
pressure client to talk.
Determine how to communicate effectively Planned communication with client improves
with client, using gestures, written words, care delivery.
signing or lipreading.
Give client clear, concise explanation Patient will be better able to join her care
explanations of treatments and procedures. with a better understanding of the treatment
Avoid information overload. Face patient plan.
when speaking; enunciate words clearly,
slowly, and in normal speaking voice.
Wearing red lipstick helps to define the
mouth.
Make sure other staff/family members are This ensures effective nursing care delivery
aware of client’s hearing deficit. Record by all staff members.
 information on client’s care plan and chart
cover.
Refer client to appropriate community These measures help client and family cope
resources to help client adapt to loss. Involve better with hearing loss.
family members in planning, and encourage
their participation.

EVALUATION:

After the 2 weeks communication and intervention, goal was fully met. Client:

 Demonstrates ability to correctly identify time, places, and people and recall past events.
 Expresses interest in interacting with others.
 Identifies and uses alternative methods of communication.
 Recognizes need for support during transition from facility to outside environment and
states plans to use community resources to help her cope with auditory deficit.

ASSESSMENT (HOPE)

SUBJECTIVE: “Sa nagpagaralan niyo, ano pwede ko gawin para hindi na bumalik pa?” asked
by the client.

OBJECTIVE:

 The client is active, cooperative and follows instruction.

 The client shows positivity and interest towards the intervention/health teaching.

NURSING DIAGNOSIS: Readiness for Enhanced Therapeutic Management

GOALS AND OUTCOMES: After the 2 weeks communication and intervention, the client will
be able to:

 Remain free of preventable complications/ progression of illness and sequelae.

 Verbalize understanding of information gained
  Demonstrate proactive management by anticipating and planning for eventualities of
condition/ potential complications
 Assume responsibility for managing treatment regimen.

INTERVENTION:

Intervention Rationale
Assess client’s perceptions of their current Indicate deficient knowledge or
health problems. Also, verify client’s level of misinformation. It also provides opportunity
understanding of therapeutic regimen. Note to assure accuracy and completeness of
specific health goals. knowledge base for future learning.
Determine motivation/ expectations for To develop plan for learning and promotes
learning. Accept client’s evaluation of own sense of self-esteem and confidence to
strengths/ limitations while working together continue efforts.
to improve abilities.
Provide information about additional learning Promotes ongoing learning at own pace.
resources. Such as: books, magazines, news
paper and t.v programs.
Review specific dietary changes/ restrictions To promote wellness
with client.
Identify available support groups Additional opportunity for role-modeling.

ASSESSMENT (GECA): Patient EVALUATION:

After the 2 weeks communication and intervention, goal was fully met. Client:

 Remain free of preventable complications/ progression of illness and sequelae.

 Was able to verbalize understanding of information gained.
 Exhibit proactive management by anticipating and planning for eventualities of
condition/ potential complications.
 Assumed responsibility for managing treatment regimen.

inability to move purposefully within the physical environment; with limited ROM
NURSING DIAGNOSIS: Impaired Physical mobility related to neuromuscular involvement
(muscle weakness and numbness e.g. steroid-induced proximal muscle weakness) as manifested
by limited range of motion.

PLANNING: At the end of nursing interventions

 The patient will be able to have at least few steps as a signs of recovery
 Patient will demonstrate measures to increase mobility
 Patient performs physical activity independently or within limits of disease

INTERVENTIONS:

Intervention Rationale
Evaluate patient’s ability to perform
Activities of Daily Living efficiently and Restricted movement influences the capacity
safely on a daily basis. to perform most activities of daily living.
Safety with ambulation is a significant matter.
 0 – Completely independent Determines strengths or insufficiency and
 1 – Requires use of equipment or may give information regarding recovery.
device This helps out in preference of actions since
different methods are used for the following:
 2 – Requires help from another
flaccid and spastic paralysis.
person for assistance, supervision,
or teaching

 3 – Requires help from another

person and equipment or device

 4 – Is dependent, does not

participate in activity

Check for functional level of mobility Understanding the particular level, guide the
Level 1: walk, regular pace, on level design of best possible management
indefinitely; one flight or more but more short
of breath than normally
 Level 2: walk one city block or 500 ft. on
level; climb one flight slowly without
stopping
Level 3: walk no more than 50 ft on level
without stopping; unable to climb one flight
of stairs without stopping
Level 4: Dyspnea and fatigue at rest

EVALUATION: Goal met; patient was able to demonstrate measures to increase mobility

Patient performs physical activity independently or within limits of disease

ASSESSMENT (GECA): “Di pa ako nakakapagbuhat ng medyo mabibigat”

OBJECTIVE: Decreased strength in extremities

NURSING DIAGNOSIS: Risk for fall r/t body weakness

SCIENTIFIC EXPLANATION: Increased susceptibility to falling that may cause physical

harm

PLANNING: At the end of nursing interventions

 The patient will be free from fall as evidenced by ability to explain the safety precautions
 Patient will relate the intent to use safety measures to prevent falls.
 Patient and caregiver will implement strategies to increase safety and prevent falls in the
home.

INTERVENTIONS:

Intervention Rationale
Identify factors that affect safety needs To know the intervention that will be
established
Assess the patient ability to ambulate safely It is helpful to determine the client’s
with or without assistive device functional abilities to plan for ways of
improving the problem areas
 Thoroughly orient the patient to environment For the client to familiarize the surroundings
Assess vision and provide adequate lighting To provide well-lighted environment and
to clearly see the pathway avoid the occurrence of injury
Ask the significant others to always with the To ensure client safety
client
Instruct the patient to call for assistance when To prevent patient from falling on bed
moving
Ensure that the patient wears proper shoes To prevent from slippering

EVALUATION: The goal was met, the client was able to meet the goals as evidence by the
intervention done.

ASSESSMENT (GECA): Patient’s desire to improve nutritional status

NURSING DIAGNOSIS: Readiness for Enhanced Nutrition Related to Improved Nutritional

intake as evident by verbalization of desire to improve nutritional status

PLANNING: at the end of nursing intervention

Patient will identify and alter behaviour that impedes enhanced nutritional status

Patient will verbalize an understanding of their nutritional needs

Patient organizes relevant activities requiring energy expenditure into daily life.

INTERVENTIONS:

Interventions Rationale
Ask patient to keep 1 to 3 day food dairy Helpful to examine usual foods eaten and
patterns of eating.
Advise patient to measure food regulary Measuring food alerts patient to normal
portion sizes. Estimating amounts can be
extremely inaccurate
Educate patient about adequate nutritional Permanent lifestyle changes must occur for
intake. A total plan permits occasional treats. weight loss to be long lasting. Excluding all
treats is not sustainable. During energy
restriction, a patient should consume 72 to 80
 g of high biological value protein per day to
lessen risk of ventricular arrhythmias.
Encourage water intake Water helps in elimination of byproducts of
fat breakdown and helps prevent ketosis

EVALUATION: Goal met. Patient was able to identify and alter behaviour that impedes
enhanced nutritional status and was to understand nutritional needs as evidenced by nursing
interventions done.

XIII. HEALTH TEACHINGS

Cancer survivors engage in cancer screenings and protective health behaviors at suboptimal rates
despite their increased risk for future illness. Survivorship care plans and other educational
strategies to prepare cancer survivors to adopt engaged roles in managing long-term follow-up
care and health risks are needed. After the cancer treatment, as a cancer survivor they’re eager to
return to good health. The recommendations for cancer survivors are no different from the
recommendations for anyone who wants to improve his or her health. But for cancer survivors,
the following strategies have added benefits. These simple steps can improve the quality of life,
smoothing the transition into survivorship. 

 Physical Activity upon Recommendations

Following a thorough physical, laboratory, and diagnostic assessment, general instructions and
considerations tailored to the patient should be developed immediately, before advocating an
activity or exercise regimen, the patient’s personal motivation to participate (e.g. the belief that
exercise will help them) and factors such as social support should be considered as these may be
important facilitators for exercise adherence.

For patients with Multiple Myeloma, remaining as physically active as possible is very
important. Regular exercise increases sense of well-being after cancer treatment and can speed
the recovery. Exercise can help keep muscles functioning and prevent problems associated with
long-term bed rest, such as stiff joints, breathing problems, constipation, skin sores, poor
appetite, inability to sleep, and general fatigue. Cancer survivors who exercise may experience:
 Increased strength and endurance
 Fewer signs and symptoms of depression
 Less anxiety
 Reduced fatigue
 Improved mood
 Higher self-esteem
 Less pain
 Improved sleep
 Lower risk of the cancer recurring
The following are exercise recommendations for patients with multiple myeloma.

What to Do:

 Do as much daily self-care as possible.

 Take a walk everyday
 Try to do a specific prescribed regimen that is approved by the doctor
 Eat a nutritious diet, drink plenty of fluids, and get plenty of rest
 Keep a log or journal of your activity
 Notify your healthcare provider about sudden onset of pain, progressive weakness,
headaches, blurred vision, numbness, and tingling.

What not to do:

 Stay in bed with little movement

 Let other do for you what you can do for yourself
 Force yourself to exercise if you are having symptoms from your disease or treatment
 Try to perform any exercise without first asking the nurse, doctor, or physical therapist
 Move any joint or body part if it is painful

Adding physical activity to your daily routine doesn't take a lot of extra work. Focus on small
steps to make your life more active. With the doctor's approval, start slowly and work the way
up. The American Cancer Society recommends adult cancer survivors exercise for at least 150
minutes a week, including strength training at least two days a week. As you recover and adjust,
you might find that more exercise makes you feel even better.

 Do what you can

While you may worry that it will take an entire overhaul of your lifestyle to achieve all these
goals, do what you can and make changes slowly. Easing into a healthy diet or regular exercise
routine can make it more likely that you'll stick with these changes for the rest of your life.

 Eat a balanced diet

Vary your diet to include lots of fruits and vegetables, as well as whole grains. When it comes to
selecting your entrees, the American Cancer Society recommends that cancer survivors:

 Eat at least 2.5 cups of fruits and vegetables every day

 Choose healthy fats, including omega-3 fatty acids, such as those found in fish and
walnuts
 Select proteins that are low in saturated fat, such as fish, lean meats, eggs, nuts, seeds and
legumes
 Opt for healthy sources of carbohydrates, such as whole grains, legumes, and fruits and
vegetables
This combination of foods will ensure that you're eating plenty of the vitamins and nutrients you
need to help make the body strong.

 Maintain a healthy weight

Client may have gained or lost weight during treatment. Try to get their weight to a healthy level.
Talk to a doctor about what a healthy weight is for you and the best way to go about achieving
that goal weight.

For cancer survivors who need to gain weight, this will likely involve coming up with ways to
make food more appealing and easier to eat. Talk to a dietitian who can help you devise ways to
gain weight safely.

You and your doctor can work together to control nausea, pain or other side effects of cancer
treatment that may be preventing you from getting the nutrition you need.
For cancer survivors who need to lose weight, take steps to lose weight slowly — no more than 2
pounds (about 1 kilogram) a week. Control the number of calories you eat and balance this with
exercise. If you need to lose a lot of weight, it can seem daunting. Take it slowly and stick to it.

 Rest well

Sleep problems are more common in people with cancer, even survivors. This can be due to
physical changes, side effects of treatment, stress or other reasons.

But getting enough sleep is an important part of your recovery. Sleeping gives your mind and
body time to rejuvenate and refresh to help you function at your best while you're awake. Getting
good sleep can boost cognitive skills, improve hormone function and lower blood pressure. It can
also just make you feel better in general.

To optimize your chances at getting good sleep, practice healthy sleep hygiene:

 Avoid caffeine for at least 8 hours before bedtime

 Stick to a regular sleep schedule
 Avoid computer or television screens for 1 to 2 hours before bedtime
 Exercise no later than 2 to 3 hours before going to bed
 Keep your bedroom quiet and dim
 Reduce stress

As a cancer survivor, you may find that the physical, emotional and social effects have taken a
toll on your psyche. Though there's no evidence that managing stress improves chances of cancer
survival, using effective coping strategies to deal with stress can greatly improve your quality of
life by helping relieve depression, anxiety, and symptoms related to the cancer and its treatment.

Effective stress management strategies may include:

 Relaxation or meditation techniques, such as mindfulness training

 Counseling
 Cancer support groups
 Medications for depression or anxiety
 Exercise
 Interacting with friends and family
 Follow-up care

During and after treatment, it’s very important to go to all follow-up appointments. During these
visits, the doctors will ask about symptoms, examine you, and order blood tests or imaging
studies such as CT scans or x-rays. Follow-up is needed to see if the cancer has come back, if
more treatment is needed, and to check for any side effects. This is the time for you to talk to
your cancer care team about any changes or problems you notice and any questions or concerns
you have. Almost any cancer treatment can have side effects. Some last for a few weeks to
several months, but others can be permanent. Don’t hesitate to tell your cancer care team about
any symptoms or side effects that bother you so they can help you manage them.

 Keeping health insurance and copies of your medical records

Even after treatment, it’s very important to keep health insurance. Tests and doctor visits cost a
lot, and even though no one wants to think about their cancer coming back, this could happen. At
some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t
know about your medical history. It’s important to keep copies of your medical records to give
your new doctor the details of your diagnosis and treatment.

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