Multiple Myeloma a Long Term Condition

Cancer appears to have appeared more frequently in recent years than it did previously. A considerable proportion of people can attest to having met or heard of someone with cancer at some point in their lives. Because body cells divide and spread swiftly, the disease can be fatal if not treated soon. The body’s composition illustrates that an individual’s old body cells should perish as new ones regenerate. In the case of cancer, however, as new cells develop, the old ones move around surrounding tissues and stack up to produce a swelling rather than dying. Consequently, the swelling becomes cancerous which in the future causes a person to become ill and later die if not discovered and treated early. The purpose of this assignment includes exploring a patient’s two problems linked to a long-term condition known as multiple myeloma and later create a care plan for the care recipient.

Pathophysiology

According to João, Costa, Coelho, Vergueiro, Ferreira & da Silva (2014, p. 173), multiple myeloma is one of the many incurable, progressive neoplasm cancers. The pathophysiology of multiple myeloma lies on the rapid spread of cell tissues within a person’s body that affect the immune system. The immune system comprises of several cells including the type T and B Lymphocytes cells, which fight infectious diseases (What is multiple myeloma? 2016, para. 3). Moreover, plasma cells are found in the bone marrow. Furthermore, B cells turn to plasma cells once they respond to an infection and mature. In this case, a person acquires multiple myeloma when several malignant plasma cells become cancerous, spread quickly, and form tumors that develop in the bone.

Incidence and Prevalence

At least 1 in every 143 people can get multiple myeloma since the disease frequently occurs among both sexes. Becker (2011, p. 25) conducted a study that indicated that on an annual basis, at least 86 000 people are diagnosed with multiple myeloma. Furthermore, at least 63 000 cases of persons diagnosed with the condition die. Since the disease is unevenly distributed worldwide, it is difficult to pinpoint a specific country that has a prevalence of the disease. However, some of the states that have registered the highest numbers of persons diagnosed with multiple myeloma include of Australia, Europe and North America (Becker 2011, p. 28). Finally, the frequency of multiple myeloma appears to be stable in Asian countries but tends to increase among the western nations.

Impact on Individuals

Multiple myeloma has psychological, social, and even economic impacts on individuals. For instance, the treatment of the condition is expensive because it requires a bone marrow transplant. In such a case, the patient plus the care recipient’s family will incur a lot of medical costs that could strain any person contributing to help the individual (Goodwin, Coleman, Sullivan, Easley, McNatt, Chowdhury & Stewart 2013, p. 304). Equally, a person diagnosed with multiple myeloma can become depressed because of the chronic state of the condition. If the patient does not have a good support system, then, the individual will face psychological torture knowing the outcome of the condition in the future. Finally, since the patient will undergo chemotherapy and radiotherapy among other treatments, the individual’s body will be affected as a response to the medication and the intense therapy sessions. Consequently, healthcare providers should equip the patient with such information so that the individual can know what to expect.

Overview of Patient’s Demographic, Social and Medical History

Demographics

In this report, I will analyze a case of one patient to help the reader understand the complexity of multiple myeloma. The patient consented to study but the care recipient’s name will be disclosed and a pseudo name used instead for confidentiality purposes. Gavin, the false name given to the patient, was diagnosed with multiple myeloma. Part of the demographics depicts that the patient is a 48-year-old male who complained of bone pain, fatigue, and chronic cases of infections. Additionally, Gavin is a Caucasian male living in America. However, the individual cautioned the release of some demographic information such as his address when writing the report for confidentiality purposes. Consequently, once the nurse provided the doctor with the demographic details, the physician conducted a series of tests and diagnosed the patient with multiple myeloma. Eventually, the physician recommended undergoing post allogeneic stem cells transplant as the recommended treatment for the patient. According to The Leukemia & Lymphoma Society (2010, p. 430), patients undergo allogeneic stem cell transplantation after experiencing high-intensity chemotherapy or radiation. In such a case, the physician recommended allogeneic stem cell transplantation, which involves the transfer of healthy stem cells from a donor to Gavin, since the care recipient’s body could not regenerate any cells after the high-conditioning regimens.

Social History

The patient’s social history also play a vital role in Gavin having multiple myeloma. For instance, the patient has been overweight for several years, and obesity remains one symptom of multiple myeloma. Equally, the patient worked in occupations that exposed him to chemicals. Once the body is exposed to chemicals such as pesticides, it increases the patient’s chances of having the multiple myeloma disease. Gavin also admitted to drinking a lot of alcohol as a way to pass the time with friends, especially after work sessions.

Medical History

In the case of Gavin’s medical history, the individual revealed several medical issues that not only signified the symptoms but also contributed to the long-term illness. For example, the patient’s medical records presented cases of regular fatigue because of infections that cause sleep disturbances. Additionally, Gavin’s medical records also depicted instances of weakness, and anemia since the bone marrow could not reproduce cells sufficient red blood cells or hemoglobin and lack of its abundance also contribute towards fatigue. Gavin’s medical history even portrayed cases of obesity in his family, which might have also led to him being overweight. However, the choice of food selected by Gavin also increased the risk of the patient having the illness. The medical history also highlighted cases of renal failure and bone pain. Gavin reported instances of feeling severe pains in the pelvis and his back, which occurred frequently. Initially, the pains centered on the lower back and as time progressed it affected the skull and the pelvis. The patient also complained of bleeding and sort medical attention at least four times in six months. Additionally, doctor’s result also depicted that the patient had Hypercalcemia, which refers to a condition that comes about when a person’s blood pressure is above average (Mayo Clinic Staff 2017, para. 1). Gavin stated that the bone pains had been on and off for about a year while renal failure became worse in when he turned 42 years. Consequently, all the mentioned risk factors contributed significantly to Galvin’s medical condition and they also helped determine the recommended treatment.

Patient’s Problems

People diagnosed with multiple myeloma usually suffer and develop particular needs depending on the individual. The issues may differ psychologically or physically. In the case of Gavin, the two patient problems linked to the disease included Chronic Graft versus Host disease developed (GVHD) and Mucositis.

GvHD

Since the doctor recommended post allogeneic stem cells transplant treatment as the most preferred one for Gavin’s case, the patient would likely experience GvHD. Saes, Klerk, Van der Klift, Cornelissen, & Broers (2017, p. 1) described GvHD as a complication that presented itself among patients who undergo bone marrow transplant treatments such as the post allogeneic stem cells transplant. Moreover, bone marrow transfer treatment also calls for high doses of chemotherapy or radiotherapy that may kill a person’s red blood cells (Horibata, Ukai, Ishikawa, Sugano & Honma 2016, p. 23). Once a person receives a stem transplant, the patient’s body might accept or reject the cells since they are a foreign body (Maschke & Gusmano 2017, p. 918). Consequently, Gavin is likely to face the same problem and would require assistance to overcome the GvHD’s physically related outcome.

Nurses taking care of post allogeneic stem cells transplant recovery patients should be aware of GvHD and the necessary care plan and treatment essential for such an individual that will enable the person recover fully. As part of the care plan and treatment, nurses can focus on the following measures. Treating Gavin’s GvHD condition may require the use of steroids. However, the nurse has to confirm the range of GvHD before providing the steroids. For instance, in case of mild GvHD cases the care provider might not use the steroids for a person in grade 4 (Cancer Research UK 2017, par. 2). Consequently, one commonly used steroid to deal with the GvHD pain include prednisolone (Hinterberger, Barrett, Lechner & Deutsch 2013, p. 315).

Caring for a patient with GvHD may also require the use of Extracorporeal Photopheresis (ECP). Nurses can work with physicians by focusing on the application of ECP, which refers to therapy that modulates the number of leukocytes from peripheral blood (Klassen 2010, p. 57). The aim of utilizing this procedure involves treating the leukocytes with ultraviolet (UV) radiation such that they can achieve their purpose (Zhu, Couriel, & Chang 2016, p. 380). Eventually, once the leukocytes have been exposed to the photosensitizing agent, 8-methoxypsoralen, and UV, they can be refused into Gavin’s body and ensure that the recipient’s body does not reject the transplant anymore (Klassen 2010, p. 57).

Another steroid that the nurses should consider giving Gavin for treating GvHD includes pentostatin medication also referred to as an anticancer chemotherapeutic drug. Pentostatin aids in inhibiting cancer cells from processing their DNA and multiplying in the future after the stem transplant (Pentostatin (nipent) 2017, para. 2). Just like pentostatin, rituximab also acts as a drug that can be used during chemotherapy or alone to fight cancer cells from regenerating after a transplant has taken place (MedlinePlus 2017, par. 3). Finally, according to Drugbank (2017, para. 20), healthcare providers can use imatinib to treat GvHD condition since it slows the growth of cancer cells. Overall, the mentioned drugs can help Gavin, deal with the side effects of GvHD condition after the transplant.

Mucositis

Unlike GvHD, nurses could also implement Mucositis as a recommendable treatment option for Gavin’s psychological need. Patients who have undergone stem replacement face not only physical problems but also encounter psychological issues that could adversely impact the individual’s recovery. For this reason, it becomes essential for nurses to establish care plans that could solve the individual’s needs. Mucositis refers an after effect of chemotherapy that affects any part of a patient’s digestive tract (Reyes-Gibby 2017, p. 2). Part of the Post allogeneic stem cells transplant requires a patient to undergo chemotherapy and radiotherapy that prepares the patient for the stem transplant.

As part of the treatment, care providers should encourage measures such as self-care mouthwash. Gavin’s mouth may develop blisters, and that could disgust the patient to the extent that he feels ugly or a bother to the people taking care of him. The problem with such an attitude is that it may affect Gavin’s mood all the time. However, nurses could help the patient control this situation by asking the patient to take care of his mouth through regular mouthwash to avoid cases of bad breath, oral thrush or mouth inflammation (Grainger 2017, p. 50). Furthermore, once the patient learns and understands the impact of regular mouthwash, it becomes easier to eat, which promotes quick recovery needed by the patient’s body.

Another way to solve the psychological issue includes involving a nutritionist to help the patient with meal plans. Just like any other patient, Gavin needs nutritious food to facilitate recovery. Therefore Ivanic (2016, p. 596) suggests that nurses should help patients create an effective nutritional plan since food choices also affect a person’s mood.

As stated earlier, patients react differently to chemotherapy, which affects their digestive system in various ways. In the case Gavin experiences terrible pain resulting from severe oral mucositis, the nurses can administer the use of Palifermin. PDA approved this the use of this drug especially for cancer patients who have received a high dosage of chemotherapy to help them deal with the pain. Additionally, the drug can also reduce the incidence of severe oral mucositis for patients like Gavin who have undergone stem transplant because of hematologic malignancies. A person in pain will do anything to reduce the feeling. In such a case, the pain formulates a psychological response such that the patient can become aggressive or due to mood swings the patient may become suicidal as a solution to dealing with the problem. After the healthcare officials informed Gavin, of the outcomes of the treatment, the patient showed some level uncertainty that was coupled with negativity, anger, fear, and rejection of treatment. However, according to the National Cancer Institute (2013, para. 2), the use of Palifermin medication can control the pain and help the patient relax after the treatment towards facilitating the needed recovery.

Conclusion

The health of every individual is vital to society since the economy of a state depends on the wellbeing of the people. Nobody likes the idea of falling ill but due to lifestyle changes among other factors, people become sick regularly, and some people become ill with cancer conditions such as Multiple Myeloma. Even though the disease is a rare one that does not mean that the healthcare industry should overlook it. The report reveals the demographics, social factors and medical history risks of Gavin as linked to Multiple Myeloma to help other people have an idea of the condition. Additionally, the text also creates awareness of problems that could arise after a person undergoes the stem transplant, which impacts a patient both physically and psychologically. The needs vary depending on the patient. Consequently, nurses should identify a patient’s needs to know how to support the patient.

Care Plan

Patient Need/Problem Nursing Goal Nursing Intervention Evaluation

GvHD

Help patient boost physical recovery Administer steroids depending on the severity of the condition.

Some of the medications that could be used for Gavin’s case include

(ECP), pentostatin, rituximab, and imatinib. I would evaluate the impact of the medications by checking on the patient’s rate of recovery. If the physical problems persist, I will inform the doctor for further analysis and change of drugs

Mucositis

Assist patient to deal with psychological problems Regular self-care mouthwash to deal with cases of bad breath or mouth inflammation that could negatively impact the patient’s mood.

The assistance of a nutritionist to plan patients meals will be necessary I will monitor the patient’s mood around family. Positive responses will indicate

Class of Drug Correct range of dosage BRIEF description of how each medication asserts its effect Side effects to be aware of

ECP Drip depends on patient Extraction of leukocytes and combing them with 8-MOP and UVA radiation Low-grade anemia

Transient hypotension, and Tachycardia

Pentostatin 4 mg/m2 per fortnight Injected into the patient’s blood vessels Anorexia, itching, cough, and muscle aches

Rituximab 375 mg/m2 eight times Used during chemotherapy Headache, fever, chill, and nausea

Bibliography

Barrett, JA & Battiwalla, M 2010, ’Relapse after allogeneic stem cell transplantation,’ Expert

Review Hematology, vol. 3, no. 4, pp. 429-441.

Becker, N 2011, ’Epidemiology of multiple myeloma,’ Recent Results Cancer Research, vol.

183, pp. 25-35.

Cancer Research UK 2017, Treatment for acute GvHD, viewed 25 December 2017,

http://www.cancerresearchuk.org/about-cancer/coping/physically/gvhd/treatment/acute-gvhd

Drugbank 2017, Imatinib, viewed 25 December 2017,

https://www.drugbank.ca/drugs/DB00619

Goodwin, JA, Coleman, AE, Sullivan, E, Easley, R, McNatt, KP, Chowdhury, N, & Stewart, BC

2013, Personal financial effects of multiple myeloma and its treatment, Cancer Nursing, vol. 36, no. 4, pp. 301-308.

Grainger, A 2016, Essential practice for healthcare assistants, New Bedford Rd, UK, Andrews

UK Limited.

Hinterberger, W, Barrett, AJ, Lechner, K & Deutsch, E 2013, 11th annual meeting of the ebmt:

european cooperative group for bone marrow transplantation, New York, NY, Springer.

Horibata, K, Ukai, A, Ishikawa, S, Sugano, A & Honma, M 2016, ’Monitoring genotoxicity in

patients receiving chemotherapy for cancer: application of the PIG-A assay,’ Mutation Research/Genetic Toxicology & Environmental Mutagenesis, vol. 808, pp. 20-26.

João, C, Costa, C, Coelho, I Vergueiro, J, Ferreira, M & da Silva, G, M 2014, ’Long-term

survival in multiple myeloma,’ Clinical Case Reports, vol. 2, no. 5pp. 173-179.

Klassen, J 2010, ’The role of photopheresis in the treatment of graft-versus-host disease,’

Current Oncology, vol. 17, no. 2, 55-58.

Maschke, KJ & Gusmano, MK 2016, ’Evidence and access to biomedical interventions: the case

of stem cell treatments,’ Journal of Health Politics, Policy & Law, vol. 41, no. 5, pp. 917-937.

Mayo Clinic Staff 2017, Hypercalcemia, viewed 25 December 2017,

https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523.

MedlinePlus 2017, Rituximab injection, viewed 25 December 2017,

https://medlineplus.gov/druginfo/meds/a607038.html

National Cancer Institute 2013, FDA approval for palifermin, viewed 26 December 2017,

https://www.cancer.gov/about-cancer/treatment/drugs/fda-palifermin

Reyes-Gibby, C et al 2017, ’Identifying novel genes and biological processes relevant to the

development of cancer therapy-induced mucositis: An informative gene network analysis,’ PLoS ONE, vol. 12 no. 7, pp. 1-21.

Saes, L, Klerk, CPW, Van der Klift, M, Cornelissen, JJ & Broers, AEC 2017, ’Etanercept for

steroid-refractory acute graft-versus-host disease: A single center experience,’ PLoS ONE, vol. 12, no. 10, pp. 1-10.

What is multiple myeloma? 2016, viewed 24 December 2017,

https://www.cancer.org/cancer/multiple-myeloma/about/what-is-multiple-myeloma.html

Zhu, L, Couriel, DR & Chang, C 2016, ’The effect of extracorporeal photopheresis on T cell

response in chronic graft-versus-host,’ Leukemia & Lymphoma, vol. 57 no. 2, p376-384.

Pentostatin (nipent) 2017, viewed 26 December 2017,

https://www.macmillan.org.uk/cancerinformation/cancertreatment/treatmenttypes/chemotherapy/individualdrugs/pentostatin.aspx

Ivanic, AS 2016, To choose (not) to eat healthy: social norms, self-affirmation, and food choice,

Psychology & Marketing, vol, 33, no. 8, pp. 595-607.