Mini Case Study

U N I T YPOINT HEA LT H M E T HODIST

LAUR EN CHA N
FA L L 2 0 1 7
Patient SP
Age/Sex: 41, Male
Height: 5’ 10”
Weight: 214 (BMI 30.7)
Occupation: Excel Foundry
Family: Wife, daughter (2), baby on the way
Date of Admission: 10/2/2017
Attending Physician: Melanie Burns MD
Unit: 7H, Oncology
Previous Medical History
Diseases/Conditions: No major medical history
Hospitalizations: No prior hospitalizations
Treatments: N/A
Family Hx: Mother w/ renal cancer, Father w/ colon cancer
Recent Care:
- Cough, 3 weeks prior to admit
- MVA, 2 weeks prior to admit
Present Admission
Diagnosis: Light Chain Multiple Myeloma, Acute Kidney Injury, Hyponatremia,
Thrombocytopenia, Abnormal Albumin, and Low bicarbonate levels
Physical Examination: No physical findings of malnutrition
Significant Laboratory Findings: Na CO2 BUN Crea Phos Uric Acid
↓ ↓ ↑ ↑ ↑ ↑
Significant Imaging Findings/Procedures:
- CT Scans of abdomen and pelvis
- Renal Ultrasound
- Bone marrow aspirations
What is Multiple Myeloma?
Disease Definition
- Formed by malignant plasma cells, typically within the bone marrow
- Cancerous plasma cells  plasmacytoma
- Isolated plasmacytoma vs. multiple myeloma
Occurrence & Etiology:
- Relatively rare: 1 in 143 (0.7%)
◦ Men
◦ African Americans
◦ Family Hx
◦ Overweight/Obese
- Oncogenes, tumor suppressor genes, and chromosomes
What does Multiple Myeloma look like?
- Low blood counts
◦ Reduced WBC, RBC, Platelets
◦ Anemia, serious bleeding
- Monoclonal Gammopathy
◦ Excessive protein in blood
◦ Blood clots, kidney malfunction
- Bone and Calcium Problems
◦ Osteoporosis, fractures, pain
◦ Nervous system symptoms
◦ Elevated blood Ca levels
- Infection
◦ Increased susceptibility
- Kidney Problems
◦ Altered waste filtration abilities
◦ Renal failure
- Light Chain Amyloidosis
◦ Deposition of excess proteins in organs
◦ Heart, kidney, liver, spleen, digestive,
nervous
- Plasmacytomas
◦ Plasma cell tumors in bones
◦ Can affect soft tissues
Treating Multiple Myeloma
Medical Treatment: Complications of Prognosis:
◦ Chemotherapy Treatment: ◦ Dependent on staging
◦ Nausea/Vomiting & of myeloma
◦ Bisphosphonates
Diarrhea ◦ Myeloma patients are
◦ Radiation highly likely to relapse
◦ Stem Cell Transplants ◦ Fatigue in cyclical patterns
◦ Plasmapheresis ◦ Poor appetite ◦ No curative therapies
◦ Taste changes at this time
◦ Mucositis
◦ Mouth Sores
SP Medical Treatment
Medications Procedures Progress so far…
◦ Antivirals/Antibiotics ◦ Plasmapheresis ◦ Improved lab values
◦ Chemotherapy ◦ Blood transfusions ◦ Initial chemotherapy
◦ Stool Softeners PRN, Hgb <7 ◦ GFR improvements
◦ Phosphorus Binders
◦ Planning for outpatient
◦ Sodium Bicarbonate care
◦ Calcium Supplement
◦ Uric Acid Reducer
◦ Antiemetic
◦ Antacids
◦ Corticosteroids
 SP Medical Nutrition Therapy
Prior to Admit Current Status Plans Before Discharge…
◦ No documented Hx ◦ Renal Diet, moderate ◦ Clarify questions on renal
◦ Obese kcal & low protein diet education
◦ Decreased appetite, 2 ◦ Education on renal diet ◦ Recommend cautious
weeks prior to patient and wife
phosphorus, protein, and
◦ 15 lb weight loss, 2 ◦ Anticipating good purine intake at home
weeks prior compliance following
discharge ◦ Provide contact for
◦ Whole 30 outpatient dietitians
◦ Few processed foods ◦ Nepro/Suplena TID
◦ Typical eating patterns ◦ 25-50 % of meals
◦ Limited appetite,
nausea, constipation
Questions?