Multiple myeloma (MM) is a complex hematologic malignancy characterized by the abnormal proliferation of plasma cells in the bone marrow. This nursing diagnosis focuses on identifying and managing symptoms, preventing complications, and improving the quality of life for patients with multiple myeloma.
Causes (Related to)
Multiple myeloma affects patients through various mechanisms and risk factors:
- Abnormal plasma cell proliferation in bone marrow
- Advanced age (typically over 60)
- Genetic factors include:
- Family history
- Specific chromosomal abnormalities
- African American descent
- Contributing conditions such as:
- Chronic inflammation
- Obesity
- Previous radiation exposure
- MGUS (Monoclonal Gammopathy of Undetermined Significance)
Signs and Symptoms (As evidenced by)
Multiple myeloma presents with various signs and symptoms that nurses must recognize for proper assessment and care planning.
Subjective: (Patient reports)
- Bone pain, especially in the spine and chest
- Fatigue and weakness
- Frequent infections
- Unexplained weight loss
- Easy bruising or bleeding
- Mental confusion
- Shortness of breath
Objective: (Nurse assesses)
- Elevated calcium levels
- Decreased hemoglobin and hematocrit
- Elevated serum protein
- Increased creatinine levels
- Pathological fractures
- Decreased urinary output
- Abnormal protein electrophoresis
Expected Outcomes
Success in managing multiple myeloma is indicated by:
- Pain levels will be effectively managed
- The patient will maintain adequate hydration
- The patient will avoid infections
- The patient will demonstrate improved mobility
- The patient will maintain optimal nutrition
- The patient will show improved blood counts
- Patient will verbalize understanding of disease management
Nursing Assessment
Monitor Blood Values
- Complete blood count
- Serum calcium
- Kidney function tests
- Protein electrophoresis
- Light chain analysis
Assess Pain Status
- Location and intensity
- Aggravating factors
- Response to interventions
- Impact on daily activities
- Pain patterns
Evaluate Mobility
- Risk for pathological fractures
- Balance and gait
- Activity tolerance
- Use of assistive devices
- Safety concerns
Monitor for Complications
- Signs of infection
- Bleeding tendencies
- Neurological changes
- Kidney function
- Bone integrity
Assess Support Systems
- Family involvement
- Understanding of disease
- Available resources
- Emotional status
- Financial concerns
Nursing Care Plans
Nursing Care Plan 1: Chronic Pain
Nursing Diagnosis Statement:
Chronic Pain related to bone destruction and pathological fractures as evidenced by a reported pain level of 7/10 and decreased mobility.
Related Factors:
- Bone lesions
- Pathological fractures
- Compression of nerves
- Disease progression
Nursing Interventions and Rationales:
- Administer prescribed pain medications as ordered
Rationale: Ensures adequate pain control and improved quality of life - Assist with positioning and mobility
Rationale: Reduces pain and prevents complications - Monitor pain levels and response to interventions
Rationale: Allows for timely adjustment of pain management strategy
Desired Outcomes:
- The patient will report pain level at 3/10 or less
- The patient will demonstrate improved mobility
- The patient will utilize effective pain management strategies
Nursing Care Plan 2: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to immunocompromised state and decreased white blood cell count.
Related Factors:
- Compromised immune system
- Chemotherapy effects
- Disease process
- Invasive procedures
Nursing Interventions and Rationales:
- Implement neutropenic precautions
Rationale: Prevents exposure to pathogens - Monitor for signs of infection
Rationale: Enables early detection and intervention - Educate about infection prevention
Rationale: Empowers patient in self-care
Desired Outcomes:
- The patient will remain free from infection
- The patient will demonstrate proper infection prevention techniques
- The patient will identify early signs of infection
Nursing Care Plan 3: Risk for Injury
Nursing Diagnosis Statement:
Risk for Injury related to weakened bone structure and hypercalcemia as evidenced by the presence of lytic lesions.
Related Factors:
- Osteoporosis
- Pathological fractures
- Balance impairment
- Confusion from hypercalcemia
Nursing Interventions and Rationales:
- Implement fall precautions
Rationale: Prevents injury from falls - Assist with safe mobility
Rationale: Maintains independence while ensuring safety - Monitor calcium levels
Rationale: Prevents complications of hypercalcemia
Desired Outcomes:
- The patient will remain free from injury
- The patient will demonstrate safe mobility techniques
- The patient will maintain normal calcium levels
Nursing Care Plan 4: Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to bone pain and weakness as evidenced by difficulty with ambulation.
Related Factors:
- Bone pain
- Fatigue
- Muscle weakness
- Fear of injury
Nursing Interventions and Rationales:
- Provide appropriate assistive devices
Rationale: Supports safe mobility - Implement exercise program as tolerated
Rationale: Maintains strength and function - Schedule activities with rest periods
Rationale: Prevents fatigue and promotes participation
Desired Outcomes:
- The patient will demonstrate safe mobility
- The patient will participate in daily activities
- The patient will maintain muscle strength
Nursing Care Plan 5: Fatigue
Nursing Diagnosis Statement:
Fatigue related to disease process and treatment effects as evidenced by decreased energy and activity intolerance.
Related Factors:
- Anemia
- Treatment side effects
- Disease progression
- Poor nutrition
Nursing Interventions and Rationales:
- Promote energy conservation
Rationale: Maximizes available energy - Monitor nutritional intake
Rationale: Ensures adequate energy resources - Balance activity with rest
Rationale: Prevents exhaustion while maintaining function
Desired Outcomes:
- The patient will report improved energy levels
- The patient will complete daily activities without excessive fatigue
- The patient will maintain adequate nutrition
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Basić-kes V, Basić-Jukić N, Kes P, Demarin V, Labar B. Neuroloske posljedice kostanih promjena pri multiplom mijelomu i njihovo lijecenje [Neurologic sequelae of bone changes in multiple myeloma and its therapy]. Acta Med Croatica. 2002;56(3):103-7. Croatian. PMID: 12630341.
- Bobin A, Leleu X. Recent advances in the treatment of multiple myeloma: a brief review. Fac Rev. 2022 Sep 29;11:28. doi: 10.12703/r/11-28. PMID: 36225211; PMCID: PMC9523543.
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- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Qureshi A, Tariq MJ, Shah Z, Abu Zar M, Aslam S, Rafae A, Shafqat M, Malik MN, Faisal MS, Anwer F. Evidence-based supportive care in multiple myeloma. J Community Hosp Intern Med Perspect. 2020 Aug 2;10(4):313-317. doi: 10.1080/20009666.2020.1771124. PMID: 32850087; PMCID: PMC7427456.
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