Discharge Care Plan Medication

Nursing Intervention - Instruct patient to take medications as prescribed. Advice to avoid waiting until the pain is too bad before taking the medication (Rationale: The drugs may not work as well at controlling the pain if intake of drugs is delayed) -Instruct patient to notify caregiver if the pain medication does not help or if the pain persist. - If the patient is undergoing chemotherapy, Instruct patient to take the medication exactly as the order. - Instruct patients about activity restrictions (e.g., lifting no more than 10 pounds, use of proper body mechanics.) -Assess the patient's ability to do activity of daily ling and, if necessary, the family's ability to provide care (Rationale: Provides information about whether the patient can live at home or will need care in a rehabilitation center.) - Instruct patient about assistive devices such braces, wheelchair or walker, handhold bars and the need for position change. - If exercise is tolerable, Encourage patient to begin exercise slowly and do more as the patient regain strength. Advice patient to talk to his/her primary healthcare provider before starting any exercise program. (Rationale: Exercise promotes lower blood pressure and makes the heart stronger.) - Advice patient to avoid contact sport as the patient may bleed, bruise, or break bone easily. - Instruct family members on how to instate safety measures to prevent fall and injuries. - Instruct family members to remove sharp objects and other potentially hazardous items from the environment If they observe manifestation of disorientation or confusion of the patient. - If the patient is bedridden, Instruct the family members to turn the patient every 2 hours to prevent bed sores. -Instruct patient and family members to maintain ambulation and adequate hydration to diminish exacerbations of hypercalcemia, dehydration and potential renal damage - Instruct patient and family members about appropriate infection prevention measure (eg. Hand and body hygiene) and to contact the health care provider immediately if fever or other signs and symptoms of infection develop. ( Rationale: Patient's antibody production is impaired, infections, particularly bacterial infections, are common and can be life threatening.) - Instruct patient and family members about the manifestations of hypercalcemia, and instruct them to report any manifestations immediately to the physician. - S/S of Hympercalcemia: - GI: Nausea, Constipation, Abdominal pain and decreased appetite

Environment And Exercise

Treatment

Health Teachings

- GU: Flank pain and frequent urination - CNS: Confusion, Lethargy and fatigue - Skeletal: Bone pains and curving of the spine Out Patient -Instruct patient to comply to dates of follow up check up with his/her physician or to the hospital. (Rationale: For proper assessment and observation) -Instruct patient to not delay any treatment such as chemotherapy or radiation therapy at the hospital or to rehabilitation centers. -If the patient is eating poorly because of the side effects of treatments and drug. - Advice to include bland foods in his/her diet. These include baked chicken, baked fish, steamed rice, and cooked vegetables. -If the patient have impaired immune system - Advice to avoid fresh fruits and vegetables, which can contain bacteria that the body cannot combat. Instead advice to choose roasted vegetables, as well as canned fruits and vegetables. - Advice patient to avoid foods that are high in saturated fat, eating no more than four 4-ounce servings of red meat weekly and limiting the consumption of full-fat dairy products. (Rationale: Eating a large amount of fat saturated increase the risk of cancer) -Advice patient for balance diet of foods with calcium and vitamin D, such as low-fat yogurt, skim milk, and cheese made with part skim milk. ( Rationale: Multiple myeloma impairs the function of the bones so the need to strengthen the bones is indicated; Too much intake of calcium can lead to hypercalcemia; Vitamin D promotes increased immunity to infections) -If the patients kidney is impaired due to myeloma - Although getting enough protein is important, Advice the patient the need to cut down on protein-containing foods, including meat and dairy products. -Advice patient to consult a dietician for proper planning of diets. Support -Advice the need of counselling for the patient and the family members to deal with the eventual fatal outcome of multiple myeloma.

Diet