Question

A 67 -year-old female is returning to the medical clinic for a follow-up visit due to complaints of back pain, frequent fevers and weight loss. CBC and serum chemistry disclosed high serum calcium and protein levels and low levels of hemoglobin, red blood cells, platelets, and white blood cells. With which problem are these signs and symptoms consistent? A. Anemia B. Arthritis C. Multiple myeloma D. Systemic lupus erythematosis

Short answer

The patient's signs and symptoms are most consistent with Multiple myeloma (C).

Step-by-step solution

Analyze the Presenting Symptoms

Review the patient's symptoms which include back pain, frequent fevers, and weight loss, along with the laboratory findings of high serum calcium and protein levels, and low levels of hemoglobin, red blood cells, platelets, and white blood cells.

Correlate Symptoms with Medical Conditions

Using medical knowledge, correlate the presenting symptoms and lab findings with the potential medical conditions listed. Anemia is associated with low hemoglobin and possibly low red blood cell count; arthritis doesn't typically cause changes in blood cell counts or high calcium and protein levels; multiple myeloma is associated with bone pain, high serum protein and calcium levels, and can cause anemia and lower blood cell counts due to bone marrow infiltration; systemic lupus erythematosis typically presents with a variety of symptoms and can cause low blood cell counts but isn't commonly associated with high serum calcium and proteins.

Determine the Most Consistent Diagnosis

Given the information provided, choose the diagnosis that best matches the array of symptoms and lab findings. Multiple myeloma is the condition most consistent with all the patient's signs and symptoms.

Key concepts

Nursing Diagnosis

Identifying the underlying health conditions through appropriate nursing diagnosis plays a crucial role in providing patient care. It involves a critical assessment of the patient’s symptoms and correlating these with the patient’s medical history and laboratory findings. For the presented case, the patient has significant symptoms such as back pain, frequent fevers, and weight loss. These symptoms, combined with her abnormal laboratory results—including high serum calcium and proteins, along with low hemoglobin, red blood cells, platelets, and white blood cells—are alarming signs that must be addressed promptly.

In nursing practice, diagnosing such a complex clinical presentation would include evaluating all patient data carefully. An accurate diagnosis allows for the development of a comprehensive plan of care, tailored to address the patient's specific needs, and for prioritization of interventions based on the urgency and severity of symptoms. This critical thinking process ensures that the patient receives the most appropriate and effective healthcare intervention possible.

Laboratory Findings Interpretation

Interpreting laboratory results is a foundational skill for healthcare professionals, providing clues to a patient's underlying condition. When a patient presents with abnormal laboratory findings, such as high serum calcium and protein levels coupled with low levels of hemoglobin and blood cells, it is essential to understand what these results might indicate. For instance, high serum calcium (hypercalcemia) can cause various symptoms and might suggest bone metabolism issues, while an elevated protein level, especially when it includes a particular type called monoclonal protein, can indicate abnormal plasma cell activity.

Low levels of hemoglobin and various blood cells (pancytopenia) are often signs of bone marrow dysfunction. By interpreting these labs within the context of the patient's presenting symptoms and medical knowledge of related disorders, healthcare providers can narrow down their differential diagnoses and move towards a more accurate diagnosis and subsequent treatment plan. Understanding how to effectively interpret these findings is imperative to formulate a correct clinical judgment.

Multiple Myeloma

Overview of Multiple Myeloma:
Multiple myeloma is a type of cancer that affects plasma cells in the bone marrow. These cells are essential for producing antibodies that fight infection, but when they become cancerous, they proliferate and produce abnormal proteins which can cause complications.

Signs and Symptoms:
Patients with multiple myeloma may exhibit symptoms such as bone pain, especially in the back or ribs, frequent infections due to lowered immunity, fatigue resulting from anemia, and weight loss. Laboratory findings of elevated calcium and abnormal protein levels (usually monoclonal protein or M protein) along with a decrease in hemoglobin and blood cell counts suggest impaired bone marrow function, often due to infiltration by multiple myeloma cells.

Diagnosis and Management:
To diagnose multiple myeloma, healthcare providers consider these symptoms and lab findings in conjunction with diagnostic imaging and bone marrow biopsy. The condition is managed with a combination of medications to control the proliferation of myeloma cells, treatments to strengthen bones and prevent fractures, and supportive therapies to mitigate symptoms. Early detection and proper treatment of multiple myeloma are critical for improving patient outcomes and quality of life.