Multiple Myeloma.

Multiple myeloma (MM) is a cancer that arises from plasma cells in bone marrow. Approximately 35,730 Americans received a new diagnosis and MM will claim the lives of an estimated 12,590 people in 2023. Complications of the disease process include anemia, leukopenia, thrombocytopenia, renal failure, severe pain, bone loss, and hypercalcemia. Patients with MM have a high risk for pathological fractures. For most forms of MM there are effective treatments that may result in long-term remission using multi-drug regimens. Although the medications approved in the United States to treat MM generally produce good outcomes, they have serious, and potentially life-threatening adverse effects. In addition, patients with specific genetic variations are at high risk for relapse. Communication with the oncology team and early intervention in the event of adverse effects of medications, complications of the disease process, or evidence of relapse are important to obtain the best possible outcome. Patients are easily overwhelmed with a three- to four-drug treatment regimen with some drugs given intravenously and/or subcutaneously at the clinic, and others taken orally at home on specific days of each 28-day cycle. Home care nursing is needed to assess for tolerance, adverse effects, and to address patient concerns. Medication management and teaching are very important in guiding patients to safely manage a schedule that changes daily. In addition, the high risk of pathological fractures and serious injury if the patient should fall supports the need for physical and occupational therapy fall prevention and safety education and exercise programs to help avert decline in functional status and combat cancer-related fatigue.

Oncology Care in Non-Small Cell Lung Cancer-Personalizing the Treatment Plan.

With potentially curative targeted and immunotherapies for non-small cell lung cancer, long term survival of at least 5 to 10 years is increasingly possible. A personalized, holistic, and multidisciplinary home healthcare treatment plan can help cancer patients transition from acute to chronic disease management. Factors to be considered include the patient's goals, treatment-related risks, the degree of metastasis, acute symptom management needs, and the desire and ability to participate in the treatment plan. The case history illustrates how genetic sequencing and immunohistochemistry testing guide treatment decisions. Strategies for pharmacological and nonpharmacological management of acute pain related to pathological spinal fractures are discussed. Care coordination that includes the patient, home care nurses and therapists, the oncologist, and the oncology nurse navigator is essential to transition the patient with advanced metastatic cancer to the highest possible functional status and quality of life. Discharge teaching should include early recognition and intervention for adverse effects of medications and signs or symptoms that may signal disease reoccurrence. The use of a written, patient-driven survivorship plan is important to assure diagnostic and treatment information is summarized, follow-up tests and scans are scheduled, and screening tests for other types of cancer are included.

Indwelling Pleural Catheters for Malignant Pleural Effusion: A Time for Action.

Malignant pleural effusion (MPE) resulting from metastatic spread to the pleura frequently occurs in patients with primary lung, breast, hematological, gastrointestinal, and gynecological cancers. These effusions tend to reaccumulate quickly, and the patient requires increasingly frequent thoracentesis. An indwelling pleural catheter allows for dramatic improvement in quality of life as the patient has the power to ease her/his own suffering by draining the effusion at home when shortness of breath and/or chest pain intensifies. Patients with MPE need home healthcare support to address symptom management related to complications of advanced metastatic cancer and antineoplasm treatment regimens. The financial obstacles for the home healthcare agency are explored by using agency supply costs, per visit costs, and the patient-driven groupings reimbursement mode grouper to estimate reimbursement. Care for a home healthcare patient with MPE costs Medicare approximately $64.50 per day, markedly less than costs for hospitalization and outpatient thoracentesis. Unfortunately, agencies must absorb the cost of vacuum drainage bottles. Whereas a small positive balance of $291 was estimated for the first 30-day posthospital episode, losses were estimated at $1,185 to $1,633 for subsequent 30-day episodes. Absorbing these costs has become extremely difficult as home healthcare agencies are experiencing unprecedented COVID-19 infection control and staffing-related costs.

The economic impact of complex wound care on home health agencies.

The cost of care for home health clients with complicated wounds frequently exceeds reimbursement received from Medicare and other payer sources. As a result, home health agencies may be reluctant to accept this type of referral. Many of the costs associated with complex wound care can be substantially reduced by appropriate use of expensive therapies and dressings and establishment of a cost-effective wound care formulary. Costs can also be reduced by collaboration with prescribing providers to ensure that orders are written generically, and avoid unnecessary nursing visits. Knowledgeable WOC nurses can play a critical role in coordinating care that is both clinically and fiscally effective. This article reviews common challenges in caring for complex wounds in the home care setting with a focus on strategies the prescribing provider and wound care clinician can use to optimize outcomes.

Preventing and responding to acute kidney injury: how to recognize the incremental changes in kidney function that adversely affect patient outcomes.

OVERVIEW: Acute kidney injury is an independent risk factor for both prolonged length of hospital stay and in-hospital mortality. Recent analysis shows that over the past decade the incidence of acute kidney injury requiring dialysis rose rapidly in the United States, with associated death more than doubling. In 2007, the Acute Kidney Injury Network proposed a new classification system for acute kidney injury, which recognized that incremental changes in kidney function may adversely affect outcomes. By identifying the signs and symptoms of acute kidney injury in its early stages, nurses may be able to help reduce the severity of injury and contribute to improved outcomes.

Clostridium difficile: preventing epidemic outbreaks in home health.

Clostridium difficile is not affected by alcohol-based hand rubs or most cleaning solutions. As a result, it spreads quickly and easily. Spores can survive for months on environmental surfaces. Epidemics of hypervirulent mutations in the United States, Canada, and Europe are causing life-threatening infections, with rising mortality rates. This article aims to teach home health clinicians what they need to know to protect patients, families, themselves, and the community beyond the patient's home.