Nursing care of patients with multiple myeloma: a paradigm for the needs of special populations.

Multiple myeloma, a B cell malignancy that has its peak incidence in the elderly and affects African Americans more frequently than Caucasians, may be used as a paradigm to examine the concerns of special populations. Special populations are those who are medically underserved or medically underrepresented. Using this disease entity to focus on concerns of special populations and access to healthcare systems, the oncology nurse can formulate an approach to cancer care with a broader view of patients from special populations and their needs and goals.

Multiple myeloma.

OBJECTIVES: To review the epidemiology, pathogenesis, clinical features, diagnosis, treatment, and nursing management of multiple myeloma. DATA SOURCES: Review articles, research studies, and book chapters related to multiple myeloma. CONCLUSIONS: Despite insights into the immunobiology of multiple myeloma and the advances in intensive therapy and supportive care, multiple myeloma remains an incurable disease. Patients will experience chronic and acute symptomatic episodes throughout the course of their disease. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can assist patients with multiple myeloma and their families to manage both the disease and treatment related symptoms and to improve their overall quality of life. Specific nursing assessments can provide early recognition of complications, such as hypercalcemia and spinal cord compression.

Uncommon leukemias: implications for clinical practice.

The nursing management of patients with rare leukemias involves physiologic, psychologic, and ethical activities. Specific nursing interventions aimed at supporting bone marrow suppressed patients have been addressed in the literature and other reports in this issue. The potential for oncologic emergencies in these rare leukemias is great. These include disseminated intravascular coagulation (DIC), cerebral and pulmonary leukostasis, sepsis, and acute renal failure. Recognition that patients are at risk for these acute events prepares nurses for their assessment, diagnosis, and plans of care. Eleven high-incidence problems for cancer patients have been described, and all can be applied to these patients. Emotionally, patients and their families rely on nurses to assist them in coping with a new diagnosis of cancer, and/or dealing with the chronic nature of their disease. Open communication, firmly based on a thorough knowledge of the particular disease and treatment, will promote trust and a sense of comfort as the patient begins treatment. Finally, it is important for all nurses caring for cancer patients to identify their personal feelings and biases. In the current environment where clinical investigation is a part of everyday care, the nurse must be comfortable with the research process and the participation of human subjects in clinical trials. Nurses play a role in the development of clinical trials and the process of informed consent, and in the management of patients involved in clinical trials. Over the last 5 years, we have witnessed a dramatic increase in the number of therapies available for one particular rare leukemia (hairy cell leukemia). This has resulted in significant improvements in patient outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative trial of moxalactam plus ticarcillin and clavulanic acid or piperacillin as empiric antibiotic therapy for febrile cancer patients.

Resistance of bacteria to beta-lactam antibiotics remains a difficult clinical problem that can be compounded in infected patients with serious underlying illness, especially those who are immunocompromised. In a prospective randomized safety and efficacy trial, febrile cancer patients received either ticarcillin disodium combined with the beta-lactamase inhibitor clavulante potassium (Timentin, Beecham Laboratories, Bristol, TN) plus moxalactam (T+M), or piperacillin plus moxalactam (P+M) as initial empiric antimicrobial therapy. Sixty-six febrile episodes in 53 patients were studied. In the T+M group, 14 (78%) of 18 clinically evaluable infections in patients with profound granulocytopenia improved as did all 14 (100%) such infections in the P+M group. In the T+M group 17 of 21 (81%) similarly evaluable infections improved irrespective of granulocyte count, as did 14 (88%) of 16 of such infections in the P+M group. These results are not statistically significantly different. Serious side effects were infrequent and comparable with both regimens. There was one antibiotic related hemorrhage in the P+M group and a serious episode of nephrotoxicity in a patient who died without recovering renal function in the T+M group. These results suggest that the overall safety and efficacy of Timentin plus moxalactam, and piperacillin plus moxalactam are comparable and similar to previous empiric antibiotic trials.

Systematic assessment and training of sex education for a mentally retarded woman.

A systematic sex education program was implemented to provide the instruction necessary for a mentally retarded woman to be able to label basic reproductive body parts and describe and demonstrate a breast examination, Pap test, and pelvic examination. The training program permitted documentation of informed consent for a reproductive health examination. Training was implemented in a multiple probe design across skill areas and consisted of providing factual information, requiring the subject to repeat factual information, using concrete teaching aids, demonstrating examination procedures, requiring the subject to demonstrate the specified examinations, and providing praise for correct responses. Results showed dramatic increases in sexual knowledge with the implementation of the program. Follow-up data indicated that the increase in sexual knowledge was maintained over a period of 3 weeks.