NUR 634 Topic 14 DQ 2

Discussion: Select one hematologic disorder/type of anemia.

NUR 634 Topic 14 DQ 2 Assessment Description

Select one hematologic disorder/type of anemia. Then complete the following:

Briefly discuss the condition/disorder.

Discuss physical exam techniques for evaluating the hematologic disorder.

Describe the symptoms and physical exam findings associated with the condition/disorder

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Identify appropriate laboratory, imaging, and other diagnostic/screening tools that apply to the disorder and explain how they will help you with your diagnosis. NUR 634 Topic 14 DQ 2 Address expected CBC findings and other hematologic laboratory results.

List two other conditions that could cause a similar presentation (differential diagnoses) and explain how you would “rule out” those differentials.

Support your description with a minimum of two APRN-approved scholarly resources. You may not select a condition or disorder that has already been profiled by another learner; you must select a different one.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 1.3.

NUR 634 Topic 14 DQ 2 Sample

Multiple myeloma is a plasma cell malignancy characterized by the accumulation of malignant plasma cells in the bone marrow, resulting in bone destruction. The condition is also characterized by the production of monoclonal antibodies in the blood that cause variable organ damage (Abduh, 2024). Unfortunately, the malignancy is incurable and has high morbidity and mortality rates due to its complications. Accumulation of the plasma cells suppresses hematopoiesis of other cell lines, resulting in pancytopenia.

A detailed musculoskeletal examination is crucial in the evaluation of the disease. As a result, one needs to detail the bones and joints the patient complains of pain and exert minimal pressure to check for pain sensitivity (Rajkumar, 2022). Additionally, one needs to palpate for bone continuity to evaluate for any associated bone fractures. NUR 634 Topic 14 DQ 2 Due to the resultant pancytopenia, one needs to inspect the palms and conjunctiva for pallor and look for sites for bruising or infection.

Patients with multiple myeloma often present with bone pains that are nonresponsive to analgesics. In addition, pathological fractures and spinal cord compression pain are also common (Rajkumar, 2022). Patients may also experience anemic symptoms such as fatigue, dyspnea, and headaches or have recurrent infections or prolonged bleeding due to thrombocytopenia or leukopenia. Edema and decreased urinary output are major complaints, especially in renal involvement. Physical examination findings may reveal pallor, pyrexia, tachypnea, petechial or purpura hemorrhages, and tender bones.

A complete blood count and peripheral blood films are crucial in the diagnosis and identification of monoclonal plasma cells and pancytopenia.  NUR 634 Topic 14 DQ 2 However, a bone marrow aspirate (BMA) is the diagnostic test for the disease (Cowan et al., 2022). A protein electrophoresis is also crucial as it identifies myeloma spikes. Additional tests performed include renal function tests and a bone or metastatic scan. Leukemia and Waldestrom’s macroglobulinemia may present similar to multiple myeloma. However, a BMA is crucial in excluding leukemia, while the protein electrophoresis excludes Waldestrom’s macroglobulinemia.

NUR 634 Topic 14 DQ 2 References

Abduh M. S. (2024). An overview of multiple myeloma: A monoclonal plasma cell malignancy’s diagnosis, management, and treatment modalities. Saudi Journal of Biological Sciences, 31(2), 103920. https://doi.org/10.1016/j.sjbs.2023.103920

Cowan, A. J., Green, D. J., Kwok, M., Lee, S., Coffey, D. G., Holmberg, L. A., Tuazon, S., Gopal, A. K., & Libby, E. N. (2022). Diagnosis and Management of Multiple Myeloma: A Review. JAMA, 327(5), 464–477. https://doi.org/10.1001/jama.2022.0003

Rajkumar S. V. (2022). Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. American Journal of Hematology, 97(8), 1086–1107. https://doi.org/10.1002/ajh.26590 NUR 634 Topic 14 DQ 2