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A patient who is to be discharged after being diagnosed with multiple myeloma is given instructions by the nurse. It is very important for the nurse to remind the patient to

Explanation

• Multiple myeloma, a cancer of plasma cells, is associated with osteoclast-mediated bone destruction and the release of calcium into the blood. 

• Anorexia and nausea may be signs of hypercalcemia, which should be reported to the physician. Severe hypercalcemia can be life-threatening.

• An increased level of calcium in the bloodstream is common in multiple myeloma. Patients who are diagnosed with multiple myeloma must be taught to monitor for the signs of hypercalcemia and they must be told to report those signs to the physician immediately. Other signs of hypercalcemia include vomiting, polyuria, weakness and fatigue, constipation, and signs of dehydration.

• To dilute calcium overload and prevent protein from precipitating in the renal tubules, a fluid intake of at least 3000 ml/day is recommended.

• A high-calorie diet may be helpful but a low-fiber diet can lead to constipation.

• Activity as tolerated is advised. Bed rest is avoided because inactivity can promote hypercalcemia.

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