The nurse cares for a client with multiple myeloma. Which assessment finding is the priority for the nurse to report to the healthcare provider?
1. Pain 4/10 after intravenous morphine dose
2. Mild intermittent confusion and drowsiness
3. Moderate joint pain and erythema
4. Overnight diaphoresis requiring a bed change
4. Overnight diaphoresis requiring a bed change
Explanation: 1. Pain should be aggressively managed for this client, but a 4/10 pain rating does not require healthcare provider notification.
2. Confusion and drowsiness are concerning for hypercalcemia, but the client's hypovolemia is more clinically significant. Additionally, treating the dehydration with adequate fluid replacement will help the body to naturally excrete excess calcium.
3. The nurse would not immediately report joint pain or other symptoms of gout. The client's uric acid is elevated and this may be corrected by replacing fluid.
4. Significant insensible fluid losses can occur with multiple myeloma. Fluids must be managed aggressively to prevent complications from dehydration, such as acute renal failure. This is a malignancy that results from the overproduction and accumulation of immature plasma cells in the bone marrow, lymph nodes, spleen, and kidneys.
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