Theoretical background based on Urinary Tract Infection

Definition

Plasma cells are terminally differentiated B-lymphocytes

that have developed characteristics morphology while actively
producing and releasing immunoglobulins. While plasma cells begin as
B-cells in the bone marrow, they usually leave to develop and mature
in the lymph nodes or spleen. After being stimulated by T-cells and
exposed to processed antigens, plasma cells begin to produce
immunoglobulins. Normally, plasma cells make up a small proportion of
the lymphoid cells found in bone marrow. Unlike viral/atypical
lymph’s, they are usually classified as a separate entity in the
differential. Plasma cells can increase in reactive marrow, and plasma
cells and their early precursors are significantly increased in plasma
cell disorders.

Stem cells are produced by your bone marrow. Some of them develop
into white blood cells, which are an essential component of your
body's immune system. White blood cells that are plasma cells.
Normally, they produce antibodies, which are proteins that aid in the
killing of germs that enter your body. However, in the case of plasma
cell neoplasms, your body produces an abnormally large number of
plasma cells. They produce an antibody known as "M protein," which is
unnecessary and can cause your blood to thicken. Some plasma cell
neoplasms cause cancerous cells to form tumors in your bones.

Types
Plasma cell neoplasms range from not much of a problem to life-
threatening. Plasma cell neoplasms develop when abnormal plasma cells
form cancerous tumors in bone or soft tissue. When there is only one
tumor, the condition is known as a plasmacytoma. Multiple myeloma
occurs when there are multiple tumors. When you have some plasma cells
that make M protein, but it's not cancer and you don't have any
tumors, you have monoclonal gammopathy of undetermined significance
(MGUS). M protein levels are usually low enough that MGUS does not
cause problems. It can cause serious problems, such as multiple
myeloma, but this occurs in only about 1% of cases each year.

The cancer lymphoplasmacytic lymphoma can spread to your bone

marrow, spleen, and lymph nodes. Due to high M protein levels, it can
also cause your blood to thicken. This condition is also known as
Waldenstrom's macroglobulinemia, or WM. Plasmacytoma is another type
of cancer in which plasma cells form a single tumor, usually in a bone
but sometimes in soft tissue outside the bone. It has the potential to
progress into multiple myeloma.
Myeloma multiplex. Tumors crowd out normal cells, resulting in fewer
healthy blood cells and weaker bones.

Etiology
The cause of plasma cell neoplasm is unknown but doctors believe that
likely related to changes in the genes of some plasma cells. They've
discovered which genes are involved, but not what causes the changes.
You might be more likely to get it if you: Age (most common in people
over 65; extremely rare in people under 35) Sex (men are slightly more
likely to have it) Race (African-Americans are more likely to be
affected)

Clinical Manifestations

Plasma cell neoplasms are diseases in which the body produces an

abnormally large number of plasma cells. B lymphocytes (B cells), a
type of white blood cell produced in the bone marrow, give rise to
plasma cells. When bacteria or viruses enter the body, some B cells
transform into plasma cells. Lymphoplasmacytic lymphoma symptoms can
include:

 Blurred vision
 Dizziness
 Headaches
 Tiredness
 Weight loss
 Shortness of breath
 Hearing problems
 Numbness or tingling
Management

A. Medical Management

Radiation Therapy

To kill cancer cells, radiation therapy employs high-energy rays or

particles. Radiation therapy may be used to treat bone damage caused
by myeloma that has not responded to chemotherapy or other drugs and
is causing pain or is on the verge of breaking. It is also the most
frequently used treatment for solitary plasmacytomas.

The nursing responsibilities are monitor and assess the patient's

pain level using a standard 0-to-10 pain scale, if appropriate, refer
patients with fatigue for physical therapy, which can ease fatigue and
improve stamina, obtain a complete list of the patient's medications
and monitor for drug interactions.

Complete Blood Count (CBC)

The CBC is used to determine whether there are any abnormalities in

the blood composition that may help point out a specific disease for
confirmation. It may be ordered if you are ill or have signs and
symptoms of a condition that affects blood cells. Patients that have
Urinary tract infection usually have high white blood cell count.
As a nurse, it is important to explain the procedure why CBC is being
taken. The nurse must explain that in CBC, fasting is not necessary.
It is important to assess, observe and speak to patient.

The nursing responsibilities are Explain test procedure

Encourage to avoid stress if possible because altered physiologic
status influences and changes normal hematologic values.
Explain that fasting is not necessary apply manual pressure and
dressings over puncture site on removal of dinner.

Immunotherapy

Immunotherapy, which employs the body's immune system to combat

cancer, is now a standard treatment option for people suffering from
multiple myeloma. Multiple myeloma is a type of cancer that develops
in a type of white blood cell known as a plasma cell. Multiple myeloma
is a type of cancer that starts in the bone marrow's plasma cells.
Plasma cells produce antibodies and play an important role in the
immune system's function in the body. In people with multiple myeloma,
abnormal plasma cells proliferate uncontrollably and crowd out healthy
cells such as other types of white blood cells, platelets, and red
blood cells, causing bone and calcium problems, low blood counts,
kidney problems, and infections. Immunotherapy can be used to treat
multiple myeloma and is frequently prescribed as first-line therapy or
after stem cell transplantation as part of a comprehensive treatment
plan. Immunotherapy, also known as biologic therapy, is intended to
assist the immune system in identifying and attacking cancerous cells.

The Nursing Responsibilities are nurses should apply the same

evidence-based practices to immunotherapy patients in order to become
experts in the field. Patients rely on us for advice, education, and
safety during treatment.

IV Therapy
Intravenous (IV) therapy involves the administration of fluids
directly into a vein. It aids treatment by allowing water, medication,
blood, or nutrients to enter the body more quickly via the circulatory
system. Doctors can administer IV therapy directly into a vein using
an IV line. This bypasses the gastric system, allowing the body to
absorb more fluids more quickly. A healthcare professional will insert
a cannula into a person's vein, usually in the crook of their arm,
during the procedure. They can then connect a tube to an IV bag
containing fluids, which will drip directly into the vein. The fluids
or nutrition used in IV therapies are tailored to the individual
receiving the treatment.

IV therapy can treat severe dehydration by administering fluids, pain

by administering pain relief, blood loss by blood transfusion, and
malnutrition or inability to take food by administering nutrients.
Inserting, monitoring, and removing an IV used to give medications,
blood products, and nutrition to a patient are all nursing
responsibilities for IV therapy. The nurse monitors the patient for
adverse reactions and ensures that the tubing, bandages, and needle
remain in place during IV therapy.

B. Surgical Management

Bone Marrow Transplant

A bone marrow transplant is a procedure that injects your body with
healthy blood-forming stem cells to replace bone marrow that isn't
producing enough healthy blood cells. A stem cell transplant is
another name for a bone marrow transplant. If your bone marrow stops
working and does not produce enough healthy blood cells, you may
require a bone marrow transplant. Cells from your own body or from a
donor can be used in bone marrow transplants.

A patient may need bone marrow transplant may be used to allow

treatment safely with high doses of chemotherapy or radiation by
replacing or rescuing the bone marrow damaged by the treatment,
replace the bone marrow that is not working properly with new stem
cells, and provide new stem cells, which will help kill cancer cells
directly.

A bone marrow transplant carries a number of risks. Some people have

minor complications following a bone marrow transplant, while others
may have serious complications that necessitate treatment or
hospitalization. Complications can be fatal at times. Many factors
influence your risks, including the disease or condition that
necessitated the transplant, the type of transplant, your age, and
your overall health.

The nursing responsibilities are providing high-quality care and

management, inform and educate the patient, know the patient
holistically, participate in specific or advanced nursing practices
(bone marrow sampling, HLA typing, transplant recipient care), and
coordinate all transplant logistics.

C. Nursing Management

Monitoring Vital Signs

Vital sign taking is the act of measuring, taking, and checking a
patient's most basic functions. Included are the pulse rate,
respiratory rate, body temperature, and blood pressure. Vital
signs can aid in the detection and monitoring of medical
problems. Vital signs can also be measured at home, in a
hospital, or anywhere else.
It is recommended for any patient who needs to be monitored
before, during, and after receiving interventions such as
medications or something as simple as changing positions. This is
done to ensure that the interventions help the patient recover.
It is also used to determine whether or not the patient is
responding to interventions, which may necessitate a reassessment
and modification of interventions such as medications and other
treatments.

When checking vital signs or as needed, nursing responsibilities

include strictly adhering to the doctor's orders. When the
patient is awake, we must first obtain permission and explain why
we need it in order for them to actively participate in future
vital sign checks. Finally, any significant changes in vital
signs, such as an unexpected drop in blood pressure, must be
documented and reported to the attending physician.

Monitory lab values

The act of checking the results provided by the medical
technologist for any deviations or abnormalities, as well as
determining whether or not the patient was able to return to his
or her normal range, is known as monitoring laboratory results.
It is recommended to evaluate any abnormalities in the findings
and determine whether the patient is gradually returning to his
or her normal range, especially before and after interventions.

Nursing responsibilities include ensuring that the patient's

personal information and results are provided in such a way that
no one else can see them except the medical team members who are
attending to the patient's condition.