Primary Nursing Diagnosis

Ineffective airway clearance related to tongue obstruction (macroglossia)

OUTCOMES. Respiratory status: gas exchange and ventilation; Oral health

INTERVENTIONS. Airway insertion; Airway management; Airway suctioning; Oral health promotion; Respiratory monitoring; Ventilation assistance

H PLANNING AND IMPLEMENTATION Collaborative

Therapy is targeted to amelioration of the underlying organ dysfunction through pharmacologic therapy, but there is no known cure. Surgical procedures may be used to treat severe symptoms. The patient may develop a complication of the tongue called macroglossia. If this occurs, a tracheotomy may be necessary to maintain oxygenation. Patients with severe renal amyloidosis and azotemia may undergo bilateral nephrectomy and renal transplantation followed by immune therapy, although the donor kidney may be susceptible to amyloidosis as well.

OTHER MANAGEMENT. A dietary consultation can provide the patient with a plan to supplement needed nutrients and bulk-forming foods based on the patient's symptoms. Unless the patient requires fluid restriction, he or she needs to drink at least 2 L of fluid per day. A referral to a speech therapist may be necessary if the patient's tongue prevents clear communication.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Melphalan and

Varies with drug

Antineoplastic

Interrupts the growth of the abnormal

prednisone com-

protocol

alkylating agent

cells that produce amyloid protein;

bined therapy

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