Primary Polycythemia Vera

Question 1

PPV - Pathophysiology

Answer 1

• Loss of cellular regulation; bone marrow goes into “overdrive”, proliferation (rapid incr) of RBCs, WBCs, & Platelets
• Results in blood hyper viscous (thick) blood
  > causes poor oxygenation of tissues; cell destruction
  > RBC > 16.5g/dL
  > Hgb > 18g/dL
  > Hct > 55%
  > High K (norm 3.5-5mEq/L)
  > High uric acid (norm 2/7-8.5mg/dL)

Question 2

PPV - CMs

Answer 2

• HTN
  > lots of pressure from thick blood
• Headaches
  > thick blood going through brain
• Dizziness
  > lack of oxygen
• Purple/gray color
  > lack of oxygen
• Itching
• Dyspnea

Question 3

PPV - Complications

Answer 3

• Angina
• Claudication
• Thromboses
• MI/CVA
  > hemorrhagic or ischemic
• Intracranial bleeds/CVA

Question 4

PPV - Medical Management

Answer 4

• Repeated apheresis 2-5x/wk
  > separation of excess RBCs
• Medications
  > Hydroxyurea to keep normal shape
  > Anticoagulants to thin blood

Question 5

PPV - Nursing Interventions

Answer 5

• Prevent clots
  > anticoags, ambulation, SCDs
• Hydration
  > 3L/day
• Stop smoking
  > causes venous stasis
• Promote venous return
• Elevate feet
  > SCDs, prevent pooling
• Avoid tight clothing
• Support hose
• Thrombocytopenia precautions
  > bleeding precautions
• Use electric razor, soft toothbrush
• Neutropenic precautions

Question 6

PPV - Pt Education

Answer 6

• Contact HCP @ 1st sign of infection or occlusion
• Exercise slowly
  > stop activity at 1st sign of chest pain or dizziness, call 911
• Interdisciplinary
  > anticoagulants
  > chemotherapy: to thin blood or stop over-production

Question 7

PPV - Nursing Diagnosis

Answer 7

• Ineffective protection
• Risk for bleeding
• Risk for ineffective tissue perfusion
• Risk for infection