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POLYCYTEMIA VERA

Polycythemia vera is a bone marrow disease that leads to an abnormal increase in the number of blood cells (primarily red blood cells).

Nursing Management:

Advised patients with a history of significant bleeding to avoid aspirin and aspirin containing medications.

Minimizing alcohol intake should be also emphasized to further diminished the risk of bleeding.

Instruct the patients that he must avoid iron supplements, including those within multivitamins supplements

Explain to avoid vigorous toweling after bathing.

Risk Factors:o Thromboseso Smokingo Obesityo Poorly controlled

hypertension

Pathophysiology:

Erythrocyte elevation predominates

Hematocrit elevation can exceed to 60%

Spleen resumes its embryonic function of hematopoises & enlarges

Lab. & Diagnostic Exams:

Bone marrow biopsy Complete blood

count with differential Comprehensive metabolic

panel Erythropoietin level Genetic test for the

JAK2V617F mutation Oxygen saturation of the

blood Red blood cell mass Vitamin B12 level

Manifestations:

Breathing difficulty when lying downDizzinessExcessive bleedingHeadacheItchinessShortness of breathFatigue

Bone marrow become fibrotic

Risk Factors:

Pathophysiology:

Nursing Management:

POLYCYTEMIA VERA

Polycythemia vera is a bone marrow disease that leads to an abnormal increase in the number of blood cells (primarily red blood cells).

Manifestations:

Breathing difficulty when lying downDizzinessExcessive bleedingHeadacheItchinessShortness of breathFatigue

.

PATHOPHYSIOLOGY

Premalignant condition

Diseased tissue destroyed by immune mechanisms

Strong immune reaction

cient new cells to replenish blood cells.]The condition, per its name, involves both aplasia and anemia. Typically, anemia refers to low red blood cell counts, but aplastic anemia patients have lower counts of all three blood cell types: red blood cells, white blood cells, and platelets, termed pancytopenia.

DIAGNOSTIC EXAMS

1. CBC and peripheral blood smear show decreased RBC, WBC and platelets (pancytopenia)

2. Bone marrow aspiration and biopsy: bone marrow is hypocellular or empty with greatly reduced or absent hematopoiesis.

SIGNS AND SYMPTOMS

Malaise, pallor and associated symptoms such as palpitations, Thrombocytopenia (low platelet counts), leading to increased risk of hemorrhage, bruising and petechiae, Leukopenia (low white blood cell count), leading to increased risk of infection and Reticulocytopenia (low reticulocyte counts).

HEALTH TEACHINGS

Tell the patient who does not require hospitalization that he can continue his normal lifestyle with appropriate restrictions.

Emphasize the need for prompt treatment of infection.

Be sure the patient understands the need to maintain a good nutritional intake to enhance the immune system and resistance to infections.

Explain the need to increase fluid intake to prevent dehydration that results from impaired ability to properly concentrate urine

To encourage normal mental and social development, warn parents against being overprotective.

MEDICATIONS

Medical therapy of aplastic anemia often includes a short course of anti-thymocyte globulin (ATG) or anti-lymphocyte globulin (ALG) and several months of treatment with ciclosporin to modulate the immune system. Mild chemotherapy with agents such as cyclophosphamide and vincristine may also be effective. Antibody therapy, such as ATG, targets T-cells, which are believed to attack the bone marrow. Steroids are generally ineffective, though are often used to combat serum sickness caused by ATG use.

NURSING INTERVENTIONS

1. Maintain established rapport.

2. Monitor vital signs, especially temp.

3. Stress proper hand washing techniques by all caregivers between therapies

4. Monitor visitors/ caregivers of the client. Instruct SO to limit visitors especially those with known contagious illnesses.

5. Maintain aseptic/sterile techniques as much as possible.

Acute severe aplasia occurs

Body’s immune system mistakenly targets the intrinsic factor, with a loss of parietal cells

Insufficient IF

PATH

OPH

YSIOLO

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Insufficient absorption of the vitamin

Vitamin B12 depletion

Anemia

one of many types of the larger family of megaloblastic anemias. It is caused by loss of gastric parietal cells, and subsequent inability to absorb vitamin B12. The loss of ability to absorb vitamin B12 is the most common cause of adult vitamin B12 deficiency.

MEDICATIONSVitamin B-12 is available for therapeutic use parenterally as either

cyanocobalamin or hydroxocobalamin.[4] Both are equally useful in the treatment of vitamin B-12 deficiency, and they are nontoxic (except for rare allergic reactions). Theoretical advantages exist to using hydroxocobalamin because it is retained better in the body and is more available to cells; both chemical forms of cobalamine provide prompt correction.

MANIFESTATIONS

Fatigue, low blood pressure, rapid heart rate, high blood pressure, pallor, depression, muscle weakness, and shortness of breath

Neuropathic pain Frequent diarrhea Paresthesias Jaundice Glossitis Personality or memory changes]

HEALTH TEACHINGS

Compliance in obtaining adequate vitamin B-12 for a lifetime by injection (or possibly orally) is necessary to avoid relapse of pernicious anemia.

Explain the need to increase fluid intake to prevent dehydration that results from impaired ability to properly concentrate urine.

Teach the patient the potential for bleeding and hemorrhage, and instruction to prevent bleeding and discuss the need for regular dental examinations and explain the importance of maintaining regular bowel movements to prevent straining.

EXAMS AND TESTS

CBC /blood smear-decrease hgb and hct, marked variations in RBC size and shapes

Normal folic acid and decrease B12 levels Gastric analysis-volume and acidity of gastric juice diminished Schilling test for absorption of vit. B12 uses small amount of

radioactive B12 orally and 24 hour urine collection to measure uptake-decreased

PERNICIOUS ANEMIA(also known as Biermer's anemia, Addison's anemia, or Addison–Biermer anemia)

NURSING INTERVENTIONS

Assess patient ability to perform ADLs Instruct client to stop activity if palpitations, chest pain, shortness of

breath, weakness, or dizziness occur Monitor vital sign (Blood Pressure, pulse, and respirations) during and

after activity Suggest client change position slowly; monitor for dizziness. Provide or recommend assistance with activities and ambulation as

necessary, allowing client to be an active participant as much as possible.

Identify and implement energy-saving techniques