Central Philippine University

College of Nursing

POLYCYTHEMIA

Presented to:
Atty. Salex E. Alibogha
In Partial Fulfillment of the
Requirements for the
Course N-418
Competency Appraisal 1

Presented by:
Barrido, Mariane Isabelle Alarice A.

October 9, 2014

CASE SCENARIO
Mr. J, a 62 year old man, complains of headache, dizziness, ringing of ears, blurring of
vision, itching of fingers and toes, cramping of lower legs when walking, and night sweats for
almost 3 nights. Physical examination reveals a blood pressure of 180/100 mmHg, presence of
plethora and spleen is palpable 10cm below left intercostal margin. Other findings includes: RBC
= 9.6 x 1012/L, Hgb = 191 g/L, Hct = 0.82 vol. fr., and an ultrasound that indicates splenomegaly.
As the nurse assigned to Mr. J, how will you manage his condition?

MINILECTURE
Polycythemia is a condition that results in an increased level of circulating red blood cells
in the bloodstream. People with polycythemia have an increase in hematocrit, hemoglobin, or red
blood cell count above the normal limits.
Polycythemia is normally reported in terms of increased hematocrit or hemoglobin.

Hematocrit (HCT): Polycythemia is considered when the hematocrit is greater than 48%
in women and 52% in men.

Hemoglobin (HGB): Polycythemia is considered when a hemoglobin level of greater

than 16.5g/dL in women or hemoglobin level greater than18.5 g/dL in men.

Polycythemia can be divided into two categories; primary and secondary.

Primary polycythemia: In primary polycythemia the increase in red blood cells is due to
inherent problems in the process of red blood cell production.

Secondary polycythemia: Secondary polycythemia generally occurs as a response to

other factors or underlying conditions that promote red blood cell production.

Neonatal (newborn) polycythemia can be seen in 1% to 5% of newborns. The most common

causes may be related to transfusion of blood, transfer of placental blood to the infant after
delivery, or chronic inadequate oxygenation of the fetus (intrauterine hypoxia) due to placental
insufficiency.
Causes of polycythemia are primary or secondary. In primary polycythemia, abnormalities in red
blood cell production cause an increase in red cell count. In secondary polycythemia, external
factors result in polycythemia.
What are the causes of primary polycythemia?
Primary polycythemias are due to acquired or inherited genetic mutations causing abnormally
high levels of red blood cell precursors. Primary familial and congenital polycythemia (PFCP)
and polycythemia vera (PV) are in this category.
Polycythemia vera
Polycythemia vera is a rare condition. It is typically associated with an elevated white blood cell
count (leukocytosis) and platelet count (thrombocytosis). An enlarged spleen (splenomegaly) and
low erythropoietin levels are other clinical features of polycythemia vera.
Primary familial and congenital polycythemia (PFCP) is also thought to be caused by genetic
mutations resulting in increased responsiveness to normal levels of erythropoietin. Most cases
are caused by different mutations to the EPOR gene.
What are the common causes of secondary polycythemia?
Secondary polycythemia is usually due to increased erythropoietin (EPO) production either in
response to chronic hypoxia (low blood oxygen level) or from an erythropoietin secreting tumor.

What are the risk factors for polycythemia?

Hypoxia from long standing (chronic) lung disease and smoking are common causes of
polycythemia. Chronic carbon monoxide (CO) exposure. Hemoglobin has a higher affinity for
CO than for oxygen; therefore, as it replaces oxygen in favor of CO, polycythemia may ensue to
compensate for the low oxygen carried by hemoglobin.Chronic carbon monoxide exposure is a
risk factor for people working in underground tunnels or parking garages, cab drivers in highly
polluted and congested cities, or workers in factories with exposure to engine exhaust.People
living at high altitudes due to low environmental oxygen levels.People with genetic mutations
and familial types of polycythemia and certain hemoglobin abnormalities also carry risk factors
for this condition as mentioned in earlier sections.
What are the symptoms of polycythemia?
Symptoms of polycythemia can be none to minimal in many people. There are some general and
non-specific symptoms that can be seen with polycythemia. Some of these
include:weakness,fatigue,headache,itching,bruising,joint pain,dizziness, orabdominal pain.
In patients with polycythemia vera, other blood disorders are also very common. Thus, bleeding
problems or clotting events may be seen in these patients. Itching after showers or baths (postbath pruritus) can also be seen in patients with polycythemia vera for unclear reasons. Joint pains
also common in patients with polycythemia vera. Tender redness of the palms and soles is called
erythromelalgia.
Symptoms of secondary polycythemia may be more closely attributed to the underlying
condition, such as, chronic lung disease, than to polycythemia itself. Therefore, shortness of
breath, chronic cough, sleep disturbance (sleep apnea), dizziness, poor exercise tolerance, or
fatigue may be common in patients with polycythemia.

If polycythemia is related to kidney cancer, liver cancer, or other erythropoietin secreting tumors,
the symptoms of these conditions, such as,weight loss, abdominal pain or fullness,
or jaundice may be predominant.
How is polycythemia diagnosed?
Polycythemia may be diagnosed incidentally on routine blood work. Hemoglobin, hematocrit,
and red blood cell concentration are typically found on a complete blood count (CBC).
Repeating the laboratory tests (blood work) to confirm the diagnosis is usually advised to rule
out possible laboratory or drawing errors.
More importantly, the cause of polycythemia needs to be determined. Medical history and
physical examination are important components of the evaluation of polycythemia. The history
usually includes questions about smoking history, living at high altitudes for extended periods,
breathing difficulties, sleep disturbances, orchronic cough. Other parts of the history may focus
on a prior diagnosis of lung disease, heart disease, kidney or liver cancer, bleeding or clotting
problems.
A complete physical examination including the assessment of body habitus (stature), vital signs,
oxygen saturation, heart and lung exams, and evaluating for an enlarged spleen (splenomegaly)
are essential in the evaluation of people with polycythemia.
Evidence of a long standing low body oxygen level (chronic hypoxia) is an important clue in
patients with polycythemia. Signs of long standing hypoxia may include cyanosis (blue or purple
appearing finger, nail, earlobes, or lips),clubbing of the fingers (elevation of the nail beds
outward), or pursed lip breathing. Redness of the palms and soles may be another sign of
polycythemia.

A chest X-ray, electrocardiogram (EKG), and echocardiogram may be performed to screen for
lung disease or heart disease. Hemoglobin analysis may be necessary if conditions with high
affinity for oxygen or 2, 3-BPG deficiency are suspected. If carbon monoxide poisoning is in
question, its level can be detected by a blood test.
Erythropoietin (EPO) blood levels may also be helpful, although the results need to be
interpreted carefully as the level may be high in response to chronic hypoxia. In polycythemia
vera, the EPO levels are low as a response to an increased production of red blood cells. In
tumors secreting erythropoietin, the EPO levels may be abnormally high.
What is the treatment for polycythemia?
The treatment for polycythemia is generally dependent on the cause.
In polycythemia vera or other primary polycythemia syndromes, the treatment options are more
specific. Phlebotomy (drawing blood or blood letting) is the most essential part of the treatment.
The recommended hematocrit of less than 45 in men and less than 42 in women is the goal of
phlebotomy.
Several medications have been considered in conjunction with phlebotomy to suppress the
abnormal production of red blood cells. Most of these chemotherapeutic drugs have been linked
with side effects and their use has been controversial and limited.
The medication hydroxyurea (Hydrea) has been recommended for some patients with primary
polycythemia and higher risk of blood clot formation due to high blood viscosity. The factors
favoring treatment with hydroxyurea are age greater than 70, platelet count greater than 1.5
million, and general cardiovascular risk factors.

Aspirin and other anti-platelet agents (dipyridamole) may also be beneficial in patients with
polycythemia by reducing clotting complications, unless the patient has a history of bleeding
problems.
PATHOPHYSIOLOGY

Polycythemia Vera

Factors:
Age (older than 60 years old)
Gender (Male)
JAK2V617F gene mutation
Panmyelosis
RBC

Hgb

Hct

Erythropoietin
Blood volume

Concentration of
blood cells

Viscosity

Cerebral Blood flow

Hypertension

Headache
Itching and pain
of fingers, toes

Hypermetabolism
Plethora

Night sweats

Weight loss

Inability to
concentrate

Hearing and
vision
difficulties
Cyanosis of
lips, fingers
and mucous
membrane

LEVELS OF CARE
PROMOTIVE

Provide adequate hydration to the patient.

Provide safe and stress free environment for the patient.
Maintain a calm, nonjudgmental approach toward the patient when explaining the reasons

of isolation precaution.
Maintain a quiet and well-ventilated environment to the patient.

Provide dietary and nutritional advice to the patient.

Assist patient in identifying positive coping skills in order to reduce anxiety and promote
self-confidence.

Encourage patient to cooperate with the treatment procedure.

Assist patient in meeting her basic needs.

Provide rest periods and comfort measures to the patient.

Provide a stress free environment.
Teach the client of the potential benefits of his medications and treatment.
Medical follow-up and continuing care is required.

PREVENTIVE
There are no known preventative measures that will reduce your chances of getting
primary polycythemia; the condition is not contagious. However, with proper treatment, you can
prevent or delay symptoms and complications such as:

Avoid contact sports to prevent splenic injury and rupture.

Prevent iron supplementation this can promote production of red blood cells.
Prevent occurrence of injury.

CURATIVE

There is no cure, but recent research suggests that individuals who have primary
polycythemia may significantly increase their overall life expectancy by seeking treatment right
away.
REHABILITATIVE

Pheresis is the withdrawal of whole blood and removal of the patients RBCs to decrease
the number of RBCs and reduce blood viscosity. The remaining plasma is then re-infused

back into the patient.

Hydroxyurea (Hydrea). Hydroxyurea can lower all elevated blood counts (WBC, red

blood cells, and platelets) and for severe manifestations of the disease.
Aspirin has also been used in treating polycythemia to lower the risk of clotting

(thrombotic) events. Aspirin is usually used in conjunction with phlebotomy.

Encourage to increase oral fluid intake.

SAFE AND QUALITY NURSING CARE

Gather the patients biographical data and the description of the presenting disease.

Obtain thorough health history to aid in treatment.

Monitor laboratory values for any changes.
Encourage patient to verbalize feelings, worries and anxieties.
Complete the patient data and history.
Maintain client privacy and confidentiality.
Evaluate the interventions given during rounds.
Provide rest periods and maintain a quiet environment.
Encourage client to drink at least 3 liters of liquid each day.
Give anticoagulants as prescribed.
Position client with feet elevated whenever seated.
Encourage client to have soft-bristle toothbrush to brush teeth and advise not to use floss

between teeth.
Provide safe environment for the patient.
Assist client with ADLs.
Instruct patient to report any manifestations felt.

NURSING CARE PLAN

Cues:
Subjective- complaints of headache, dizziness, ringing of ears, blurring of vision, itching
of fingers and toes, cramping of lower legs when walking and night sweats for
almost 3 nights.
Objective- RBC = 9.6 x 1012/L, Hgb = 191 g/L, Hct = 0.82 vol. fr., and ultrasound that
indicates splenomegaly.

Nursing Diagnosis: Ineffective tissue perfusion r/t reduction or interruption of arterial or

venous blood flow insufficiency and viscosity evidenced by dizziness, blurring of vision
and night sweats.

Desired outcomes:
Short term:
After 4 hrs of effective nursing interventions, the patient will be able to:
1. Demonstrate increased perfusion as individually appropriate. (e.g skin warm & dry,
strong peripheral pulses, free of pain & discomfort)
2. Verbalize understanding of condition, therapy regiment, side effects of medications &
when to contact healthcare provider.
Long term:

After 2 weeks of effective nursing interventions the patient will be able to:
1. Demonstrate behaviors & lifestyle changes to improve circulation.

Interventions- Ratiomale
Independent:
1. Note current situation or presence of conditions that can affect perfusion to all body
systems (e.g polycythemia vera). To determine what affects systemic circulation/perfusion
or for baseline data.
2. Determine history of conditions associated with thrombus or emboli (e.g history of
coronary disease, myeloproliferative disorders). To identify client at higher risk for venous
stasis, vessel wall injury & hypercoagulability.
3. Note location of restrictive clothing, pressure dressing, circular wraps, cast and traction
devices. It may restrict circulation to limb.
4. Compare skin temperature & color with other limbs when assessing extremity circulation.
Helps differentiate type of problem (e.g edema, redness, swelling incalf of one leg is
associated with localized thrombophlebitis)
5. Measure capillary refill. To determine adequacy of systemic circulation.
6. Note client's nutritional & fluid status. Protein energy & malnutrition make ischemic
tissues more prone to breakdown. Dehydration reduces blood volume & compromises
peripheral circulation.
7. Evaluate extremity pain reports, noting associated symptoms (e.g cramping or heaviness,
discomfort etc) & determine time (day or night) that symptoms are worse, precipitating or
aggravating events (e.g walking) and relieving factors (e.g rest). To keep isolate and

differentiate problems such as intermittent chronic claudication versus loss of function &
pain due to loss of arterial blood flow.
8. Assess motor & sensory functions. Problems with ambulation, hypersensitivity, loss of
sensation, numbness and tingling are changes that can indicate neurovascular dysfunction
or limb ischemia.
9. Review laboratory studies such as clotting times, Hgb/Hct, renal or cardiac function tests &
diagnostic studies. Collaborate in treatment of underlying conditions such as blood
disorders. To maximize systemic circulation and organ perfusion.
Dependent
1. Administer fluids, electrolytes, nutrients, & O2 as indicated. To promote optimal blood
flow, organ perfusion & function.
2. Administer medications such as antiplatelet agents, thrombolytics, and antibiotics. To
improve tissue perfusion or organ function.
3. Assist with or prepare for medical procedure such as endovascular stent placement, surgical
revascularization procedure, thrombectomy. To improve peripheral circulation.

Evaluation:
Goals MET:
Short term:
After 4 hrs of effective nursing interventions, the patient was able to:
1. Demonstrate increased perfusion as individually appropriate. (e.g skin warm & dry,
strong peripheral pulses, free of pain & discomfort)

2. Verbalize understanding of condition, therapy regiment, side effects of medications &

when to contact healthcare provider.
Long term:
After 2 weeks of effective nursing interventions the patient was able to:
1. Demonstrate behaviors & lifestyle changes to improve circulation.

Discharge planning:
M- Medications - Continue administering medications such as antiplatelet agents,
thrombolytics and antibiotics to improve tissue perfusion or organ function using the 10Rs
of drug administration.
E- Environment - Maintain a calm & safe environment appropriate for the healing process.
T- Treatment - Identify necessary changes in lifestyle and to assist client to incorporate disease
mgt into ADLs & to limit complications associated with poor perfusion and tissue injury.
H- Health Teachings - Encourage early ambulation when possible. Provide pressure-relieving
devices for immobilized client. Elevate legs. Avoid massaging the leg in presence of
thrombosis.
O- OPD- Stress need for regular medical and laboratory follow up to evaluate disease
progression and response to therapies. Follow up with the physician next schedules of
appointments.
D - Diet - Refer to dietician for a well balanced, low saturated fat, low cholesterol diet or other
modifications as needed.
S- Emphasize importance of spirituality & support groups.

HEALTH TEACHING PLAN

Objectives:
After 30 minutes the client will be able to:
a.
b.
c.

Define polycythemia vera.

Identify the causes, and, signs and symptoms of polycythemia vera
Follow the importance of treatment regimen of polycythemia vera and preventive

measures of symptoms and complications

d. Acquire other information regarding the illness
Content Outline:

Definition of Polycythemia Vera.

Causes of Polycythemia Vera
Signs and Symptoms of Polycythemia Vera
Treatment of Polycythemia Vera
Preventive measure of symptoms and complications

Materials:

Hand-outs

Teaching Methodology:

Discussion
Lecture

Time Allotted:

30 minutes

Resources:

Handouts
Books
Internet
Pictures

Method of Evaluation:

Question and answer

COMMUNICATION

Approach the patient in a formal manner and refrain from social chitchats.
Establish rapport with the client by listening attentively to clients queries.
Use information sharing as a nonthreatening approach to engage with the patient and

build rapport.
Encourage patient to ask question and participate in their care.
Be mindful of the patients psychological readiness to communicate, as well as respect

their preference as to whom they wish to share their thoughts/emotions with.

Respect and protect confidential information.
Spend time with the client, let the patient verbalize and express worries and anxieties.
Listen attentively to queries and concerns of the patient.
Avoid elderspeak the make older adults feel disrespected and powerless and can lead to

actual physical health consequences.

Pay attention to sentence structure when conveying critical information.
Maintain eye contact with patient instead of focusing on something else.
Include the patient the family in the care planning.

COLLABORATION AND TEAMWORK

Encourage family members to maintain a safe environment.

Establish good interpersonal relationship with the client. This will help establish rapport

in formulating an effective care plan for the patient.

Collaborate with the laboratory department for review of laboratory tests if there is
alteration in blood chemistry and by following up results of laboratory and diagnostic

tests to avoid delay of analyzing the test results.

Collaborate with the physician for the medications ordered.
Encourage family and significant others to be involved in treatments given to the patient.
Maintain good interpersonal relationship with members of the health care team.
Nurses can help them focus on treatment achievements and the patients strengths.
Allowing caregivers to get time away from their care giving role and offering comfort

and support when life challenges seem overwhelming are important aspects of the
nursing role.
ENABLING COMPENTENCY
MANAGEMENT OF RESOURCES AND ENVIRONMENT

Thorough hand washing must be performed by everyone who enter the patients room

everytime.
Provide a safe, non-stimulating and comfortable atmosphere conducive for rest with good

ventilation.
Explain that limiting physical activity helps reduce fatigue.
Emphasize importance of adequate rest.
Keep the room clean and odor=free.

RECORD MANAGEMENT

Patients information and records must remain confidential and must be updated.
Document the medication given.
Appropriately record the physicians order.
Document the date and time of when the pheresis was done.
Document the exact contents of infusion fluid and volume infused.
Procedures and interventions done with the patient must be documented accurately.
Monitor patients vital signs accurately.
Record all observation of signs and symptoms of the patient.
Avoid loitering patient data to unauthorized personnel.
Closely monitor laboratory values especially hemoglobin and hametocrit level.

FDAR
FOCUS
Ineffective tissue perfusion r/t reduction or interruption of arterial or venous blood flow
insufficiency and viscosity evidenced by dizziness, blurring of vision and night sweats.
DATA

Complaints of headache, dizziness, ringing of ears, blurring of vision, itching of fingers

and toes, cramping of lower legs when walking and night sweats for almost 3 nights.
Laboratory and diagnostic results of RBC = 9.6 x 1012/L, Hgb = 191 g/L, Hct = 0.82 vol.
fr., and ultrasound that indicates splenomegaly.
ACTION

Note current situation or presence of conditions that can affect perfusion to all body

systems (e.g polycythemia vera).

Determine history of conditions associated with thrombus or emboli (e.g history of

coronary disease, myeloproliferative disorders).

Note location of restrictive clothing, pressure dressing, circular wraps, cast and traction

devices.
Compare skin temperature & color with other limbs when assessing extremity circulation.
Measure capillary refill.
Note client's nutritional & fluid status.
Evaluate extremity pain reports, noting associated symptoms (e.g cramping or heaviness,
discomfort etc) & determine time (day or night) that symptoms are worse, precipitating or

aggravating events (e.g walking) and relieving factors (e.g rest).

Assess motor & sensory functions.
Review laboratory studies such as clotting times, Hgb/Hct, renal or cardiac function tests
& diagnostic studies. Collaborate in treatment of underlying conditions such as blood

disorders.
Administer fluids, electrolytes, nutrients, & O2 as indicated.
Administer medications such as antiplatelet agents, thrombolytics, and antibiotics.
Assist with or prepare for medical procedure such as endovascular stent placement,
surgical revascularization procedure, thrombectomy.

RESPONSE
The patient will develop increased perfusion as individually appropriate. (e.g skin warm
& dry, strong peripheral pulses, free of pain & discomfort), verbalize understanding of

condition, therapy regiment, side effects of medications & when to contact healthcare
provider, and demonstrate behaviors & lifestyle changes to improve circulation.

ENHANCING COMPETENCY
RESEARCH
The evolution into and the treatment of late stage polycythemia vera.
Silverstein MN.
Abstract:
The onset of postpolycythemic myeoloid metaplasia or spent polycythemia has been recognized
for many years. As the result of many different series, the development of postpolycythemic
myeolid metaplasia might be expected in from 15%-20% of patients with postpolycythemia vera.
It appears that an etiologic role for sodium phosphate 32P may exist in this evolutionary pattern.
About 70% of patients with PPMM will have symptoms with the onset of the syndrome. The
major mechanisms producing symptoms result from (1) anemia, (2) pressure from massive
splenomegaly, and (3) bleeding problems. Iron deficiency is a frequent cause of anemia in
patients with PPMM. The major mechanism of anemia in these patients, however, relates to
ineffective erythropoiesis and shortened red cell survival. Androgen trials for ineffective
erythropoiesis seem worthwhile, although data on this point is too limited to draw any firm
conclusions. A steroid trial for those patients with major hemolytic episodes is indicated. In those
patients in whom adrenal steroid therapy fails to control major hemolysis, a consideration for
splenectomy exists. Pressure-related manifestations secondary to massive splenomegaly have
been treated with radiation therapy and oral alkylators. Although there is data to document
amelioration of painful symptoms with associated shrinking of the spleen, long-term control of

this problem has not been forthcoming. Again, patients who are medical failures in control of
pressure-related manifestations may be considered for splenectomy. Bleeding problems may
arise with PPMM secondary to thrombocytopenia, thrombocythemia, or qualitative platelet
dysfunction. Adrenal steroids have met with some success in improving platelet counts in
patients with life-threatening thrombocytopenia. Those patients who are medical failures with
adrenal steroids in terms of thrombocytopenia might be candidates for splenectomy. Control
of thrombocythemia has been observed with oral alkylator therapy and chlorambucil may have a
special role in managing this complication. Qualitative platelet defects leading to severe bleeding
are best managed with fresh platelet transfusions. Patients with PPMM in contrast to patients
with agnogenic myeoloid metaplasia have a more lethal syndrome and shortened survivorship.
Causes of death in patients with PPMM include cardiac problems, transition to acute leukemia,
hemorrhage, and infection.

Chromosome studies in polycythemia vera patients

Roland Berger, Alain Bernheim, Maryvonne Le Coniat, et.,al.
Abstract:
One hundred thirty-five polycythemia vera (PV) patients (30 untreated by chemotherapy and 105
treated) were studied cytogentically. The incidence of clonal chromosomal abnormalities was
20.7% (28 patients in nonleukemic phase). The incidence of 20q was 3.7% (5 patients). The
presence of cytogenetically abnormal clones did not allow prediction of the evolution of the
disease. In a few cases, abnormal clones disappeared at the time of later studies. Although
nonrandom, the majority of clonal chromosomal abnormalities are believed to be secondary
events in PV patients.

QUALITY IMPROVEMENT
STRUCTURE

The nurse must provide clean and well ventilated room.

The hospital must be complete in their facilities and equipments and must be available at
all times.

PROCESS

Teach the patient appropriate intervention on corrective and preventive measures for
polycythemia.

Improve patient's stay on the hospital by reporting any patient's necessary needs at the
bedside.

Document and record all nursing care action done to the patient

Document observed variances of clients health status everyday

Encourage patient to speak about her condition

OUTCOME

The complications was prevented/minimized

Patient satisfaction from the services of the health care team

EMPOWERING COMPETENCY
ETHICO-MORAL RESPONSIBILITIES
The patient has the right to regain and/or acquire the highest attainable standard of health,
in a non-discriminatory, gender sensitive, and equal manner, which health authorities and health

practitioners must progressively contribute to realize. (House Bill 261, Sec. 5, Societal Rights of
a Patient, Right to Health)
The nurse assigned to the patient must know and respect all of the Rights of the Patient as
stated in House Bill 261, in order to give fair and non-discriminatory care to the client. Such as:
Right to Informed Consent & Right to Information. Mr. J, had to take diagnostic tests and other
laboratory test to be able to know what his condition was. The client should be informed about
his condition so that he will be able to know what is really happening to him. Before the
healthcare team should proceed with the tests, they should share information to the client about
the procedures to be done so that the client will be able to decide and make an informed consent.
Right to Self-Determination. Mr. J has the right to make his own decisions. He will have the final
say when it comes to deciding what procedures to undergo. And if Mr. J decides to refuse any
procedure, he has the right to do so and the healthcare team must respect that.
LEGAL RESPONSIBILITIES

The nurse is responsible for everything that he/she does.

The nurse is responsible for carrying out the physicians orders correctly.
The nurse is responsible for documenting all interventions done for the patient.

Republic Act 9994 or the Expanded Senior Citizens Act of 2010 - This law can assist the patient
in availing himself of health care and financial aid in receiving health care. It states that the
Department of Health (DOH), in coordination with local government units (LGUs), nongovernment organizations (NGOs) and people's organizations (Pos) for senior citizens, shall
institute a national health program and shall provide an integrated health service for senior
citizens.

Republic Act 9502 or Universally Accessible Cheaper and Quality Medicines Act of 2008- This
law may help the patient in obtaining medicine that is necessary for his condition.
Republic Act 9173 or Philippine Nursing Act of 1991 - Aims to provide a sound general and
professional foundation for the practice of nursing through quality nursing education.
PERSONAL AND PROFESSIONAL DEVELOPMENT
The nurse must be aware of what his or her learning needs are. If possible, he or she should
attend activities or programs that enhance knowledge by sharing pertinent information about
Polycythemia Vera. If he/she wishes, he/she could go into continuing education. The nurse is
expected to participate in the nursing profession's ongoing efforts and activities to expand the
core of research-based knowledge for nurses.

NURSING IMPLICATIONS
NURSING EDUCATION
Nurses must be knowledgeable about the signs and symptoms of polycythemia vera. They must
be aware of potential complications and medical management to be given to the patient. They
should also provide a thorough patient teaching. Nurses should involve the patient and their
family members in their own plan of care therefore empowering the patient to assess his or her
condition. By aiming to ensure that they can correlate and understand the treatment regimen,

they can recognize signs and symptoms and understand the treatment regimen, and understand
the importance and significance of any changes and the appropriate action to be taken.
They should attend activities or programs that enhance their knowledge by sharing pertinent
information about Polycythemia Vera. If he/she wishes, he/she could go into continuing
education. Nurses are expected to participate in the nursing profession's ongoing efforts and
activities to expand the core of research-based knowledge for nurses.
NURSING PRACTICE
Nurses are responsible in documenting, managing and evaluating the complaints of the client.
The specialty nurse is an ideal position to do this as she has the ability to focus on the clinical
needs of the patient and also educational and supportive needs of the patient and their family.
NURSING RESEARCH
Nurses are responsible in keeping current and new research findings related to polycythemia vera
because it essential for the development of new knowledge and mostly it enables nurses to
provide evidence based health care. Such findings may improve healthcare outcomes for patients
with polycythemia vera or reduce the cost of care. They have personal responsibility to remain
updated on current best practices which include ability to critically appraise new research.
Nurses should also identify issues in patient care processes that need to be explored, involving
clinical practice, education, ethical issues, and specific needs of patients with polycythemia vera.
NURSING MANAGEMENT
The goal of nursing management is to improve outcomes for patients with polycythemia vera to
significantly reducing of unplanned readmission, length of hospital stay, hospital costs and

mortality. Nurse mangers are responsible in planning, directing, coordinating and evaluating the
nursing practice of the department with the goals of achieving excellence and continuing
improvement in quality, patient safety and patient satisfaction. Interventions should be carried
out as appropriate to prevent complications and any untoward sign and symptoms should be
documented and reported to the physician.