Polycythemia vera is a rare disease in which the body makes too many red blood cells. The excess cells make the blood too thick, this thickness causes blood to flow very slowly. It is a slow-growing cancer of the blood.
A person may have this disease and not know, it may be discovered during a blood test for another reason. A rare disease that can occur at any age, but it is common in people over 60 years. Polycythemia vera can be life-threatening if it is not treated quickly. Survival time may be 10 to 15 years with new treatment.
There are two types:
- Primary which is a chronic myeloproliferative disorder from chromosomal mutation.
- Secondary polycythemia can be hypoxia driven. Hypoxia stimulates the kidneys to produce more erythropoietin which then stimulates the production of erythrocytes. The need for more oxygen in the secondary type could be due to multiple reasons: cardiovascular disease, pulmonary disease, or tissue hypoxia.
Sign and Symptoms:
- Hypertension and Hyperviscosity from polycythemia vera are the cause of circulatory manifestations that are seen in this disorder.
- Polycythemia vera causes headache, vertigo, tinnitus
- Pruritus which is exacerbated by hot bath may be a confirmatory symptom.
- Other sign and symptoms include painful fingers and toes, hyperuricemia, weakness, and easy fatigability.
Complications include abnormal blood clots, which can lead to a heart attack or stroke.
Blood tests – elevated hemoglobin, increased platelets, uric acid, cobalamin levels. Increased histamine levels. Increased RBCs are noted in Bone marrow examination.
Treatment for polycythemia vera includes administering oxygen, radioisotope therapy, or chemotherapy agents for bone marrow suppression. Phlebotomy is the top treatment, to reduce the percentage of hematocrit; during phlebotomy, about 300ml of blood or more may be removed every other day until hematocrit is down to normal level.
- Maintain adequate oxygenation. This may prevent secondary polycythemia; primary polycythemia is not preventable.
- Control of pulmonary diseases, teach client to stop smoking.
- Educate clients to avoid high altitudes
- Assist with phlebotomy per orders and facility policies during acute exacerbations
- Monitor client for complications that may result from phlebotomy
- Monitor hydration therapy closely to avoid fluid overload.
- Moderate activities, to decrease the risk of clot formation
Reference: Lewis & Heitkemper, Med-Surg Nursing 2007
Rophem Nursing 😊
Raynaud’s disease (Raynaud’s phenomenon)
- Vasoconstrictive disease.
- Rare condition that affects the arteries – the blood vessels become narrow.
- The amount of blood that flows to the body is affected
- It mainly affects blood flow to fingers and toes.
- More common in women, triggered by cold temperatures and stress.
- Vasospasm leads to pain and pallor in affected extremities
- There may be ulceration of the fingers occasionally
- Color changes of the affected areas,
- Causes of Primary Raynaud’s disease is unknown
- Secondary Raynaud’s disease is more serious.
- Caused by other health issues, medications, or injuries
- Related health issues include – rheumatoid arthritis, scleroderma, Sjögren’s syndrome, or lupus, blood disorders, polycythemia vera, pulmonary hypertension.
Diagnostic tests – Cold stimulation test to trigger an episode
- Medication – Vasodilators (e.g. Nifedipine)
- Teach client to stay warm, avoid cold
- Teach to wear gloves, warm but nonconstructive.
- Encourage the client that smoking cessation is very important.
- Inform client to contact doctor if any sores or ulcers appear on fingers or toes.
Reference: Lewis & Heitkemper, Med-Surg Nursing 2007
Rophem Nursing 😊
A form of arthritis characterized by severe burning pain, redness, tenderness and stiffness in joints. Gout is a kind of arthritis caused by uric acid crystals forming in one or more joints.
- Usually start at night
- Very common in the big toe joint but can also occur in other joints
- Affected joint becomes red, feels hot, and painful.
- Pain increases when the joint is touched.
Causes & Risk Factors
- Foods that are rich in purines increase the risk for gout – Salmon, sardines, organ meats, asparagus, mushrooms and herring are examples of foods rich in purines.
- Gout is hereditary.
- Overweight, Alcohol, High cholesterol, Diabetes, high blood pressure
- Men develop gout more often than women.
- Pain relievers & anti-inflammatory medications – Motrin, Advil and Naproxen
Patient teaching – Teach patient to
- Take all medication as prescribed.
- Inform the MD before taking any aspirin product because aspirin can interfere with other medications
- Lose weight if patient is overweight.
- Seek treatment promptly for high blood pressure, high cholesterol or diabetes
- Follow diet prescribed – low-salt, & low-fat diet.
- To avoid alcohol and foods that are high in purines.
- To drink lots of water to help flush uric acid from the body.
- When gout is not treated, a gout attack can last for days or even weeks.
- Prolong attacks for many years may lead to TOPHI – uric acid crystals that form lumps under the skin.
- Tophi usually form on the toes, fingers, hands and elbows.
- Gout may also lead to kidney disease or kidney stones from uric acid crystals that collect in the urinary tract.
Reference: Lewis & Heitkemper, Med-Surg Nursing 2007
Rophem Nursing 🙂
- Reye’s syndrome is a rare illness, most common in children.
- It is a serious illness that can be harmful to the brain and the liver.
- Usually occurs in children who are recovering from a viral infection; which may include cold, flu, or chickenpox.
- Reye’s syndrome is commonly associated with the use of aspirin in children.
- To prevent Reye’s syndrome, aspirin (salicylates) should not be given to children.
Symptoms of Reye’s syndrome
- Symptoms can be very mild and may not be easily noticed.
- These symptoms can also can be very serious and may get worsen within few hours.
- Symptoms of Reye’s Syndrome may lead to death.
- Common symptoms include:
- Changes in level of consciousness
- Vomiting, Diarrhea
- Irritability and aggressive behavior
- Tachypnea (in children under 2 years old)
- Confusion, Lethargy, Seizures & Coma
Causes of Reye’s Syndrome
- The cause of Reye’s syndrome is not known yet.
- The use of aspirin to treat children with viral illness increases the chances of developing Reye’s syndrome.
Diagnosis of Reye’s Syndrome
- Diagnosis usually starts with blood and urine tests.
- Doctors may also test for metabolic disorders that could affect the liver.
- Sometimes more invasive tests are needed – lumbar puncture, liver biopsy, MRI, or CT.
Prevention of Reye’s syndrome
- Education – nurses should teach parents to avoid giving children aspirin
- Aspirin should not be given to any child under the age of 19
- Prevent viral illnesses in children, teach parents to make sure the child’s vaccinations are up to date.
Treatment for Reye’s Syndrome
- There is no cure for Reye’s syndrome.
- Early diagnosis helps towards successful treatment.
- A client with Reye’s Syndrome will be treated in the hospital, mostly in the intensive care unit (ICU).
- Treatments include:
- IV fluids and Diuretics
- Medicines to prevent bleeding
- Client may also need ventilator
Nursing Interventions – Prevent further complications
- Monitor vital signs – BP, RR, HR, Temp. Administer oxygen. Maintain airway.
- Monitor Intracranial Pressure and prevent seizures. Position to decrease ICP.
- Monitor blood glucose levels closely
- Intake and output, make sure to prevent fluid overload
- Assess hemodynamic status; monitor cardiac, respiratory and neurologic status.
- Administer medications per doctor’s orders, monitor for adverse effects, prevent injury and complications.
- Provide skin and mouth care, provide range of motion exercise to promote joint mobility.
- Provide supportive care for the client and the family members.
Reference: Wong’s Essentials of Pediatric Nursing 9th edition
Tip #1 – Study to understand, keep memorizing to a minimum.
Good students don’t always study more than other students. They just know how to manage their time, concentrate fully and effectively while studying. Students often express frustration about how much they have to study and how quick they forget. You just get it and forget it. At times like that, it’s important to remember that the NCLEX is an exam that test critical thinking and how well you can apply what you learned in school to a potential nursing situation. So, to prepare for such an exam, understanding of contents is absolutely important. When you understand a topic or a section, it becomes a part of you. If you get it and really understand it; it will be hard to forget it.
Concentrate during your study time – be sure to maintain your attention and focus without distractions. You may not want to hear this, but it’s very important to identify any distraction or disturbance that can make it hard for you to concentrate, then find a way to get rid of the distraction so you can understand what you study. At that point, if you are still having a hard time studying, an NCLEX review class can help you to tame the information you’re given in your textbooks and apply it to the exam. At Rophem, we host interactive classes with content mastery, test taking strategies, and critical thinking exercises designed to guide students step-by-step to pass the NCLEX.
Rophem Nursing Notes 🙂
Bowed but not Broken!
I remember receiving a phone call from a woman one afternoon. She sounded so disappointed and unhappy because her dearly beloved son had failed his exam. Her son was devastated and was ready to quit. After about half an hour conversation with him, I was able to convince him that he needed to bounce back; that was not what he expected to hear from me.
So many times in life, bad things happen as you are trying to move on to your destiny. Remember, you can be resilient. Tell yourself – Okay, I have to be strong and healthy. Know that you are stronger than you think or believe.
Seasons change and that’s natural. So as you try again, and be strong, you will discover the great plans that God has in store for you.
Rise Up. Try Again. Be Resilient.
Set your eyes on the prize; always remember that nothing comes easy in life. If it were to be easy then everyone will have it and it wouldn’t worth that much.
What is the goal that you want to achieve at this time; stay focused, have the strong will and gently find available resources.
Other things will happen at the same time, life has to go on and these things may appear to stand in your way. Try not to pay too much attention to distractions. Stay focused. A person does not fail until they give up. Never give up!!!
We all have goals of what we want to do or become in life. The interest in what we want to become is highly important. The goal will not achieve itself but the joy that comes into our lives once it is accomplished is usually what keeps us going. The first step is developing the motivation to get there, then do something every day to refresh the motivation; this becomes a habit and it will get you there!
It is a brilliant idea to want to do something or become somebody (become a Nurse). Nurses are heroes, nurses are the best, nurses are awesome; and you want to be the best, you want to be a hero, you want to be a nurse! So don’t wait to accomplish your dreams, you’ve started school, congratulations, but you have to push to graduation!
Here is what’s important; how motivated are you to do this? You are really motivated to join one of the best professions in the world; be motivated to finish. You cannot allow the flame to die too quickly after you’ve started. To become a hero is hard but it’s worth it at the end. You will do a lot of work and a lot of studying. It will be hard but you have to remember what prompted you to start, the goal that you have set will help you to develop the habit that will keep you going.
Don’t give up!
– Rophem 🙂
Congratulations!! You have achieved those things that you really wanted – you’ve finished nursing school, passed the NCLEX and now you probably secured your first job as a nurse or you are waiting to get one. So what’s next, how ready are you for the tasks ahead? There are challenges ahead and most graduates feel overwhelmed and unprepared; as a matter of fact, some new nurses find it hard to keep their first job past their orientation time.
I remember when I finished nursing school, honestly, it was a great achievement to become a nurse but then the reality of this lovely and wonderful profession can be shocking. As a graduate or new nurse, you really do not know everything; yes, you passed every test but you are still learning and now you learn where you work. Note that as a new nurse, you are not expected to have answers to every question. So here are some ideas to help get through your first year as a Nurse.
- Be Patient: Remember you are still learning, you don’t know everything, and there are some questions you may not be to answer right away. Give yourself time to learn and you will surely get there. The same thing applied to the unit you work, it will take some time for you to know all the policies and get used to the unit in general. So do not be harsh on yourself. If there is anything you don’t know, don’t feel bad because it is okay. Be Patient; take one day at a time.
- Don’t be afraid to ask: one of those things that will help you to learn is asking questions. This is a sign that you are ready to learn, and that you do not want to make mistakes. Making assumptions when you don’t know what to do will only lead to mistakes. Remember you are a nurse, and that you are taking care of people – mistakes could be bad, so ask questions. Protect your practice.