Signs of thrombotic events (chest pain, sudden weakness, slurred speech, unilateral leg swelling, dyspnea) require immediate reporting.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A nurse is caring for a client with polycythemia vera. Which intervention is most important to include in the plan of care?
Answer: A. Polycythemia vera causes overproduction of red blood cells, increasing blood viscosity and the risk of clotting (thrombosis, stroke, MI). Key measures include encouraging adequate hydration to reduce viscosity, promoting mobility, and supporting therapeutic phlebotomy. Encouraging generous fluid intake helps lower viscosity and clot risk. Restricting fluids would dangerously increase viscosity.
Question 2 of 3
A client with polycythemia vera has an elevated hematocrit. Which intervention does the nurse anticipate to reduce the risk of thrombosis?
Answer: A. Polycythemia vera causes overproduction of red cells, thickening the blood and raising clot risk. Therapeutic phlebotomy removes blood to lower the hematocrit, and adequate hydration plus anticoagulation help reduce thrombosis.
Question 3 of 3
A client suddenly develops a regular narrow-complex tachycardia at a rate of 180 beats per minute and is alert with a stable blood pressure. The provider orders adenosine. Which nursing action is essential when administering this drug?
Answer: B. Adenosine has an extremely short half-life of less than 10 seconds, so it must be given as a rapid IV push over 1 to 2 seconds at a port closest to the client and followed immediately by a rapid saline flush. A brief period of asystole or a flat-line pause is expected after administration. Giving it slowly, over several minutes, or as a slow drip would render it ineffective.
Keep the streak going with more questions like these, each with a full rationale.
What is polycythemia vera?
The thick, sluggish blood raises the risk of clotting, hypertension, and impaired perfusion. Most cases are associated with a JAK2 gene mutation. Hallmark findings include ruddy/plethoric flushed skin, hypertension, headache, and intense itching after a warm bath/shower (aquagenic pruritus).
Key points to remember
- Elevated hematocrit, hemoglobin, and RBC mass increase blood viscosity and thrombosis risk (stroke, MI, DVT).
- Classic signs include a ruddy/plethoric complexion, hypertension, headache, dizziness, visual disturbances, and splenomegaly.
- Pruritus, especially after a warm bath or shower (aquagenic), is a characteristic symptom.
- Therapeutic phlebotomy to reduce hematocrit is the cornerstone of treatment; myelosuppressive drugs like hydroxyurea may be added.
- Low-dose aspirin is commonly prescribed to lower clotting risk despite the high cell counts.
- Hyperviscosity and increased cell turnover can cause hyperuricemia and gout.
Signs & symptoms
- Ruddy/plethoric face, HTN
- Pruritus after warm bath
- HA, dizziness, splenomegaly
Nursing priorities
- Assist with and monitor response to therapeutic phlebotomy to lower hematocrit and blood volume.
- Encourage adequate hydration to reduce blood viscosity and clot risk.
- Promote mobility and leg exercises, and assess frequently for signs of thrombosis (DVT, stroke, MI).
- Administer prescribed low-dose aspirin and myelosuppressive agents; monitor blood counts.
- Assess for bleeding (paradoxical platelet dysfunction) and manage pruritus.
Labs & values
Patient teaching
- Drink plenty of fluids and avoid dehydration to keep blood from thickening.
- Recognize and immediately report signs of clots: leg pain/swelling, chest pain, sudden weakness or speech changes.
- Keep all phlebotomy appointments as scheduled to control blood thickness.
- Bathe in cooler water and use starch baths or prescribed medication to relieve itching.
- Avoid prolonged sitting or immobility; perform leg exercises and stop smoking to lower clot risk.
Red flags: report now
- Signs of thrombotic events (chest pain, sudden weakness, slurred speech, unilateral leg swelling, dyspnea) require immediate reporting.
- Severe headache, vision changes, or altered mental status may indicate cerebral thrombosis or hemorrhage.
- Abnormal bleeding combined with hyperviscosity signals dangerous complications needing urgent care.
References
Clinical references for this topic
