NORTHWESTERN UNIVERSITY

College of Allied Health Sciences

DEPARTMENT OF NURSING
Laoag City

SEPSIS, RESOLVED, SECONDARY TO ACUTE PYELONEPHRITIS

DM TYPE 1, POORLY CONTROLLED

NON- ALCOHOLIC FATTY LIVER DISEASE

In partial fulfilment of the requirement in NCM 118 (Care of Clients with Life Threatening
Condition, Acute Illnesss, Multi Organ Problems, High Acuity and Emergency Situation,
Acute and Chronic)

Submitted by:

BSN-IVB Students, Batch 2023-2024

Aquillo, Nathalie B.

Borja, Desiree Lyn T.

Cristobal, Mica Diane C.

Dancel, Sheyden D.

Galano, Shainah Reign T.

Maquiraya, Brittany Lei

Pacis, Ma Luisa Xeena F.

Salvador, Erika Jhane O.

Sinfuego, Lei Justine A.

Tolentino, Roel T.

Tomas, Sherylle Joyce Z.

Presented to

Faculty of Level IV

November 2023
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College of Allied Health Sciences
DEPARTMENT OF NURSING

Table of Contents

A. Overview of the Background of the Case

B. Pertinent Information

C. Readings

Definition
Types/Classification/ Kinds of the Disease
Risk Factors
Statistical Data (Incidence/Prevalence)
Clinical Manifestations
Complications
Management

D. Anatomy and Physiology

E. Health History

F. Physical Assessment

G. Pathophysiology

H. Developmental Data

I. Patterns of Functioning

J. Level of Competencies

K. On going appraisal

L. Diagnostic/Laboratory Confirmatory Test

M. Medical Management

N. Drug Study

O. Nursing Care Plan

P. General Evaluation

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DEPARTMENT OF NURSING

C. READINGS

I. Community Acquired Pneumonia – Moderate Risk

Community-acquired pneumonia (CAP) refers to an acute infection of the pulmonary

parenchyma acquired outside of the hospital, which is a leading cause of morbidity and

mortality worldwide. Pneumonia is a form of acute respiratory infection that affects the

lungs. Pneumonitis is a more general term that describes an inflammatory process in the lung

tissue that may predispose or place the patient at risk for microbial invasion. Pneumonia is an

inflammation of the lung parenchyma caused by various microorganisms, including bacteria,

fungi, and viruses. The most common bacterial causes include Streptococcus pneumoniae

(pneumococcus), Haemophilus influenzae, and atypical bacteria such as Mycoplasma

pneumoniae and Legionella pneumophila. Viruses such as influenza (flu) and respiratory

syncytial virus (RSV) can also cause CAP. The clinical presentation of CAP varies, ranging

from mild pneumonia characterized by fever and productive cough to severe pneumonia

characterized by respiratory distress and sepsis. Due of the wide spectrum of associated

clinical features, CAP is a part of the differential diagnosis of nearly all respiratory illnesses.

Global:

National:

Local:

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DEPARTMENT OF NURSING

CLASSIFICATION

 Community-acquired pneumonia (CAP) – it refers to an acute infection of the

pulmonary parenchyma acquired outside of the hospital.

 Nosocomial pneumonia - it refers to an acute infection of the pulmonary parenchyma

acquired in hospital settings and encompasses both hospital-acquired pneumonia

(HAP) and ventilator-associated pneumonia (VAP).

o HAP refers to pneumonia acquired ≥48 hours after hospital admission.

o VAP refers to pneumonia acquired ≥48 hours after endotracheal intubation.

Risk Factors

Non-modifiable Risk Factors:

Age: The risk of CAP increases with age, particularly in older adults.

Underlying Health Conditions: Certain medical conditions such as chronic lung

diseases (e.g., COPD), heart disease, diabetes, and immune system disorders increase the risk

of developing CAP.

Weakened Immune System: Conditions or medications that weaken the immune

system, such as chemotherapy or immunosuppressive drugs, increase susceptibility to CAP.

Recent Respiratory Infections: Having recently had a cold, flu, or other respiratory

infection can increase the risk of developing CAP.

Socioeconomic Factors: Factors such as poverty, overcrowded living conditions, and

lack of access to healthcare can contribute to the risk of CAP.

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DEPARTMENT OF NURSING

Modifiable Risk Factors:

Smoking: Smoking damages the lungs and impairs the immune system, increasing

the risk of respiratory infections, including CAP. Quitting smoking can reduce this risk.

Alcohol Consumption: Excessive alcohol consumption can weaken the immune

system and increase susceptibility to infections, including CAP. Moderating alcohol intake

can help reduce this risk.

Poor Nutrition: Malnutrition or a diet lacking in essential nutrients can weaken the

immune system, making individuals more vulnerable to infections. Eating a balanced diet

rich in fruits, vegetables, and protein can help strengthen immunity.

Immunization Status: Vaccination against common bacterial and viral pathogens

that cause pneumonia, such as Streptococcus pneumoniae and influenza virus, can

significantly reduce the risk of CAP.

Hygiene Practices: Good hygiene habits, such as frequent handwashing, avoiding

close contact with sick individuals, and practicing respiratory etiquette (covering coughs and

sneezes), can help prevent the spread of respiratory infections, including CAP.

Causes

 Many pathogens cause community-acquired pneumonia, including bacteria, viruses,

and fungi. Common bacterial pathogens can be classified as:

 Gram-positive agents such as Streptococcus pneumoniae, Staphylococcus

aureus, group A streptococci, and other streptococci

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DEPARTMENT OF NURSING

 Gram-negative agents such as Haemophilus influenzae, Moraxella catarrhalis,

and Enterobacteriaceae

 Atypical agents such as Legionella, Mycoplasma, Chlamydia pneumoniae, and

Chlamydia psittaci

 Among viruses, rhinovirus, influenza, severe acute respiratory syndrome coronavirus

2 (SARS-CoV-2), and other respiratory viruses (parainfluenza, respiratory syncytial

virus, human metapneumovirus, etc) have become increasingly detected as pathogens

based on molecular detection methods. Worldwide, S pneumoniae and H influenzae

are still the leading causes of acute bacterial pneumonia.

Clinical Manifestations

 Dyspnea is a frequent symptom in patients with acute pneumonia but is generally not

the predominant complaint. Difficulty breathing or shortness of breath may occur,

especially with exertion. In severe cases, it may occur at rest.

 Crackles, these sounds occur if the small air sacs in the lungs fill with fluid and

there’s air movement in the sacs, such as when breathing.

 Weakness/ Fatigue, lung capacity is reduced, and muscles may be weak, feelings of

tiredness or fatigue are common with CAP, especially in the early stages of the illness.

 Fever is common in CAP and may be moderate to high-grade. It is often accompanied

by chills and sweating.

 Cough, A persistent cough is a hallmark symptom of CAP. It may produce sputum,

which can vary in color and consistency depending on the type of organism causing

the infection.

 Chest Pain, Chest pain may occur, particularly with coughing or deep breathing. The

pain is often described as sharp or stabbing and may worsen with movement.

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 Rapid Breathing (Tachypnea), Increased respiratory rate, or tachypnea, may be

observed, especially in severe cases.

 Cyanosis, Bluish discoloration of the lips or nail beds, may occur in severe cases due

to inadequate oxygenation of the blood.

 Generalized Symptoms, Other general symptoms such as headache, muscle aches,

and loss of appetite may also be present, particularly in systemic infections.

Complications

 Acute respiratory distress syndrome (ARDS), ARDS is a severe form of respiratory

failure characterized by widespread inflammation in the lungs, leading to difficulty

breathing and low oxygen levels in the blood. Pneumonia is one of the leading causes

of ARDS.

 Lung abscess is defined as necrosis of the pulmonary tissue and formation of cavities

containing necrotic debris or fluid caused by microbial infection. A lung abscess is a

localized collection of pus within the lung tissue. It may develop as a complication of

severe or untreated pneumonia.

 Respiratory failure happens when the capillaries, or tiny blood vessels, surrounding

your air sacs can’t properly exchange carbon dioxide for oxygen. In severe cases of

pneumonia, particularly if there is significant inflammation and fluid accumulation in

the lungs, respiratory failure can occur, leading to inadequate oxygenation of the

blood.

 Sepsis, pneumonia can lead to a systemic inflammatory response known as sepsis.

Sepsis occurs when the body's response to infection becomes dysregulated, leading to

widespread inflammation and potentially life-threatening organ dysfunction.

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 Bacteremia, Bacterial pneumonia can lead to the presence of bacteria in the

bloodstream, a condition known as bacteremia. This can lead to the spread of

infection to other organs and tissues in the body.

 Pleural Effusion, in some cases of pneumonia, fluid may accumulate in the pleural

space surrounding the lungs, leading to a condition known as pleural effusion. This

can cause chest pain and further impair breathing.

 Meningitis, Certain bacteria that cause pneumonia, such as Streptococcus

pneumoniae, can also cause meningitis, an infection of the membranes covering the

brain and spinal cord.

 Long-Term Lung Damage, pneumonia can cause long-term lung damage, leading to

conditions such as bronchiectasis or fibrosis, which may impair lung function and

quality of life.

Pharmacological Management

 Antibiotics: the cornerstone of treatment for bacterial pneumonia. The choice of

antibiotic depends on whether the pneumonia is mild, moderate, or severe, as well as

other factors such as the patient's age and underlying health conditions.

o Macrolides

 They are often used as first-line agents in patients without risk factors

for drug-resistant pathogens, an example would be azithromycin,

clarithromycin, and erythromycin.

o Beta-lactam antibiotics

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 They are frequently used alone or in combination with a macrolide or a

respiratory fluoroquinolone. Penicillin, amoxicillin, and cephalosporins

(such as ceftriaxone or cefuroxime) are one of such drugs.

o Respiratory fluoroquinolones

 They are reserved for patients with comorbidities or risk factors for

drug-resistant pathogens, or in cases of treatment failure with other

antibiotics. Examples include levofloxacin, moxifloxacin, and

gemifloxacin.

 Antiviral Agents: Antiviral drugs may be used in the treatment of viral pneumonia

caused by influenza or other respiratory viruses. Examples include oseltamivir

(Tamiflu) for influenza and ribavirin for certain respiratory viruses.

 Antipyretic/ Analgesic agents: used as fever reducers and relieve discomfort,

acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) are examples.

 Corticosteroids: In some cases, corticosteroids may be used as adjunctive therapy,

particularly in patients with severe CAP or those with refractory hypoxemia.

Corticosteroids can help reduce inflammation and improve oxygenation,

dexamethasone and prednisone are such drugs.

 Bronchodilators: These may be used in patients with underlying lung disease, such

as asthma or chronic obstructive pulmonary disease (COPD), to relieve bronchospasm

and improve airflow, albuterol and ipratropium bromide are such drugs.

Medical Management

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 Supportive treatment: it includes hydration, antipyretics, antihistamines, or nasal

decongestants.

 Oxygen Therapy: Supplemental oxygen may be necessary for patients with severe

pneumonia and hypoxemia to maintain adequate oxygenation.

 Respiratory Support: In severe cases, mechanical ventilation or noninvasive

ventilation may be required to support breathing.

 Monitoring of patient’s status: Regular monitoring of vital signs, oxygen saturation,

and clinical status is essential to assess treatment response and detect any

complications promptly.

 Treatment of atelectasis, pleural effusion, shock, respiratory failure, superinfection is

instituted, if needed.

Surgical Management

 Pleural Effusion Drainage

o In cases where a significant pleural effusion (accumulation of fluid around the

lungs) develops as a complication of pneumonia, drainage of the effusion may

be necessary. This can be done through procedures such as thoracentesis

(insertion of a needle into the pleural space to remove fluid), chest tube

placement, or, in some cases, surgical decortication (removal of the thickened

pleural peel).

 Empyema Drainage

o If a pleural effusion becomes infected and progresses to empyema (pus

accumulation in the pleural space), drainage of the empyema may be required.

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This typically involves more extensive procedures such as video-assisted

thoracoscopic surgery (VATS) or open thoracotomy to drain the infected fluid

and remove any necrotic tissue or debris.

 Lung Abscess Drainage

o In rare cases, severe pneumonia may lead to the formation of a lung abscess (a

localized collection of pus within lung tissue). Drainage of the abscess may be

necessary if it fails to resolve with antibiotic therapy alone. This can be

achieved through percutaneous needle aspiration, bronchoscopy with drainage,

or surgical resection of the affected lung tissue.

 Lobectomy or Segmentectomy

o In cases of severe or recurrent pneumonia localized to a specific lobe or

segment of the lung, surgical resection of the affected portion of the lung

(lobectomy or segmentectomy) may be considered.

 Surgical Biopsy

o In cases where the diagnosis of pneumonia is uncertain or where there is

suspicion of an underlying malignancy or other pathology, a surgical lung

biopsy may be performed to obtain a tissue sample for histopathological

analysis.

Nursing Management

 Administer oxygen as prescribed

o Rationale: This is one way to help patients who cannot breathe adequately on

their own.

 Monitor V/S

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o Rationale: to determine patients current status and prevent any signs of

deterioration.

 Encourage to drink plenty of water

o Rationale: To hydrate the body, loosen mucus in the lungs, and help bring up

phlegm.

 Administer antibiotics as prescribed.

o Rationale: To prevent complications and to help the body clear the infection

 Prevent the spread of infection by hand washing and the proper disposal of

secretions.

o Rationale: reduces the rate of respiratory infections by removing respiratory

pathogens from hands and preventing them from entering the body or passing

on to other people.

 Prevention through Vaccination

o Rationale: encourage patient to have vaccinations against common pathogens

that cause pneumonia, such as Streptococcus pneumoniae and influenza virus,

is an essential component of pneumonia prevention.

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DEPARTMENT OF NURSING

II. POLYCYTHEMIA VERA

Polycythemia vera (PV) is a rare blood disorder in which there is an increase in all

blood cells. It is one of three stem-cell–derived myeloid malignancies commonly known as

myeloproliferative neoplasms. It is characterized by erythrocytosis, often with associated

leukocytosis and thrombocytosis. It has a significant negative impact on overall mortality and

morbidity in the form of arterial and venous clots, symptoms of fatigue and pruritus, and

conversion to leukemia and myelofibrosis, it is a blood cancer that begins in the marrow of

the bones, the soft center where new blood cells grow particularly red blood cells. It causes

the marrow to make too many red blood cells making the blood too thick. It may likely cause

a person to have clots, a stroke, or a heart attack. This disease gets worse slowly, usually over

many years. It can be life-threatening if a person doesn’t get treatment, but the right care can

help live a long life. Most people who have PV don’t get diagnosed until they’re 60 or older,

usually after a routine blood test. But it can happen at any age. Men get it more often than

women.

 Acute myeloproliferative neoplasms – it is a rare and aggressive subtype of

myeloproliferative neoplasm characterized by the rapid and uncontrolled

proliferation of myeloid cells in the bone marrow. These abnormal cells

typically include blasts (immature white blood cells) and may lead to the

replacement of normal bone marrow cells, resulting in impaired production of

healthy blood cells.

Incidence and Prevalence

Global, National, Local –

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Classifications

1. Spontaneous Polycythemia: occurs without an identifiable cause or underlying

condition.

2. Secondary Polycythemia: results from condition or factors outside the bone marrow

that stimulate the production of RBC’s. Causes include chronic hypoxia (e.g., high

altitude, chronic lung disease), tumors (e.g., renal cell carcinoma), and certain

medications (erythropoietin theraphy).

Risk Factors

The exact cause of polycythemia vera (PV) is not fully understood, but certain factors

may increase the risk of developing the condition.

 Age: PV is more commonly diagnosed in older adults, with the median age of

diagnosis typically around 60 to 65 years old. However, it can occur at any age,

including in younger individuals.

 Gender: PV affects both men and women, but some studies suggest a slightly higher

prevalence in men.

 Genetic Mutations: The majority of individuals with PV have a specific genetic

mutation known as the JAK2V617F mutation. This mutation is believed to play a

central role in the development of PV by activating signaling pathways that promote

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the proliferation of blood cells. Other mutations, such as mutations in the genes for

the thrombopoietin receptor (MPL) or calreticulin (CALR), may also be present in

some cases of PV.

 Family History: Having a family history of PV or other myeloproliferative

neoplasms (MPNs) increases the risk of developing PV. In some cases, PV may be

inherited in an autosomal dominant pattern, although most cases are sporadic.

 Exposure to Radiation: Prolonged exposure to ionizing radiation, such as from

radiation therapy for cancer treatment or occupational exposure, has been associated

with an increased risk of developing PV.

 Exposure to Chemicals: Some studies suggest that exposure to certain chemicals,

such as benzene or pesticides, may increase the risk of developing PV. However, more

research is needed to fully understand the role of environmental exposures in the

development of the condition.

Causes

Polycythemia vera is caused by a genetic change (mutation) that develops during a

person’s lifetime. Normally, the body regulates the number of each of the three types of blood

cells - red blood cells, white blood cells and platelets. But in polycythemia vera, the bone

marrow makes too many of some of these blood cells. The cause of the gene mutation in

polycythemia vera is unknown, but it's generally not inherited from parents.

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DEPARTMENT OF NURSING

Clinical Manifestations

 Related to increased blood cell production:

o Headaches - a throbbing or pressure-like, due to increased blood volume and

pressure.

o Dizziness - especially when standing up quickly, due to sluggish blood flow

and decreased oxygen delivery to the brain.

o Fatigue or weakness - which may be persistent and impact daily activities.

o Itchiness - particularly after exposure to warm water (aquagenic pruritus),

caused by histamine release from excessive basophils.

o Blurred or double vision - due to increased blood viscosity affecting retinal

blood flow.

o Reddish or purplish skin discoloration - particularly in the hands and feet,

due to increased blood flow to the skin.

 Symptoms related to increased blood viscosity:

o Easy bruising or bleeding - due to impaired platelet function and increased

risk of clotting.

o Thrombosis (blood clots) - which can occur in various locations such as the

deep veins of the legs (deep vein thrombosis), lungs (pulmonary embolism),

brain (stroke), or heart (heart attack).

 Symptoms related to hyperviscosity syndrome (rare)

o Neurological symptoms such as confusion, dizziness, or even coma, due to

impaired blood flow to the brain.

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o Respiratory symptoms such as shortness of breath or cough, due to impaired

oxygen exchange in the lungs.

Complications

 Blood Clots

o When blood gets thick, it can stick together and form clots inside the veins.

This can happen in different places in the body.

o Deep vein thrombosis (DVT) is a clot in a vein deep inside the leg.

o Sometimes a clot gets loose and travels through a blood vessel. From there, it

can move into the lung and get stuck. This is a pulmonary embolism, and it’s

an emergency.

o A clot can also lodge in the brain and cause a stroke. Or it can block a blood

vessel in the heart and cause a heart attack.

 Low Oxygen

o Blood carries oxygen around the body. When PV slows blood flow, it's hard

for oxygen to reach the organs which may cause fatigue, weakness, headache,

dizziness, shortness of breath, ringing in your ears, vision changes, such as

flashes of light, and chest pain.

 Bleeding

o Sometimes polycythemia vera prompts the body to make extra platelets.

Platelets normally help in blood clotting, but the extra ones in PV don't always

work well. They prevent the blood from clotting the way it should.

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o Some people with this condition bleed too easily. They may have bleeding

gums, a bleeding ulcer or other bleeding in the GI tract, nosebleeds, and

bruises or pooled blood under the skin

 Enlarged spleen (splenomegaly) or liver (hepatomegaly)

o Which may cause abdominal discomfort or fullness.

o Splenomegaly in PV is often due to increased blood flow through the spleen

caused by elevated blood cell counts, particularly red blood cells. The spleen

plays a role in filtering blood, and in PV, the increased blood viscosity can

lead to congestion and enlargement of the spleen.

o Hepatomegaly in PV may result from increased blood flow through the liver

due to elevated blood cell counts and congestion within the liver sinusoids. It

can also occur as a consequence of portal hypertension, a condition in which

increased resistance to blood flow through the liver leads to elevated pressure

within the portal vein system.

 Gout

o Gout is a type of arthritis. It's caused by the buildup of uric acid in the joints.

o Uric acid forms into hard crystals that leave the joints sore and swollen. A

patient get gout when cells turn over too quickly in the body -- like in PV.

o Signs of gout include swelling and pain in the joints, especially in the big toe.

 Myelofibrosis and Leukemia

o After years of pumping out extra red blood cells, the bone marrow can become

so filled with scar tissue that it can't make enough blood cells to meet body's

needs. Doctors call this condition myelofibrosis.

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o It’s rare, but abnormal bone marrow cells grow out of control. This can lead to

acute myelogenous leukemia, a cancer of the blood and bone marrow.

Pharmacological Management

 Cytoreductive Therapy:

o Hydroxyurea - a commonly used cytoreductive agent that works by inhibiting

DNA synthesis in rapidly dividing cells, including blood cells. It is often used

as first-line therapy for PV to reduce red blood cell, white blood cell, and

platelet counts.

o Interferon-alpha - a type of immunomodulatory medication that can suppress

bone marrow activity and reduce blood cell production. It may be used as an

alternative or adjunct to hydroxyurea, particularly in younger patients or those

planning pregnancy.

o Ruxolitinib - a Janus kinase (JAK) inhibitor that interferes with signaling

pathways involved in blood cell production. It is approved for the treatment of

PV in individuals who are resistant to or intolerant of hydroxyurea.

 Antiplatelet Therapy:

o Low-dose Aspirin - it is commonly used in PV to reduce the risk of

thrombosis by inhibiting platelet aggregation. It is typically recommended for

individuals with PV who have additional risk factors for thrombosis.

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 Anticoagulant Therapy:

o Warfarin - Warfarin is an oral anticoagulant that interferes with the body's

ability to form blood clots by inhibiting vitamin K-dependent clotting factors.

It may be used in individuals with PV who have a history of thrombosis or are

at high risk of thrombosis despite other treatments.

o Direct Oral Anticoagulants (DOACs) - DOACs such as rivaroxaban,

apixaban, and dabigatran are alternative oral anticoagulants that directly

inhibit specific clotting factors in the blood. They may be used in place of

warfarin in certain cases.

 Symptom Management:

o Antihistamines: Antihistamines may be used to alleviate pruritus (itchiness)

associated with PV, particularly aquagenic pruritus (itchiness triggered by

water).

o Topical Corticosteroids: Topical corticosteroids may be used to relieve skin

symptoms such as erythromelalgia (reddish or purplish discoloration of the

hands and feet).

Medical Management

 Phlebotomy (Venesection)

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o Phlebotomy is the primary treatment for PV and involves the removal of

excess red blood cells by periodically drawing blood from a vein. This helps

reduce blood viscosity and the risk of thrombosis. The frequency of

phlebotomy sessions is determined based on factors such as age, overall

health, and blood cell counts.

 Regular Monitoring

o Regular monitoring of blood cell counts, symptoms, and potential

complications is essential for assessing treatment effectiveness and adjusting

therapy as needed. This often involves periodic blood tests and physical

examinations.

Surgical Management

Surgical management is not typically a primary treatment modality for polycythemia vera

(PV), as PV is primarily managed with medical therapies aimed at reducing blood cell counts

and preventing complications. However, in certain cases where complications arise or there

are specific indications, surgical interventions may be considered.

 Splenectomy

o In rare cases of severe symptomatic splenomegaly (enlarged spleen) that do

not respond to medical therapy, surgical removal of the spleen (splenectomy)

may be considered. Splenectomy can help alleviate symptoms such as

abdominal pain or fullness and may reduce the need for frequent phlebotomy

by decreasing blood cell sequestration in the spleen. However, splenectomy is

generally avoided due to the risks associated with surgery, including infection

and an increased risk of thrombosis.

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 Portal Decompression Surgery

o In cases of PV complicated by portal hypertension (elevated pressure in the

portal vein system), surgical procedures to decompress the portal circulation

may be considered. This may include procedures such as portosystemic

shunting to divert blood flow away from the liver and reduce portal vein

pressure. Portal decompression surgery is typically reserved for individuals

with severe complications of portal hypertension, such as variceal bleeding or

refractory ascites, and is not commonly performed in the setting of PV alone.

 Bone Marrow Transplantation:

o For individuals with PV who develop myelofibrosis (scarring of the bone

marrow) or progress to acute leukemia, bone marrow transplantation may be

considered as a potentially curative treatment option. Bone marrow

transplantation involves replacing the diseased bone marrow with healthy

donor bone marrow or stem cells to restore normal blood cell production.

However, bone marrow transplantation is associated with significant risks and

complications, and it is typically reserved for individuals with advanced

disease or those who have failed other treatments.

Nursing Management

 Educate patient and significant other

o Rationale: Provide information about the nature of PV, including its causes,

symptoms, and potential complications.

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o Educate patients about the importance of adhering to their treatment plan,

including medication adherence, phlebotomy schedule, and follow-up

appointments.

o Teach patients about lifestyle modifications to help manage PV, such as

maintaining hydration, avoiding smoking, and engaging in regular physical

activity.

 Monitor vital signs

o Rationale: to assess for signs of complications such as hypertension or

thrombosis and to assess the patient’s response to treatment and to identify any

sign of worsening condition.

 Care for before, and after phlebotomy.

o Rationale: Monitor patients during and after phlebotomy for signs of

hypovolemia or other complications and provide appropriate nursing

interventions as needed.

 Assess and address symptoms such as pruritus, headache, or vasomotor

symptoms.

o Rationale: to timely provide comfort measures, such as cool compresses or

topical corticosteroids, to alleviate symptoms of pruritus or skin discomfort

and any other manifestations.

 Emotional Support

o Rationale: to reassure patients and their families and to offer them emotional

and mental assistance

 Promotion of Self-care

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o Rationale: providing guidance on self-care strategies, such as maintaining

adequate hydration, avoiding excessive alcohol consumption, and managing

stress for patients health improvement.

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REFERENCES

Ramirez, J. R. (2023, April 13). Overview of community-acquired pneumonia in adults.

Uptodate. Retrieved March 1, 2024, from https://www.uptodate.com/contents/overview-of-
community-acquired-pneumonia-in-adults

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