Polycythemia Vera

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Polycythemia Vera

• What is it?
• Manifestations
• Complications
• Interdisciplinary Care

Plethora
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Polycythemia Vera

• Nursing Management

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Medications

• epoetin (EPO, Procrit, Epogen)
• Administration
• Nursing Management

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Leukopenia Neutropenia

• Absolute Neutrophil Count (ANC)
• ANC total WBC x neutrophils
• Significance
• Clinical Manifestations
• Nursing Management
• Neutropenic Precautions

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Leukemia

• What is it?
• Classifications
• Clinical Manifestations
• Diagnostic Studies

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Leukemia Treatment

• Chemotherapy
• Bone Marrow Transplant
• HSCT (Hematopoietic stem cell transplantation)
• Biological Therapy

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BMT / HSCT

• Categories
• Suppression
• Complications
• Infection
• Thrombocytopenia
• Graft Versus Host (GVH) Disease

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Nursing Management

• Infection control
• Strict asepsis
• Protective isolation
• Frequent assessment

Who wears the mask and when do they wear it?
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Leukemia

• Nursing Management

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Malignant Lymphoma

• Hodgkins Disease
• Non-Hodgkins Lymphoma

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Multiple Myeloma

• Incidence / risk factors
• Risk ? with age
• Hazards associated with low socioeconomic status
• Clinical Manifestations
• Insidious onset
• Bone pain primary symptom
• Hypercalcemia
• Neurologic dysfunction
• (lethargy, confusion, weakness)

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Multiple Myeloma

• Diagnostic Studies
• X-rays
• Bone marrow biopsy
• Labs
• Bence Jones protein in urine
• Biopsy of lesions
• Interdisciplinary Care
• Induction chemotherapy
• Stem cell transplant
• Treatment of electrolyte imbalance

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Multiple Myeloma

• Complications
• Nursing Management
• Chronic Pain
• Impaired physical mobility
• Risk for injury

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Multiple Myeloma

• Community based care
• Patient / family education for discharge
• Signs and symptoms of complications
• Manfestations of infection
• Case management
• Referrals home health and home maintenance
  services
• Physical / occupational therapy
• Hospice care (as appropriate)

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Medications and Platelet Function

• Prescription
• Aspirin containing analgesics
• Chemotherapy
• Antibiotics (PCN)
• Carbamazepine (Tegretol)
• Colchicine
• Heparin
• Sulfonamides
• Thiazide diuretics

• Over the counter
• Aspirin
• NSAIDs

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Problems of Hemostasis

• Thrombocytopenia
• Plt count lt 100,000 /ml blood
• Mechanisms
• ? production
• ? sequestration in spleen
• Decelerated destruction

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Thrombocytopenia

• Primary
• Immune Thrombocytopenic purpura (ITP)
• Heparin-induced thrombocytopenia (HIT)

• Secondary
• Diseases
• Drugs
• Treatments

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ons.htm
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Nursing Care

• What will you assess?
• What diagnostic tests will you anticipate?
• What are the most appropriate nursing diagnoses?

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Problems with Hemostasis

• Hemophilia
• Hemophilia A (classic)
• von Willebrand disease
• Disseminated intravascular coagulation (DIC)

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Hemophilia

• X-linked recessive disorders
• Hemophilia A classic
• Von Willebrands disease
• Manifestations

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Hemophilia
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ml
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Hemophilia

• Nursing Management
• Health Promotion
• Acute Intervention
• Home Care

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Problems of Hemostasis

• Nursing Management
• Health Promotion
• Nursing Diagnoses
• Acute Intervention
• Precautions RANDI

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DIC

• What a paradox
• Not a disease
• Predisposing conditions
• Clinical Manifestations
• Diagnostic studies

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DIC

• Interdisciplinary Care
• Nursing Management
• Nursing Diagnoses
• Implementation
• Expected Outcomes

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Splenomegaly
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References

• Amgen. (2007). Epogen product information.
  Retrieved September 3, 2006, from
  http//www.epogen.com/pdf/epogen_pi.pdf.
• Deglin, J. H., Vallerand, A. H. (2007). Daviss
  drug guide for nurses (10th ed.). Philadelphia
  F. A. Davis Company.
• Gahart, B. L., Nazareno, A. R. (2009).
  Intravenous medications A handbook for nurses
  and health professionals (25th ed.). St. Louis,
  MO Mosby Elsevier.
• Kee, J. L., Hayes, E. R., McCuiston, L. E.
  (2006). Pharmacology A nursing process approach
  (5th ed). St. Louis, MO Saunders Elsevier.

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References

• LeMone, P., Burke, K. (2008). Medical-surgical
  nursing Critical thinking in client care (4th
  ed.). Upper Saddle River, NJ Pearson Prentice
  Hall.
• Lewis, S. L., Heitkemper, M. M., Dirksen, S. R.,
  Graber OBrien, P., Bucher, L. (2007).
  Medical-surgical nursing Assessment and
  management of clinical problems (7th ed.).
  Philadelphia Mosby Elsevier.
• National Marrow Donor Program. (2006).
  Graft-versus-host-disease. Retrieved September 3,
  2007, from http//www.marrow.org/PATIENT/Plan_Life
  _after_Tx/Managing_Long-Term_Effects_of_/Graft-Ver
  sus-Host_Disease/index.html.

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References

• PubMed. (2006). Clinical inquiries. Which
  vaccinations are indicated after splenomegaly?
  Retrieved September 3, 2006, from
  http//www.ncbi.nlm.nih.gov/sites/entrez?cmdRetri
  evedbpubmeddoptAbstractPluslist_uids16882446
  .
• Schnell, Z. B., Leeuwen, A. M., Kranpitz, T. R.
  (2003). Daviss comprehensive handbook of
  laboratory and diagnostic tests with nursing
  implications. Philadelphia F. A. Davis Company.
• Smeltzer, S. C., Bare, B. G., Hinkle, J. L.,
  Cheever, K. H. (2008). Brunner Suddarths
  textbook of medical-surgical nursing (11th ed.).
  Philadephia Lippincott Williams Wilkins.
• Smeltzer, S. C., Bare, B. G. (2004). Brunner
  Suddarths textbook of medical-surgical nursing
  (10th ed.). Philadephia Lippincott Williams
  Wilkins.