The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations would the nurse include in the client’s teaching plan? Select all that apply.
A. Hearing loss
B. Visual disturbance
C. Headache
D. Orthopnea
E. Gout
F. Weight loss
Correct Answers: B, C, D, E.
Polycythemia vera, a condition in which too many RBCs are produced in the blood serum, can lead to an increase in hematocrit and hypervolemia, hyperviscosity, and hypertension. Subsequently, the client can experience dizziness, tinnitus, visual disturbances, headaches, or a feeling of fullness in the head. The client may also experience cardiovascular symptoms such as heart failure (shortness of breath and orthopnea) and increased clotting time or symptoms of an increased uric acid level such as painful swollen joints (usually the big toe).
Option A: Hearing loss is a symptom of polycythemia vera, not a complication. Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm which is characterized by clonal proliferation causing the accumulation of morphologically normal red and white blood cells, platelets, and their precursors. Bilateral or unilateral sensorineural hearing loss, acute hearing loss, and vertigo may be the first presenting findings of PV.
Option B: Isolated monocular blindness as the presenting feature of polycythemia has been presented only four times indicating the rarity of presentation. Repeated occlusions in the same eye were postulated to be due to hyperviscosity. The most interesting feature was the presence of ocular pain and congestion before both episodes of monocular blindness indicating the severity of ischemia.
Option C: As polycythemia vera is a myeloproliferative syndrome, it is based on an autonomic increase in the proliferation of all hematopoietic cells–mostly of erythropoiesis. An increase in blood viscosity induces disturbed microcirculation, resulting in headaches with clinical symptoms.
Option D: Blood carries oxygen around the body. When PV slows blood flow, it’s hard for oxygen to reach the organs. PV treatments can improve blood flow and oxygen transport to prevent these symptoms.
Option E: The high turnover of red blood cells in people with PV can raise the amount of uric acid in your blood, which can cause gout, a painful joint inflammation. Gout often affects the big toe, but it may strike other joints as well.
Option F: Weight loss is not manifestations associated with polycythemia vera. Many people who have PV will develop an enlarged spleen. Your spleen filters your blood, so when you have polycythemia vera, the excess cells tend to collect in that organ. Symptoms of an enlarged spleen include discomfort, pain or fullness in the upper left side of the abdomen, indigestion, and a loss of appetite.
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