ST.

LUKE’S COLLEGE OF NURSING

1st Semester
School Year: 2020-2021
LEVEL 3 RLE
NCM 112

1ST CASE: POLYCYTHEMIA RUBRA VERA (PRV) OR POLYCTHEMIA VERA (PV)

Day 1: The patient presented in May 2020 at age 62 with a two-year history of fatigue and pruritus of his extremities. He smoked
one pack of cigarettes per day as he had for 25 years and had about five to six alcoholic drinks daily. VS: BP 160/100, PR 75, RR
18, T 37.8. Height is 183 cms and weight is 85kgs.

Presence of pruritic rashes on all extremities, back, abdomen and face, edema on all extremities and erythromelalgia
COMPLETE BLOOD COUNT
Hemoglobin 21.9 g/dL (14.0–18.0)
RBC 7.96 × 106/µL (4.50–6.00)
MCV fL 90.1 (80.0–99.0)
WBC 10.1 × 103/µL (4.5–10.8)
Neutrophils 71%
Lymphocytes 18%
Monocytes 8%
Eosinophils 2%
Basophils 1%
platelets 154 × 103/µL
Reticulocytes 5 percent

Patient was admitted in the Hematology ward with working diagnosis of Polycythemia Vera. The following orders was made by
her Attending Physician:
• Start IVF of PNSS 1 liter to run for 60cc/hr
• For Phlebotomy at 3pm, prepare materials and secure consent
• For CT scan of whole abdomen with contrast
• Blood tests: EPO level and repeat CBC post phlebotomy
• Medications
o Give aspirin 80 mg 1 tablet daily
o Cetirizine 10mg 1 tablet at bedtime daily
Day 2:
• CT scan of abdomen revealed Splenomegaly
• EPO level is subnormal
• For bone marrow biopsy, prepare materials and secure consent
• For genetic testing of JAK 2 mutation
• Additional Medications
o Hydroxyurea 500mg 2 tablets daily
o Ranitidine 150 mg 1 tablet twice daily
 o Allopurinol 100mg 1 tablet twice daily
Day 3:
• Genetic testing result is positive for JAK 2 mutation
• Bone marrow biopsy revealed hypercellular bone marrow
• IVF discontinued
• Repeat CBC
o Hgb 13g/dL
o Hct 40%
o RBC 4M/µL
o WBC 7.8 X 10³/µL
o Platelet 154 X 10³/µL
• Reticulocytes 3%

Day 4:
• Patient discharged
o FINAL DIAGNOSIS: Absolute Primary Polycythemia Vera
o HOME MEDICATIONS:
▪ Aspirin 80 mg 1 tablet daily
▪ Cetirizine 10mg 1 tablet at bedtime daily
▪ Hydroxyurea 500 mg 2 tablets daily
▪ Ranitidine 150 mg 1 tablet twice a day
▪ Allopurinol 100mg 1 tablet twice daily
o FOLLOW UP AFTER 4 WEEKS

LEARNING PACKETS

I. HISTORY TAKING
II. PHYSICAL EXAMINATION/CONTRAPTIONS
 III. PATHOPHYSIOLOGY
IV. DIAGNOSING THE DISEASE
V. CORRELATE DOCTOR’S ORDER TO LABORATORY RESULTS TO PT’S S/SX (PATHOPHY)
VI. FORMULATION OF PLAN OF CARE
VII. FORMULATION OF NURSING DIAGNOSIS
VIII. NCP
IX. NURSING SKILLS VIDEO
X. DRUG STUDY OF MEDICATIONS ON BOARD AND OTHER MEDICATIONS RELATED TO THE DEASE
XI. ANY SPECIAL PROCEDURE OR OPERATION
XII. DISCHARGE HEALTH TEACHINGS ABOUT THE DISEASE AND ITS COMPLICATIONS