An older client is diagnosed with polycythemia vera and has a hematocrit of 58%. Which interventions are most important for the nurse to implement? Select all that apply.
1. Evaluate for activity intolerance
2. Assess for hypervolemia
3. Administer hydroxyurea
4. Assess for hypertension
5. Arrange for phlebotomy
2. Assess for hypervolemia
3. Administer hydroxyurea
4. Assess for hypertension
Explanation: 1. It is important to assess for fatigue and activity intolerance as part of the client's plan of care, but this is not an urgent need.
2. The client may have urgent symptoms related to hypervolemia due to the excess of red blood cells.
3. In polycythemia vera, hydroxyurea can decrease the risk of thrombosis. This is a chemotherapeutic agent that reduces red blood cell numbers.
4. The client with polycythemia vera is at increased risk for stroke and hypertension. Blood pressure must be controlled to prevent complications.
5. The client needs immediate phlebotomy. Periodic phlebotomy is begun and significantly decreases the risk of thrombosis. Interventions to bring down the hematocrit level must be instituted urgently.
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