1
Q
Nursing Diagnosis for Anemia
A
- Imbalanced nutrition: < body requirements r/t inadequate iron intake
- Activity Intolerance r/t decrease of O2 carrying capacity of the blood
- Ineffective tissue perfusion r/t decrease of O2 carrying cap. of the blood
1
Q
Platelets
(Transfusion Therapy)
A
- pt w/ platelets count < 20,000/ 80,000 if active bleeding is present
- filter can be used
- infuse in 15-30 min
2
Q
Hemolytic Anemias S/S
A
- Bone deformity & fractures
- Splenomegaly
- Jaundice
3
Q
Hemolytic Anemias
A
- Premature destruction of RBCs
- lysis of RBCs may occur w/in the circulatory system or from phagocytosis by WBCs in the spleen
hemolysis–> increases hemtopoietic activity in the bone marrow–> increased immature RBCs released into circulating blood
3
Q
Diagnostics for Acute Blood Loss
A
- BP
- HR
- RR
- Urine Output
- Hematocrit values
3
Q
Erythropoietin
A
-hormone produced by the juxtaglomerular cells of the kidneys during hypoxia
4
Q
Intrinsic Factor
A
- Secreated by gastric mucosa
- Binds w/ vitamin B-12
- travels to the ileum (where B-12 is absorbed)
5
Q
Hypoxia
A
Decreased blood O2 level
6
Q
Hematocrit
A
Is the % of RBCs in relation to the total blood volume
7
Q
Iron dietary sources
A
- Beef
- Chicken
- egg yolk
- turkey
- whole-grain breads
- dried fruits & beans
- greens
- brown rice
9
Q
Anemia (General S/S)
A
- Pallor (skin, nail beds, mucous membranes
- SOB/Fatigue, especially upon exertion
- Tachycardia & palpitations
- Bone Pain
9
Q
Anemia lab & diagnostic testing
A
- CBC: Hgb, Hct, total RBCs,reticulocyte count
- Serum B-12 & folate levels
- Iron staus
- Hgb electrophoresis
- Schilling test
- Bone marrow aspiration
10
Q
Anemias are due to:
A
- Blood loss
- Inadequate RBC production (hypoproliferative)
- Increased RBC destruction (hemolytic)
- Deficiency of necessary components (folic acid, iron, erythropoietin, vitamin B-12)
11
Q
Iron studies
A
Use serum transferrin to measure the iron stores in the body
12
Q
Hemoglobin
A
Transports O2 & CO2 to and from the cells and can be used as an index of the O2 carrying capacity of blood
13
Q
What is Anemia?
A
- Abnormally low amount of circulating RBCs, Hgb concentration, or both
- It’s an indicator of an underlying disease/disorder
14
Q
Aplastic Anemia
A
- Bone marrow fails to produce all 3 types of blood cells
- Normal bone marrow is replaced by fat
- Anemia develops as bone marrow fails to repllace RBCs at the end of their lifespans
15
Q
Therapies (Collaborative care) Aplastic anemia
A
- Withdrawal of causative agent, if known
- blood transfusions
- Bone marrow transplant as indicated
17
Q
Pernicious Anemia S/S
A
- Smooth, sore, beefy red tongue
- diarrhea
- paresthesias
- propioception deficits
18
Q
Therapies (Collaborative care) Vitamin B-12 deficiency anemia
A
- increase dietary intake of foods w/ B-12
- oral & parental supplements
- parental B-12 if malabsorption/ lack of intrinsic factor
19
Q
Normal hemoglobin (Hgb) levels
A
adult males: 13.8-18g/dL
adult females: 12-15g/dL
19
Q
Ferrous sulfate (Iron)
A
-prevents/treats iron deficiency anemia
S/E: dizziness, seizures, hypotension, tachycardia, skin staining (IM), dark stools (PO), constipation (PO), staininng of teeth (PO)
-Teach: to monitor for overdose (stomach pain, N/V, bluish lips & fingernails)
vitamin C enhances absorption
20
Q
Management of acute blood loss
A
Monitor:
- hematologic studies
- urine output
- cardiovascular indicators
- skin changes
- pain descriptions
- administer transfusions as indicated
22
Q
Vitamin B-12 deficiency anemia S/S
A
- Pallor/slight jaundice
- weakness
- fainting
- headache
- forgetfulness
- nausea
- anorexia
- night cramps
23
Iron deficiency anemia S/S
- cheilosis (cracks at the mouth)
- spoon-shaped nails
- smooth, sore, bright red tongue
23
Folic Acid dietary sources
- green leafy veggies
- broccoli
- organ meats
- eggs
- wheat germ
- milk
- yeast
- asparagus
- Kidney beans
23
Hgb electrophoresis
- separates normal Hgb from abnormal
- used to detect thalassemia & sickle cell disease
23
Schilling Test
- measures B-12 absorption w/ or w/o intrinsic factor
- distinguishes between malabsorption & pernicious anemia
25
Therapies (Collaborative care) Sickle Cell anemia
- Hydroxyurea (q.d.)
- During sickle cell crisis: Rest, O2 therapy to maintain SaO2, narcotic analgesia, vigorous hydration
- During acute chest syndrome: careful hydration, vitals monitored, O2 therapy, transfusion
- Folic acid supplements
- Blood transfusion during sugery/ pregnancy as necessary
- Genetic conseling recommended
27
Activity Intolerance (Interventions)
Side note: S/S are SOB w/ weakness, fatigue, vertigo on exertion
These will increase O2 demand
- help identify ways to conserve energy when performing desired activities
- Assist in scheduling alternating periods of activities & rest for throughout the day
- Encourage 8-10 hrs of sleep
- Monitor vitals before & after activities
- Stop activity if pt shows signs of intolerance
- instruct pt not to smoke
28
Risk Factors
- Acute/chronic blood loss
- Increased hemolysis
- Inadequate dietary intake/malabsorption
- Bone-marrow suppression
- smoking
- excessive alcohol intake
- sdentary lifestyle
29
Pernicious Anemia
- it develops from the lack of intrinsic factor
- In the abscence of Intrinsic factor, vitaminn B-12 can't be absorbed into the body
30
Vitamin B-12
Necessary for DNA synthesis & found in foods derived from animals
-Important for neurological function
31
Aplastic Anemia S/S
Low RBCs: fatigue, pallor, progressive weakness, exertional dyspnea, headache, ultimately heart failure & tachycardia
Low Platelets: Bleeding problems, gum bleeding, excessive bruising
Low WBCs: increased risk of infection, sore throat & fever
33
Patient Outcomes
- The pt will make appropriate dietary choices to increase iron intake
- The pt will demonstrate appropriate self-administration of supplements
- The pt's RBC count/hemoglobin will improve
34
Epogen (Erythropoietin)
-Increases the production of RBCs in the bone marrow
S/E: bone pain
Teach: give to pt w/ kidney failure on a weekly basis
35
Vitamin B-12 deficiency anemia
- Occurs when inadequate B-12 is consumed/ poorly absorbed from the GI tract
- Deficiencies impair cell division; maturation of nucleus; causes rapid proliferation RBCs
- Creates Large, oval-shaped RBCs, that are fragile and incapibale of carrying adequate amounts of O2
35
Vitamin B-12 (cyanocobalamin)
- required for RBC formation
- treats pernicious anemia
S/E: diarrhea, itching, rash, hypokalemia, anaphylaxsis
-Teach to eat foods high in vitamin B-12
37
Vitamin B-12 dietary sources
- liver
- fresh shrimp&oysters
- eggs
- milk
- kidney
- meats (muscles)
- cheese
39
Anemia Pathology
- Regardless of cause, anemia is due to the decrease in the O2-carrying capacity of the blood
- Insufficient O2 reaching the cells & tissues
- Tissue Hypoxia
[Anemia is usually asymptomatic. The body's compensatory mechanisms prevent S/S, until when it really needs O2 (during exercise & infecton)]
40
Therapies (Collaborative care) for iron deficiency anemia
- Increase dietary intake of iron-rich foods
- Oral/parental supplements
41
Iron deficiency anemia
- develops when supplies of iron are inadequate for optimal RBC formation
- body can't synthesize hemoglobin w/o Fe, and Fe is necessary for RBC production
- Characterized by low number of RBCs; also small, pale, or malformed RBCs
43
Transfusion therapy
- monitor for fluid overload, transfusion reaction
- severe reactions occur during the 1st 50 mL of blood transfused
- stay w/ pt. for the intial 15-30 min. of the infusion
44
Whole Blood and Packed Blood
| (Transfusion therapy)
- infuse w/ NS only
- complete transfusion in 4hrs
- never add drugs to blood
45
Anemia Hemoglobin levels
Mild: Hgb 10-12 g/dL
Moderate: Hgb 7-11 g/dL
Severe: Hgb \< 7 g/dL
46
Fresh Frozen Plasma
| (Transfusion therapy)
- clotting factor deficiency, liver disease, DIC, and PT or PTT \> than 1.5 times normal
- infuse over 20-30 min
- use blood filter for infusion
Nursing 3
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