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blood cells imageIron deficiency anemia, anemia of chronic disease, pernicious anemia, Aplastic anemia, hemolytic anemia. The anemias are a group of blood disorders characterized by too little hemoglobin in the blood. Hemoglobin is a substance contained in red blood cells that carries oxygen from the lungs to other body tissues. Anemia is often a sign or symptom of an underlying disease rather than a disease in its own right. There are three tests commonly used to detect anemia: the number of red blood cells can be counted; the amount of hemoglobin in the red blood cells can be measured; or the proportion of blood cells to serum (the liquid part of blood, called the hematocrit) can be assessed.

Adult anemia is usually defined as a Hemoglobin Hgb level lower than 11 g/dL, with severe anemia defined as Hemoglobin Hgb lower than 8 g/dL. Anemia Associated with many physiological complications, including dyspnea, fatigue, dizziness, decreased cognition, impaired sleep, sexual dysfunction, and significant debilitation

Anemia can develop in three ways: loss of blood through injury, diseases of the digestive tract, or heavy menstrual flow in women; rapid destruction of red blood cells (e.g. sickle cell anemia); or inadequate production of healthy red blood cells (e.g. thalassemia). The underlying causes of anemias range from poor nutrition (iron-deficiency anemia) and digestive disorders (Crohn disease, celiac disease) to colorectal cancer, parasitic diseases (e.g. hookworm), and genetic disorders (sickle cell anemia, thalassemia).

Pathophysiology: decreased number of circulating red blood cells (RBCs), reduction in the amount of hemoglobin (Hgb) in the RBCs, or a combination of both, resulting in diminished oxygen-carrying capacity of the blood

  1. Iron deficiency anemia inadequate iron stores, which results in insufficient Hemoglobin Hgb, causing cells to appear abnormal, unusually small (microcytic), and pale (hypochromic)
  2. Anemia of chronic disease; accompanies chronic inflammatory, infectious, or neoplastic disorders
  3. Pernicious anemia; lack of intrinsic factor in the stomach results in inability to absorb vitamin B12 causing abnormal RBC formation
  4. Aplastic anemia: failure of bone marrow to produce cells, including RBCs and white blood cells (WBCs) and platelets
  5. Hemolytic anemia: premature destruction of RBCs

Causes and Complications of Anemia
Causes and Etiology for Anemia, Anemia is often a sign or symptom of an underlying disease rather than a disease in its own. Anemia goes undetected in many people, and symptoms can be minor or vague. The signs and symptoms can be related to the anemia itself, or the underlying cause.

Iron deficiency anemia

Causes by Lack of iron in the body due to a variety of causes, inadequate nutrition, such as not enough foods that contain iron or Malabsorption syndromes.

Anemia of chronic disease

Primarily due to slowed production of RBCs because of low reticulocyte production.  Symptoms usually associated with the disease causing the anemia rather than the anemia itself.

Pernicious anemia

An autoimmune disorder Characterized by the production of auto antibodies that destruct  gastric parietal cells and their secretory product leads to a lack of intrinsic factor, which is needed for vitamin B12 absorption include Crohn’s and Whipple’s diseases, gastrectomy or gastric bypass, and chemotherapeutic medications.

Aplastic anemia

Bone marrow failure; May be associated with conditions that affect erythropoietin production and secretion, such as certain cancers and cancer treatments, hepatic, or endocrine disorders. Exposure to chemicals, immune conditions, such as systemic lupus erythematosus, or rheumatoid arthritis.

Hemolytic anemia

Accelerated destruction of RBCs sickle cell anemia Causes include hereditary factors, such as sickle cell trait or disease, blood transfusion reactions, acute viral or infectious agents, certain drugs, and toxins, such as chemicals and venoms.

Complications of Anemia:

Anemia is often a sign or symptom of an underlying disease rather than a disease in its own Mild anemia does not have any significant long-term consequences. As the anemia becomes more severe, medical problems may arise:

  • High-output heart failure increased risk for a heart attack
  • The lack of iron associated with anemia can cause many complications, including hypoxemia, brittle or rigid fingernails, cold intolerance, and possible behavioral disturbances in children.

Anemia Nursing Diagnosis
Nursing Assessment nursing care plans for Anemia.

Patient’s history because Anemia symptoms usually develop insidiously Patient’s history may not help to establish disease onset. The patient may report signs and symptoms of anemia (progressive weakness and fatigue, shortness of breath, and headache) or signs of thrombocytopenia (easy bruising and bleeding, especially from the mucous membranes)

Inspection patients with Anemia may reveal pallor if the patient is anemic, and ecchymosis, petechiae, or retinal bleeding if thrombocytopenia is present. You may note alterations in the level of consciousness and weakness if bleeding into the central nervous system has occurred.

Auscultation may reveal bibasilar crackles, tachycardia, and a gallop murmur if severe anemia results in heart failure.

Fever, oral and rectal ulcers and sore throat may indicate the presence of an infection but without characteristic inflammation due to leukopenia.

Diagnostic test for Anemia

  • Complete blood count (CBC): Hgb; hematocrit (Hct); RBC count, morphology, indices, and distribution width index; platelet count and size; and WBC count and differential.
  • Bone marrow biopsies

Nursing diagnosis for Anemia

  • Activity Intolerance related to Imbalance between oxygen supply or delivery and demand
  • Impaired oral mucous membrane
  • Imbalanced Nutrition: Less than Body Requirements related to Failure to ingest or inability to digest food or absorb nutrients necessary for formation of normal RBCs
  • Constipation/Diarrhea related to Decreased dietary intake, changes in digestive processes Drug therapy side effects
  • Risk for Infection Inadequate secondary defenses—decreased Hgb, leukopenia, or decreased granulocytes (suppressed inflammatory response) Inadequate primary defenses—broken skin, stasis of body fluids, invasive procedures, chronic disease, malnutrition
  • Risk for deficient fluid volume
  • Deficient Knowledge regarding condition, prognosis, treatment, self-care, prevention of crisis, and discharge needs related to Lack of exposure, recall  Information misinterpretation Unfamiliarity with information resource
  • Fatigue
  • Fear
  • Ineffective coping
  • Ineffective thermoregulation

Nursing Care Plans for Anemia

Anemia are a group of blood disorders characterized by too little hemoglobin in the blood. Hemoglobin is a substance contained in red blood cells that carries oxygen from the lungs to other body tissues. Anemia is often a sign or symptom of an underlying disease rather than a disease in its own right. There are three tests commonly used to detect anemia: the number of red blood cells can be counted; the amount of hemoglobin in the red blood cells can be measured; or the proportion of blood cells to serum (the liquid part of blood, called the hematocrit) can be assessed.

Common nursing diagnosis found in Nursing care plans for anemia

Activity Intolerance, Impaired oral mucous membrane, Imbalanced Nutrition: Less than Body Requirements, Constipation/Diarrhea, Risk for Infection, Risk for deficient fluid volume, Deficient Knowledge regarding condition, prognosis, treatment, self-care, prevention of crisis, and discharge needs, Fatigue, Fear, Ineffective coping, Ineffective thermoregulation.

Sample Nursing care plans for anemia

NURSING DIAGNOSIS INTERVENTIONS RATIONALE EVALUATION
Activity Intolerance related to Imbalance between oxygen supply or delivery and demand
  • Assess patient ability to perform ADLs
  • Monitor vital sign (Blood Pressure, pulse, and respirations) during and after activity
  • Suggest client change position slowly; monitor for dizziness.
  • Provide or recommend assistance with activities and ambulation as necessary, allowing client to be an active participant as much as possible.
  • Identify and implement energy-saving techniques
  • Instruct client to stop activity if palpitations, chest pain, shortness of breath, weakness, or dizziness occur

Collaborative

  • Monitor laboratory studies, such as Hgb/Hct, RBC count, and arterial blood gases (ABGs).
  • Provide supplemental oxygen as indicated.
  • Administer the following, as indicated: Whole blood, packed RBCs (PRCs); blood products as indicated.
  • Monitor closely for transfusion reactions.
  • Prepare for surgical intervention, if indicated.
  • Influences choice of interventions and needed assistance.
  • Cardiopulmonary manifestations result from attempts by the heart and lungs to supply adequate amounts of oxygen to the tissues.
  • Postural hypotension or cerebral hypoxia may cause dizziness, fainting, and increased risk of injury.
  • Although help may be necessary, self-esteem is enhanced when client does some things for self.
  • Encourages client to do as much as possible, while conserving limited energy and preventing fatigue.
  • Cellular ischemia potentiates risk of infarction, and excessive cardiopulmonary strain and stress may lead to decompensation and failure
  • Identifies deficiencies in RBC components affecting oxygen transport, treatment needs, and response to therapy.
  • Maximizing oxygen transport to tissues improves ability to function
  • Increases number of oxygen-carrying cells; corrects deficiencies to reduce risk of hemorrhage in acutely compromised individuals.
  • Surgery is useful to control bleeding in clients who are anemic because of bleeding, such as in ulcers and uterine bleeding; or to remove spleen as treatment of autoimmune hemolytic anemia. Bone marrow and stem cell transplantation may be done in presence of bone marrow failure aplastic anemia.
Report an increase in activity tolerance, including ADLs.Demonstrate a decrease in physiological signs of intolerance pulse, respirations, and BP remain within client’s normal range.

Display laboratory values (Hgb/Hct) within acceptable range.

Patient Teaching and Home Healthcare Guidelines for Anemia

  • Teach the patient to avoid contact with potential sources of infection which can harbor organisms.
  • Reassure and support the patient and his family by explaining the disease and its treatment, particularly if the patient has recurring acute episodes.
  • Explain the purpose of all prescribed drugs, and discuss possible adverse reactions, including those he should report promptly.
  • Tell the patient who does not require hospitalization that he can continue his normal lifestyle with appropriate restrictions.
  • To prevent folic acid deficiency anemia, emphasize the importance of a well balanced diet high in folic acid. Teach the patient to meet daily folic acid requirements by including a food from each food group in every meal, Advise the patient not to stop taking the supplements when he begins to feel better.
  • To help prevent exacerbation of sickle cell anemia, advise the patient to avoid tight clothing that restricts circulation.
  • Emphasize the need for prompt treatment of infection.
  • Explain the need to increase fluid intake to prevent dehydration that results from impaired ability to properly concentrate urine. Tell parents to encourage a child with sickle cell anemia to drink more fluids.
  • To encourage normal mental and social development, warn parents against being overprotective. Although the child must avoid strenuous exercise, he can enjoy most everyday activities.
  • Refer parents of children with sickle cell anemia for genetic counseling to answer their questions about the risk to future offspring. Recommend screening of other family members to determine if they are heterozygote carriers.
  • In sickle cell anemia Inform the patient and his parents that if he must be hospitalized for a vaso-occlusive crisis, I.V. fluids and a parenteral analgesic may be administered. He may also receive oxygen therapy and blood transfusions.
  • Women with sickle cell anemia Warn them that they are poor obstetric risks.
  • Emphasize the need for preventing trauma, abrasions, and breakdown of the skin.
  • Be sure the patient understands the need to maintain a good nutritional intake to enhance the immune system and resistance to infections.
  • Teach the patient the potential for bleeding and hemorrhage, and instruction to prevent bleeding.
  • Discuss the need for regular dental examinations.
  • Explain the importance of maintaining regular bowel movements to prevent straining.

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