a sign of an underlying disorder There are several kinds of anemia A physiologic approach classifies anemia according to whether the deficiency in erythrocytes is caused by a defect in ID: 908799
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Slide1
ANEMIA
Slide2Key points
Anemia is not a specific disease state but a sign
of an underlying
disorder
There are several kinds of anemia.
A
physiologic
approach classifies anemia according to whether
the deficiency in erythrocytes is caused by a defect in
their production
(
hypoproliferative
anemia),
by
their
destruction (hemolytic
anemia),
or
by
their loss (bleeding).
Slide3Key points a& Definitions
Anemia
is an abnormally low amount of circulating
RBCs,
Hgb
concentration,
Hct
concentration, or all.
Anemia results in diminished
O2-carrying
capacity and delivery to
tissues and
organs.
Therefore, the
goal of treatment is to restore and maintain adequate
tissue oxygenation
.
Causes of Anemia:
Blood loss.
Inadequate RBC production.
Increased RBC destruction.
Insufficient or defective hemoglobin.
Iron deficiency anemia is the most common anemia.
Slide4Slide5Slide6Slide7Risk Factors for Anemia
Acute
or chronic blood
loss
; menorrhagia, GI bleeding.
Increased hemolysis
; defective
Hgb
(sickle cell
disease), impaired
glycolysis
(G6PD) deficiency anemia, i
mmune
disorder
or destruction (transfusion
reactions
) Or mechanical
trauma to RBCs (mechanical heart valve,
cardiopulmonary bypass
)
Dietary inadequacy
; IDA,
megaloblastic
anemia, pernicious anemia, pica
Bone-marrow suppression
; exposure
to radiation or
chemicals, aplastic anemia
Slide8Anemia?
Production?
Survival/Destruction?
The key test is the …..
Slide9Slide10Diagnostic Procedures and Nursing Interventions
Laboratory
Assessment
Complete blood count (
CBC)
RBCs
Hemoglobin
(
Hgb
)
Hematocrit
(
Hct
)
WBCs
Platelets
Slide11Slide12Slide13Diagnostic Procedures and Nursing Interventions
RBC indices to determine the type and cause of most
anemias
:
Mean corpuscular volume (MCV): size of red blood cells
Normocytic – normal size
Microcytic – small cells
Macrocytic – large cells
Slide14Slide15Diagnostic Procedures and Nursing Interventions
Mean corpuscular hemoglobin (MCH): to determine the amount
of hemoglobin
per RBC
Normochromic – normal amount of
Hgb
per cell
Hypochromic – decreased
Hgb
per
cell
Mean corpuscular hemoglobin concentration (MCHC): to indicate
Hgb
amount relative to the size of the cell
Slide16Slide17Slide18Diagnostic Procedures and Nursing Interventions
Iron studies
Total iron-binding capacity (TIBC) reflects an indirect measurement
of serum
transference.
Serum ferritin is an indicator of total body iron stores.
Serum iron measures the amount of iron in the blood.
Low
serum
iron and
elevated TIBC indicates iron deficiency anemia.
Slide19Diagnostic Procedures and Nursing Interventions
Hemoglobin electrophoresis separates normal hemoglobin from abnormal.
It is used to detect thalassemia and sickle cell disease.
Sickle cell
test,
Schilling
test
(vitamin B12)factor,
used to differentiate between
malabsorption
and
pernicious anemia
.
Bone marrow examination diagnoses aplastic
anemia.
After
bone
marrow aspiration
:
Apply pressure to the site for 5 to 10 min.
Assess
VS
frequently.
Apply pressure dressing.
Monitor for signs of bleeding and infection for 24 hr.
Slide20Slide21Clinical Manifestation
Several factors influence
the development of anemia-associated symptoms:
the rapidity with which the anemia has developed,
the duration of
the anemia (
ie
, its chronicity
),
the metabolic
requirements of
the
client
,
other
concurrent disorders or
disabilities (
eg
, cardiac or pulmonary disease), and
complications
or
concomitant features
of the condition that produced the anemia
.
Slide22Monitor for signs and
symptoms
May
be asymptomatic in mild cases
Pallor
Fatigue
Irritability
Numbness and tingling of
extremities
Dyspnea on exertion
Impaired skin healing
Brittle, spoon-shaped
nails (
Koilonychia
)
Cheilosis
Smooth, sore, bright red tongue
Sensitivity to cold
Brittle and ridged nails
Pain and hypoxia with sickle cell
crisis
Leg cramps
Pica
Slide23Slide24Slide25Client’s respiratory status, activity tolerance, fatigueClient’s history regarding risk factors for anemiaGeneral appearance
Laboratory and diagnostic findings
Slide26NANDA Nursing Diagnoses
Risk
for injury
Activity intolerance
Fatigue
Self-care deficit
Risk for
infection
Altered nutrition, less than
body
requirements
Altered
tissue
perfusion
Noncompliance
with prescribed therapy
Slide27Nursing Interventions
Assess and monitor laboratory results.
Assess and monitor activity intolerance.
Encourage increased dietary intake of the deficient nutrient (iron, vitamin B12, folic acid).
Administer medications as prescribed; instruct the client on side effects.
Iron supplements
Oral iron supplements (ferrous sulfate, ferrous
fumarate
, ferrous
gluconate
)
Parenteral
iron
supplements
(
iron
dextran
)
Take with meals if gastrointestinal side effects occur.
Slide28Nursing Interventions
Vitamin C improves absorption.
Do not take within 2
hr
of milk or
antacids (Al,
Ca
, Mg), proton pump inhibitor.
Stools will be black.
May cause constipation; increase intake of fluids and foods high
in fiber.
May use sustained release iron tabs
Use a straw with liquid iron to avoid staining of teeth.
Administer parenteral iron using Z-track method.
Erythropoietin (Procrit)
Cobalamin
(vitamin B12)
parenterally
or
intranasally
Folic acid supplements
Oxygen
Vitamin C supplements (to enhance iron absorption)
IV
fluids (sickle cell crisis, G6PD anemia)
Teach the client and family about energy conservation.
Slide29Nursing Interventions
Teach the client the time frame for resolution.
Transfusions – lead to an
immediate improvement in blood cell counts
and client
signs and symptoms.
Typically only used when the client has significant symptoms
of
anemia
because of the risk of blood-borne infections.
Oral supplements – 4 to 6 weeks for increase in RBCs
Vitamin B12 supplements – increased RBCs in 1 week
Vitamin B12 supplementation
B12 supplementation can be given orally if the deficit is due to
poor
dietary
intake.
However
, with pernicious anemia it must be
given
parenterally
because it won’t be absorbed if given orally.
Administer parenteral forms intramuscularly or deep
subcutaneous to
decrease irritation. Do not mix other medications in the syringe.
Pernicious anemia must be treated for life.
Slide30Nursing Interventions
Folic acid supplementation
Can be given orally or
parenterally
.
Large doses will stain urine dark yellow.
Slide31Complications and Nursing Implications
Monitor
the client for signs of hypoxemia: dyspnea, decreased oxygen
saturation, central
cyanosis.
Administer oxygen therapy. Monitor SaO2.
Administer blood transfusions as ordered.
Assess the neurologic status of clients with macrocytic
anemias
.
Vitamin B12 is essential for neurological function.
Administer supplements. Notify
the provider of any changes in mentation.
Slide32Complications and Nursing Implications
Sickle Cell Crisis
A
n
autosomal recessive
condition.
At least 40% of total hemoglobin is the abnormal hemoglobin S (
HbS
)
in sickle
cell disease.
When
exposed to hypoxic environments, it contracts and
clusters together
within the cell.
Cells become rigid, forming a “sickle” or “C” shape which causes them
to clump
together and impede blood
flow; leading to
further tissue hypoxia.
S &
Sx
: cyanosis, abdominal pain, leg and back pain,
low-grade fever, seizures, and stroke manifestations (weakness,
paresthesia
).
Administer oxygen and hydration therapy
. As well as
analgesia.
Organ failure can result if left untreated.
Slide33Slide34Slide35