Transcript ANEMIA

ANEMIA
Definition
• A decrease in the number of RBCs, the
quantity of Hgb, and/or the volume of
PRBCs (which is measured by Hct).
• It is not a disease, it is a symptom of a
disease or condition
• Can lead to tissue hypoxia
• How do you know if someone has
hypoxia?
Etiologies
• Inadequate production of RBCs
• Premature or excessive destruction of
RBCs
• Acute or chronic blood loss
• Nutrition deficits
• Hereditary factors
• Chronic diseases
Types of Anemias
 Inadequate production
 Iron deficiency, thalassemia, aplastic anemia, B-12 deficiency,
folic acid deficiency, chemotherapy induced
 Increased RBC destruction (usually hereditary)
 Sickle cell, hemolytic
 Blood loss (usually caused by trauma or an underlying
condition or disease)
 Acute: injury, PUD
 Chronic: metorrhagia, colon cancer, PUD
General Manifestations
• Deficient oxygenation of tissues results in:
– Pallor
– Complaints of feeling cold
– Fatigue, shortness of breath
– Dizziness, headache, light-headedness,
slowing of thought processes, irritability,
restlessness, depression
– Increased cardiac workload manifested as
tachycardia, palpitations, chest pain, and even
CHF in those patients with weak myocardium.
Specific Manifestations
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Glossitis, chelitis
Tingling, numbness, confusion, ataxia
Joint pain
Mental retardation
Hepatomegaly, splenomegaly
Sudden hemorrhage, tachycardia,
hypotension
General Labs
• CBC (includes H & H)
• Hgb electrophoresis (identifies abnormal forms
of hemoglobin)
• Serum iron
• Serum ferritin
Iron deficiency
• Iron-binding capacity
• Microscopic analysis—tells size/shape/color
• Schilling test or serum gastrin—B-12 deficiency
• Bone marrow examination
Treatments
• Depends on type of anemia identified
– Pharmacologic therapy—iron, folic acid,
vitamin B-12
– Improved nutrition—eggs, red meat, dark
green leafies, dried fruit, fish, seafood, ironfortified cereals and grains, bean family
– Blood transfusions
Nursing Management
• Ask about SOB, fatigue, weakness dizziness,
syncope, palpitations, bleeding, menstrual hx,
meds, chronic diseases, diet, ETOH and
cigarettes
• Look at general appearance, skin color, VS, heart
and lung sounds, pulses, cap refill, abdominal
tenderness, pain, bleeding, bruising
Nursing Diagnoses
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Activity Intolerance
Altered Oral Mucous Membranes
Self-Care Deficit
Decreased Cardiac Output
Fatigue
Deficient fluid volume
Impaired gas exchange
Risk for injury
Impaired physical mobility
Ineffective tissue perfusion
Imbalanced nutrition
Nursing Management cont’d
• Direct general management toward addressing
the cause of anemia and replacing blood loss as
needed to sustain adequate oxygenation
• Promote optimal activity and protect from injury
• Reduce activities and stimuli that cause
tachycardia and increase cardiac output
• Provide for nutritional needs
• Provide teaching
Client Education
 Organize activities with rest periods
 Identify situations that cause palpitations, dyspnea
 Explain the need to ensure adequate oxygenation
 Drink at least 2-3 liters of fluid a day
 Instruct the client to report signs of fluid retention,
paresthesias, poor coordination, ataxia and
confusion
 Discuss dietary requirements
 Encourage a well balanced diet
 Advise the client to avoid alcoholic beverages and
spicy foods
 Explain the need for ongoing lab tests and treatment