Transcript Anemia (1).
Focus on Anemia Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia • A deficiency in the Number of erythrocytes (red blood cells [RBCs]) Quantity of hemoglobin Volume of packed RBCs (hematocrit) Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia • Diverse causes such as Blood loss Impaired production of erythrocytes Increased destruction of erythrocytes Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Causes of Anemia Fig. 31-1 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia • RBC function Transport oxygen (O2) from lungs to systemic tissues Carry carbon dioxide from the tissues to the lungs Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia • Not a specific disease • Manifestation of a pathologic process • Identified and classified by laboratory diagnosis Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia • Classified as Morphologic • Cellular characteristics • Descriptive, objective laboratory information Etiologic • Underlying cause Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Clinical Manifestations • Caused by the body’s response to tissue hypoxia • Hemoglobin (Hb) levels are used to determine the severity of anemia Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Integumentary Manifestations • Pallor ↓ Hemoglobin ↓ Blood flow to the skin • Jaundice ↑ Concentration of serum bilirubin • Pruritus ↑ Serum and skin bile salt concentrations Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Cardiopulmonary Manifestations • Additional attempts by the heart and lungs to provide adequate O2 to the tissues • Cardiac output maintained by increasing the heart rate and stroke volume Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. QuickTime™ and a YUV420 codec decompressor are needed to see this picture. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Clinical Manifestations • Mild = Hb 10 to 14 g/dl May exist without symptoms Possible symptoms • Palpitations, dyspnea, diaphoresis • Moderate = Hb 6 to 10 g/dl Increased cardiopulmonary symptoms Experienced at rest or during activity Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Clinical Manifestations • Severe = Hb <6 g/dl Involve multiple body systems • Integument • Eyes • Mouth • Cardiovascular Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Clinical Manifestations • Severe = Hb <6 g/dl Manifestations (cont'd) • Pulmonary • Neurologic • Gastrointestinal (GI) • Musculoskeletal Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Assessment • Subjective data Important health information • Past health history • Medications • Surgery or other treatments Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Assessment • Subjective data Functional health patterns • Health perception–health management • Nutritional-metabolic • Elimination • Activity-exercise • Cognitive-perceptual • Sexuality-reproductive Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Assessment • Objective data General Integumentary Respiratory Cardiovascular Gastrointestinal Neurologic Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Diagnoses • Activity intolerance • Imbalanced nutrition: Less than body requirements • Ineffective therapeutic regimen management • Potential complication: Hypoxemia Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Management • Goals Assume normal activities of daily living Maintain adequate nutrition Develop no complications related to anemia Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Implementation • Dietary and lifestyle changes • Blood or blood product transfusions • Drug therapy Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Implementation • Oxygen therapy • Patient teaching Nutrition intake Compliance with drug therapy Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Gerontologic Considerations • Common in older adults Chronic disease Nutritional deficiencies • Signs and symptoms may go unrecognized or mistaken for normal aging changes Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Erythrocyte Production • Erythropoietin (EPO) is a glycoprotein primarily produced in the kidneys (10% in the liver) ↑ Number of stem cells committed to RBC production Shortens the time to mature RBCs Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Erythrocyte Production • Life span of an RBC is 120 days • Three alterations in erythropoiesis that decrease RBC production Decreased hemoglobin synthesis Defective DNA synthesis in RBCs Diminished availability of erythrocyte precursors Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia • One of the most common chronic hematologic disorders • Iron is present in all RBCs as heme in hemoglobin and in a stored form • Heme accounts for two thirds of the body’s iron Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Normal Iron Metabolism Fig. 30-4 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Etiology • Inadequate dietary intake 5% to 10% of ingested iron is absorbed • Malabsorption • Blood loss • Hemolysis Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Clinical Manifestations • General manifestations of anemia • Pallor is the most common finding • Glossitis is the second most common Inflammation of the tongue Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Diagnostic Studies • Laboratory findings Hb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets • Stool guaiac test • Endoscopy • Colonoscopy Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Collaborative Care • Goal is to treat the underlying disease Increased intake of iron Nutritional therapy Oral or occasional parenteral iron supplements Transfusion of packed RBCs Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Drug Therapy • Oral iron Inexpensive Convenient Factors to consider • Enteric-coated or sustained-release capsules are counterproductive • Vitamin C is helpful with absorption of Iron Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Drug Therapy • Oral iron Factors to consider (cont’d) • Best absorbed as ferrous sulfate in an acidic environment • Liquid iron should be diluted and ingested through a straw • Side effects • Heartburn, constipation, diarrhea Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Nursing Management • At-risk groups Premenopausal women Pregnant women Persons from low socioeconomic backgrounds Older adults Individuals experiencing blood loss Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Nursing Management • • • • • Diet teaching Supplemental iron Discuss diagnostic studies Emphasize compliance Iron therapy for 2 to 3 months after the hemoglobin levels return to normal Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Folic Acid Deficiency • Also a cause of megaloblastic anemia • Folic acid is required for DNA synthesis RBC formation and maturation Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Folic Acid Deficiency • Common causes Poor nutrition Malabsorption syndromes Drugs Alcohol abuse and anorexia Lost during hemodialysis Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Folic Acid Deficiency • Clinical manifestations are similar to those of cobalamin deficiency • Insidious onset • Absence of neurologic problems • Treated by replacement therapy • Encourage patient to eat foods with large amounts of folic acid Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia of Chronic Disease • Underproduction of RBCs • Mild shortening of RBC survival Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia of Chronic Disease • Causes End-stage renal disease • Primary factor: ↓ Erythropoietin Chronic liver disease Chronic inflammation Malignant tumors Chronic endocrine diseases Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia of Chronic Disease • Anemia of chronic disease findings ↑ Serum ferritin ↑ Iron stores Normal folate and cobalamin levels Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia of Chronic Disease • Treating underlying cause is best • Rarely blood transfusions • Erythropoietin therapy Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Reference • Black, J. & Hawks, M. Medical Surgical Nursing Clinical Management for Positive Outcomes. St Louis: SaundersElsevier. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.