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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.

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ANEMIA

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  1. ANEMIA

  2. 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?

  3. Etiologies Inadequate production of RBCs Premature or excessive destruction of RBCs Acute or chronic blood loss Nutrition deficits Hereditary factors Chronic diseases

  4. 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, Thalassemia, G6PD • Blood loss (usually caused by trauma or an underlying condition or disease) • Acute: injury, PUD • Chronic: metorrhagia, colon cancer, PUD

  5. 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.

  6. Specific Manifestations and Complications • Glossitis, chelitis, spoon-shaped nails, petechiae, chronic leg ulcers • Tingling, numbness, confusion, ataxia • Joint pain • Mental retardation • Hepatomegaly, splenomegaly • Sudden hemorrhage, tachycardia, hypotension, murmurs, angina • Injury from falls (bone deformities, fractures, fainting

  7. General Labs • CBC (RBC and indices; 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

  8. Microscopic Analysis • Hemoglobin & Hematocrit • Males—14-18 g/dL; 42-52% • Females—12-16 g/dL; 37-47% • NB—14-24; 44-64 • 2-6 mos 10-17; 35-50 • RBC (values are approximate): • males 4-6 • females 4-5.5 • Newborns 5-7 • 2-6 months 3.5-5.5

  9. RBC indices • MCV—size • Macrocytic (H): B12 or folic acid deficiency • Microcytic (L): iron deficiency or Thalassemia • MCH—average amount of Hgb in a cell • Follows values for size • MCHC—color (has to do with concentration) • Hypochromic (L): iron deficiency or Thalassemia • Normochromic (may read as H due to abnormal shape of cell): hemolytic anemia • RDW—has to do with identifying a wide variation of sizes in the cells, indicating abnormal blood conditions

  10. 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, iron-fortified cereals and grains, bean family • Blood transfusions

  11. 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

  12. Nursing Diagnoses • 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

  13. 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

  14. 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 and meds • Encourage a well balanced diet • Advise the client to avoid alcoholic beverages and spicy foods • Explain the need for ongoing lab tests and treatment

  15. Ferrous Sulfate • Action: Replaces iron stores needed for RBC development, energy, and O2 transport • Dosage: po 750-1500 mg/d; IV 125 mg in 100 mL over 1h; requires IV push test dose first. • SE: Nausea, constipation, epigastric pain, black stools • Nursing: If giving IV, give IVP test dose first to assess for reactions. If giving IM, give Z-track in large muscle. • Education: (Related to po route only) Take tabs whole, between meals with juice. If upset occurs, take after meals. Do not take with antacids or milk. Drink liquid through straw. Store in tight, light resistant container. Stools will turn black. Do not substitute one type with another. Take 1h before lying down. Eat iron-rich foods.

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