Adult 2 04a Anemia PDF

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adult health nursing 2...

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Anemia Objectives: • Compare and contrast with regard to cause, assessment findings, management and the significance of preventive health care. • Identify the clinical significance and related nursing implications of the various tests and procedures used for diagnostic assessment. • Use the nursing process as a framework for care of patients with disorder. • Demonstrate appropriate documentation and reporting.

Anemia • Anemia is a reduction in the number of RBCs, the quantity of hemoglobin, or the volume of RBCs • Because the main function of RBCs is oxygenation, anemia results in varying degrees of hypoxia • Anemia has multiple causes, and is commonly associate with other diseases and disorders. • Anemias most commonly seen in adults. • Iron-deficiency Anemia • Pernicious Anemia • Folic-Acid Deficiency • Aplastic Anemia • Prevalent conditions • Blood loss • Decreased production of erythrocytes • Increased destruction of erythrocytes

Iron Deficiency Anemia

Iron Deficiency Anemia • Other names, microcytic or hypochromic • A condition in which the total body iron content is decreased below a normal level, affecting hemoglobin synthesis. • RBCs appear pale and are small. • From a diet too low in iron or from the body not absorbing enough iron from the gastrointestinal tract • The most common cause is chronic blood loss (GI bleeding)

Iron Deficiency Anemia Assessment Findings: • Pallor (most common symptom) • Glossitis • Headache • Irritability • Impaired thought processes • Depression • Parasthesias • Weakness and fatigue • Sensitivity to cold

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Dizziness Dypsnea Palpitations Cheilosis (scalp and fissure of the lips) Koilonychia (spoon-shaped nails) Pale, dry mucous membranes Stomatitis

Iron Deficiency Anemia Diagnostic Evaluation: • Hematology shows decreased Hemoglobin level, hematocrit, iron, ferritin, reticulocytes, red cell indices, transferrin, and saturation; absent hemosiderin; and increased iron-binding capacity. • Peripheral blood smear reveals microcytic and hypochromic RBCs.

Treatment: • Diet high in Iron, roughage, and protein with increased fluids and avoidance of teas and coffee, which reduce iron absorption. • Transfusion therapy with packed RBCs, if necessary Drug therapy options: • Anti-anemic: ferrous sulfate, iron dextran • Vitamins: pyridoxine hydrochloride (vitamin B6), Ascorbic acid (vitamin C), cyanocobalamin (Vitamin B12)

Iron Deficiency Anemia Nursing Diagnosis: • Imbalanced nutrition: less than body requirements related to inadequate intake of iron. • Activity intolerance related to decreased oxygen-carrying capacity of the blood. • Ineffective tissue perfusion related to decreased oxygen-carrying capacity of the blood. Nursing Planning and Goals: • The client will express feelings of increased energy. • The client will maintain weight without further loss. • The client will maintain adequate ventilation.

Iro Deficiency Anemia: Nursing Intervention: • Assess cardiovascular & respiratory status • Monitor vital signs • Recognizing sign and symptoms of bleeding • Monitor stool, urine and emesis for occult blood • Diet teaching—foods rich in iron • Provide periods of rest • Supplemental iron • Discuss diagnostic studies • Emphasize compliance • Iron therapy for 2-3 months after the hemoglobin levels return to normal

Iron Deficiency Anemia Nursing Evaluation: • The client reports increased energy and decreased periods of fatigue. • Incorporates several food high in iron into diet; takes prescribed iron supplementation as ordered. • Tolerates increased activity obtains sufficient rest. • Vital signs stable without complaints of chest pain, palpitations, or shortness of breath. • The client maintains a stable weight • The client has adequate ventilation as evidenced by normal respirations.

Pernicious Anemia

Pernicious Anemia • A megaloblast is a large, nucleated erythrocyte with delayed and abnormal nuclear maturation • Pernicious anemia is a type of megaloblastic anemia associated with vitamin B12 deficiency. • Also called, amegaloblastic anemia or Addison’s anemia. • Vitamin B12 is necessary for normal deoxyribonucleic acid synthesis in maturing RBCs. • Pernicious anemia demonstrates familial incidence related to autoimmune gastric mucosal atrophy. • Normal gastric mucosa secretes a substance called intrinsic factor, necessary for absorption of vitamin B12 in ileum. If a defect exists in gastric mucosa, or after gastrectomy or small bowel disease, intrinsic factor may not be secreted and orally ingested B12 not absorbed.

This picture shows large, dense, oversized, red blood cells (RBCs) that are seen in megaloblastic anemia.

Pernicious Anemia • A megaloblast is a large, nucleated erythrocyte with delayed and abnormal nuclear maturation • Pernicious anemia is a type of megaloblastic anemia associated with vitamin B12 (Cobalamin) deficiency. • Also called, amegaloblastic anemia or Addison’s anemia. • Vitamin B12 is necessary for normal deoxyribonucleic acid synthesis in maturing RBCs. • Pernicious anemia demonstrates familial incidence related to autoimmune gastric mucosal atrophy. • Normal gastric mucosa secretes a substance called intrinsic factor, necessary for absorption of vitamin B12 in ileum. If a defect exists in gastric mucosa, or after gastrectomy or small bowel disease, intrinsic factor may not be secreted and orally ingested B12 not absorbed

Pernicious Anemia Assessment Findings: • Weakness, fatigue • Glossitis, sore mouth • Tingling and paresthesia of hands and feet • Constipation or diarrhea • Depression, delirium This picture shows large, dense, oversized, red blood • Dypsnea cells (RBCs) that are seen in megaloblastic anemia. • Mild jaundice of sclera • Pallor • Paralysis, gait disturbances • Positive Babinski’s and Romberg’s signs • Loss of bowel and bladder control • Impotence (males) • Altered vision (diplopia, blurred vision), taste, and hearing (tinnitus) • Tachycardia, palpitations • Weight loss, anorexia, dyspepsia

Pernicious Anemia Assessment Findings: • Severe pallor • Fatigue • Weight loss • Smooth, beefy red tongue (Sore tongue) • Slight jaundice • Paresthesias of the hands and feet • Disturbances with gait and balance • Anorexia • Parathesias of the feet and hands • Altered thought processes • Confusion  dementia

Pernicious Anemia Diagnostic Evaluation: • Blood chemistry test results reveal increased bilirubin and lactate dehydrogenase levels (LDH) • Bone marrow aspiration specimen shows increased megaloblasts, few maturing erythrocytes, and defective leukocyte maturation • Gastric analysis shows hypochlorhydria • Hematology shows decreased HCT and Hb levels • Romberg Test and/or Schilling Test: a medical investigation used for patients with vitamin B12 deficiency. The purpose of the test is to determine if the patient has pernicious anemia. • Upper G.I. series shows atrophy of gastric mucosa • Peripheral blood smear reveals oval, macrocytic, hyperchromic erythrocytes.

Pernicious Anemia Treatment: • Establishing a diet high in iron and protein and restricting highly seasone, coarse, or extremely hot foods. • Parenteral administration of cobalamin • Increase Dietary cobalamin does not correct the anemia • Still important to emphasize adequate dietary intake • Transfusion therapy with packed RBCs • Intranasal form of cyanocobalamin (Nascobal) is available • High dose oral cobalamin and sublingual cobalamin can use be used (cyanocobalamin) • Anti-anemic: ferrous sulfate, iron dextran • Vitamins: ascorbic acid (vitamin C), pyridoxine HCl (Vitamin B6), folid acid (vitamin B9)

Pernicious Anemia Nursing Diagnosis: • Disturbed thought processes related to neurologic dysfunction in absence of vitamin B12. • Impaired sensory perception (kinesthetic) related to neurologic dysfunction in absence of vitamin B12. • Imbalanced nutrition: less than body requirements • Impaired as exchange Nursing Planning and Goals: • The client will maintain diet as prescribed • The client will demonstrate signs of adequate gas exchange • The client will identify precautions to prevent injury

Pernicious Anemia Nursing Interventions: • Familial disposition • Early detection and treatment can lead to reversal of symptoms • assess patient for diminished sensations to heat and pain • Compliance with medication regime • Ongoing evaluation of GI and neuro status • Evaluate patient for gastric carcinoma frequently • Increase dietary intake of foods rich in vitamin B12 if the anemia is the result of a dietary deficiency • Administer vitamin B12 injections as prescribed, weekly initially and then monthly for maintenance (lifelong) if the anemia is the result of a deficiency of intrinsic factor or disease or surgery of the ileum.

Foods Rich in Vitamin B12 ■ Brewer’s yeast ■ Citrus fruits ■ Dried beans ■ Green, leafy vegetables ■ Liver ■ Nuts ■ Organ meats

Pernicious Anemia Nursing Evaluation: • Oriented, cooperative and follow instructions • Carries activities without injury • The client verbalizes the importance of maintaining a diet high in iron and protein and of taking vitamins and supplements as prescribed. • The client has normal vital signs and exhibit no signs of respiratory distress.

Folic Acid Deficiency

Folic Acid Deficiency • Folic Acid Deficiency also causes chronic megablastic anemia (RBCs that are large and fewer in number) • Folic Acid required for RBC formation and maturation • Impaired utilization from folic acid antagonists (methotrexate) and other drugs (phenytoin, broad spectrum antibiotics, sulfamethoxazole, alcohol, hormonal contraceptives) • Causes • Poor dietary intake • Malabsorption syndromes • Drugs that inhibit absorption • Alcohol abuse • Hemodialysis

Folic Acid Deficiency Assessment Findings: • Fatigue • Weakness • Pallor • Dizziness • Headache • Tachycardia • Sore tongue • Cracked lips Diagnostic Evaluation and Treatment: • Vitamin B12 and folic acid level – folic acid will be decreased. • Complete blood count (CBC) will show decreased RBC, hemoglobin, and hematocrit with increased mean corpuscular volume and mean corpuscular hemoglobin concentration. • Oral folic replacement on daily basis

Folic Acid Deficiency Nursing Diagnosis: • Imbalanced Nutrition: Less than body requirements related to inadequate intake of folic acid Nursing Planning and Goals: • Improving Folic Acid Intake

Nursing Intervention: • Assess diet for inclusion of food rich in folic acid: beef liver, peanut butter, red beans, oatmeal, broccoli, asparagus. • Arrange nutritionist referral appropriate • Assist alcoholic patient to obtain counseling and additional medical care

Folic Acid Deficiency Nursing Intervention: Patient Education and Health Maintenance • Teach patient to select balanced diet that includes green vegetables (asparagus, broccoli, spinach), yeast, liver and other organ meats, some fresh fruits; avoid overcooking vegetables. • Encourage patient to follow up periodically to monitor CBC Nursing Evaluation: • Eats appropriate and nutritious diet; takes folic acid supplements as prescribed

Aplastic Anemia • Also known as Normocytic Anemia is characterized by bone marrow hypoplasia or aplasia resulting in pancytopenia (insufficient numbers of RBCs, WBCs and Platelets). • Complete failure of the bone marrow • Extremely low red blood cell count, white blood cell counts, and platelet counts because bone marrow is not making any of these cells • Certain drugs (e.g., streptomycin and chloramphenicol) and exposure to toxic chemicals/radiation cause bone marrow failure • In many cases, cause of bone marrow failure is never identified

Aplastic Anemia

Aplastic Anemia Assessment Findings: • Pallor • Extreme fatigue, weakness • Tachycardia • Shortness of breath • Hypotension • Purpura, petechiae, ecchymosis • Unusually prolonged or spontaneous bleeding (epistaxis, hematuria, melena) • Frequent infections that do not resolve

Aplastic Anemia Diagnostic Evaluation: • Hematologic studies show decreased granulocytes, thrombocytes and RBCs, platelets (pancytopenia) • Bone marrow aspiration and biopsy: bone marrow is hypocellular or empty with greatly reduced or absent hematopoiesis. • Fecal occult blood test result is positive • Peripheral blood smear shows pancytopenia • Urine chemistry reveals hematuria Treatment: • Removal of causative agent or toxin • Bone marrow transplantation • Dietary changes, including establishing a high protein, high-calorie, high-vitamin diet • Supportive care to prevent or treat infections and hemorrhage • Transfusion of platelets and packed RBCs

Aplastic Anemia Drug Therapy Options: • Analgesics: Ibuprofen, acetaminophen • Androgens: fluoxymesterone, oxymetholone • Antibiotic, according to the susceptibility of the infecting organism Nursing Diagnosis: • Risk for infection related to granulocytopenia secondary to bone marrow aplasia • Risk for injury related to bleeding • Risk for deficient fluid volume • Activity intolerance. Planning and Goals: • The client will maintain an adequate fluid balance • The client will remain free from infection • The client will be free from complications caused by decreased activity.

Aplastic Anemia Nursing Intervention: • Assess respiratory status • Assess vital signs and cardiovascular status • Monitor and record intake and output and urine specific gravity • Monitor laboratory values • Monitor for infection, bleeding, and bruising • Encourage fluids and administer I.V. fluids • Administer oxygen to improve tissue oxygenation • Assist with turning, coughing, and deep breathing exercises • Administer transfusion therapy, as prescribed • Maintain the client’s diet • Encourage verbalization of concerns and fears • Alternate rest periods with activity • Provide cooling blankets and tepid sponge baths for fever • Maintain protective precautions to prevent infection and skin breakdown • Provide mouth care before and after meals • Avoid giving the client I.M. injections • Provide genetic counseling resources for client for further information.

Aplastic Anemia Nursing Intervention: • Review key teaching topics with the client to ensure adequate knowledge about his condition and treatment, including: • Recognizing the early signs and symptoms of bleeding and infection • Avoiding contact sports • Wearing a medical identification bracelet • Refraining from using over-the-counter medications • Monitoring stool for occult blood • Using an electric razor to avoid bleeding • Refraining from taking aspirin Nursing Evaluation: • The client remains free from infection • Episodes of bleeding rapidly controlled • The client has a balanced intake and output and normal vital signs • The client displays no complication from inactivity....