Download Anemia

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.