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Hematologic Problems Klecka, Spring 2016 Learning Outcomes (Anemia) • Describe and classify anemia's • Understand the nursing management for specific anemia’s • Incorporate medical pharmacology into the nursing management of anemia Anemia Classification Clinical Manifestations • Caused by the body’s response to tissue hypoxia • Hemoglobin (Hb) levels are used to determine the severity of anemia. Remember norms (Hemoglobin Normal Range) Female: 12-16 g/dl Male: 13-17 g/dl Types of Anemia • • • • • • • Iron-Deficiency Anemia Thalassemia Megaloblastic Anemias Chronic Anemia Aplastic Anemia Acute/chronic Blood Loss Anemia Hemolytic Anemias Integumentary Manifestations • • • • • • • Pallor ↓ Hemoglobin ↓ Blood flow to the skin Jaundice ↑ Concentration of serum bilirubin Pruritus ↑ Serum and skin bile salt concentrations 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 • HR X SV = CO Anemia: Nursing Assessment • • • • • • Subjective Data Important health information Past health history Medications Surgery or other treatments Dietary history Anemia: Nursing Assessment • • • • • • • • Subjective Data Functional health patterns Health perception–health management Nutritional-metabolic Elimination Activity-exercise Cognitive-perceptual Sexuality-reproductive Anemia: Nursing Assessment • • • • • • • Objective Data General Integumentary Respiratory Cardiovascular Gastrointestinal Neurologic Anemia: Nursing Diagnoses • Fatigue • Altered nutrition: Less than body requirements • Ineffective self-health management Anemia: Nursing Management • • • • Goals Assume normal activities of daily living. Maintain adequate nutrition. Develop no complications related to anemia Anemia: Nursing Implementation • • • • Blood or blood product transfusions Drug therapy Volume replacement Dietary and lifestyle changes Anemia: Nursing Implementation • Oxygen therapy • Patient teaching – Nutrition intake – Compliance with safety precautions to prevent falls and injury Iron Deficiency Anemia • • • • 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 Iron Supplementation Pharmacological • Single drug or as part of a multivitamin preparation • Oral iron preparations are available as ferrous salts (ferrous fumarate, ferrous gluconate, ferrous sulfate) • Parenteral – iron dextran – ferric gluconate (Ferrlecit) – iron sucrose (Venofer) Iron Deficiency: • • • • • Nursing Management Diet teaching Supplemental iron Discuss diagnostic studies. Emphasize compliance. Iron therapy for 2 to 3 months after hemoglobin levels return to normal Megaloblastic Anemias • Group of disorders caused by impaired DNA synthesis – Characterized by the presence of large RBCs (megaloblasts) – Easily destroyed because of fragile cell membrane • Majority result from deficiency in – Cobalamin (vitamin B12) – Folic acid Cobalamin Deficiency • Intrinsic factor (IF) – Protein secreted by the parietal cells of the gastric mucosa • IF is required for cobalamin absorption in the small intestine. • Causes Pernicious Anemia Cobalamin Deficiency Clinical Manifestations • Neuromuscular manifestations – Weakness • Paresthesias of the feet and hands – ↓ Vibratory and position senses • Ataxia – Muscle weakness – Impaired thought processes Folic Acid Deficiency • Common causes – Dietary deficiency – Malabsorption syndromes – Drugs – Increased requirement – Alcohol abuse and anorexia – Loss during hemodialysis Anemia of Chronic Disease • Review – Conditions/Meds that would effect Erythropoietin production Immunomodulators (IMs) • Include drugs from several classes – Immunosuppressants – Immunizing drugs – Biologic response modifiers (BRMs) • Hematopoietic drugs • Immunomodulating drugs Acute Blood Loss • Nursing management – Assess for cause – Volume Replacement Chronic Blood Loss Reduced iron stores Bleeding ulcer Hemorrhoids Menstrual and postmenopausal blood loss Pair and Share #1 At an outpatient clinic, a 78-year-old woman is found to have a Hb of 8.7 g/dL (87 g/L) and a Hct of 35%. Based on the most common cause of these findings in the older adult, the nurse collects information regarding: 1. A history of jaundice and black tarry stools. 2. A 3-day diet recall of the foods the patient has eaten. 3. Any drugs that have depressed the function of the bone marrow. 4. A history of any chronic diseases such as cancer or renal disease. Answer: 4 • 4. A history of any chronic diseases such as cancer or renal disease • Rationale: A common cause of anemia in the older adult population is comorbid conditions such as cancer or renal disease. OTHER RED BLOOD CELL DISORDERS Thrombocytopenia • Reduction of Platelets below 150,000 • (ITP) Immune Thrombocytopenic Purpura Hemophilia Hemophilia Bone Marrow Biopsy