Anemia: Symptoms, Diagnosis, and Nursing Considerations

• Anemia is a condition characterized by a deficiency in red blood cells (RBCs) and/or hemoglobin (Hgb) in the circulating blood
• Hemoglobin carries oxygen, anemia results in a reduced capacity to deliver oxygen to the tissues
• A decrease in the number of RBCs can be caused by impaired production, increased destruction, or blood loss (massive or chronic)

Signs and Symptoms of Anemia

• Pallor
• Tachycardia
• Tachypnea
• Fatigue
• Shortness of breath
• Lightheadedness
• Dizziness
• Weakness
• Palpitations

Nursing Considerations for Anemia

• Monitor hemoglobin (Hgb) and hematocrit (Hct) levels
• Monitor responses to therapy
• Assess fatigue level
• Evaluate the ability to ambulate safely and perform activities of daily living (ADLs)
• Monitor dyspnea and oxygen saturation
• Observe for pallor in the skin and conjunctivae

Nursing Diagnoses for Anemia

• Decreased activity tolerance related to tissue hypoxia and dyspnea
• Imbalanced nutrition: less than body requirements related to disease, treatment, or lack of knowledge about adequate nutrition
• Impaired oral mucous membrane integrity related to altered dietary status

Interventions for Anemia

• Monitor vital signs before and after activity
• Plan care to conserve energy after periods of activity
• Assist the patient with self-care activities as needed
• Encourage the patient to limit visitors, telephone calls, and unnecessary interruptions to conserve energy
• Administer oxygen as ordered to relieve dyspnea
• Consult a dietitian to provide diet instruction if the anemia is caused by a dietary deficiency
• Teach patients with folic acid deficiency to include foods from each food group at every meal
• Instruct the patient to take supplements as ordered
• Instruct patients with pernicious anemia (vitamin B12 injections are given for life, because oral B12 is not absorbed in pernicious anemia)
• Administer intramuscular iron injections by the Z-track method to avoid staining of the injection site
• Administer liquid iron supplements with a drinking straw to avoid staining the teeth
• Provide oral hygiene to keep the oral cavity clean and prevent infection
• Encourage soft, bland foods, which are more tolerable until healing can occur
• Instruct the patient to use a soft toothbrush for oral care because it is gentler until healing can occur
• Vitamins that help produce RBCs include iron, folic acid, and vitamin B12

Monitoring for Blood Transfusion Reaction

• Observe the patient for a reaction in the first 15 minutes of the blood transfusion

Signs of a Transfusion Reaction

• Rash
• Elevated temperature (increase of 1.8 degrees Fahrenheit or 1 degree Celsius from baseline)
• Aches (back pain, chest pain, headache)
• Chills
• Tachycardia (especially if increased from baseline)
• Increased respirations (increase from baseline)
• Oliguria (low or no urine output)
• Nausea/GI issues like diarrhea
• Back pain
• Chest pain
• Itching
• Shortness of breath
• Headache
• Nausea and vomiting
• Anxiety
• Hypotension
• Feeling of impending doom

Nursing Interventions for Transfusion Reaction

• If a patient shows signs or symptoms of a transfusion reaction, stop the transfusion immediately and note the time this occurred
• Stay with the patient and closely monitor them
• Monitor vital signs every five minutes
• Disconnect the blood tubing at the access site and replace it with new tubing and 0.9% normal saline running to keep the vein open
• Notify the doctor and the blood bank of what is happening
• Call for help from other staff members to make phone calls

Medications for Transfusion Reaction

• Corticosteroids (to suppress the immune response)
• Antihistamines (to decrease the immune response)
• Antipyretics (to decrease temperature)
• Vasopressors like epinephrine (to open up the airways) or dopamine (to increase renal blood flow)
• Diuretics (to help get rid of excess fluid)

Iron Deficiency Anemia

• Inadequate intake of iron-rich foods can contribute most to iron deficiency anemia

Foods That Are Good Sources of Iron

• Animal meats
• Legumes
• Iron-fortified grains
• Dried fruits
• Dark leafy greens
• Vitamin C can also help the body absorb iron

Good Sources of Vitamin C

• Citrus fruits
• Strawberries
• Kiwis
• Mangos
• Tomatoes
• Broccoli
• Peppers
• Cabbage

Polycythemia

• Condition in which the blood becomes thick with too many RBCs, hindering circulation

Types of Polycythemia

• Polycythemia vera (PV), also known as primary polycythemia, is a rare type of cancer
• Most people with PV have a specific genetic mutation
• PV onset is usually in adults over age 50
• In PV, the RBCs, platelets, and white blood cells (WBCs) are all overproduced, and the bone marrow becomes packed with too many cells
• As this overabundance of cells spills out into the general circulation, the organs become congested with cells and the tissues become packed with blood
• The thick blood and excess platelets can cause thrombosis and occlusion of vessels

Secondary Polycythemia

• Secondary polycythemia is the result of long-term hypoxia
• Common coexisting conditions that may predispose a patient to secondary polycythemia include pulmonary diseases such as chronic obstructive pulmonary disease (COPD), cardiovascular problems such as chronic heart failure, living in high altitudes, and smoking
• The body makes more RBCs in response to the low oxygenation associated with these conditions
• Secondary polycythemia is a compensatory mechanism rather than an actual disorder
• Elevated hematocrit (Hct) level are observed with polycythemia

Polycythemia Vera Lab Values

• Hemoglobin level greater than 18 mg/dL
• Hematocrit level greater than 55%

Normal Hematocrit Values

• Males 43%-49%
• Females 38%-44%
• Ecchymoses is used to describe larger areas of discoloration from hemorrhage under the skin, and these areas referred to as bruises

Pernicious Anemia

• Pernicious anemia neuro symptom is numbness of the hands or feet, weakness, and memory problems

Low Platelet Count

• A platelet count is 20,000/mm3
• Action the nurse would take is initiate bleeding precautions

Blood Transfusion Rxn

• The nurse should discontinue the blood transfusion if a pt is having a rxn

White blood cells (WBC)

• Normal lab value is 4,500–11,000/mm3

Normal values (HgB) and Hematocrit

• Male: 14-17.3 g/100 mL
• Female: 11.7–15.5 g/100 mL

Hematocrit (Hct) levels

• Male: 43%-49%
• Female: 38%-44%

Red Blood Cells Function

• Carry oxygen from the lungs throughout the body
• RBCs remove carbon dioxide (CO2) from the body and transport it to the lungs to be exhale

Low Red Blood cell value

• Means the patient has anemic

Other Fluids with Transfusion

• 0.9% normal saline