Iron Deficiency Anemia

Anemia

• A decrease in the oxygen-carrying capacity of the blood.

General Nursing Interventions

• Balance physical activity and rest.
• Maintain adequate nutrition and perfusion.
• Monitor vital signs, SpO2, and administer O2 PRN.
• Provide patient education.
• Monitor for complications.

Iron Deficiency Anemia - Etiology and Pathophysiology

• Etiology: Excessive iron loss due to bleeding, decreased iron intake, or malabsorption.
• Pathophysiology: Hypoxemia because of the blood's reduced oxygen-carrying capacity.

Iron Deficiency Anemia - Signs and Symptoms

• Develops gradually and may not be noticeable until hemoglobin drops to 7-8 g/dL.
• Earliest signs include weakness, fatigue, and shortness of breath with activity/exertion.
• Other signs include pallor, glossitis, cheilosis, brittle spoon-shaped nails, smooth sore tongue, and PICA.

Iron Deficiency Anemia - Diagnostics and Lab Tests

• Low iron levels.

Iron Deficiency Anemia - Diagnostics and Lab Tests

• Low MCV and MCHC.
• Low serum iron and ferritin levels.
• Elevated serum iron-binding capacity.

LABS

• Stool occult blood test to assess stool color, frequency, consistency, and amount.
• Patients may have greenish black or tarry stools.

Iron Deficiency Anemia - Interventions

• Note that iron deficiency can be caused by blood loss.
• Increase iron-rich food intake and provide oral supplementation.
• Administer 100-200 mg of ferrous sulfate (slow FE) 2 to 3 times daily for 3-6 months.
• EPO stimulation is possible, as is IM or IV administration.

Iron Deficiency Anemia - Patient Education

• Teach patients to maintain adequate nutrition and select iron-rich foods.
• Preferred foods include meats, fish, and poultry as well as vegetables, fruits, nuts, and iron-fortified cereals.
• Administer on an empty stomach or with vitamin C for faster absorption.
• Avoid grapefruit juice, antacids, and caffeine.
• Report persistent GI side effects like CONSTIPATION.
• Bowel movements will appear black and tarry with iron supplements.
• Teach energy-saving strategies.

Megaloblastic Anemia

• Results in decreased RBC production.
• High MCV, MHC, MCHC, but LOW NUMBER OF RBCs.

Megaloblastic Anemia #2

• B12/Cobalamin deficiency (pernicious anemia).
• Folate deficiency.

Megaloblastic Anemia - B12/Cobalamin Etiology and Pathophysiology

• Inadequate B12 dietary intake.
• Faulty absorption.
• Medication preventing the process.
• Absence of intrinsic factor, which results in pernicious anemia.
• Lack of B12 causes the formation of megaloblastic cells.
• Interruption of DNA synthesis and normal maturation of RBCs.

Megaloblastic Anemia - B12/Cobalamin Assessment

• Develops slowly. Median age of diagnosis is 60 years old.
• Possible signs include pallor with slight jaundice, weakness, smooth/sore/beefy red tongue (glossitis), and diarrhea.
• Conduct assessments for neurological deficits like paresthesias and impaired proprioception.

Megaloblastic Anemia - B12/Cobalamin Risk and Diagnostics

• Populations at risk include older adults, those on long-term metformin, H2 blockers, PPIs, post-bariatric surgery patients as well as strict vegans.
• Bariatric patients are missing intrinsic factor.
• Diagnostic and lab tests reveal increased MCV and MCHC, decreased hemoglobin and hematocrit, and lower serum B12 levels.

Megaloblastic Anemia - B12/Cobalamin Medications and Education

• Vitamin B12 (cyanocobalamin) 1000mcg IM daily for 7 days, then monthly for life for pernicious anemia.
• Increase oral intake, PO supplement, or IM injections, for dietary deficiency.
• Folate deficiency and hypokalemia often occur together so replace potassium PRN.
• Dietary sources of B12 include animal products like meat, eggs, milk, poultry, and fish, as well as fortified cereals.
• If the condition is pernicious, regular B12 injections are required.

Megaloblastic Anemia - Folate Deficiency Etiology and Pathophysiology

• Poor nutrition and decreased vegetable (leafy green) intake
• This is most often observed in those with poverty, alcoholics, elderly
• Malabsorption in celiac disease
• Some medication effects on absorption include OC, anticonvulsants, methotrexate, and alcohol.
• Lack of folic acid causes the formation of megaloblastic cells.
• Interruption of DNA synthesis and normal maturation of RBCs.

Megaloblastic Anemia - Folate Deficiency Etiology and Pathophysiology Risk Factors

• Increased alcohol use.
• Pregnancy.
• Infancy.
• Teenage years.
• Methotrexate.
• Hemodialysis.

Megaloblastic Anemia - Folate Deficiency Assessment

• May notice pallor, progressive weakness, fatigue, dyspnea, cardiac palpitations, severe GI symptoms, depression, irritability, insomnia, cognitive decline, psychosis.
• No neurological involvement.

Megaloblastic Anemia - Folate Deficiency Interventions

• Energy saving techniques.
• Provide small bites of soft food due to tongue and mouth soreness.
• Dietary counseling to increase folate.
  • Assess for food access issues like poverty and old age, and consider a social worker.
• Administer folate 1-5 mg/day for 3-4 months.
• Give with B12 if both are deficient.

Megaloblastic Anemia - Acute Blood Loss

• Result of sudden hemorrhage caused by trauma, surgery complications, or disrupted vascular integrity.
• Monitor for shock and reduced plasma volume.

Megaloblastic Anemia - Acute Blood Loss Interventions

• Replace blood/fluid volume.
• Stop the source of hemorrhaging.
• Correct RBC loss.
• Provide short-term supplemental iron.

Anemia of Chronic Disease/Inflammation

• Diagnosed in the presence of a chronic inflammatory condition, autoimmune disease, or chronic illness.
• Identify and treat the underlying cause of anemia.
• Administer epogen (procrit) IV or IM if needed and use cautiously.

RBC destruction due to Chronic Blood Loss

• Chronic blood loss reduces iron stores, it can result from things like bleeding ulcers, hemorrhoids, and menstrual/postmenopausal bleeding.
• Identify the source and stop the bleeding.
• Use supplemental iron PRN.
• Give PRBCs for Hgb less than 7 PRN.

RBC destruction due to Sickle Cell Disease and Anemia

• A hereditary, chronic form of anemia.
• Autosomal genetic defect that results in the synthesis of hemoglobin S.
• Elevated serum bilirubin and elevated retic count.
• Blood cells experience a lack of O2. The cells become a crescent shape and clot, and leads to obstructing blood flow.
• Life span of RBCs are 10-20 days.

RBC destruction due to Sickle Cell Disease

• Assessment- Baseline Varies
• Generally healthy and without symptoms.
• Anemic with a baseline range of 5-11 Hgb.
• Observe pallor, jaundice, fatigue, pain, tachycardia, cardiac murmurs, and cardiomegaly.
• Chronic health problems due to organ damage.
• Enlargement of the bones in the face and skull.
• Prone to infection.

RBC destruction due to Sickle Cell Disease

• Assessment- Crisis

1. PAIN
2. Large joint swelling
3. Priapism
4. Fatigue, dyspnea
5. Anxiety, depression, irritability

Sickle Cell Crisis

• VASO-OCCLUSIVE CRISIS
• Severe pain due to erythrocytes becoming trapped and is often located in the hands and feet in children.
• Additional symptoms are fever, HTN, swelling, tachypnea, nausea, vomiting

Sickle Cell Crisis Triggers

• Infection.
• Low O2 levels.
• Comorbidities.
• Dehydration.
• Alcohol.
• Pregnancy.
• Cold weather.

Sickle Cell Crisis - Assessment and Management

• Assess pain levels, fatigue, and swelling.
• Conduct cardiopulmonary and neurological exams.
• Check for current presence of infection and anemia.

Sickle Cell Crisis - Management

• IV rehydration.
• Pain management with morphine, hydromorphone, or PCA.
  • At home, use Tylenol, aspirin, codeine, oxycodone, and non-pharmacological methods.
• Administer oxygen PRN.
• Blood transfusion to bring patient to their BASELINE.
• Teach the patient to avoid triggers.
• Administer PAIN MEDICATION WITHIN 30 MINUTES IS THE GOAL.

Sickle Cell Disease - Sequestration Crisis and Aplastic Crisis

• Sequestration Crisis:
  • Spleen involved
  • Thrombocytopenia
  • Reticulocytosis
• MANAGEMENT:
  • Treat hypovolemia
  • Blood transfusion
  • Possible spleenectomy

Aplastic Crisis

• Aplastic Crisis:
  • Results from viral infection.
  • Rapid fall in hemoglobin.
• MANAGEMENT:
  • Blood transfusion.

Sickle Cell Disease - Medical Management

• Gene therapy (Lyfgenia and Casgevy).
• Pharmacotherapy: hydroxyurea (Droxia, Hydrea) are the GOLDEN STANDARD DRUGS for Sickle Cell Disease.
• Maintain hydration.
• Administer folic acid and a multivitamin.
• Pain analgesics.
• Avoid extreme temperatures.
• Avoid alcohol and smoking.

Sickle Cell Disease - Management

• Vaccinations.
• Hematopoietic cell transplant.
• Blood transfusions.
• Screenings.
• Treat depression PRN.

Sickle Cell Disease - Patient Education

• Crisis prevention.
• Infection monitoring.
• Fatigue management.
• Immediately seek MEDICAL ATTENTION FOR ANY FEVER 101 OR HIGHER.
• Stress reduction.

Sickle Cell Disease - Complications

• Organ damage (CHF, Hepatic dysfunction, renal failure, retinopathy).
• Infection.
• Stroke, heart attack.
• DVT/PE.
• Leg ulcers.
• Priapism.
• Stunted growth and delayed puberty.

Acute Chest Syndrome

• Manifestations include fever and chest pain.
• Also tachypnea, wheezing, cough, hypoxia, respiratory distress, infiltrates on chest x-ray.
• Causes may be from atypical bacteria causing pneumonia or viruses as well as pulmonary or fat embolism.

Acute Chest Syndrome : Management

• Packed red blood cell transfusion.
• RESPIRATORY SUPPORT.
• Antimicrobial therapy.
• Bronchodilators.
• Inhaled nitric oxide therapy.
• Fluids.
• Pain management.

Acute Chest Syndrome : Prevention

• Incentive spirometry during vaso-occlusive crisis.
• Flu and pneumonia vaccine.
• Perioperative blood transfusion.

Thalassemia - Destruction of RBCs

• Autosomal recessive disorder caused by inadequate production of normal Hgb.
• Person has microcytic, hypochromic RBCs.
• Two types of Thalassemia
  • Alpha-Asymptomatic
  • Beta- severity ranging from mild to life threatening.

Priority Nursing Diagnoses for Anemia

• Activity intolerance.
• Risk for infection.
• Ineffective Tissue perfusion.
• Impaired gas exchange.
• Knowledge deficit.
• Fatigue.
• Imbalanced nutrition: less than body requirements.

Polycythemia

• Increased volume of RBCs.
• Secondary Polycythemia.
  • Excessive production of erythropoietin from reduced oxygen, cyanotic heart disease, non-pathologic conditions, or neoplasms.
• Can happen in people who eat too much red meat. Is more common in men than women.
• Medical management includes treatment not needed if the condition is mild. Treatment of underlying diseases and therapeutic phlebotomy.

Bleeding Disorders

• Failure of homeostatic mechanisms.
• Caused by trauma, platelet disorder, or coagulation factor abnormality.
• Management includes specific blood products and anticoagulants.
• Nursing management aims to limit injury, assess for bleeding, apply bleeding precautions, and educate the patient on management and risks.

Bleeding Disorders: Thrombocytopenia

• Causes:
  • 1. Increased platelet consumption - Severe bleeding, Severe thrombosis or PE
  • 2. Increased platelet destruction infection, immune thrombocytopenia purpura,
  • Thrombocytopenia (ex- Malignancy or chronic liver disease).
• Caused by antibodies forming against and destroying platelets
• Symptoms: Bruising easily, heavy menses, petechia

Hemophilia

• Inherited disorder- x-linked trait. Most are MALE
• Clinical Manifestations:
  • BLEEDING INTO JOINTS AND MUSCLES, hematomas, Gl, Mucous membranes, Intracranial bleeding
• Hemophilia: Treatment-
  • FACTOR VIII and IX replacement Desmopressin (DDAVP) as it increased a rise in factor VIII to control bleeding:.
  • Emicizimab (Hemlibra).
  • Aminocaproic acid. Hemophilia: Nursing Management, and Patient Education

Hemophilia- Nursing Managment and Patient Education

• Avoid injury and trauma.
• Avoid medications that affect platelet aggregation.
  • Example- ASPRIN, NSAIDS, ALCOHOL Avoid injections) Avoid Injections

Von Willebrand Disease

• Deficiency of vWF which is required for factor VIII activity and for platelet aggregation.
• Common symptoms: nosebleeds, heavy menses, easy bruising, prolonged bleeding.
• Treatment DDAVP at time of bleeding or prior to invasive procedures.

Acquired Bleeding Disorders includes

• Liver disease caused by hepatotoxicity or liver failure.
• Vitamin K deficiency.,
• Complications of anticoagulant therapy (Heparin induced thrombocytopenia).
• Disseminated Intravascular Coagulation (DIC)( Heparin.

Heparin Induced Thrombocytopenia Treatment

• DECREASE IN PLATELETS BY 50%.
• Treatment Stop heparin Alternative anticoagulant
• Hypertcoaqulability States Causes).

Hypercoagulability States

• Causes - Exaggerated homeostasis- excessive clotting can cause blood vessel occlusion. Increased platelet function Thrombocytosis/ OCCLUSION LEADS TO ISCHEMIA Hypertcoagulation Related to Platelets Thrombocytosis

Hypercoagulation Related to Platelets

• Platelet count over 1 million, Atherosclerosis, Arterial turbulence, Venous stasis.
• Hypertension, smoking. elevated cholesterol, stress, DM, inlfammation

Hypercoagulation Management

• Baby aspirin - Clopidogrel (Exercise, Anti-embolism)
• stocking Avoid smoking, limit alcohol, Avoid circulatory stasis Mobility, crossing legs

Assessing Cardiac System Cholesterol: BNP Homocyestine

Labs for Cardiac System Assessment

• CHOLESTEROL: Cholesterol less than 200LDL- Less than 100HDIL
• Greater Than 40, Triglycerides- Less than 150, BNP,, Homocysteine C reactive protein
• Serum Cardiac Markers CK-MB, TropONIN T- Returns to normal in 10 days* Troponin I Myoglobin Electrocardiography
• Tests: Telemetry Generally-5 leads, EKG and Continuous cardiac monitoring.

Stress Testing Diagnostic

• Measures perfusion into cormary arteries - Monitor for chest pain, SOB , EKG rythm changes- POOR CORONARY PERFUSION
• Echocardiography* Heart ultrasoundMeasures cardiac preeures

Echocardiography

• Measures cardiac pressures
• measures EJECTION FRACTION- volume of blood coming out of left ventricle - TEE transesophageal echocardiogram- needs to sedate - TTE (Transthoracic-hoc echocardiogramh Non-invassive
• Cardiac Catherizationinvasive procedure that can be ether diagnostic or deliver treatment

Cardiac Cath Procedure

• catheter placed inradial or femord artery and advanced to heart contrast to measure cardiac pressures very accurately Horoscopy (X-ray, Heart Inflammation
• Different types of heart inflammation are: •Pericarditis Endocarditis. Myocarditis

Heart Imflamation

• Types Different types of heart inflammation are
  • •Pericarditis Heart Imflammation, EndocarditisMyocarditsDifferent types of heart inflammation

Heart Conditions

• Infections and treatments Infective Endorditthe treatment ofinfection of endocardium is penicillin, Acute Pericarditis Myocarditis Infection of the pericardial sac infection of myocardium leads to cardiac tamponade-
• Beck's Triad, Becks Triad Hypotension Mumours and Jugular vein distention

Nursing care

• Nursing Care
  • Daily weights
  • Administer Oxygen
  • Maintain fluid and sodium restriction Valvular Disease

Various valve Disorders

• Types of valvular disease stenosis- constriction narrowing of flow Prevents forward flow, legurgitation insufficincy of blood, badk backward flow of blood prolapse Leatlelts bodede bado anto the chamber primary mitral valve prolapse (MVP)

Types of Heart Failure

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Types of Heart failure

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Labs

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