Nursing Management of Anemia

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the first laboratory measure to decrease in cases of iron deficiency anemia?

Serum iron (correct)

Serum ferritin

Total iron binding capacity (TIBC)

Transferrin saturation

Which condition is characterized by decreased number of RBC precursors?

Megaloblastic anemia

Aplastic anemia (correct)

Sickle cell anemia

Iron deficiency anemia

What would be an acute intervention for a patient with anemia experiencing fatigue?

Stress management techniques

Blood transfusion (correct)

Electrolyte replacement therapy

Increased physical activity

Which of the following is a primary goal of nursing management for patients with anemia?

Facilitate normal daily activities Signup and view all the answers

What is the purpose of the Schilling Test in the context of anemia?

To evaluate vitamin B12 absorption Signup and view all the answers

In managing anemia, how should a nurse prioritize patient activities?

By balancing periods of rest and activity Signup and view all the answers

What is the process advocated to prevent transfusion errors?

Two-person patient identification process Signup and view all the answers

Which type of anemia is most commonly associated with macrocytic characteristics?

Megaloblastic anemia due to vitamin B12 deficiency Signup and view all the answers

Which intervention is NOT typically part of the management for patients with anemia?

Increased dietary fiber Signup and view all the answers

What is the correct approach to assessing nutritional needs in patients with anemia?

Evaluate overall diet and specific vitamin deficiencies Signup and view all the answers

Which of the following symptoms is LEAST likely to be associated with iron deficiency anemia?

Hemorrhoidal pain Signup and view all the answers

Which dietary factor could contribute to the development of iron deficiency anemia?

Inadequate dietary intake of iron Signup and view all the answers

What is the primary site of iron absorption in the gastrointestinal tract?

Duodenum Signup and view all the answers

Which laboratory result is expected in iron deficiency anemia?

Decreased serum iron Signup and view all the answers

What condition would most likely lead to inadequate absorption of iron?

Duodenal bypass surgery Signup and view all the answers

Which clinical finding might indicate a diagnosis of iron deficiency anemia upon physical examination?

Atrophic glossitis Signup and view all the answers

What is the relationship between serum ferritin and serum iron in patients with iron deficiency anemia?

Both serum ferritin and serum iron decrease Signup and view all the answers

Which of the following is an indication of chronic blood loss potentially leading to iron deficiency anemia?

Altered stool color Signup and view all the answers

Which sign might suggest iron deficiency anemia during a physical examination?

Splenomegaly Signup and view all the answers

What is a common treatment strategy for correcting iron deficiency anemia?

Oral iron supplementation Signup and view all the answers

What is the primary role of erythrocytes in the hematologic system?

Transport oxygen Signup and view all the answers

Which type of anemia is characterized by small size and pale color of the red blood cells?

Microcytic anemia Signup and view all the answers

Which of the following conditions can lead to normocytic, normochromic anemia?

Sickle cell anemia Signup and view all the answers

What is the volume range for normal hematocrit levels?

38-52% Signup and view all the answers

Which factor is NOT a common cause of anemia?

Increased blood pressure Signup and view all the answers

Which type of diagnostic study is specifically used to measure iron stores in the body?

Serum ferritin Signup and view all the answers

Which symptom is most likely to result from severe anemia?

Bounding pulse Signup and view all the answers

What blood cell type primarily protects the body from infection?

Leukocytes Signup and view all the answers

In microcytic anemia, which laboratory value would likely be observed?

MCV < 80 fL Signup and view all the answers

What major complication arises from acute blood loss, particularly related to the body's response?

Hypovolemic shock Signup and view all the answers

In hemolytic anemia, which of the following symptoms indicates severe hemolysis?

Jaundice Signup and view all the answers

Which of the following treatments is LEAST likely to be used for managing hemolytic anemia?

Iron supplements Signup and view all the answers

What is the primary reason for the poor prognosis in untreated severe aplastic anemia?

Lack of hematopoiesis Signup and view all the answers

In sickle cell disease, what specific change occurs in the hemoglobin structure?

Replacement of Hb A with Hb S Signup and view all the answers

Which symptom is NOT commonly associated with acute crises in sickle cell disease?

Palpitations Signup and view all the answers

What underlying condition can lead to the development of chronic blood loss anemia?

Menstrual bleeding Signup and view all the answers

What is a possible outcome of the obstruction caused by sickle-shaped red blood cells?

Tissue ischemia Signup and view all the answers

Which of the following lab findings is NOT typically expected in the diagnosis of aplastic anemia?

Elevated reticulocyte count Signup and view all the answers

What essential nursing management action is necessary for a postoperative patient experiencing blood loss?

Monitor blood loss and administer blood products Signup and view all the answers

What primarily causes primary polycythemia vera?

Genetic defect leading to increased RBC production Signup and view all the answers

Which clinical manifestation is least likely associated with polycythemia?

Shortness of breath Signup and view all the answers

What is the primary treatment approach for managing polycythemia?

Monitoring of Hgb and HCT levels with periodic phlebotomy Signup and view all the answers

Which factor accurately describes secondary polycythemia?

Can result from tumors producing erythropoietin Signup and view all the answers

What complication is most associated with the increased blood viscosity seen in polycythemia?

Thrombo-embolism events, including strokes Signup and view all the answers

What is the role of erythropoietin (EPO) in hypoxia-driven secondary polycythemia?

It stimulates the production of red blood cells by the kidneys. Signup and view all the answers

Study Notes

Hematologic System

The hematologic system encompasses structures and functions responsible for blood production and circulation.
Bone marrow, the primary site of blood cell production, is found in flat bones.
Red marrow is responsible for creating blood cells.
Yellow marrow primarily stores fat.
Blood, a connective tissue, carries out essential transportation, regulation, and protection functions, maintaining homeostasis of coagulation.
Plasma, comprising approximately 55% of blood, primarily consists of water but also contains proteins, electrolytes, gases, nutrients, and waste products.
Blood cells, making up approximately 45% of blood, include:
- Erythrocytes (RBCs): Primarily responsible for oxygen transport.
- Leukocytes (WBCs): Protect against infections.
- Thrombocytes (Platelets): Crucial for blood coagulation.

Anemia

Anemia is a condition characterized by a deficiency in:
- Number of erythrocytes (RBCs).
- Quantity or quality of hemoglobin (Hgb).
- Volume of packed RBCs (hematocrit).
Causes of anemia:
- Decreased RBC production: Due to factors like iron deficiency, vitamin deficiencies, bone marrow disorders.
- Blood loss: Acute or chronic bleeding.
- Increased RBC destruction: Hemolysis, or the premature breakdown of RBCs.
- Hereditary (intrinsic): Genetic disorders affecting RBC production or function.
Manifestations of anemia: Result from the body's response to hypoxia (oxygen deficiency) as a result of impaired RBC function.

Normal CBC Values

Normal Hemoglobin (Hgb) levels:
- Female: 12-16 g/dL.
- Male: 14-18 g/dL.
Normal WBC count: 5,000-10,000/uL.
Normal Platelets: 150,000-400,000.

Anemia Classifications

Mild anemia (10-12 g/dL): Often asymptomatic.
Moderate anemia (6-10 g/dL): Symptoms include fatigue, palpitations, dyspnea (shortness of breath).
Severe anemia (<6 g/dL): Symptoms include pallor, dizziness, headache, vertigo, impaired thought processes, lethargy, severe palpitations, tachycardia (fast heart rate), orthopnea (difficulty breathing when lying down), dyspnea at rest, sensitivity to cold, and anorexia (loss of appetite).

Anemia Morphology and Etiology

Normocytic, Normochromic Anemia:
- Red blood cells are normal in size and color.
- MCV (Mean Corpuscular Volume): 80-100 fL.
- MCH (Mean Corpuscular Hemoglobin): 27-34 pg.
- Causes: Acute blood loss, hemolysis, chronic kidney disease, sickle cell anemia, pregnancy, and cancer.
Microcytic, Hypochromic Anemia:
- Red blood cells are small in size and pale in color.
- MCV: < 80 fL.
- MCH: < 27 pg.
- Causes: Iron deficiency anemia, vitamin B6 deficiency, thalassemia, and lead poisoning.
Macrocytic (megaloblastic), Normochromic Anemia:
- Red blood cells are large in size and normal in color.
- MCV: > 100 fL.
- MCH: > 34 pg.
- Causes: Cobalamin (vitamin B12 deficiency), folic acid deficiency, liver disease, and the effects of alcohol abuse.

Diagnostic Studies for Anemia

CBC (Complete Blood Count): Measures hemoglobin (Hgb), hematocrit (Hct), white blood cells (WBCs), and platelets.
Reticulocyte count: Indicates the number of immature red blood cells in the blood, reflecting bone marrow's ability to produce new RBCs.
Red blood cell indices:
- MCV (Mean Corpuscular Volume): Measures the average volume of a single red blood cell.
- MCH (Mean Corpuscular Hemoglobin): Measures the average amount of hemoglobin in a single red blood cell.
Serum ferritin: Measures iron stores in the body. The first to drop in iron deficiency anemia.
Serum iron: Measures the amount of iron circulating in the blood. Drops after serum ferritin in iron deficiency anemia.
TIBC (Total Iron Binding Capacity): Measures the ability of transferring, a protein that carries iron in the blood, to bind iron.
Vitamin B12 and folate levels: Measure levels of these vitamins, crucial for RBC production.
Schilling Test: Evaluates vitamin B12 absorption (rarely performed).

Etiology and Management of Anemia

Decreased RBC production:
- Iron deficiency: Caused by inadequate iron intake, absorption issues, or chronic blood loss.
- Thalassemia: A genetic condition impairing hemoglobin production.
- Aplastic anemia: A rare disorder impacting bone marrow's ability to produce blood cells.
Nutritional anemias:
- Iron deficiency anemia: Caused by insufficient iron intake or absorption.
- Macrocytic or megaloblastic anemias: Caused by vitamin B12 (cobalamin) or folate deficiency.
Blood loss:
- Acute blood loss: Sudden bleeding due to trauma, surgery, or other disruptions of vascular integrity.
- Chronic blood loss: Caused by conditions like bleeding ulcers, hemorrhoids, or excessive menstrual bleeding.
Hereditary (intrinsic):
- Sickle cell anemia: An inherited disorder affecting hemoglobin structure and RBC shape.
Assessment: Includes reviewing complete blood count (CBC) results, specifically hemoglobin (Hgb) and hematocrit (Hct).
Planning: The goal of management is to restore normal activity levels.

Nursing Implementation

Nursing interventions: Vary depending on the specific cause and severity of anemia. May include:
- Acute interventions:
  - Blood transfusions.
  - Drug therapy: Iron supplements, vitamin supplements, or erythropoietin (EPO) injections to stimulate RBC production.
  - Oxygen therapy.
Long-term management:
- Rest and activity: Alternate periods of rest and activity to manage fatigue.
- Prioritize activities: Focus on essential tasks and avoid strenuous activities during periods of fatigue.
- Maximize oxygen supply: Ensure adequate oxygenation during activity.
- Minimize risk of injury: Monitor for falls and other injuries due to dizziness or weakness.
- Monitor cardiorespiratory response: Observe for changes in heart rate, breathing rate, and blood pressure.
- Evaluate nutritional needs: Ensure adequate dietary intake of iron, vitamins, and other essential nutrients.

National Patient Safety - Eliminate Transfusion Error

Goal: Eliminate transfusion errors related to patient misidentification.
Two-person patient identification process: Requires two individuals, including the person administering the blood and another qualified person, to independently verify the patient's identity.
Blood and patient matching: Ensure that the blood unit matches the provider's order and the patient's identification information.

Nutritional Anemia: Iron Deficiency Anemia

Causes:
- Chronic blood loss: From gastrointestinal (GI) or genitourinary (GU) systems or hemolysis (premature RBC destruction).
- Menstruation: Iron loss through menstrual bleeding.
- Inadequate dietary intake: Insufficient intake of iron-rich foods.
- Inadequate absorption of iron: Issues with absorption in the small intestine, where iron is primarily absorbed (for example, after GI surgery).
- GI surgeries: Procedures involving bypass of the duodenum, which can impair iron absorption.
- Malabsorption syndromes: Conditions impairing nutrient absorption.
Signs and symptoms: Depend on age and severity.
- **Few symptoms until hematocrit (HCT) falls below 30%: **
- Symptoms: Pallor, glossitis (inflammation of the tongue), cheilitis (inflammation of the lips), headache, paresthesia (tingling or numbness).
History and physical assessment:
- Menstrual history: To assess iron loss through menstruation.
- Onset and duration of symptoms: To understand the progression of anemia.
- Change in stool patterns: Indicates potential GI bleeding.
- Color of stool: Abnormal stool color may suggest blood loss.
- Dietary intake: To assess iron consumption.
- Medication history: To identify potential causes of anemia or medications that may interfere with iron absorption.
Physical examination:
- Skin: Examine for pallor (paleness), jaundice (yellowing), and pruritus (itching).
- Tongue: Examine for atrophic glossitis (inflammation and thinning of the tongue) and burning sensations.
- Corners of the mouth: Check for cheilosis (cracking and soreness).
- Nails: Examine for koilonychias (spooning of the nails).
- Abdomen: Palpate for tenderness, splenomegaly (enlarged spleen), and hepatomegaly (enlarged liver).
- Stool: Obtain a stool sample for occult blood testing.
Diagnostics:
- Laboratory tests:
  - Low hemoglobin (Hgb): Indicates a decrease in RBCs.
  - Decreased serum iron: Measures circulating iron, carried by transferring. Drops after serum ferritin in iron deficiency anemia.
  - High TIBC (Total Iron Binding Capacity): Indicates the ability of transferring to bind iron.
  - Low serum ferritin: Measures iron stores in the body. The first to drop in iron deficiency anemia.
  - Low MCV (Mean Corpuscular Volume): Indicative of microcytic anemia.
  - Low MCH (Mean Corpuscular Hemoglobin): Indicates a decrease in hemoglobin content in each red blood cell.

Aplastic Anemia

Pancytopenia: A decrease in all types of blood cells (RBCs, WBCs, platelets).
Hypocellular bone marrow: Reduced production of blood cells in the bone marrow.
Severity range: Moderate to very severe, potentially fatal.
Bone marrow activity: The activity of the bone marrow is depressed or has ceased, leading to pancytopenia.
Causes: Can be congenital or acquired, idiopathic (unknown cause) or autoimmune.
- Exposure to certain drugs: Antineoplastic drugs (cancer drugs), sulfonamides (antibiotics), anticonvulsants such as Dilantin.
- Infections: Hepatitis B & C, cytomegalovirus (CMV).
- Radiation: Exposure to ionizing radiation.

Clinical Manifestations of Aplastic Anemia

Onset: Can be abrupt or insidious (gradual).
Symptoms: Caused by suppression of any or all bone marrow elements.
- General manifestations of anemia: Fatigue, dyspnea (shortness of breath), cardiovascular (CV) and cerebral (brain) responses to low oxygen.
- Neutropenia: A decrease in neutrophils, a type of WBC, leading to increased risk of infection.
- Thrombocytopenia: A decrease in platelets, leading to increased risk of bleeding.

Diagnosis of Aplastic Anemia

Laboratory studies:
- Decreased Hgb, WBC, and platelet values: Reflect pancytopenia.
- Decreased reticulocyte count: Indicating reduced bone marrow activity.
- Elevated serum iron and TIBC (Total Iron Binding Capacity): Reflecting the body's inability to utilize iron effectively.
- Hypocellular bone marrow: Shows a decrease in blood-forming cells with an increase in yellow marrow (fat content).

Management of Aplastic Anemia

Prognosis: Poor for severe untreated aplastic anemia.
Treatment options:
- Immunosuppressive therapy: Can help suppress the immune system's attack on bone marrow cells.
- HSCT (Hematopoietic Stem Cell Transplantation): Transplants healthy stem cells into the bone marrow to restore blood cell production. Can be curative.

Anemia from Blood Loss (Acute and Chronic)

Anemia from blood loss: Caused by acute or chronic bleeding.
Acute blood loss: Occurs due to rapid bleeding from trauma, surgery, or other factors that disrupt vascular integrity.
- Two primary clinical concerns:
  - Hypovolemic shock: Reduced blood volume leading to circulatory collapse.
  - Compensatory increased plasma volume: The body tries to maintain adequate blood volume by increasing plasma (fluid portion of blood) but with fewer oxygen-carrying RBCs.
Clinical manifestations of acute blood loss: Caused by the body's attempt to compensate for blood loss and maintain oxygen delivery:
- Pain: From internal bleeding, tissue distention, organ displacement, or nerve compression.
- Retroperitoneal bleeding: Bleeding behind the abdominal cavity, causing numbness and pain in the lower extremities.
- Shock: A major complication.
Interprofessional and Nursing management of acute blood loss:
- Replace blood volume: Administer fluids and possibly blood transfusions.
- Promote coagulation: Administer clotting factors or blood products as needed.
- Find and stop the source of bleeding: Identify and control the bleeding source.
- Correct RBC loss: Administer blood transfusions if necessary.
- Provide supplemental iron: To replenish iron stores lost through bleeding.
Chronic blood loss: Caused by ongoing bleeding from conditions like bleeding ulcers, hemorrhoids, or menstrual bleeding.
- Management:
  - Identify and control the source of bleeding: To stop ongoing blood loss.
  - Provide supplemental iron: As needed to replenish iron stores.

Hemolytic Anemia

Destruction of RBCs: Premature breakdown or hemolysis of RBCs at a rate exceeding their production.
Causes: Problems intrinsic (within the RBCs) or extrinsic (external factors) to the RBCs.
- Intrinsic forms: Typically hereditary, resulting from defects in the structure or function of the RBCs.
- Acquired forms: RBCs are initially normal, but damage is caused by external factors.
General manifestations of anemia:
Specific manifestations:
- Jaundice: Yellowing of the skin and whites of the eyes, due to the buildup of bilirubin, a breakdown product of hemoglobin.
- Enlargement of the spleen and liver: The spleen and liver work harder to filter and remove damaged RBCs.
Focus of treatment: Maintaining kidney function.
Signs and symptoms:
- Cold-reacting symptoms:
  - Raynaud's disease: Reduced blood flow to the extremities in response to cold temperatures, causing numbness, tingling, and color changes.
  - Cyanosis: Bluish discoloration of the skin due to reduced oxygen.
  - Pain: Pain in the extremities.
  - Paresthesia: Tingling or numbness.
- Warm-reacting symptoms:
  - Severe hemolysis: Leads to jaundice, splenomegaly (enlarged spleen), and heart failure (HF).
  - CHF (Congestive Heart Failure): Reduced heart function due to increased workload.
  - Palpitations: Awareness of a rapid heartbeat.
Diagnosis:
- Coombs test: Detects antibodies or complement bound to the surface of RBCs, suggesting an autoimmune reaction.
Treatment:
- Corticosteroids: To suppress the immune system and reduce RBC destruction.
- Transfusions: To replenish RBCs.
- Splenectomy: Removal of the spleen, where damaged RBCs are filtered and destroyed, to reduce hemolysis.

Sickle Cell Disease (SCD)

Inherited, autosomal recessive disorders: A group of genetic disorders affecting hemoglobin structure and function.
- Abnormal form of hemoglobin: Hemoglobin S (HbS), which replaces normal hemoglobin A (HbA).
- Genetic disorder: Usually detected through routine neonatal screening.
- Incurable: No cure, significantly impacting quality of life.
Inheritance pattern: Passed on to offspring from both parents carrying the sickle cell trait.
Hemoglobin S: Less efficient at carrying oxygen and more prone to clumping, particularly during periods of low oxygen levels.
Sickle cell crisis: Occurs when RBCs under low oxygen conditions transition into a sickle shape, blocking blood flow and causing tissue ischemia (lack of oxygen supply).
Shortened RBC lifespan: Sickle cells have a lifespan of 7 to 20 days, compared to 120 days for normal RBCs.
Predominant population: African-American population.
Symptoms: Result from the blockage of blood vessels by sickled RBCs.
- Acute:
  - Pain: In the back, chest, and extremities.
  - Low-grade fever: 1-2 days after onset of pain.
  - Stroke: Obstruction of blood vessels in the brain.
  - Jaundice: Yellowing of the skin and whites of the eyes due to increased bilirubin levels.
- Chronic:
  - Kidney: Damage to the kidneys.
  - Vision: Visual impairments.
  - Musculoskeletal: Bone and joint pain and damage.
  - Spleen: Enlargement of the spleen due to increased filtering of sickled RBCs.

Complications of Sickle Cell Disease

Infection: The most common cause of mortality in SCD patients.
- Spleen dysfunction: The spleen becomes compromised due to the presence of sickled cells, increasing susceptibility to infections.
- Pneumococcal pneumonia: The most common type of infection.
- Severe infections: Can lead to gallstones and organ failure.
Acute chest syndrome: A serious complication characterized by pneumonia, tissue infarction (tissue death), and fat embolism (fat globules blocking blood vessels).
- Symptoms: Fever, chest pain, cough, lung infiltrates (areas of fluid in the lungs), and dyspnea (shortness of breath).
- Complications: Pulmonary hypertension (high blood pressure in the lungs), myocardial infarction (heart attack), cor pulmonale (right heart failure due to high blood pressure in the lungs), HF (heart failure), retinal detachment and blindness, renal failure (kidney failure), and stroke.

Management of Sickle Cell Disease

Maintaining adequate fluids: To prevent dehydration and improve blood flow.
Pain management: To alleviate pain and discomfort associated with sickle cell crisis.
Oxygen therapy: To increase blood oxygen levels and reduce sickling of RBCs.
Avoid high altitudes: Low oxygen levels at high altitudes can trigger sickle cell crises.
Treat infections promptly: To prevent complications.
Screening for retinopathy: To detect and manage eye damage.
Immunizations: To prevent infectious diseases, including pneumococcal, Haemophilus influenzae, and hepatitis B.
Urgent hospital visits during crises: To manage severe symptoms.
Patient and caregiver support: To provide education, resources, and emotional support.

Polycythemia

Increased RBC production: Characterized by an excess of red blood cells in the blood.
Primary polycythemia (Polycythemia vera): A bone marrow disorder leading to an abnormal increase in all blood cells, primarily red blood cells.
- Cause: Genetic defect (primary) or oxygen deficit (secondary).
- Result: Hemoglobin (Hgb) and hematocrit (Hct) levels rise significantly (above 48% in women and 52% in men).
- Blood viscosity: The blood becomes thicker, increasing the risk of blood clots.
- Increased blood viscosity and volume: Increases the risk of thrombosis (blood clots) and embolism (blood clot traveling to another location).
- Splenomegaly and hepatomegaly: Enlargement of the spleen and liver due to increased filtering of blood cells.
Secondary polycythemia: Due to factors other than a bone marrow disorder.
- Hypoxia-driven: Low oxygen levels stimulate kidney production of EPO (erythropoietin), a hormone that increases RBC production.
- Hypoxia-independent: Certain cancers or benign tumors produce EPO, leading to increased RBC production.

Clinical Manifestations of Polycythemia

Headache, dizziness, blurred vision, tinnitus (ringing in the ears), plethora (ruddy complexion), and erythromelalgia (painful redness and burning of hands and feet).
Thrombo-embolic events: Blood clots, including stroke, deep vein thrombosis (DVT), pulmonary embolism (blood clot in the lungs).
Hemorrhagic events: Bruising, gastrointestinal bleeding, due to increased blood viscosity and impaired platelet function.

Treatment of Polycythemia

Monitoring: Regular blood tests to follow Hgb and Hct levels.
Periodic phlebotomy: Removing blood periodically to reduce excess RBC levels.
Hydration: Increasing fluid intake to reduce blood viscosity.
Chemotherapy: To reduce the number of RBCs.
Interferon: To reduce blood counts.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on key concepts of nursing management for patients with anemia. This quiz covers laboratory measures, interventions, and the purpose of diagnostic tests like the Schilling Test. Enhance your understanding of anemia and its implications in healthcare.