Module 1 - Anemia PDF

**Module 1: Anemia** Objectives: - Factors essential to successful ventilation, perfusion, and diffusion - How are ventilation and perfusion interrelated - Patho of COPD, asthma, and anemia - Roles of drug therapy in managing COPD, asthma, and anemia Anemia Video Overview: Anemia:...

**Module 1: Anemia** Objectives: - Factors essential to successful ventilation, perfusion, and diffusion - How are ventilation and perfusion interrelated - Patho of COPD, asthma, and anemia - Roles of drug therapy in managing COPD, asthma, and anemia Anemia Video Overview: Anemia: terms to know -- - **RBCs (erythrocytes)**: primary function to transport oxygen - **Anemia**: reduction in the total number of erythrocytes - **Hematocrit**: percentage of RBCs in the total blood volume - **Hemoglobin**: the protein in RBCs that carry oxygen - **Hematopoiesis**: the production of RBCs - **Erythropoiesis**: the development of RBCs - **Reticulocyte**: immature RBCs made in the bone marrow - **Leukocyte**: WBCs - **Leukopenia**: low WBC in the blood - **Thrombocyte**: platelets, essential for blood coagulation/clotting - **Thrombocytopenia**: low platelets in the blood Common [causes of anemia] -- - Impaired erythrocyte production - Blood loss due to acute or chronic conditions - Increased erythrocyte destruction - Or a combo of the 3 above Anemia is [classified by] -- - Their cause - Changes that affect erythrocyte size, shape, or substance **Cytic** -- refers to cell size **Chromic** -- refers to hemoglobin content Clinical manifestations of anemia: - **Hypoxia** -- Due to reduce oxygen caring capacity of the blood - **Hypoxemia** -- reduced oxygen level in the blood, contributes to cardiovascular dysfunction by causing dilation of arterials, capillaries and venous. - Lead to increase heart rate and stroke volume - **Tissue hypoxia** -- affects the pulmonary and hematologic systems - Increase respiratory rate, dyspnea, rapid pounding heartbeat, dizziness, and fatigue - Skin changes can occur, skin, mucus membrane, lips, nailbeds, and conjunctivae become pale **MUDDY POINTS** Anemia is a condition characterized by a reduction in the number of red blood cells, the amount of hemoglobin (Hgb), or the hematocrit (Hct). It is important to note that anemia is a **clinical indicator** rather than a specific disease. Anemia can be categorized based on its causes or the changes that occur within the erythrocytes, such as alterations in size, shape, or substance. The total number of circulating RBCs may be influenced by changes in plasma volume, which can occur due to dehydration or fluid retention. **Cues for Identifying Anemia** - **Age:** Certain age groups, especially the elderly, are more susceptible. - **Dietary Intake:** A poor diet lacking in essential nutrients. - **Intestinal Disorders:** Conditions affecting nutrient absorption. - **Blood Loss:** Can be acute (from injuries) or chronic (gastrointestinal bleeding, menstruation). - **Bone Marrow Suppression:** Factors affecting the body\'s ability to produce RBCs. - **Chronic Diseases:** Conditions such as: - Rheumatoid arthritis or other autoimmune diseases - Kidney disease - Cancer - Liver disease - Thyroid disease - Inflammatory bowel disease (Crohn\'s disease or ulcerative colitis) **Signs and Symptoms of Anemia** The manifestations of anemia can vary based on severity and underlying causes, but the common signs include: - **Skin:** General pallor, particularly visible in areas like the ears, nail beds, palm creases, and around the mouth; skin may feel cool to the touch, and patients often have a lower tolerance for cool temperatures; chronic anemia may lead to brittle, concave nails. - **Cardiovascular:** Symptoms such as rapid heartbeat that can increase after meals or with physical activity. Severe anemia may produce abnormal heart sounds, such as murmurs or gallops, and lead to orthostatic hypotension. - **Respiratory:** Shortness of breath and decreased oxygen saturation levels can be observed as anemia worsens. - **Neurologic:** Patients may experience fatigue or, in severe cases, delirium. **Types of Anemia** Anemia can be classified into several types, including: - **Iron Deficiency Anemia:** The most common form. - **Sickle Cell Disease:** A genetic disorder that leads to abnormal hemoglobin. - **Hemolytic Anemia:** Characterized by the premature breakdown of RBCs. - **Vitamin B12 Deficiency Anemia:** Often related to inadequate dietary intake or absorption issues. - **Folic Acid Deficiency Anemia:** Similar symptoms to vitamin B12 deficiency but without neurological symptoms. - **Aplastic Anemia:** A rare form caused by the failure of the bone marrow to produce enough blood cells. **Iron Deficiency Anemia** This is the most common type of anemia, frequently seen in women, older adults, and individuals with inadequate dietary intake. The causes of iron deficiency include blood loss (which may be acute or chronic), gastrointestinal issues, and a poor diet. Chronic iron deficiency leads to microcytic (small) and hypochromic (pale) cells, presenting with signs and symptoms like fatigue and pallor. If oxygen delivery is severely compromised, symptoms can escalate to tachycardia, dyspnea, angina, and reduced exercise tolerance. In children, iron deficiency anemia can lead to developmental issues and cognitive impairments. Medication used to treat: Ferrous sulfate, Ferrous gluconate, Ferrous fumarate, Ferrous aspartate, Iron Dextran **Iron Preparations** Iron supplements are available in two main forms: ferrous salts and ferric salts. Ferrous salts are absorbed up to three times more effectively than ferric salts. While all preparations are effective, they can cause gastrointestinal disturbances, especially during initial therapy. **Adverse effects** may include: nausea, heartburn, bloating, constipation, diarrhea, and even teeth staining when taken in liquid form. Additionally, parenteral iron dextran can cause serious side effects, including potentially fatal anaphylaxis. Iron poisoning is particularly hazardous for young children. **Nursing considerations** involve administering intramuscular injections (Iron Dextran) using the Z-track technique and advising patients to take liquid iron through a straw and rinse mouth to prevent dental staining. To mitigate gastrointestinal side effects, it\'s recommended to take the medication 1-2 hours before meals and avoid crushing or chewing sustained-release formulations. Patients with a history of peptic ulcers, regional enteritis, or ulcerative colitis should use caution. **Drug interactions** to be aware of include antacids/dairy and tetracycline. **Vitamin B12 Deficiency Anemia** Medication used to treat: **Cyanocobalamin (Vitamin B12)** Vitamin B12 deficiency arises from conditions that impair the activation of enzymes necessary for absorption, including the intrinsic factor. This deficiency leads to the production of **enlarged RBCs**, described as **megaloblastic** or macrocytic anemia. **Causes** can include vegan diets, gastrointestinal conditions, and bacterial overgrowth in the intestine. Cyanocobalamin is administered via various routes: intramuscular, subcutaneous, oral, or intranasal. As an antianemia drug, it is essential for correcting **megaloblastic** anemia and supporting cell reproduction and hematopoiesis. **Nursing considerations** include monitoring potassium levels due to the potential for **hypokalemia** and educating patients on the importance of identifying signs of low potassium. It is also crucial to inform patients that intranasal doses should not be taken within one hour of consuming hot foods or beverages. **Drug interactions** include the caution that while folic acid can mitigate hematologic effects of B12 deficiency, it does not address neurological symptoms and may mask the deficiency, leading to further complications. **Folic Acid Deficiency Anemia** Similar in presentation to vitamin B12 deficiency, folic acid deficiency anemia is caused by inadequate dietary folate intake, often due to poor nutrition, malabsorption, and alcohol consumption. Symptoms mirror those of B12 deficiency but typically exclude neurological manifestations. Medication used to treat: **Folic Acid (Folate)** As an antianemia medication, folic acid is vital for treating **megaloblastic** anemia and preventing folate deficiencies, particularly in women who are pregnant or may become pregnant. It stimulates production of RBCs, WBCs, and platelets, and is crucial for normal fetal development. **Adverse reactions** may include **rash**, sleep disturbances, and fever. Patients should be advised to increase their intake of folate-rich foods (e.g., green vegetables, liver) if dietary deficiency is suspected, and to consider counseling for alcoholism if applicable. **Drug interactions** can include **methotrexate and triamterene**, which inhibit folic acid\'s activation, while certain medications can affect folic acid absorption. Expected evaluation indicators involve resolving megaloblastic anemia and preventing neural tube defects in pregnancies. **Aplastic Anemia** Aplastic anemia is characterized by a deficiency of circulating RBCs due to **impaired bone marrow function**, often resulting from long-term exposure to toxic agents, certain medications, ionizing radiation, or infections. The signs and symptoms include profound fatigue and severe anemia. **Sickle Cell Anemia and Hemolytic Anemia** Sickle cell anemia is a **genetic disorder** caused by **abnormal hemoglobin chains** (HbS) that become distorted under low oxygen conditions, leading to the characteristic sickle shape of RBCs. The **sickle-shaped cells** are sticky and fragile, obstructing normal blood flow, which can lead to pain, shortness of breath, fatigue, heart murmurs, pallor, and jaundice.