Anemia

Question 1

Anemia - Etiology

Answer 1

• Reduction of RBC, Hgb, and/or Hct
• A clinical sign; not a specific disease
• Classifications:
  > blood loss
  > hemolytic: lysis of blood cells
  > impaired RBC production

Question 2

Iron-Deficiency Anemia (microcytic) - Causes

Answer 2

• Small blood cell anemia
• Blood loss
  > GI bleeds, heavy periods, child birth, chronic nosebleeds, from kidneys or bladder
• Poor nutrition
  > rich in iron: meat, poultry, seafood, beans, legumes, dark leafy greens, dried fruit, seeds, nuts, eggs, whole grains

Question 3

Hemolytic Anemia - Causes

Answer 3

• The breakdown of RBCs
• Immune response
  > body destroys own RBCs
• Mechanical Trauma
  > something that is broken/open the blood cells
• Sickle Cell
  > affects the carring capacity of oxygen in RBCs

Question 4

Immune Mechanism Hemolytic Anemia Triggers

Answer 4

• Infections
  > Epstein-Barr virus, cytomegalovirus, HIV, hepatitis, bacterial infections
• Medications
  > penicillin, methyldopa (Aldomet), quinine (Qualaqin), sulfonamides
• Blood transfusions
  > due to differing blood types
• Cancers
  > chronic lymphocytic leukemia, non-Hogdkin’s
• Autoimmune Disorders
  > lupus, rheumatoid arthritis, ulcerative colitis
• Pregnancy

Question 5

Megaloblastic (macrocytic) - Causes

Answer 5

• Vitamin B12 (Cobalamin) deficiency
  > lacking in diet
• Pernicious anemia
  > lack of intrinsic factor for absorbing B12
• Folic Acid deficiency
  > folate is B vit tht helps produce RBCs, a lack of folate = lack of oxygen

Question 6

Aplastic Anemia - Causes

Answer 6

• Bone marrow depression:
• Autoimmune disorders
• Genetics
• Toxic substances
• Chemo/radiation
• Viral infections
• Pregnancy

Question 7

Chronic Disease Anemias

Answer 7

• Chronic Renal Failure
  > kidneys can no longer produce RBC; Erythropoietin
  > stops production of RBCs leading to anemia

Question 8

Symptoms of Anemia

cns, bld vessels, heart
severe anemia

Answer 8

• Central
  > fatigue, dizziness, fainting
  > due to lack of oxygen carrying capacity
• Blood Vessels
  > low BP
  > hypotension, hypovolemia
• Heart
  > palpatations
  > rapid HR
  > chest pain, angina, heart attack ; low O2 carrying capacity

Question 9

Symptoms of Anemia

eyes, skin, resp

Answer 9

• Eyes
  > yellowing; best sign of anemia in POC
• Skin
  > paleness
  > coldness
  > yellowing
• Respiratory
  > SOB

Question 10

Symptoms of Anemia

muscular, intestinal

Answer 10

• Muscular
  > weakness
• Intestinal
  > changed stool color

Question 11

Anemia - Diagnostics Review

Answer 11

• Complete blood count w/ differential & RBC indices
  > tells if large or small blood cells
• Reticulocyte Count
  > how fast RBCs are made by bone marrow
• Iron Studies
  > Ferritin & total iron binding capacity
• Coomb’s Test
  > test for hemolytic anemia; antibodies on the surface of RBC
• Bone Marrow Aspiration
  > anything w/in or stimulation of bone marrow tht could be preventing RBC production

Question 12

Anemia - Labs: Red Blood Cells (RBC)

Answer 12

• F: 4.2-5.4
• M: 4.7-6.1
• Significance
  > Dcrd: anemia or bleeding
  > Incrd: severely dehydrated or PV

Question 13

Anemia - Labs: Hemoglobin (Hgb)

Answer 13

• F: 12-16 g/dL
• M: 14-18 g/dL
• Significance
  > Dcrd: anemia, bleeding, or fluid overload
  > Incrd: severely dehydrated; PV

Question 14

Anemia - Labs: Hematocrit (Hct)

Answer 14

• % of packed RBCs in total blood vol, use to determine ig Hgb is high or low due to hydration status
• F: 37-47%
• M: 42-52%
• Significance
  > Dcrd: anemia, bleeding, or fluid overload
  > Incrd: severely dehydrated; PV

Question 15

RBC Indices

Answer 15

Relate measurements of RBC, Hct & Hgb; provides info on types of anemia

Question 16

Anemia - Medical Surgical Management

Answer 16

• Determine underlying cause

Question 17

Anemia - Medical Surgical Management: Iron Deficiency

Answer 17

• Mild: oral ferrous sulfate (iron)
  > vitamin C enhances absorption; take btwn meals
  > Hgb should rise 2g in 4 weeks

Question 18

Anemia - Medical Surgical Management: Vitamin B Deficiency

Answer 18

• Diet
  > incr intake of liver, chicken, beef, tuna, egg, milk, yogurt, cheese
• Oral supplements
• Injections

Question 19

Anemia - Medical Surgical Management: Blood Loss

Answer 19

• Stop bleeding
• Transfusions

Question 20

Anemia - Medical Surgical Management: Immune

Answer 20

• Immunosuppressive therapies
  > extreme high risk for infection
• Transfusions
• Bone marrow transplant

Question 21

Anemia - Assessment

Answer 21

• Gather hx, diet, meds, menstrual flow, symptoms
  > meds like chemo will dcr RBC production
• Assess for:
  > fatigue, pallor, cyanosis, jaundice (sign of hemolytic anemia), bleeding, dry skin
  > mouth ulcers or fissures, smooth tongue (glossitis)
  > lymph nodes, resp rate & rhythm, tachycardia
  > VS, O2 sat, review labs

Question 22

Anemia - Nursing Diagnosis

Answer 22

• Activity intolerance
• Fatigue
• Alt tissue perfusion
• Impaired gas exchange
  > low Hgb
• Anxiety
• Impaired comfort
• Risk for bleeding
• Risk for injury
• Impaired memory

Question 23

Anemia - Interdisciplinary Interventions

Answer 23

• Oxygen
• Oral or IM iron
• Supplements
  > vit B, folic acid
• Epoetin (Procrit) SQ weekly
  > after dialysis
• RBC transfusion
  > Hgb < 7.5
  > transfusion can occur if Hgb > 7.5 if pt is extremely symptomatic

Question 24

Anemia - Nursing Interventions

Answer 24

• Energy conservation
• Supportive care
• Correction of anemia
  > diet changes
• Teaching self-care