ANEMIA Flashcards
What are the 3 main ways anemia develops?
Blood loss
Impaired erythrocyte production
Increased erythrocyte destruction
What is anemia?
A condition marked by deficiency in:
RBC count
Hemoglobin concentration
Hematocrit volume
It is a manifestation of a disease, not a disease itself.
What are the Hgb values for mild, moderate, and severe anemia?
Mild: 10–12 g/dL
Moderate: 6–10 g/dL
Severe: <6 g/dL
Clinical signs of severe anemia (Hgb <6)?
Pallor, fatigue, tachypnea, tachycardia
Dyspnea at rest
Sensitivity to cold
Potential cardiac complications
Common integumentary signs of anemia?
Pallor
Jaundice (↑ bilirubin from hemolysis)
Pruritus (bile salts on skin)
What are priority nursing interventions for fatigue in anemic patients?
Alternate activity and rest
Prioritize essential tasks
Maximize oxygen delivery
Prevent falls/injury
Common causes of iron-deficiency anemia?
Inadequate intake
Malabsorption (duodenum diseases)
Blood loss (GI, GU)
Pregnancy
Clinical signs specific to iron-deficiency anemia?
Pallor
Glossitis (inflamed tongue)
Cheilitis (cracked lips)
Headache, paresthesias, burning tongue
Iron-rich foods to teach patients?
Red meat, liver, eggs, green leafy vegetables, fortified cereals, legumes
How should oral iron be administered for best absorption?
On an empty stomach with vitamin C
Use a straw for liquid form (prevent teeth staining)
May cause constipation or GI upset
What causes pernicious anemia?
Lack of intrinsic factor (IF), needed to absorb B12
Often due to autoimmune destruction of gastric parietal cells
Key neurologic symptoms of B12 deficiency?
Paresthesias, muscle weakness
Ataxia, confusion
↓ balance & position sense
Treatment for pernicious anemia?
IM cobalamin injections: daily x2 weeks, weekly, then monthly for life
Oral B12 is not effective in these patients
What causes folic acid deficiency?
Poor nutrition, malabsorption, alcohol abuse
Certain medications
Hemodialysis
How to distinguish folic acid deficiency from B12 deficiency?
No neurologic symptoms in folate deficiency
Otherwise, symptoms are similar
Foods high in folic acid?
Leafy greens, liver, citrus fruits, beans, whole grains
What are causes of acute blood loss anemia?
Trauma, surgery, GI bleeding
Can lead to hypovolemic shock
What are signs of acute blood loss?
Rapid HR, hypotension
Dizziness, cool/clammy skin
Decreased urine output
Pain if internal bleeding
What are interventions for acute blood loss anemia?
Stop the source of bleeding
Fluid resuscitation (LR, blood transfusion)
Monitor hemodynamic status
Causes of chronic blood loss anemia?
GI ulcers, hemorrhoids
Menorrhagia
Slow GI bleeds (cancer, polyps)
What happens in hemolytic anemia?
RBCs are destroyed faster than produced
Causes: autoimmune, genetic, toxins, infections
Key signs of hemolytic anemia?
Anemia symptoms + jaundice
Hepatosplenomegaly
Increased bilirubin levels
What is a nursing priority in hemolytic anemia?
Monitor kidney function
Prevent complications from free hemoglobin and bilirubin overload
What does epoetin alfa do?
Stimulates bone marrow to increase RBC production
Used for anemia related to CKD, chemotherapy, or chronic disease
What are side effects of epoetin alfa?
Hypertension
Fever
Headache
Risk of thrombosis
What are nursing considerations for epoetin alfa?
Monitor Hgb (stop if >10–11)
Check BP
Assess iron stores and bone marrow function
May need supplemental iron
What is the normal range of Hemoglobin (Hgb) for males?
13.5–17.5 g/dL
What is the normal range of Hemoglobin (Hgb) for females?
12.0–15.5 g/dL
What does a low Hgb indicate?
Decreased oxygen-carrying capacity of blood → leads to tissue hypoxia
What is hematocrit (Hct)?
The percentage of RBCs in total blood volume. Normal: ~38–50% (varies by sex)
What lab values are reviewed in anemia diagnosis?
- Hgb
- Hct
- RBC count
- MCV
- MCH
- MCHC
- Reticulocyte count
- Iron studies
- Vitamin B12
- Folate
- TIBC
- Bilirubin
What is MCV and how is it used in anemia?
Mean Corpuscular Volume = average size of RBCs. Low MCV = microcytic anemia (e.g., iron deficiency). High MCV = macrocytic anemia (e.g., B12 or folate deficiency)
What is TIBC and what does it tell us in anemia?
Total Iron Binding Capacity. ↑ in iron deficiency anemia. Reflects the blood’s ability to transport iron
What are reticulocytes, and why are they important in anemia?
Immature RBCs. Elevated: body is compensating for anemia (e.g., blood loss). Low: inadequate production (e.g., marrow suppression)
What is the connection between anemia and the concept of Gas Exchange?
Anemia reduces the oxygen-carrying capacity of the blood, impairing tissue oxygenation even if ventilation is normal
What compensatory mechanisms occur in response to anemia-related hypoxia?
- Increased heart rate and stroke volume
- Increased respiratory rate
- Redistribution of blood to vital organs
Why might a patient with severe anemia experience angina or heart failure?
The heart must work harder to compensate for decreased oxygen delivery, increasing cardiac workload
What is glossitis and in which anemias is it common?
Inflammation of the tongue. Seen in iron-deficiency, B12 deficiency, and folic acid deficiency
What is cheilitis?
Inflammation and cracking of the lips. Common in iron-deficiency anemia
What is the priority nursing intervention for a patient with symptomatic anemia and Hgb <7 g/dL?
Prepare for blood transfusion and monitor for signs of tissue hypoxia and cardiac compromise
Why should iron therapy continue for 2–3 months after anemia resolves?
To replenish iron stores in bone marrow and tissues
What diagnostic test is used to confirm internal bleeding as a cause of anemia?
Stool guaiac test (occult blood), endoscopy, or colonoscopy
What are early signs of anemia in older adults that may be misinterpreted?
- Fatigue
- Confusion
- Dyspnea
- Dizziness may be misattributed to aging
Why is it important to assess for falls in elderly patients with anemia?
Fatigue, weakness, and orthostatic hypotension increase fall risk
Which anemias require lifelong treatment?
- Pernicious anemia (B12 deficiency due to IF loss)
- Genetic hemolytic anemias (e.g., sickle cell disease)
How is parenteral iron administered IM?
Z-track method. Avoid massaging the site. Rotate sites to prevent irritation and staining
What nursing teaching is important for liquid iron supplementation?
- Dilute with juice or water
- Drink through a straw
- Rinse mouth afterward to prevent staining teeth
What GI side effects can iron supplements cause?
- Constipation
- Black stools
- Nausea
- Heartburn
Why is Epoetin alfa not effective if iron stores are low?
Erythropoiesis requires iron; without it, Epoetin cannot stimulate adequate RBC production
What are common nursing diagnoses related to anemia?
- Fatigue
- Activity intolerance
- Risk for injury
- Imbalanced nutrition
- Ineffective tissue perfusion
What’s a major safety teaching point for patients with neurologic symptoms from B12 deficiency?
Encourage fall precautions, use assistive devices, and avoid activities that require balance until improved
