Anemia: Class 2 Flashcards
Normal Hemoglobin levels for male and female
- 14-18 g/dl for Male
2. 12-16 g/dl for Female
Clinical Manifestations of Anemia R/T??
Tissue hypoxia
Normal Hematocrit Level for male and female
- 40-54% for male
2. 38-47% for female
Mild Hemoglobin levels
-Symptoms
10-14 g/dl
- May exist w/out symptoms
- Symptoms may include:
- Fatigue / diaphoresis / palpitations / dyspnea
Moderate Hemoglobin levels
-Symptoms
6-10 g/dl
- Increased cardiopulmonary symptoms
- Experienced at rest or during activity
Severe Hemoglobin levels
<6 g/dl
Integumentary manifestations of Anemia
-All 3
- Pallor
- Jaundice
- Pruritus
Integumentary manifestations of Anemia
-Pallor
- Caused by decreased Hgb and decreased blood flow to skin
- Look for pallor in Pt’s
- Oral mucosa, hands, nail beds, conjunctiva
Integumentary manifestations of Anemia
-Jaundice
- Increase concentration of serum bilirubin
2. Caused by hemolytic anemias (RBC’s lysed releases bilirubin)
Cardiopulmonary manifestations of Anemia
- Increased pulse pressure
- Systolic murmur due to lowered viscosity of the blood
- Angina/MI from Tissue Hypoxia (Ischemia)
Hemolytic Anemias
-Symptoms (severe anemia)
- Splenomegaly
- Bone deformities and fractures
- Jaundice
Aplastic Anemia
-Symptoms (severe anemia)
- Petechiae
2. Purpura
Iron Deficiency Anemia
-Symptoms (severe anemia)
- Behavior disturbances (PICA)
- Spoon shaped nails
- Cheilosis
Pernicious Anemia
-Symptoms (severe anemia)
- Paresthesia
- Proprioception deficits
- Diarrhea
- Sore beefy red tongue
Vitamin B12 Anemia
-Symptoms (severe anemia)
- Headache
- Fainting
- Forgetfulness
- Anorexia
- Nausea
- Night Cramps
Sickle Cell Anemia
-Symptoms (severe anemia)
- Pain
- Gallstones
- Abdominal Pain
- Joint Pain
- Heart Failure
- Chronic leg ulcers
Acute Blood loss
-What to assess?
- Hypovolemic Shock
- hypotension w/ tachycardia
- Changes in level of consciousness - Reduced Plasma Volume
- Decrease amount of RBC causes decreased 02
Acute Blood Loss and Anemia
- Secondary iron deficiency anemia related to blood loss.
- The body might try to refill sources and use up iron stores
- Reticulocyte count will show if a pt is bleeding
Clinical Manifestation of Anemia
-Pain
- Ischemia
2. tissue distention (compression of nerves)
Retroperitoneal bleeding
- Punctured Femoral artery
- change in vascular integrity causes bleeding - Can cause Numbness
- Pain in extremities or back
- bruising
- Listen for bruis over affected area
Pt comes into ER with Blood loss. What do you do?
- Assess for signs of bleeding
- Start two IV’s in both arms
- Give the Pt fluids
Assessment of Stool
- Hemroids are bright red stool
2. Ulcers would be black tarry stools
Nutritional anemias
- Microcytic (small cells) Hypochromic (pale) cells
2. Assess people in low socioeconomic class due to inability to get good nutrition
Iron Deficient Anemia
-Diagnostics
- Lab tests
- Bilirubin - check for hemolytic anemias
- Platelets - check for aplastic anemia (Affects all CBC) - Stool guaiac test
- Endoscopy & Colonoscopy
Oral and Parenteral Iron supplements
- Ferrous sulfate or Ferrous gluconate
2. Iron Dextran IM or IV
Foods High in Iron
- Firm Tofu
- Spinach
- Broccoli
How to take Iron supplements
- Take with acidic product like orange juice
2. Take liquid Iron through Straw because it stains the teeth
Iron IM administration
Use the Z-track method because it can stain the skin
Change in Stools while on Iron therapy
- Black, Dark / tarry stools
Megaloplastic Anemias
-Classifications
- Vitamin B12 (Cobalamin) and folic acid deficiency
Erythroleukemia
- Malignant disorder characterized by Erythropoeitic cells in the bone marrow
Intrinsic Factor
- Protein secreted by the parietal cells of the gastric mucosa
- Required for B12 absorption in the small intestine (ilium)
Vitamin B12 Deficiency
Causes what?
- Pernicious anemia
2. Nutritional deficiencies
Schilling test
-Stage 1
- Give pt 2 doses of Oral and IV B12
- Check urine in 24 hrs to see how much B12 was excreted - 5% or more B12 is excreted is normal (It is a nutrition problem)
- Less than 5% excreted Go to stage 2
Schilling test
-Stage 2
- Administer B12 with IF
- If normal, it is an IF problem
- If abnormal, it is a malabsorption problem
Schilling test
-Stage 3
- Done after 2 weeks of antibiotic therapy
- Could be H. Pylori
- If it helps it is a bacterial problem
Schilling test
-Stage 4
- Pancreatic enzymes for 3 days followed by IV B12
Oral B12 and Intrinsic Factor
- Pt cannot have oral Vitamin B12 if they do not have intrinsic factor
Folic Acid Deficiency
-Common Causes
- Alcohol abuse and anorexia **
- Drugs
- Hemodialysis
Folic Acid Deficiency
-Manifestations
- Absence of neurological complications
2. Similar to B12 deficiency
Folic Acid Deficiency
-Pregnancy
- Can cause neural tube defects in children
Folic Acids
-Foods
- Fruits and green leafy veggies
Hemolytic Anemia
-Manifestations
- Jaundice
- breakdown of RBC’s releases bilirubin - General symptoms of anemia
- Enlarged Spleen or liver
- Hyperactive with macrophage phagocytosis of defective RBC’s - TUBULAR NECROSIS (monitor urine output as nurse)**TEST
- Accumulation of Hgb molecules can obstruct tubules
Thalassemia
- Genetic disorder that causes inadequate production of normal Hgb
- Common in Mediterranean people and people near the equator in Asia and Africa
- Hemolysis occurs
- Problem with globulin protein
Thalassemia Minor
- One defective Gene
- Usually asymptomatic
- May have moderate anemia- Splenomegaly
- Microcytic and hypochromic
Major Thalassemia
- 2 thalassemic genes
Thalassemia major
-Clinical Manifestations
- Life-Threatening
- Pale
- Mental and physical growth retardation
- Splenomegaly, hepatomegaly, Jaundice
- Chronic Bone marrow hyperplasia
- Expansion of bone marrow space
Thalassemia
-Collaborative Care
- Body adapts to decreased Hb in thalassemia minor
- Pt rarely reaches adulthood in thalassemia major and pt is given blood transfusions to increase life
- No specific Drug or Diet is available for treatment of thalassemia
Hemosiderosis
- Associated w/ excess iron accumulation in the body
Glucose 6 phosphate dehydrogenase Anemia (G6PD)
- Hereditary
- Occurs more in mediterranean and African decent - Hemolysis occurs when person is exposed to stressors
- Aspirin and Sulfonamides can be stressors - Defective Gene is on X chromosome–affects more Males
- Develop Jaundice, Pallor, elevated Reticulocyte count,
G6PD
-Pt Education
- Avoid Aspirin and Sulfonamides
- These can be stressors that cause hemolysis to occur
Aplastic Anemia
- Decrease in all blood cell types: WBC’s RBC’s and Platelents
- Can be congenital or acquired
- It is acquired in cancer due to treatment
Aplastic Anemia
-Management
- Erythropoietin
2. Blood transfusions
Aplastic Anemia
-Manifestations
- Symptoms caused by suppression of any or all bone marrow elements
- Infection - General manifestations of anemia
- Fatigue, pallor
Aplastic Anemia
-Diagnostics
- Decreased Hb, WBC, and platelets
- Reticulocyte count is low
- decreased production of RBC’s in bone marrow - Bleeding time prolonged -
Aplastic Anemia
-Nursing Mgmt (Treatment Options
- Bone marrow transplant
- Immunosuppressive therapy
- Erythropoietin therapy
- Blood transfusions if necessary
Untreated prognosis is poor
Iron-deficiency Anemia
-Diagnostics
- Low serum Iron
- Elevated Total Iron Binding Capacity (TIBC)
-Indicate Iron-deficiency anemia
Vitamin C and Iron
- Vitamin C may increase oral iron absorption
