anemias Flashcards
anemia
a reduction in the number of RBCs, the quantity of hemoglobin, or the volume of RBCs.
anemia caused by
- Blood loss
- Inadequate RBC production (hypoproliferative)
- Increased RBC destruction (hemolytic)
- Deficiency of necessary components such as folic acid, iron, erythropoietin, and/or vitamin B12
contributing factors
Acute/chronic blood loss (GI bleed)
Abnormal bone marrow (chemotherapy)
Decreased erythropoietin (renal failure)
Inadequate maturation of RBCs (cancer)
Nutritional deficiencies
Diagnostic Tests
CBC Count
Iron Studies
Sickle-cell test
Schilling Test
Sickle-cell test
Evaluates the sickling of RBCs in the presence of decreased oxygen tension.
Schilling Test
- Measures vitamin B12 absorption
- Used to differentiate between malabsorption and pernicious anemia.
causes of acute or chronic blood loss
- Trauma
- Menorrhagia
- Gastrointestinal bleed (ulcers, tumor)
- Intra or postsurgical blood loss or hemorrhage
- Chemical or radiation exposure
Increased Hemolysis cause
- Defective Hgb (sickle-cell disease): RBCs become malformed during periods of hypoxia and obstruct capillaries in joints and organs
- Immune disorder or destruction (transfusion reactions, autoimmune diseases)
- Mechanical trauma to RBCs (mechanical heart valve, cardiopulmonary bypass)
- acute chest: deprived of 02
Inadequate dietary intake or malabsorption cause
- Iron deficiency
- Vitamin B12 deficiency
- Folic acid deficiency: complex grains (wheat), prenatal vitamins have it
- Pica, or a persistent eating of substances not normally considered food ( clay, dirit, chewing ice)
clinical manifestations anemia
- Possibly asymptomatic in mild cases
- Pallor
- Fatigue
- Irritability
- Numbness and tingling of extremities
- Dyspnea on exertion
- Sensitivity to cold
- Pain and hypoxia with sickle-cell crisis
- Shortness of breath/fatigue, especially upon exertion
- Tachycardia and palpitations
- Dizziness or syncope upon standing or with exertion
- Pallor with pale nail beds and mucous membranes
- Nail bed deformities (spoon-shaped nails)
- Smooth, sore, bright-red tongue (vitamin B12 deficiency)
Nursing Care for Anemia
- Encourage increased dietary intake of the deficient nutrient
- Monitor oxygen saturation to determine a need for oxygen therapy.
- Administer medications.
- Teach the client and family about energy conservation in the client and the risk of the client experiencing dizziness upon standing.
Total iron-binding capacity (TIBC) reflects
an indirect measurement of serum transferrin, a protein that binds with iron and transports it for storage.
Serum ferritin is an indicator of
total iron stores in the body.
Serum iron measures the
amount of iron in the blood. Low serum iron and elevated TIBC indicates iron-deficiency anemia.
medications for anemias
- Iron supplements
- Ferrous sulfate, ferrous fumarate, ferrous gluconate
- Oral iron supplements are used to replenish serum iron and iron stores.
- Parenteral iron supplements (iron dextran) are only given for severe anemia.
educations on medication
- Instruct to have hemoglobin checked in 4 to 6 weeks to determine efficacy.
- Vitamin C can increase oral iron absorption.
- Instruct the client to take iron supplements between meals to increase absorption, if tolerated.
- Inform the client stools can appear green to black in color while taking iron.
Erythropoietin: epoetin alfa (prokrit)
A hematopoietic growth factor used to increase production of RBCs
Erythropoietin: epoetin alfa nursing considerations
- Monitor for an increase in blood pressure.
- Monitor Hgb and Hct twice per week.
- Monitor for a cardiovascular event if Hgb increases too rapidly (greater than 1 g/dL in 2 weeks).
vitamin b12 supplementation
Can be given orally if the deficit is due to inadequate dietary intake.
- Administer vitamin B12 according to appropriate route related to cause of vitamin B12 anemia (parenteral vs. oral).
- Administer parenteral forms of vitamin B12 IM or deep subcutaneous to decrease irritation.
- A client should receive vitamin B12 injections on a monthly basis.
folic acid
- Folic acid supplements.
- Folic acid is a water-soluble, B-complex vitamin. It is necessary for the production of new RBCs.
- Folic acid can be given orally or parenterally.
- Large doses of folic acid can mask vitamin B12 deficiency.
- Large doses of folic acid will turn the client’s urine dark yellow.
blood transfusions for anemias
- Blood transfusions lead to an immediate improvement in blood-cell counts and manifestations of anemia.
- Typically only used when the client has significant manifestations of anemia, because of the risk of blood-borne infections.
what is Aplastic Anemia and what is it caused by
- Bone marrow suppression of new RBC production.
- Deficiency of circulating WBCs, platelets, and RBCs.
- Caused by medications, viruses, toxins, and radiation.
- starts in bone marrow and included wbc
Nursing Care for Aplastic Anemia
- Monitor labs.
- Put in isolation room= big risk for infection
- Monitor for infection.
- Implement barrier precautions
meds for aplastic anemia
Immunosuppressive therapy (resets bone marrow)
- Prednisone, cyclosporine
Chemotherapy
- Ctyoxan, Procytox
