Topic 6: Anemias Flashcards
anemia
Deficiency in the amount of erythrocytes (RBCs), they quantity or quality of hemoglobin, and/or volume of packed RBCs
Anemia symptoms:
· Fatigue
· Decreased energy
· Weakness
· SOB
· Lightheadedness
· Palpitations
· Pallor
Severe anemia symptoms:
· Chest pain, angina, heart attach
· Dizziness
· Fainting or passing out
· Rapid HR
· Glossitis, smooth tongue
when checking for jaundice, where should the nurse check in a dark skinned patient
check sclera and mucous membranes for jaundice
diagnosis of anemia
CBC
(Hbg expecially)
what are acute interventions for anemia
· Blood transfusions
· Drug therapy (erythropoietin, vitamin supplements)
· O2 therapy
· Dietary and lifestyle changes (in specific types of anemia)
for patients with fatigue:
· Encourage alternate rest and activity periods
· Help patient prioritize activities to accommodate energy levels
· Avoid activity right after meals to reduce competition for O2
Monitor cardiorespiratory response to activity
Most common anemia
iron deficiency anemia
chronic manifestations of iron deficiency anemia
· Pallor (pale skin)
· Glossitis (inflammation of the tongue)
· Cheilitis (inflammation of the lips)
HA, paresthesia, burning sensation of the tongue
what is the main goal of treatment for iron deficiency anemia
treat underlying problem that is causing iron loss or reduced intake (malnutrition, alcoholism)
oral iron
ferrous sulfate or ferrous gluconate
IM or IV iron
iron dextran, sodium ferrous gluconate, iron sucrose
when should you take iron
1 hour before meals
what should you take iron with
vitamin C or orange juice
what is a common SE of taking iron
stools turning black
after taking oral iron, how long should the patient stay upright
30 minutes
what food are high in iron
· Lean beef
· Turkey
· Pork
· Chicken
· Fish
· Legumes
· Dark green leafy vegetables
· Whole grain and enriched bread and cereals
Beans
thalassemia
Inadequate production of hemoglobin, which decreases RBC production.
what groups is thalassemia common in
ethnic groups near the Mediterranean Sea, equatorial or near equatorial regions of Southeastern Asia, the Middle East, India, Pakistan, China, Southern Russia, and Africa
manifestations of thalassemia minor
· Often asymptomatic
· Small (microcytosis) pale (hypochromic) cells
· Mild splenomegaly
· Bronzed color of the skin
· Bone marrow hyperplasia
manifestations of thalassemia major
· Life threatening where growth (physical and mental) is often slowed
· Pale and displays other general symptoms of anemia
· Jaundice
· Pronounced splenomegaly
May cause thickening of the cranium and maxillary cavity
treatment for thalassemia minor
does not need treatment because the body adapts to the reduction of normal hemoglobin
treatment for thalassemia major
managed with blood transfusions or exchange transfusions in conjunction with chelating agents that bind to iron
types of Megaloblastic Anemia
B12 & folic acid deficiency anemia
most common cobalamin deficiency (Vit. B12) anemia
pernicious anemia
pernicious anemia (Vitamin B12 deficiency)
caused by absence of intrinsic factor (IF). IF is required for cobalamin (Vit. B12) to be absorbed.
folic acid is needed for
DNA synthesis leading to RBC formation and maturation.
Cobalamin (Vit. B12) Deficiency Manifestations:
· Sore, red, beefy and shiny tongue
· Anorexia, N/V, abdominal pain
· Weakness, paresthesia of the feet and hands, reduced vibratory and position senses, ataxia, muscle weakness
· Impaired thought process (confusion to dementia)
Folic Acid Deficiency Manifestations:
· Stomatitis
· Cheilosis
· Dysphagia
· Flatulence
· Diarrhea
Thiamine deficiency, which is often present with folate deficiency, can cause neurologic symptoms
Cobalamin (Vit. B12) Deficiency Management:
· Increasing dietary cobalamin DOES NOT CORRECT THIS ANEMIA
· Parenteral Vit. B12 or intranasal cyanocobalamin (Nascobal) is needed (without this the patient will die w/in 1-3 years)
· Assess for neurological difficulties
· Implement measure to reduce risk for injury from the decreased sensitivity to heat and pain related to neurologic impairment
· Protect patient from falling, burns, trauma
Folic Acid Deficiency Management:
Folic Acid Deficiency Management:
· Treated with replacement therapy, usually 1mg/day PO (a patient with malabsorption or chronic alcoholism may need up to 5mg/day)
· Teach the patient to eat food high in folate
Food high in folate
o Green leafy vegetables
o Enriched grain products and breakfast cereals
o Orange juice
o Peanuts
Avocado
aplastic amenia
Patient has peripheral blood pancytopenia (decrease of all blood cell types- RBCs, WBCs, and platelets) and hypocellular bone marrow.
aplastic anemia manifestations
· Fatigue and dyspnea
· The patient with neutropenia (low neutrophil count) is susceptible to infection and at risk for septic shock and death
Thrombocytopenia is manifested by a predisposition to bleeding (petechiae, bruising, nosebleeds
aplastic anemia management
-Removing causative agent (when possible) and providing supportive care until the pancytopenia reverses.
-Nursing actions are directed at preventing complications from infection and hemorrhage
acute blood loss
Occurs because of sudden hemorrhage (trauma, complications of surgery, conditions or diseases that disrupt vascular integrity)
Manifestations based on Volume Lost: 10% or 500mL
none
Manifestations based on Volume Lost: 20% or 1000mL
o No detectable S/S at rest
o Tachycardia with exercise and slight postural hypotension
Manifestations based on Volume Lost: 30% or 1500mL
o Normal supine BP and pulse at rest
o Postural hypotension and tachycardia with exercise
Manifestations based on Volume Lost: 40% or 2000mL
o BP, central venous pressure, and CO below normal at rest
o Air hunger
o Rapid thready pulse
o Cold, clammy skin
Manifestations based on Volume Lost: 50% or 2500mL
o Shock
o Lactic acidosis
Potential death
management for acute blood loss
· Replace blood volume to prevent shock
· Finding source of the hemorrhage ns stopping blood loss
· IV FLUID
chronic blood loss
Caused by bleeding ulcer, hemorrhoids, menstrual and postmenopausal blood loss. Effects are usually related to the depletion of iron stores and considered iron-deficiency anemia
chronic blood loss management
· Identifying source
· Stop bleeding
Supplemental iron may be needed
sickle cell anemia
a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape
manifestations of sickle cell anemia
· Patient is often anemic but asymptomatic except during sickling episodes
· Most patients with sickle cell anemia have dark colored skin; so pallor can be noted in the mucous membranes
· Skin may have a grayish cast
· Jaundice
· Prone to gallstones (cholelithiasis)
· PAIN!! (because of ischemia of tissue)
Pain episodes are accompanied by:
· Fever
· Swelling
· Tenderness
· Tachypnea
· Hypertension
· N/V
Complications of repeated sickling episodes:
Spleen: Splenic atrophy
· Lungs: Acute chest syndrome, pulmonary HTN, pneumonia
· Kidneys: Hematuria, renal failure
Brain: Thrombosis or hemorrhage causing paralysis, sensory deficits or death; stroke
sickle cell anemia management
· O2 therapy (treats hypoxia and controls sickling)
· Assess for respiratory changes
· DVT prophylaxis (using anticoagulants)
· FLUIDS! (to reduce blood viscosity and maintain renal function)
· PAIN MANAGEMENT!!!
pain management for sickle cell anemia
o May develop tolerance and larger dose maybe needed to reduce pain to a tolerable level
o Morphine and hydromorphone are drugs of choice
o Opioid analgesics
o PCAs
Referral to social and chaplain services
patient teaching for sickle cell anemia
Teach patient to avoid crisis.
Review steps to avoid dehydration and hypoxia, such as avoiding high altitudes and seeking medical attention quickly to counteract problems such as URI
Teach patient adequate fluid intake
Teaching about pain control is needed because pain during crisis can be severe and often requires considerable analgesia
acquired hemolytic anemia
Results from hemolysis of RBCs from extrinsic factors:
1. Physical destruction
2. Antibody reactions
3. Infections agents and toxins
management fro acquired hemolytic anemia
· General supportive care until causative agent can be eliminated
· Emergency therapy: hydration, electrolyte replacement
Supportive care: giving corticosteroids and blood products, or removing the spleen
polycythemia
Production and presence of increased numbers of RBCs. The increase in RBCs can be so great that blood circulation is impaired because of increased blood viscosity and volume.
what are common liver and spleen manifestations related to polycythemia
Splenomegaly and hepatomegaly are common (may cause patient to feel satiety or fullness).
polycythemia Manifestations:
(often occur because of the hypertension caused by hypervolemia and hyper viscosity)
· HA
· Vertigo
· Dizziness
· Tinnitus
· Visual changes
· Generalized pruritis
· Paresthesia and erythromelalgia (painful burning and redness of the hands and feet)
· Plethora (ruddy complexion)
Hyperuricemia and gout (as RBC destruction increases, uric acid production increases)
polycythemia management
· Treatment directed toward recusing blood volume and viscosity and bone marrow activity
· PHLEBOTOMY is the mainstay of treatment
· Hydration therapy can also reduce blood viscosity
· Assess fluid I&Os during hydration therapy or fluid deficit
· Begin activities and/or medications to decrease thrombus formation.
Start active or passive leg exercises and ambulation when possible
Thrombocytopenia
low platelet count; A reduction of platelets below 150,000/uL
manifestations of thrombocytopenia
· Often asymptomatic
· Mucosal or cutaneous bleeding
o Mucosal bleeding: nosebleeds or gingival bleeding
o Skin: petechiae, purpura or superficial ecchymoses
· Petechiae: small, flat, red/brown microhemorrhages
· Purpura: when there are many petechiae resulting in reddish skin
· Ecchymoses: purplish lesions caused by hemorrhages
· Pain and tenderness
Manifestations of internal blood loss
· Weakness
· Fainting
· Dizziness
· Tachycardia
· Abdominal pain
Hypotension
health promotion for thrombocytopenia
· Discourage the use of OTC medications known to reduce platelets (ASPIRIN OR IF ASPIRIN IS AN INGREDIENT)
· Encourage persons to have a complete medical evaluation of manifestations of bleeding tendencies
acute care for thrombocytopenia
· Prevent or control bleeding
· AVOID SQ and IM injections
· Closely monitor platelet, coagulation, hemoglobin and hematocrit labs
· Women: count sanitary napkins during menses to detect excess blood, suppression of menses with hormonal agents may be needed
patient and caregiver teaching of thrombocytopenia
· Teach patient to avoid aspirin and other drugs that affect platelet function or production
· Notify HCP with signs of bleeding
· Ask about restrictions of normal activities (vigorous exercise or lifting weights). Generally walking is safe.
-Do not blow nose forcefully
· Do not bend down with head below waist
· Prevent constipation
· Shave with an electric razor
· Do not tweeze eyebrows or other body hair
· Use soft bristle toothbrush
· Women, keep track of how many pads are used per day
Ask HCP before having invasive procedures (dental cleaning, manicure/pedicure
signs of bleeding
o Black tarry stool
o Black or bloody vomit, sputum or urine
o Bleeding from mouth or anywhere else in the body
o Bruising or small red or purple spots on the skin
o Difficulty talking, sudden weakness of arm or leg, confusion
o HA or changes in vision
hemophilia
Genetic disorder caused by a defective coagulation factor
Hemophilia A: NO factor VIII
Hemophilia B: NO factor IX
Hemophilia manifestations
· Relate to bleeding and may lead to life-threatening hemorrhage
· Slow, persistent, prolonged bleeding from minor trauma and small cuts
· Delayed bleeding after minor injury
· Uncontrollable hemorrhage after dental extractions or irritation of gingiva with hard toothbrush
· Nosebleeds (especially after blow to face)
· GI bleeding
· Bruising and SQ hematoma
Neuro: pain, anesthesia, paralysis (may develop from nerve compression caused by hematoma)
management for hemophilia
· PREVENT AND TREAT BLEEDING
· Replacement therapy during acute bleeding episodes and as prophylaxis
· Replacement of clotting factors is PRIMARY means of supporting patient
acute care for hemophilia
· Stop bleeding ASAP: apply direct pressure or ice, pack the area with Gelfoam or fibrin foam and apply topical hemostatic agents, such as thrombin
· Give specific coagulation factor. Monitor for hypersensitivity
· Joint bleeding:
o RICE!!
what is done for joint bleeding in hemophilia
o RICE!! Rest, Ice (20 mins every 3-4 hours), Compress/wrap the joint, Elevate
o Give analgesics to reduce severe pain (BUT NOT ASPIRIN)
o Encourage mobilization as soon as bleeding ceases
patient teaching for hemophilia
· Teach oral hygiene without causing trauma
· NONCONTACT SPORTS
· Wear gloves when doing household chores (knives hammers, other tools)
Wear medic alert tag
neutropenia
A reduction of neutrophils; leukopenia refers to a decrease of total WBC; granulocytopenia (deficiency in granulocytes which includes neutrophils, eosinophils and basophil. Play a key role in phagocytizing pathogenic microbes, are closely monitored in clinical practice as an indicator of a PATIENTS RISK FOR INFECTION
manifestations of neutropenia
· Patient is predisposed to infection
· Inflammation signs (like redness, heat, swelling) MAY NOT OCCUR
· Pus formation is ABSENT
· Fever- REQUIRES IMMEDIATE ATTENTION
Sore throat and dysphagia, ulcerative lesions of pharyngeal and buccal mucosa, diarrhea, rectal tenderness, vaginal itching and discharge, SOB, nonproductive cough
management for neutropenia
-Identification of site of infection and causative organism
-Antimicrobial therapy
-Blood cultures STAT, before antibiotics, try and start antibiotic at once!
· Strict hand hygiene
· Patient hygiene
· Single-patient room, positive-pressure, or HEPA filtration (depending on risk)
· Community isolation and home precautions (if outpatient)
· Nutritional therapy
· Safe activity and ambulation to maintain physical and pulmonary function
· Monitor for S/S of infection (any fever over 100.4)
patient and caregiver teaching for neutropenia
· WASH YOUR HANDS
· Notify HCP if you have any of the following:
o Fever >100.4
o Chills or feeling hot
o Redness, swelling, discharge, or new pain on or in body
o Changes in urination or bowl movements
o Cough, sore throat, mouth sores, blisters
· Avoid crowds and people with colds, flu, or any infection. In public area wear mask and use hand sanitizer frequently.
· Avoid uncooked meats, seafoods, or eggs and unwashed fruits and vegetables
· Bathe/shower daily. Moisturize to prevent skin from drying and cracking
· Maintain daily activity like walking while avoiding crowds
· Brush teeth with soft toothbrush 4x day. Floss 1x day if it doesn’t cause pain or bleeding. Avoid alcohol-based mouthwashes
