week 7- anemia Flashcards
Anemia
Reduction in either the number of red blood cells, the amount of hemoglobin, or the hematocrit
Reduced RBCs result in tissue hypoxia
Hypoxia results in clinical sign (not a specific disease); anemia is a manifestation of several abnormal conditions
Types of Anemia
- Intrinsic-eg: Sickle Cell Disease, Enzyme deficiency (G6PD)
- Extrinsic- eg: Antibodies (autoimmune)
- Decreased Erythrocyte Production-eg: Iron Deficiency, leukemia
- Blood Loss- eg: acute (trauma) chronic (gastritis, menstrual)
Manifestations of Anemia- skin
Cool to touch
Cold intolerance
Brittle nails (lose convex shape..become concave and fingers club-like)
Pallor, especially: ears, nail beds, palmar creases, conjunctivae, circumoral (around the mouth)
Manifestations of Anemia- cradiovascular
Tachycardia (without activity)
• HR increases with activity and during/after meals
• Murmurs and gallops when anemia severe
• Orthostatic hypotension
Manifestations of Anemia- Respiratory
Dyspnea on exertion
Decreased oxygen saturation
manis of anemia-Neurological
Increased somnolence and fatigue
Headache
Irritable
Difficulty concentrating, memory
Sickle Cell Disease
Genetic disorder resulting in chronic anemia, pain, disability, organ damage, increased risk for infection, and early death
Sickle cell disease state and sickle cell trait
Sickle cell Crisis
• Extensive cell sickling
• May occur weekly or once per year
• Impaired blood flow results in vasospasm
• Can lead to tissue ischemia and infarction
• Repeated blockages can result in organ damage or failure
incidence of sickle cell
Incidence: 1 in 350 to 500 African Americans, also affects Mediterranean, Caribbean south and Central Americans, Arab or East Indian descent
Sickle Cell Disease: Pathophysiology
Main problem of the disorder is formation of abnormal hemoglobin chains
Cells may return to normal shape when causative factors resolved, O2 levels and perfusion normalize
Some cells permanently affected
RBCs with >40% HbS live 12-15 days (N=120 days)
Results in hemolytic anemia
Triggers of Sickle Cell Disease
• Hypoxia • Dehydration • Infection • Venous stasis • Pregnancy • High altitude • ETOH consumption • Low or high environmental or body temperature • Stress (emotional or physical exertion) • Acidosis • Anaesthesia •
Sickle Cell Disease: Laboratory Assessment
- Hemoglobin S (HbS)
- Number of RBCs with permanent sickling
- Hematocrit
- Reticulocyte count
- Total bilirubin (Bilirubin results from the breakdown of heme which is released with the breakdown of hemoglobin (therefore RBC breakdown)
- Total white blood cells
- Imaging assessment
Sickle Cell Disease: Clinical Manifestations
Symptoms vary greatly from person to person but complications include: • Cardiovascular changes • Skin changes • Abdominal changes • Renal and urinary changes • Musculoskeletal changes • CNS changes • What does your assessment include?
Organs with high need for oxygen are most often affected
CV-pulmonary infarctions can lead to pulmonary hypertension or MI
Risk for high-output HF
Assess for: SOB, general fatique or weakness, murmurs, S3, increased JVD, Compare PP, temp, cap refill in all extremities-may be cool with diminished or absent pulses, HR may be increased, BP low to average with decreased pulse pressure.
assess for
Skin- Pallor or cyanosis, assess lips, tongue (grey) palms, soles conjunctivae and nail beds cyanotic, jaundice (d/t RBC destruction and release of bilirubin). Inspect roof of mouth in patients with dark skin for yellowish appearance, and skin for itching, assess skin for venous stasis ulcers (hands/feet)
Priapism-prolonged penile erection, very painful, may last hours, usually cannot urinate during episode
Abdo- hepatomegaly, splenomegaly-both first to be damaged due to hypoxia and ischemia. Assess for guarding and rebound tenderness. Diffuse leg and back pain in SC crisis
MSK- joint swelling, increased temp, decrease ROM, pain
Retinal- obstruction results in detachments or blindness
CNS-low grade fever, seizures, manifestations of stroke
Psychosocial: behavioural changes may indicate cerebral
hypoxia- observe pt and discuss with family.
Assess social supports, coping mechanisms, disease progression, lifestyle changes, limitations and response to disease
Sickle Cell Disease Interventions:
Potential for Multiple Organ Dysfunction
Interventions include:
• Oxygen therapy- to treat hypoxia
• Rest- to decrease metabolic requirements
• Hydration- oral or IV to reduce blood viscosity & maintain renal function
• Transfusion therapy-for aplastic crisis
Pain is the most common problem:
• Pain is often undertreated*
• Drug therapy—During the acute phase 48 hours of continuous IV opioid analgesics
• Patient controlled analgesia may be effective
• Complementary and alternative therapies
eg: warm room, distraction, relaxation techniques, positioning, aromatherapy, therapeutic touch, warm soaks/compresses
