Question

List the Sign/Symptoms for each type of anemia listed below, and include 2 Nursing Interventions for each type of anemia:

Hypovolemic Anemia:

Iron-Deficiency Anemia:

Sickle Cell Disease:

Hemolytic Anemia:

Pernicious Anemia:

Folic Acid Deficiency Anemia:

Answer 1

1) Hypovolemic anemia - manifestations/assessment

Weakness, stupor; irritability, pale, cool moist skin, hypotension, tacky cardia (rapid, weak, thready pulse), hypthermia, hemoglobin less than 10g/100ml, hematocrit less than 40%.

2) Pernicious anemia - manifestations/assessment

extreme weakness, dyspnea, fever, hypoxia, weight loss, jaundice (destruction of RBCs), pallor, GI complaints, dysphagia, sore burning tongue, (smooth and erythematous), Neurological symptoms (tingling of the hands and feet, disorientation, personality changes, behavior problems, partial or total paralysis).

3) Iron deficiency anemia - manifestations/assessments

Pallor, fatigue, weakness, SOB, Angina, (signs and symptoms of heart failure), glossitis (burning tongue), pagophagia, headache, paresthesia.

4) Sickle cell anemia - manifestations/assessment

Precipitating factors (dehydration, change in oxygen tension in the body), loss of appetite, irritability, weakness, abdominal enlargement, joint and back pain, edema of extremities.

5) Hemolytic anemia

Signs and symptoms may include fatigue, dizziness, heart palpitations, pale skin, headache, confusion, jaundice, and a spleen or liver that is larger than normal. Severe hemolytic anemia can cause chills, fever, pain in the back and abdomen, or shock.

6) Folic acid deficiency anemia clinical manifestations include -

persistent fatigue

weakness

lethargy

pale skin

shortness of breath

irritability

#. Nursing interventions :-

Nursing Interventions

Managing FATIGUE

Maintaining Adequate NUTRITION

Activity Intolerance

Promoting ADHERENCE w/ Prescribed Therapy

Moitoring Managing POTENTIAL COMPLICATIONS

1) MANAGING FATIGUE

most common symptom and complication of anemia is fatigue.

Fatigue is often the symptom that has the greatest negative impact on a patient's level of functioning and consequent quality of life.

Therefore, it should not be minimized.

Patients often describe the fatigue from anemia as oppressive.

Fatigue can be significant, yet the anemia may not be severe enough to warrant transfusion.

Fatigue can interfere with a person's ability to work and to participate in activities with family and friends.

Patients often lose interest in hobbies and activities, including sexual activity.

The distress from fatigue is often related to a person's responsibilities and life demands as well as the amount of assistance and support received from others

Nursing interventions:- focus on assisting the patient to prioritize activities and to establish a balance between activity and rest that is acceptable to the patient.

Patients with chronic anemia need to

maintain some physical activity and exercise to prevent the deconditioning that results from inactivity.

It is also important to assess for other conditions that can exacerbate fatigue, such as pain, depression, and sleep disturbance.

2) MAINTAINING ADEQUATE NUTRITION

Inadequate intake of essential nutrients, such as iron, vitamin B12, folic acid, and protein, can cause some anemias.

The symptoms associated with anemia (e.g., fatigue, anorexia) can in turn interfere with maintaining adequate nutrition.

A healthy diet should be encouraged.

The nurse should inform the patient that alcohol interferes with the utilization of essential nutrients and advise moderation in the intake of alcoholic beverages

). Dietary education sessions should be individualized, involve family members, and include cultural aspects related to food preferences and food preparation.

Dietary supplements (e.g., vitamins, iron, folate, protein) may be prescribed.

Equally important, the patient and family must understand the role of nutritional supplements in the proper context, because many forms of anemia are not the result of a nutritional deficiency.

In such cases, even an excessive intake of nutritional supplements will not improve the anemia.

A potential problem in patients with chronic transfusion requirements occurs with the indiscriminate use of iron supplements.

Unless an aggressive program of chelation therapy is implemented, these patients are at risk for iron overload from their transfusions

). The addition of an iron supplement only exacerbates the situation.

3) ACTIVITY INTOLERANCE

Patients with acute blood loss or severe hemolysis may not tolerate typical activities because of decreased blood volume or reduced circulating erythrocytes (decreased hematocrit).

Lost volume is replaced with transfusions or intravenous (IV) fluids, based on symptoms and laboratory test results.

Supplemental oxygen may be necessary, but it is rarely needed on a long-term basis unless there is underlying severe cardiac or pulmonary disease.

The nurse monitors the patient's vital signs and pulse oximeter readings closely; other medications, such as antihypertensive agents, may need to be adjusted or withheld.

4) PROMOTING ADHERENCE WITH PRESCRIBED THERAPY

For patients with anemia, medications or nutritional supplements are often prescribed to treat the condition.

These patients need to understand the purpose of the medication, how to take the medication and over what time period, and how to manage any side effects of therapy.

To enhance adherence, the nurse assists the patient to develop ways to incorporate the therapeutic plan into everyday activities rather than merely giving the patient a list of instructions.

For example, many patients have difficulty taking iron supplements because of related GI effects.

Rather than seeking assistance from a health care provider in managing the problem, some patients simply stop taking the iron.

Abruptly stopping some medications can have serious consequences, as in the case of high-dose corticosteroids to manage hemolytic anemias

. Some medications, such as growth factors, are extremely expensive.

Patients receiving these medications may need assistance to obtain needed insurance coverage or to explore alternative ways to obtain these medications.

5) MONITORING AND MANAGING POTENTIAL COMPLICATIONS

significant complication of anemia is HF from chronic diminished blood volume and the heart's compensatory effort to increase cardiac output.

Patients with anemia should be assessed for signs and symptoms of heart failure HF

In megaloblastic forms of anemia, the significant potential complications are neurologic.

neurologic assessment should be performed for patients with known or suspectedmegaloblastic anemia.

Patients may initially complain of paresthesias in their lower extremities.

These paresthesias are usually manifested as numbness and tingling on the bottom of the foot, and they gradually progress.

As the anemia progresses, other signs become apparent.

Position and vibration sense may be diminished

. Difficulty maintaining balance is not uncommon, and some patients have gait disturbances as well

. Initially mild confusion may develop; it may become severe

Evaluation

Reports less fatigue

Follows a progressive plan of rest, activity, and exercise

Prioritizes activities

Paces activities according to energy level

Attains and maintains adequate nutrition

Eats a healthy diet

Develops a meal plan that promotes optimal nutrition

Maintains adequate amounts of iron, vitamins, and protein from diet or supplements

Adheres to nutritional supplement therapy when prescribed

Verbalizes understanding of rationale for using recommended nutritional supplements

Verbalizes understanding of rationale for avoiding nonrecommended nutritional supplements

Maintains adequate activity level

Has vital signs within baseline for patient

Has pulse oximetry (arterial oxygenation) value within normal limits

Absence of complications

Avoids or limits activities that trigger dyspnea, palpitations, dizziness, or tachycardia

Uses rest and comfort measures to alleviate dyspnea

Has vital signs within baseline for patient

Has no signs of increasing fluid retention (e.g., peripheral edema, decreased urine output, neck vein distention)

Remains oriented to time, place, and situation

Remains engaged in social situations, exhibits no signs of depression

Ambulates safely, using assistive devices as necessary

Remains free of injury

Verbalizes understanding of importance of serial CBC measurements

Maintains safe home environment; obtains assistance as necessary