1. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Focus on Anemia

2. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia A deficiency in the  Number of erythrocytes (red blood cells [RBCs])  Quantity of hemoglobin  Volume of packed RBCs (hematocrit)

3. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Diverse causes such as  Blood loss  Impaired production of erythrocytes  Increased destruction of erythrocytes

4. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Causes of Anemia Fig. 31-1

5. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia RBC function  Transport oxygen (O 2 ) from lungs to systemic tissues  Carry carbon dioxide from the tissues to the lungs

6. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Not a specific disease Manifestation of a pathologic process Identified and classified by laboratory diagnosis

7. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Classified as  Morphologic Cellular characteristics Descriptive, objective laboratory information  Etiologic Underlying cause

8. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Clinical Manifestations Caused by the body’s response to tissue hypoxia Hemoglobin (Hb) levels are used to determine the severity of anemia

9. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Integumentary Manifestations Pallor  ↓ Hemoglobin  ↓ Blood flow to the skin Jaundice  ↑ Concentration of serum bilirubin Pruritus  ↑ Serum and skin bile salt concentrations

10. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Cardiopulmonary Manifestations Additional attempts by the heart and lungs to provide adequate O 2 to the tissues Cardiac output maintained by increasing the heart rate and stroke volume

11. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

12. Anemia Clinical Manifestations Mild = Hb 10 to 14 g/dl  May exist without symptoms  Possible symptoms Palpitations, dyspnea, diaphoresis Moderate = Hb 6 to 10 g/dl  Increased cardiopulmonary symptoms  Experienced at rest or during activity

13. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Clinical Manifestations Severe = Hb <6 g/dl  Involve multiple body systems Integument Eyes Mouth Cardiovascular

14. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Clinical Manifestations Severe = Hb <6 g/dl  Manifestations (cont'd) Pulmonary Neurologic Gastrointestinal (GI) Musculoskeletal

15. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Assessment Subjective data  Important health information Past health history Medications Surgery or other treatments

16. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Assessment Subjective data  Functional health patterns Health perception–health management Nutritional-metabolic Elimination Activity-exercise Cognitive-perceptual Sexuality-reproductive

17. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Assessment Objective data  General  Integumentary  Respiratory  Cardiovascular  Gastrointestinal  Neurologic

18. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Diagnoses Activity intolerance Imbalanced nutrition: Less than body requirements Ineffective therapeutic regimen management Potential complication: Hypoxemia

19. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Management Goals  Assume normal activities of daily living  Maintain adequate nutrition  Develop no complications related to anemia

20. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Implementation Dietary and lifestyle changes Blood or blood product transfusions Drug therapy

21. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Nursing Implementation Oxygen therapy Patient teaching  Nutrition intake  Compliance with drug therapy

22. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia Gerontologic Considerations Common in older adults  Chronic disease  Nutritional deficiencies Signs and symptoms may go unrecognized or mistaken for normal aging changes

23. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Erythrocyte Production Erythropoietin (EPO) is a glycoprotein primarily produced in the kidneys (10% in the liver)  ↑ Number of stem cells committed to RBC production  Shortens the time to mature RBCs

24. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Erythrocyte Production Life span of an RBC is 120 days Three alterations in erythropoiesis that decrease RBC production  Decreased hemoglobin synthesis  Defective DNA synthesis in RBCs  Diminished availability of erythrocyte precursors

25. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia One of the most common chronic hematologic disorders Iron is present in all RBCs as heme in hemoglobin and in a stored form Heme accounts for two thirds of the body’s iron

26. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Normal Iron Metabolism Fig. 30-4

27. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Etiology Inadequate dietary intake  5% to 10% of ingested iron is absorbed Malabsorption Blood loss Hemolysis

28. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Clinical Manifestations General manifestations of anemia Pallor is the most common finding Glossitis is the second most common  Inflammation of the tongue

29. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Diagnostic Studies Laboratory findings  Hb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets Stool guaiac test Endoscopy Colonoscopy

30. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Collaborative Care Goal is to treat the underlying disease  Increased intake of iron  Nutritional therapy  Oral or occasional parenteral iron supplements  Transfusion of packed RBCs

31. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Drug Therapy Oral iron  Inexpensive  Convenient  Factors to consider Enteric-coated or sustained-release capsules are counterproductive Vitamin C is helpful with absorption of Iron

32. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Drug Therapy Oral iron  Factors to consider (cont’d) Best absorbed as ferrous sulfate in an acidic environment Liquid iron should be diluted and ingested through a straw Side effects Heartburn, constipation, diarrhea

33. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Nursing Management At-risk groups  Premenopausal women  Pregnant women  Persons from low socioeconomic backgrounds  Older adults  Individuals experiencing blood loss

34. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Iron-Deficiency Anemia Nursing Management Diet teaching Supplemental iron Discuss diagnostic studies Emphasize compliance Iron therapy for 2 to 3 months after the hemoglobin levels return to normal

35. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Folic Acid Deficiency Also a cause of megaloblastic anemia Folic acid is required for DNA synthesis  RBC formation and maturation

36. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Folic Acid Deficiency Common causes  Poor nutrition  Malabsorption syndromes  Drugs  Alcohol abuse and anorexia  Lost during hemodialysis

37. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Folic Acid Deficiency Clinical manifestations are similar to those of cobalamin deficiency Insidious onset Absence of neurologic problems Treated by replacement therapy Encourage patient to eat foods with large amounts of folic acid

38. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia of Chronic Disease Underproduction of RBCs Mild shortening of RBC survival

39. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia of Chronic Disease Causes  End-stage renal disease Primary factor: ↓ Erythropoietin  Chronic liver disease  Chronic inflammation  Malignant tumors  Chronic endocrine diseases

40. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia of Chronic Disease Anemia of chronic disease findings  ↑ Serum ferritin  ↑ Iron stores  Normal folate and cobalamin levels

41. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Anemia of Chronic Disease Treating underlying cause is best Rarely blood transfusions Erythropoietin therapy

42. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Reference Black, J. & Hawks, M. Medical Surgical Nursing Clinical Management for Positive Outcomes. St Louis: Saunders- Elsevier.