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1

Anemia
- Not a specific disease
- Manifestation of a pathologic process
- Classified by laboratory review of?

- Classified by laboratory review of
* Complete blood count (CBC)
* Reticulocyte count
* Peripheral blood smear

2

Anemia Clinical Manifestations

- Caused by the body’s response to tissue hypoxia
- Manifestations vary based on rate of development, severity of anemia, presence of co-existing disease.
- Hemoglobin (Hgb) levels are used to determine the severity of anemia.

3

Anemia Integumentary Manifestations

- Pallor
↓ Hemoglobin
↓ Blood flow to the skin
- Jaundice
↑ Concentration of serum bilirubin
- Pruritus
↑ Serum and skin bile salt concentrations

4

Anemia Cardiopulmonary Manifestations

- Result from additional attempts by heart and lungs to provide adequate O2 to the tissues
- Cardiac output maintained by increasing the heart rate and stroke volume

5

Used to determine the severity of anemia

Hemoglobin (Hgb) levels

6

Anemia Nursing Assessment
-Subjective data

* Important health information
- Past health history
- Medications
- Surgery or other treatments
- Dietary history
* Functional health patterns

7

Anemia Nursing Assessment
-Objective data

- General
* Integumentary
* Respiratory
* Cardiovascular
* Gastrointestinal
* Neurologic
* Diagnostic findings

8

Anemia Nursing Diagnoses

- Fatigue
- Imbalanced nutrition: Less than body requirements
- Ineffective self-health management
* Assume normal activities of daily living
* Maintain adequate nutrition
* Develop no complications related to anemia

9

Iron supplements cause stools to darken

.

10

Anemia Gerontologic Considerations

- Common in older adults
* Chronic disease
* Nutritional deficiencies
- Signs and symptoms may go unrecognized or may be mistaken for normal aging changes.

11

Anemia Decreased 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

12

Erythrocyte Production

- Life span of an RBC is 120 days.
- Three alterations in erythropoiesis may decrease RBC production:
1) Decreased hemoglobin synthesis
2) Defective DNA synthesis in RBCs
3) Diminished availability of erythrocyte precursors.

13

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.

14

Iron-Deficiency Anemia Etiology

- Inadequate dietary intake
* 5% to 10% of ingested iron is absorbed.
- Malabsorption
* Iron absorption occurs in the duodenum.
* Diseases or surgery that alter, destroy, or remove the absorption surface of this area of the intestine cause anemia.
- Blood loss
* 2 mL whole blood contain 1 mg iron.
* Major cause of iron deficiency in adults
* Chronic blood loss most commonly through GI and GU systems
- Hemolysis
* Pregnancy contributes to this condition.

15

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
* Cheilitis
- Inflammation of the lips

16

Iron-Deficiency Anemia Diagnostic Studies

- Laboratory findings
* Hgb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets
* Stool guaiac test
* Endoscopy
* Colonoscopy
* Bone marrow biopsy

17

Iron-Deficiency Anemia Collaborative Care

- Goal is to treat the underlying disease causing reduced intake or absorption of iron.
- Efforts are aimed at replacing iron.
* Nutritional therapy
* Oral or occasional parenteral iron supplements
* Transfusion of packed RBCs

18

Iron-Deficiency Anemia Drug Therapy

- Oral iron
* Inexpensive
* Convenient
* Factors to consider
- Enteric-coated or sustained-release capsules are counterproductive.
- Daily dose is 150 to 200 mg

19

Iron-Deficiency Anemia Drug Therapy
Oral iron
Factors to consider

- Best absorbed as ferrous sulfate in an acidic environment
- Liquid iron should be diluted and ingested through a straw.
- Side effects
* Heartburn, constipation, diarrhea

Teaching Opportunity ???

20

Iron-Deficiency Anemia Drug Therapy
Parenteral iron

- Indicated for malabsorption, oral iron intolerance, need for iron beyond normal limits, poor patient compliance
- Can be given IM or IV
- IM may stain skin

21

Iron-Deficiency Anemia Nursing & Collaborative Management
-At risk groups

- Premenopausal women
- Pregnant women
- Persons from low socioeconomic backgrounds
- Older adults
- Individuals experiencing blood loss

22

Iron-Deficiency Anemia Nursing & Collaborative Management

- Diet teaching
- Supplemental iron
- Discuss diagnostic studies.
- Emphasize compliance.
- Iron therapy for 2 to 3 months after hemoglobin levels return to normal

23

Thalassemia Etiology

- A group of diseases involving inadequate production of normal hemoglobin
- Therefore decreased erythrocyte production

24

Thalassemia Etiology

Common in ethnic groups near the Mediterranean Sea and in equatorial or near-equatorial regions of Asia, Middle East, and Africa

25

Thalassemia Etiology

- Problem with globulin protein
* Abnormal Hgb synthesis
- Hemolysis also occurs.
- One thalassemic gene
* Thalassemia minor
- Two thalassemic genes
* Thalassemia major

26

Thalassemia Clinical Manifestations
Thalassemia minor

- Asymptomatic frequently
- Moderate anemia
* Microcytosis
* Hypochromia
- Body adapts to reduction of Hgb – thus no treatment is indicated.

27

Thalassemia Clinical Manifestations
Thalassemia major

- Life-threatening
- Physical & mental growth often retarded
- Pale & jaundiced
- Splenomegaly, hepatomegaly, & cardiomyopathy
- Symptoms develop in childhood

28

Thalassemia Clinical Manifestations
Thalassemia major

- As the bone marrow responds to the deficit of O2-carrying capacity of the blood, RBC production is stimulated, & marrow becomes packed with immature erythroid precursors that die.
- Chronic bone marrow hyperplasia
- Hepatitis C

29

Thalassemia Collaborative Care

- No specific drug or diet is effective in treating thalassemia.
- Thalassemia major
* Blood transfusions or exchange transfusions with chelating agents that bind to iron to reduce iron overloading
* Splenectomy

30

Megaloblastic Anemias

- Group of disorders
* Caused by impaired DNA synthesis
* Presence of megaloblasts
- Majority result from deficiency in
* Cobalamin (vitamin B12)
* Folic acid