Anemia is the most common hematologic disorder in which the hemoglobin level is lower than normal, reflecting the presence of a decrease in number or derangement in function of red blood cells within the circulation. As a result, the amount of oxygen delivered to body tissues is also lessened.
Anemia may be classified in many ways. In iron deficiency anemia, it is a hypochromic, microcytic type of anemia, resulting from inadequate iron supplementation, chronic blood loss seen in men and older women who have ulcers or GI tumors and younger women with heavy menstruation.
Aplastic anemia, on the other hand, is caused by damage to hematopoietic stem cells and the bone marrow. This causes a depression of all blood elements: (pancytopenia): red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia). While pernicious anemia is caused by faulty absorption of vitamin B12 from the GI tract, which is required in the production of red blood cells.
Nursing care plan for clients with anemia includes: assess risk factors, decrease fatigue, maintenance of adequate nutrition, maintenance of adequate tissue perfusion, compliance with prescribed treatment regimen, and be free from complications.
Here are four (4) nursing care plans (NCP) and nursing diagnosis for patients with anemia (aplastic, iron deficiency, cobalamin, pernicious):
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- Complexity of treatment.
- Lack of recall.
- Lack of resources.
- New condition or treatment.
- Unfamiliarity with the disease condition.
Possibly evidenced by
- Inaccurate follow-through of instructions.
- Questioning members of health care team.
- Verbalized inaccurate information.
- Client will verbalize understanding of own disease and treatment plan.
|Assess current knowledge of the diagnosis, disease process, possible causative factors, and treatment.||Determining the client’s current knowledge and perceptions will facilitate the planning of individualized teaching. Clients may have a general understanding of anemia related to iron deficiency but limited knowledge of other types of anemia.|
|Assess the client’s and family’s understanding of the new medical vocabulary.||Usually, people have a limited understanding of medical vocabulary, hence are not exposed to the language being used by the health care professionals.|
|Explain the importance of the diagnostic procedures (such as complete blood count), bone marrow aspiration and a possible referral to a hematologist.||Diagnosing a type of anemia will be based on the changes in the RBC indexes and the findings in the bone marrow aspiration.|
|Explain the hematological vocabulary and the functions of blood elements, such as white blood cells, red blood cells, and platelets.||Clients usually have a basic knowledge of the hematological system.|
|Instruct client to avoid known risk factors.||Causative factors such alcoholism, exposure to toxic chemicals, dietary deficiencies, and the use of some medications can affect red blood cell production and lead to anemia.|
|For aplastic anemia:|
|Histocompatibility antigens may lead to donor marrow rejection.|
|The human leukocyte antigen (HLA) test, also known as HLA typing or tissue typing, identifies antigens on the white blood cells (WBCs) that determine tissue compatibility for organ transplantation|
|The treatment of choice in clients without HLA-matched donors is immunosuppression with granulocyte-macrophage-colony-stimulating factors, cyclophosphamide, anti-thymocyte globulin, and cyclosporine.|
|Hematopoietic stem cell transplantation (HCT) is an effective therapy for many life-threatening diseases. Usually, a client’s own (autologous) cells or (allogeneic) cells from a donor with same genetic makeup are used.|
|Explain the potential complications associated with immunosuppressive therapy.|
|Earliest symptoms include a red maculopapular rash, dryness of the eye, abdominal pain, and jaundice.|
|Clients with Chronic GVHD may present with a variety of symptoms. Skin rash and mouth sores are among the common initial signs of the disease. The rash is often slightly raised and may be itchy.|
|Rejection happens when a sensitization to histocompatibility antigens acquired during previous blood transfusions and carries a high mortality rate. Conditioning regimens using cyclophosphamide (Cytoxan) and total lymphoid irradiation show a decrease in the risk for graft failure.|
|For nutritional deficiency anemia:|
|Vitamin B12 injections used to treat low levels (deficiency) of this vitamin. They are given monthly for the remainder of the client’s life. It elevates levels of vitamin B12, a deficiency caused by a lack of intrinsic factor that impairs the vitamin absorption.|
|A balanced diet that includes a variety of foods from each food group usually contains essential nutrients needed to promote RBC formation. Clients need to have an adequate intake of dark-green leafy vegetables, animal products, including fish, meat, poultry, eggs, milk, and fortified breakfast cereals.|
|The dosage and frequency of administration will depend on the severity of anemia. Iron supplements are given orally with meals to prevent gastric upset. Intramuscular injections are also available given via Z-track method to prevent leakage of the solution in the subcutaneous tissue along the needle tract. While folic acid is given orally with a full glass of water.|
|For blood loss anemia:|
|Recombinant human erythropoietin, a hematological factor, elevates hemoglobin levels and decreases the need for a transfusion of packed RBC.|
|One unit of packed RBC raises the hemoglobin level by 1 g/dL.|
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