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):
Risk For Bleeding
Risk for Bleeding: At risk for a decrease in blood volume that may compromise health.
- Bone marrow malfunction.
- Marrow replacement with fat in aplastic anemia.
Possibly evidenced by
- [not applicable].
- Client will have a reduced risk for bleeding, as evidenced by normal or adequate platelet levels and absence of bruises and petechiae.
|Assess the skin for bruises and petechiae.||Bruises and petechiae is usually evident when the platelet count drops to 20,000 mm3.|
|Assess for any frank bleeding from the nose, gums, vagina, or urinary or gastrointestinal tract.||Early assessment facilitates immediate treatment. These sites are most common for spontaneous bleeding.|
|Monitor platelet count.||A low platelet count or thrombocytopenia is caused by a bone marrow malfunction resulting from nutritional deficiencies, drugs, certain viral causes, or aplastic anemia. The risk for bleeding is increased as platelet count is decreased.|
|Monitor stool (guaiac) and urine (Hemastix) for occult blood.||These test help identify the site of bleeding.|
|Consolidate laboratory blood sampling test.||Repeated blood sampling over time can lead to anemia. Consolidation minimizes the number of venipunctures and optimizes blood volume.|
|Instruct the client in dietary modifications to reduce constipation.||Eating a diet high in fiber and drinking a lot of fluids to avoid constipation or using a stool softener and other laxatives as prescribed if having difficulty passing stool.|
|Instruct the client about bleeding precautions.||Once the client’s platelet count drops to 50,000mm3, bleeding precaution should be instituted immediately to avoid risk of spontaneous bleeding.|
|Anticipate the need for a platelet transfusion once the platelet count drops to a very low value.||Platelet replacement may be required to reduce the risk of bleeding. Premedication with antihistamine and antipyretics reduce transfusion reaction side effects.|
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