Anemia

ARRANGED BY:
Mishael Immanuel Dae Pany (2014.03.010)
Firman Syalasah (2014.03.006)

NURSING ACADEMY OF WILLIAM BOOTH

SURABAYA
2014

Definition Anaemia
is a condition in which the number of red blood cells or their oxygen-carrying
capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking,
and pregnancy status.
There are several types and classifications of anaemia. This is a condition in which the body
lacks the amount of red blood cells to keep up with the body's demand for oxygen.

Symptoms of Anemia
According to John Hopkins Point-of-Care Information Technology Center, (The John
Hokins POC-IT Center), the most common causes of anemia include:

dizziness,

weakness and fatigue,

shortness of breath with activity,

dizziness,

occasional chest pains, and

cold, clammy skin.

Types of Anemia

Different types of anemia have different causes and symptoms.

Iron Deficiency Anemia: Iron deficiency is one of the most common causes of anemia,
especially in women. In the U.S. alone, twenty million women suffer from iron deficiency
anemia. Iron deficiency causes insufficient hemoglobin production which, in turn, causes
anemia and anemia symptoms.

Sickle Cell Anemia:

Sickle cell anemia, or sickle cell disease, is one of the hereditary causes of anemia.
Most often seen in people of African descent, sickle cell anemia is characterized by the
production of rigid, sickle-shaped red blood cells. These abnormal sickle cells break down
faster then normal red blood cells, resulting in a chronic shortage of red blood cells and
anemia symptoms.
Sickle cell anemia is a form of hemolytic anemia, which describes types of anemia caused by
the rapid destruction of red blood cells.
Pernicious Anemia:
Certain types of anemia are referred to as megaloblastic, or vitamin deficiency
anemia. Pernicious anemia is caused by an inability of the intestines to absorb sufficient
amounts of vitamin B12, which is required in the production of red blood cells.
Pernicious anemia symptoms include vision problems, memory loss, difficulty walking and
numb hands and feet, as well as the more common anemia symptoms.
Risk factors for pernicious anemia include a family history of pernicious anemia,
Scandinavian or European ancestry or a history of autoimmune endocrine disorders.
Vitamin B12 injections are the standard pernicious anemia treatment. Oral vitamin B12
supplements may also be used as pernicious anemia treatment, but theyre not as efficient as
B12 injections.
Folic Acid Deficiency Anemia:
Folic acid deficiency anemia, like pernicious anemia, is a megaloblastic anemia.
Folic acid is essential for healthy blood and a healthy nervous system. A folic acid deficiency
during pregnancy can cause birth defects.
Folic acid supplements form the basis of folic acid anemia treatment. Anemia treatment also
includes eating a diet high in folic acid, including such foods as:

beans and legumes

citrus fruits and juices

dark green leafy vegetables

pork

poultry

shellfish

wheat bran

Thalassemia:
Causes of anemia often include genetic mutations. Thalassemia is one of the
genetically inherited types of anemia. Thalassemia occurs when the bodys genes, which are
responsible for proper hemoglobin production, become damaged or mutated. Like sickle cell
anemia, thalassemia is one of the hemolytic anemia types.
Many possible gene variations can cause thalassemia, and the disease has both mild and
severe varieties. Cooleys anemia is the most common severe thalassemia in the U.S. The
disease tends to be present at birth and its symptoms include:

dark colored urine

deformed facial bones

fatigue

jaundice

poor growth rates

a swollen abdomen caused by an enlarged spleen and liver

weakness

A number of ethnic groups are at higher risk of developing thalassemia, including people of
African, Chinese, Filipino, Indian, Italian, Greek and Middle Eastern ethnicity.
Treatment for thalassemia depends on the severity of the disease. Mild types of thalassemia
may be treated with regular blood transfusions. Severe cases require multiple blood
transfusions, iron chelation therapy to remove excess iron from the blood and bone marrow
transplants. Without treatment, severe thalassemia often proves fatal in early childhood.
Aplastic Anemia: Aplastic anemia is one of the rarer types of anemia, occurring when the
body makes insufficient red and white blood cells. Causes of aplastic anemia include:

radiation therapy

chemotherapy

toxic chemicals

some medications

bone marrow infections

Causes of Anemia
Except for the acute form, anemia is a result of systemic toxemia and acidosis-a
condition of poisons, toxins and accumulated waste products floating in the blood - and
lymph-streams, and of enervation or lowered nerve-tone. There is either an accumulation of
these injurious substances due to failure of eliminative organs to handle a normal amount of
such products, or they are produced in such considerable quantities that even normal organs,
eliminating a normal amount or more than a normal amount of eliminations can not remove
them rapidly enough. They have the effect of poisoning the organs that make the blood cells,
which produce a deficient amount of blood cells or altered blood cells.

The signs and symptoms of this disease are:

1. Paleness
2. Headache
3. Irritability
Symptoms of more severe iron deficiency anaemia include:
1. Dyspnea
2. Rapid heartbeat
3. Brittle hair and nailsThere are several causes of anemia, which include:

Iron deficiency

Kidney disease

Pregnancy

Poor nutrition

Deficiency of vitamin B12 known as pernicious anemia

Sickle cell anemia

Thalassemia

Alcohol

Bone marrow related anemia

Aplastic anemia

Hemolytic anemia

Active bleeding, eg. heavy bleeding during menstration.

Treatments of Anemia

Once the doctor determines the cause he or she will initiate a treatment program for
you. Here are some causes along with their treatment protocol. Blood Loss: the source of the
bleeding will be determined and stopped. For example you may be given a blood transfusion
and iron to build up your red blood cell count. Iron Deficiency: If you have inadequate iron
levels you most likely will be prescribed iron supplements.
Do not do this on your own but under the care of a physician because consuming too much
iron can be dangerous. Red blood cell destruction: Known as hemolytic anemia, there are
various causes for it. So the treatment would of course depend on the cause. Follow up care:
You need to stay under your doctor's care and have repeated blood work done to determine if
the anemia has gone away. Your response to the treatments prescribed will determine what
the next steps are to take. The hopeful outcome is that you have overcome your anemia.
If not, with continued care over time you should be able to do so. Before doing any dietary or
lifestyle changes always consult with your health care provider, particularly if you have been
diagnosed with a disease or are taking any prescription medication.

Exams and Test

diagnose anemia based on your medical and family histories, a physical exam, and
results from tests and procedures.
Because anemia doesn't always cause symptoms, your doctor may find out you have it while
checking for another condition.

A.Medical and Family Histories

Your doctor may ask whether you have any of the common signs or symptoms of
anemia. He or she also may ask whether you've had an illness or condition that could cause
anemia.
You also may be asked about the medicines you take, your diet, and whether you have family
members who have anemia or a history of it.

B.Physical Exam
Your doctor will do a physical exam to find out how severe your anemia is and to check
for possible causes. He or she may:

Listen to your heart for a rapid or irregular heartbeat

Listen to your lungs for rapid or uneven breathing

Feel your abdomen to check the size of your liver and spleen

Your doctor also may do a pelvic or rectal exam to check for common sources of blood loss.

Diagnostic Tests and Procedures

You may have various blood tests and other tests or procedures to find out what type
of anemia you have and how severe it is.
Complete Blood Count

Often, the first test used to diagnose anemia is a complete blood count (CBC). The
CBC measures many parts of your blood.
The test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is
the iron-rich protein in red blood cells that carries oxygen to the body. Hematocrit is a
measure of how much space red blood cells take up in your blood. A low level of hemoglobin
or hematocrit is a sign of anemia.
The normal range of these levels may be lower in certain racial and ethnic populations. Your
doctor can explain your test results to you.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your
blood. Abnormal results may be a sign of anemia, another blood disorder, an infection, or
another condition.
Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a
measure of the average size of your red blood cells and a clue as to the cause of your anemia.
In iron-deficiency anemia, for example, red blood cells usually are smaller than normal.

Prevention
Many types of anemia can't be prevented. However, you can help avoid iron deficiency
anemia and vitamin deficiency anemias by choosing a diet that includes a variety of vitamins
and nutrients, including:

Iron. Iron-rich foods include beef and other meats, beans, lentils, iron-fortified
cereals, dark green leafy vegetables, and dried fruit.

Folate. This nutrient, and its synthetic form folic acid, can be found in citrus fruits
and juices, bananas, dark green leafy vegetables, legumes and fortified breads,
cereals, and pasta.

Vitamin B-12. This vitamin is found naturally in meat and dairy products. It's also
added to some cereals and soy products, such as soy milk.

Vitamin C. Foods containing vitamin C such as citrus fruits, melons and berries
help increase iron absorption.

Nursing diagnosis for Anemia

Activity Intolerance related to Imbalance between oxygen supply or delivery and

demand

Impaired oral mucous membrane

Imbalanced Nutrition: Less than Body Requirements related to Failure to ingest or

inability to digest food or absorb nutrients necessary for formation of normal RBCs

Constipation/Diarrhea related to Decreased dietary intake, changes in digestive

processes Drug therapy side effects

Risk for Infection Inadequate secondary defensesdecreased Hgb, leukopenia, or

decreased granulocytes (suppressed inflammatory response) Inadequate primary

defensesbroken skin, stasis of body fluids, invasive procedures, chronic disease,

malnutrition

Risk for deficient fluid volume

Deficient Knowledge regarding condition, prognosis, treatment, self-care, prevention

of crisis, and discharge needs related to Lack of exposure, recall Information
misinterpretation Unfamiliarity with information resource

Fatigue

Fear

Ineffective coping

Ineffective thermoregulation

Nursing Care Plans for Anemia

Anemia are a group of blood disorders characterized by too little hemoglobin in the
blood. Hemoglobin is a substance contained in red blood cells that carries oxygen from the
lungs to other body tissues. Anemia is often a sign or symptom of an underlying disease
rather than a disease in its own right. There are three tests commonly used to detect anemia:
the number of red blood cells can be counted; the amount of hemoglobin in the red blood
cells can be measured; or the proportion of blood cells to serum (the liquid part of blood,
called the hematocrit) can be assessed.
Common nursing diagnosis found in Nursing care plans for anemia
Activity Intolerance, Impaired oral mucous membrane, Imbalanced Nutrition: Less
than Body Requirements, Constipation/Diarrhea, Risk for Infection, Risk for deficient fluid
volume, Deficient Knowledge regarding condition, prognosis, treatment, self-care, prevention
of crisis, and discharge needs, Fatigue, Fear, Ineffective coping, Ineffective thermoregulation.
Nursing care plans for anemia

NURSING

INTERVENTIONS

RATIONALE

DIAGNOSIS
Activity
Intolerance

EVALUATION
Report an increase in

Assess patient

Influences choice of

activity tolerance,

related to

ability to perform

interventions and

including

Imbalance

ADLs

needed assistance.

ADLs.Demonstrate a

between oxygen
supply or delivery

and demand

Monitor vital sign

Cardiopulmonary

(Blood Pressure,

manifestations result

pulse, and

from attempts by the

respirations)

heart and lungs to

during and after

supply adequate

activity

amounts of oxygen to
the tissues.

Suggest client
change position

Postural hypotension

slowly; monitor

or cerebral hypoxia

for dizziness.

may cause dizziness,

fainting, and increased

Provide or

risk of injury.

recommend
assistance with

Although help may be

activities and

necessary, self-esteem

ambulation as

is enhanced when

necessary,

client does some

allowing client to

things for self.

be an active
participant as

Encourages client to
do as much as

much as possible.

possible, while

Identify and

conserving limited

implement energy-

energy and preventing

saving techniques

fatigue.

Instruct client to

Cellular ischemia

decrease in
physiological signs
of intolerance pulse,
respirations, and BP
remain within
clients normal
range.
Display laboratory
values (Hgb/Hct)
within acceptable r

stop activity if

potentiates risk of

palpitations, chest

infarction, and

pain, shortness of

excessive

breath, weakness,

cardiopulmonary

or dizziness occur

strain and stress may

lead to

Collaborative

decompensation and
failure

Monitor laboratory
studies, such as

Hgb/Hct, RBC

in RBC components

count, and arterial

affecting oxygen

blood gases

transport, treatment

(ABGs).

needs, and response to

therapy.

Provide
supplemental

oxygen as

improves ability to
function

Administer the
following, as

indicated: Whole

corrects deficiencies

RBCs (PRCs);

to reduce risk of

blood products as

hemorrhage in acutely

indicated.

reactions.

compromised
individuals.

Monitor closely
for transfusion

Prepare for
surgical

Increases number of
oxygen-carrying cells;

blood, packed

Maximizing oxygen
transport to tissues

indicated.

Identifies deficiencies

Surgery is useful to
control bleeding in
clients who are
anemic because of
bleeding, such as in

intervention, if

ulcers and uterine

indicated.

bleeding; or to remove
spleen as treatment of
autoimmune
hemolytic anemia.
Bone marrow and
stem cell
transplantation may
be done in presence of
bone marrow failure
aplastic anemia.