Anemia - Nursing Care Plan

Anemia Definition

Anemia is characterized by levels of hemoglobin (Hb) and red blood cells (erythrocytes) is lower than normal. If the hemoglobin level is less than 14 g / dl and erythrocyte less than 41 % in men, then a man is said to be anemic. Similarly in women, women with hemoglobin levels less than 12 g / dl and erythrocyte less than 37 %, then the woman was said to be anemic. Anemia is not a disease, but rather a reflection of the state of a disease or disorder caused by the body's functions. Physiologically anemia occurs when there is a shortage of hemoglobin to carry oxygen to the tissues.

Anemia was defined as a decrease in the volume of red blood cells or hemoglobin level to below the range of accepted values ​​for healthy people. Anemia is a symptom of an underlying condition, such as loss of blood components, elements inadequate or lack of nutrients needed for the formation of blood cells, resulting in decreased oxygen-carrying capacity of the blood, and there are many types of anemia with different causes.

Etiology

1. Hemolysis (erythrocytes easily broken).
2. Bleeding.
3. Bone marrow suppression (eg by cancer).
4. Nutrient deficiency (nutritional anemia), including iron deficiency, folic acid, pyridoxine, vitamin C and copper.

According to various sources the causes of anemia include:

1. Less consumption of foods containing iron, vitamin B12, folic acid, vitamin C, and the elements necessary for the formation of red blood cells.
2. Excessive menstrual blood. Women who are menstruating prone to iron deficiency anemia when much menstrual blood and not enough iron stores.
3. Pregnancy. Pregnant women are prone to anemia because the fetus to absorb iron and vitamins for growth.
4. Certain diseases. Diseases that cause continuous bleeding in the digestive tract such as gastritis and appendicitis can lead to anemia.
5. Certain drugs. Several types of medications can cause stomach bleeding (aspirin, anti- inflammatory, etc.). Other drugs can cause problems in the absorption of iron and vitamins (antacids, birth control pills, antiarthritis, etc.).
6. Retrieval operation of part or all of the stomach (gastrectomy). It can cause anemia because the body absorbs less iron and vitamin B12.
7. Chronic inflammatory diseases such as lupus, rheumatoid arthritis, kidney disease, thyroid gland problems, some types of cancer and other diseases can cause anemia because they affect the process of the formation of red blood cells.
8. In children, anemia can occur due to hookworm infection, malaria, or dysentery that caused a severe shortage of blood.

Pathophysiology

The presence of an anemia marrow reflects the existence of a failure or loss of red blood cells or both. Marrow failure (for example, reduced erythropoiesis) can occur as a result of nutritional deficiencies, toxic exposure , tumor invasion or other unknown causes.

Red blood cells can be lost through bleeding or hemolysis (destruction).
Red blood cell lysis (dissolution) occurs primarily in phagocytic cells or in the reticuloendothelial system, mainly in the liver and spleen. Byproducts of this process is bilirubin that would enter the bloodstream. Any increase in red blood cell destruction (hemolysis) immediately reflected by an increase in plasma bilirubin (normal concentration of ≤ 1 mg / dl, levels above 1.5 mg / dl result in jaundice in the sclera).

If the destruction of red blood cells in the circulation experience, (in hemolytic disorders) then it will appear in the plasma hemoglobin (hemoglobinemia). If the plasma concentration exceeds the capacity of plasma haptoglobin ( protein binding to free hemoglobin ) to bind everything, hemoglobin diffuses in the renal glomerulus and into the urine (hemoglobinuria).

Conclusions about whether an anemia in patients caused by destruction of red blood cells or red blood cell production is not sufficient usually be obtained on the basis of : 1 . reticulocyte count in the blood circulation ; 2 degree of the proliferation of young red blood cells in the bone marrow and maturation ways, as seen in the biopsy ; and presence or absence of hyperbilirubinemia and hemoglobinemia.


Signs and Symptoms

1. Weak, tired, lethargic and tired.
2. Often complain of headache and dizziness.
3. Further symptoms such as eyelids, lips, tongue, skin and palms became pale. Pale because of lack of blood volume and hemoglobin, vasoconstriction.
4. Tachycardia and heart murmur (an increase in blood flow velocity) Angina (chest pain).
5. Dyspnea, shortness of breath, tired quickly when activity (reduced O2 delivery).
6. Headache, weakness, tinnitus (ringing in the ears) illustrates the reduced oxygenation of the CNS
7. Severe anemia GI disorders, and CHF (anorexia, nausea, constipation or diarrhea).

Complication 

• Heart failure.
• Seizures.
• Poor muscle development (long-term).
• Concentration decreases.
• The ability to process information that is heard decrease.

Test

• Hemoglobin concentration, hematocrit, red blood cell indices, white blood cell studies, the levels of Fe, iron binding capacity measurement, folate, vitamin B12, platelet count, bleeding time, prothrombin time, and partial thromboplastin time.
• Bone marrow aspiration and biopsy. Unsaturated iron - binding capacity of serum.
• Diagnostic assay to determine the presence of acute and chronic diseases as well as the source of chronic blood loss.

Nursing Care Plan for Anemia

Nursing Diagnosis for Anemia

1. Ineffective Cerebral Tissue Perfusion related to changes in the oxygen bond with hemoglobin, decrease in hemoglobin concentration in the blood.
2. Imbalance nutrition less than body requirements related to inadequate food intake .
3. Self-care deficit related to weakness
4. Risk for infection related to inadequate secondary defenses (decreased hemoglobin )
5. Activity intolerance related to imbalance between supply and demand of oxygen .
6. Impaired gas exchange related to ventilation perfusion .
7. Ineffectivene breathing pattern related to fatigue .
8. Fatigue related to anemia .