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Hypovolemic Anemia (Blood Loss Anemia)
- Abnormally low circulating blood volume. Sudden reduction in total blood volume can lead to hypovolemic shock.
- S/S: weakness; stupor; irritability; pale, cool, and moist skin.
- subjective data: complains of thirst, weakness,irritability and restlessness.
- objective data: decreased BP, rapid, weak, and thready pulse; rapid resp. cold clammy skin w/ pallor.
- medical management: blood transfusion.
- nursing intervention: keep pt flat and warm. V/S should be taken frequently.
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Pernicious Anemia
(vit B-12 deficiency)
- metabolic defect: the absence of a glycoprotein intrinsic factor. Intrinsic factor essential for absorption of Vit B12
- manifestation: extreme weakness; skin color pale lemon-yellow. edema in the legs.
- subjective data: complaints of palpitations, nausea, flatulence, and indigestion. *soreness and burning in the tongue.
- objective data: a smooth and erythematous tongue.
- Diagnostic test: Schilling test. erythrocytes appear large and have abnormal shapes.
- medical management: vit b-12 injections, transfusion packed RBC. usu vit b-12 injections monthly for life.
- nursing interventions: V/S checked q 4hrs, special mouth care performed several times daily, diet high in protein, vits, minerals. warm blankets.
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Aplastic Anemia
(failure of normal process of cell generation and development)
congenital and acquired
- Congenital = 30% in childern is inherited.
- Acquired aplastic anemia r/t exposure viral invasion, meds, chemicals, radiation, or chemotherapy. 70% acquired is idiopathic.
- manifestations: weakness, general malaise, dyspnea, palpitations. petechiae, ecchymoses, bleeding gums, and epistaxis, GI bleeding.
- subjective data: hx of exposure to chemicals such as insecticides and drugs. hx of aplastic anemia
- objective data: pallor, signs of infection, bleeding tendencies. dyspnea and tachycardia.
- diagnostic tests: bone marrow study, increased yellow marrow.
- medical management: antineoplastic meds, radiation therapy, blood transfusion, bone marrow transplant, splenectomy
- nursing interventions: look for signs of bleeding, stool tobe monitored for occult blood. encourage activities on progressive basis.
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Iron Deficiency Anemia
- RBC's have a decreased levels of hemoglobin. excessive iron loss is usu cause. chronic intestinal and uterine bleeding. subtotal gastrectomy.
- manifestations: pallor, glossitis (inflammation of the tongue). fatigue, weakness, and shortness of breath. s/s of angina.
- subjective data: glossitis, pagophagia (desire to eat ice, clays, or starches. complaints of headaches, paresthesia, burning sensation of tongue.
- diagnostic tests: peripheral blood counts that show RBC and hemoglobin levels and hematocrit are decreased.
- medial management: iron salts such as ferrous sulfate. 900mg daily.
- interventions: foods high in iron include leafy green vegtables, organ meats, white beans, dried fruits, egg yolk.
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Sickle Cell Anemia
most common genetic disorder in US.
defective hemoglobin molecule.
1 in 500 African-Americans has sickle cell anemia
- abnormal, crescent-shaped RBC containing hemoglobin S which is a defective hemoglobin molecule.
- manifestation: pain brought on by events that cause dehydration or the oxygen tension in the body. abdominal enlargement due to pooling of blood.
- subjective data: sickling symptom is pain. aching of joints in hands and feet. deep, gnawing and throbbing pain.
- objective data: abdominal enlargement, jaundice, edema in extremities.
- diagnostic test: Hemoglobin S not Hemoglobin A. Low hemocratic and hemoglobin values.
- interventions: rest is encouraged, opioid analgesics are used to treat pain.
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Polycythemia (Erythrocytosis) excessive bone marrow production
polycythemia vera - erythrocytosis - abnormal increase in the number of circulating red blood cells.
myeloproliferative disorder with hyperplasia
secondary polycythemia generated by any source of hypoxia.
- increase in erythrocytes, granulocytes, and platelets. elevated WBC with basophilia. predisposes to infarctions of vital organs.
- manifestations: venous distention and platelet dysfunction cause esophageal varices, epistaxis, GI bleeding. Hepatomegaly and splenomegaly.
- subjective data: complaints of sensitivity to hot can cold. generalized pruritus r/t histamine release from increased # of basophils.
- objective data: eczema and dermatologic changes. skin may develop erythemic appearance. elevated BP accompanies left ventricular hypertrophy.
- diagnostic test: plasma and RBC volume are increased. Hypercellularity of RBCs, WBCs, and platelets.
- medical management: repeated phlebotomy decreases blood viscosity: removal of 500-2000 mL until hemocratic 45%-48%. reduce blood vol.
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Agranulocytosis
severe reduction in granulocytes
neutrophil count < 200/mm. Normal 3000-7000
WBC count is extremely low (leukopenia)
- suppression of the bone marrow reduces the number and production of white blood cells.
- manifestations: fever, chills, headache, and fatigue. ulcerations of mucuous mambranes are also found. bronchial pneumonia
- subjective data: complaints of fever, extreme fatigue, and prostration.
- objective data: erythema and pain from ulcerations.
- diagnostic test: leukocytes w/ neutrophils differential will be below normal.
- medical management: alleviate the factors responible for bone marrow depression. prevent or treat infection.
- intervention: protect against infection. meticulous hand washing by medical and nursing personnel and strict asepsis are mandatory. frequent oral hygiene.
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Leukemia
excess of leukocytes accumulates in the bone marrow and lymph nodes
ALL - acute lymphocytic leukemia
AML - acute myelogenous leukemia
CML - chronic myelogenous (granulocytic) leukemia
CLL - chronic lymphocytic leukemia
- manifestations: bone marrow overcrowding by abnormal cells. inadequate production of normal marrow elements.
- subjective data: pain in bones or joints is often noticed. fatigue, malaise, decreased activity tolerance, and irritability.
- objective data: infections are common. occult blood is detected. petechiae and ecchymoses.
- medical management: achieve remission or control the symptoms.
- intervention: thrombocytopenia-induced hemorrhage may be life threatening.
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Coagulation Disorders
- manifestation: petechiae and ecchymoses. epistaxis and gingival bleeding are common. circulatory hypovolemia. cool clammy skin. GI tracr bleeding.
- subjective data: hx of bleeding after surgical, dental procedures. exposure to toxic or hazardous agents. complaints of headache, extemity pain, and numbness.
- objective data: pain on pressure to the abdomen. occasionally hematoma.
- diagnostic test: platelet count will be low.
- medial management: underlying cause is assessed and corrected. transfusion may be ordered. heprin may be the cause.
- intervention: monitir vitals, watch for hypovolemic shock.
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Thrombocytopenia
number of platelets is fewer than 150,000 / mm
medical management: corticosteroid therapy
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