Anemia powerpoint: Seminar A

Why do problems arise from sickle shaped RBCs?

- Sickle-shape RBCs cannot pass through the smaller veins and capillaries of the circulatory system ◦This can cause a vaso-occlusive process to occur leading to ischemia of the area and potential infarction. Severe pain will likely occur as a result of decreased circulation to the area

what does therapeutic management of sickle cell anemia include?

- Therapeutic management for those with sickle cell anemia focuses on preventing a sickling crisis. - Preventing infection is also of huge importance as child with sickle cell anemia is at an increased risk for serious infections.

Additional tests to help differentiate the type of anemia

Ferritin Folate B12 Serum Iron TIBC (gold standard) Bone marrow biopsy (last resort)

When should infants be introduced to iron-fortified formula and iron-fortified cereals and why?

Fetal iron stores become depleted by 6 months of age, so, breastfed infants will need iron supplementation beginning at 4-5 months and breastfeeding mother should be encouraged to increase iron intake in her own diet

What is needed for proper blood formation?

◦Intact bone marrow ◦Function erythropoietin mechanism ◦Uncompromised DNA synthesis ◦Unimpaired hemoglobin synthesis if one of these areas fails, anemia can occur

what patient education should you give your patient on medications used to treat iron deficiency anemia?

◦When taking PO iron, taking it with milk or antacids may inhibit absorption(if they must, must be taken minimum of an hour before iron) ◦Iron taken with a source of Vitamin C (juice) promotes iron absorption ◦Parenteral (IV) medication usually only used if PO iron is unsatisfactory ◦Oral liquid iron should be given through a straw because it stains the teeth

MCHC

(Mean corpuscular hemoglobin concentration) - average concentration of Hgb inside a single RBC

MCH

(Mean corpuscular hemoglobin) - Average amount of Hgb inside a single RBC

MCV

(Mean corpuscular volume) - Average RBC size

what is sickle cells disease?

- A group of inherited hemoglobinopathies in which the RBCs do not carry the normal adult hemoglobin, but they carry a less effective type of hemoglobin (S) - Sickle Cell Anemia is the most common of this group of diseases - Most common in persons of African, Mediterranean, Middle Eastern, & Indian decent (1in 400 African Americans has sickle cell anemia!)

complication of Sickle Cell anemia

- Recurrent vaso-occlusive crises - Stroke - Sepsis - Acute chest syndrome - Splenic sequestration - Reduced visual acuity - Delayed growth & development - Delayed puberty

what is the most common type of anemia in the US?

- iron- deficiency anemia- Most common type of anemia in the US, especially in children, women, elders, or in those with inadequate iron intake It is a microcytic anemia (RBC's are smaller = MCV is low) - Inadequate iron suppy = smaller RBC's, decreased number of RBC's and decreased quantity of Hgb = decreased oxygen-carrying capacity of the blood

splenic sequestatration

- sickle cells have become trapped in the spleen. can be acute or chronic. acute can be life threatening -first thing to treat this patient is a blood transfusion because blood transfusion may push sickle cells out of spleen - if this does not work, patient has splenectomy

TIBC level

250

The nurse is preparing to teach a client with iron-deficiency anemia about the diet to follow after discharge. Which of the following foods should be included in the diet? A - Eggs B - Lettuce C - Citrus fruits D - Cheese

A - Eggs

Which of the following blood components is decreased in anemia? A - Erythrocytes B - Granulocytes C - Leukocytes D - Platelets

A - Erythrocytes

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? A - Hematocrit B - Partial thromboplastin time C - Hemoglobin concentration D - Prothrombin time

A - Hematocrit

The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? A - Eat animal protein and dark leafy vegetables each day B - Avoid exposure to others with acute infection C - Practice yoga and meditation to decrease stress and anxiety D - Get 8 hours of sleep at night and take naps during the day

B - Avoid exposure to others with acute infection

A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse's first response? A - Assess for potential abuse B - Check for diminished sensations C - Document the findings D - Clean and dress the area

B - Check for diminished sensations

A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? A - Little is known about iron-deficiency anemia and its relationship to infection in children B - Children with iron deficiency anemia are more susceptible to infection than are other children C - Children with iron deficiency anemia are less susceptible to infection than are other children D - Children with iron-deficient anemia are equally as susceptible to infection as are other children

B - Children with iron deficiency anemia are more susceptible to infection than are other children

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions? A - Infection B - Trauma C - Fluid Overload D - Stress

C - Fluid Overload

Which of the following symptoms is expected with hemoglobin of 10 g/dl? A - Shortness of Breath B - Pallor C - None D - Palpitations

C - None

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? A - Autoimmune reaction complicated by hypoxia B - Lack of oxygen in the RBCs C - Obstruction to circulation D - Elevated serum bilirubin concentration

C - Obstruction to circulation

A client with anemia may be tired due to a tissue deficiency of which of the following substances? A - Carbon dioxide B - Factor VIII C - Oxygen D - T-cell antibodies

C - Oxygen

Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vaso-occlusive sickle cell crisis? A - Ineffective coping related to the presence of a life-threatening disease B - Decreased cardiac output related to abnormal hemoglobin formation C - Pain related to tissue anoxia D - Excess fluid volume related to infection

C - Pain related to tissue anoxia

A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? A - "Take the medication with an antacid" B - "Take the medication with a glass of milk" C - "Take the medication with cereal" D - "Take the medication on an empty stomach"

D - "Take the medication on an empty stomach"

A mother asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate? A - "The placenta bars passage of the hemoglobin S from the mother to the fetus." B - "The red bone marrow does not begin to produce hemoglobin S until several months after birth." C - "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." D - "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

D - "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

Total Iron Binding Capacity (TIBC)

Golden standard for weather or not a patient has enough iron in their body

What is a lab to look at to assess for blood loss?

H&H

What are three major causes of anemia?

Inadequate production of erythrocytes Excessive destruction of erythrocytes Blood Loss (usually GI)

Prevention of vaso-occlusive events with sickle cell

Seek immediate attention for any febrile illness Obtain vaccinations on schedule Encourage adequate daily fluid intake Avoid extreme temperatures (too hot or too cold) Avoid overexertion or stress Have 24-hour access to your sickle cell medical provider/facility

what is the hallmark sign of hypo proliferative anemia?

a decreased reticulocyte count

infants should not be given cow's milk until what age and why?

after 12 months, causes GI bleeding

What can trigger sickling of cells?

any source of stress

Why would alcoholics be anemic?

because of poor nutrition

what can acute chest syndrome lead to

pulmonary embolism, may have fever, cough, or trouble breathing

what should the hematocrit be roughly compared to hemoglobin level

should be roughly 3 times the hemoglobin value

is aplastic anemia prone to infections

yes they are, and they have bone marrow damage

can you live without a spleen?

yes, but you are more prone to infection

signs and symptoms of iron-defieiciency anemia

•Growth retardation •Delayed sexual maturation •Decreased attention span •Irritability •PICA (wanting to eat paper, clay, etc.) •Low BP •Nail bed deformities •Systolic heart murmurs

what would cause chronic blood loss?

◦Excessive menstruation ◦Uterine fibroids ◦GI bleed (ulcers, intestinal infection, inflammatory conditions, cancer, etc.)

when do fetal iron stores become depleted?

6 months of age

Signs and symptoms of anemia

- Fatigue - Failure to grow in children - Pale, cool skin - Cold intolerance - Tachycardia - Orthostatic hypotension - Dyspnea - Decreased O2 saturation

medications used to treat iron-deficiency anemia

- Ferrous sulfate (Feosol, Slow Fe) - Iron dextran (parenteral medication)

Treatment of sickle cell Crisis

- Focus is on PAIN CONTROL! - Oxygen administration (to help with sickling) --Adequate hydration with IV Fluids (helps to decrease chance of more cells sickling) - Close monitoring of CBC to identify if transfusion is needed - drug of choice is morphine

dietary concerns with iron-deficiency anemia

- In adults, diet is rarely a cause of iron-deficiency anemia but contributes significantly in children. - Protein & Vitamin C help to produce new RBCs and folic acid helps to convert the iron from ferritin to hemoglobin, so a diet deficient in these areas can cause a problem with anemia.

More education for patient with iron-deficiency anemia

- Instruct patient to make sure they follow-up with routine lab work (CBC) - Rest when feeling fatigued - Let them know of the possibility that blood transfusion might be necessary at some point - Dietary teaching

A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease? A - Platelet count B - Hematocrit level C - Reticulocyte count D - Hemoglobin level

C - Reticulocyte count

what is the most common cause of microcytic anemia?

iron-deficiency anemia

A vegetarian client was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client: ◦A - Adds dried fruit to cereal and baked goods ◦B - Cooks tomato-based foods in iron pots ◦C - Drinks coffee or tea with meals ◦D - Adds vitamin C to all meals

◦C - Drinks coffee or tea with meals

What would cause acute blood loss?

◦Hemorrhage ◦Trauma