Anemia Chap 17 pg 346

Leukemia - Headache, disorientation, and other CNS symptoms

Abnormal white cells infiltrate the CNS

S/Sx sickle cell

Acute chest problem Make sure eating a diet to promote RBC growth and production hypoxia: LOC, pain Estemia - clumps of defective cells; Many RBC's sickle shaped. Need adequate fluid intake Dehydration very bad Avoid the cold - vasoconstriction

Implementation for anemia

Administer blood, iron, Vit B12 and folic acid Monitoring for desired effects Educating pts about needed dietary adjustments. (Know foods rich in Fe)

Hypovolemic shock

Amount of blood loss that leads to hypovolemic shock varies, depending on the ability of the pt's body to compensate for the lost fluid volume. 500ml loss may cause hypovolemic shock.

3 major classifications of anemia

Anemia resulting from blood loss Anemia resulting from a failure in blood cell production (lack of nutrients) Anemia associated with an excessive destruction of red cells ( some blood transfusions)

Severe anemia in GI

Anorexia, difficulty swallowing, glossitis, enlarged liver, enlarged spleen, smooth tongue

Aplastic anemia

Aplastic anemia is a condition in which the bone marrow does not make enough new blood cells.

Intervention

Based on understanding of kind of anemia affecting pt. Pt with anemias that interfere with clotting that tend to cause bleeding episodes, nursing actions are directed toward preventing the episodes. Pt with anemia severe enough to cause fatigue, assist with ADL and provide planned rest periods.

Aplastic anemia

Bone marrow, all blood cells decreased, bone biopsy;

Severe anemia in Musculoskeletal

Bone pain

Aplastic anemia

(Toxic drug, Toxic chemicals, Radiation)> damaged bone marrow> inability to produce adequate normal erythrocytes, leukocytes or platelets> anemia, neutropenia, and thrombocytopenia> infection, bleeding> death

Patho of iron deficiency anemia

(blood loss incr, RBC destruction incr, RBC production decr.) > oxygen carrying ability of blood decr. >tissue hypoxia> s/sx: pallor, fatigue, headache, dizziness, faintness

Leukemia

(means white blood but never enough to make blood white). There is an increase in the number of leukocytes, the number rarely rises above 500,000/mm3. These WBC are abnormal cells that do not function as normal WBC's do.

Leukemia - enlarged spleen, liver, and lymph nodes

Excess white cells accumulate within organs, causing distention of tissues.

Elder Care of anemia

Fe supplements should be taken 1 hr before or 2 hrs after meal - as long as no GI distress. (for old and young alike) elder may be taking other meds. Antacids and many other drugs interfere with iron absorption.

Iron SE

GI upset, constipation. Take with food and have more fluids

Look at anemia

If years of taking H2 antagonists (tines)? and proton pump inhibitor -ozol, look at possibility of source of anemia

Leukemia - Severe infections

Immature and abnormally functioning leukocytes, even though there is an increased number of them.

Sickle cell trait

In only about 50% on individual's total hemoglobin is affected

Fluid intake with PV

Increased fluid intake is essential to decrease blood viscosity and aspirin is used to decrease platelet clumping and clot formation.

Leukemia - Weakness, pallor and weight loss due to elevated metabolic rate

Increased production of white cells requires large amounts of amino acids and vitamins. Increased destruction of cells leads to more metabolic wastes that must be disposed of by the body.

Vit C

Iron is absorbed more readily if vit C is simultaneously present in the GI system. Take Fe with orange juice.

Antacids and Fe

Many antacids contain Al, Ca, Mg which may iterract with Fe.

Pernicious anemia

Megaloblasts, immature nucleated cells. Deficit of intrinsic factor due to immune reaction. Neurologic damage. Achlorhydria ( absence of hydrochloric acid in gastric secretions).

ecchymoses

Nonraised skin discoloration caused by the escape of blood into the tissues from ruptured blood vessels.

Aplastic anemia

Often normal cells. Pancytopenia ( shortage of all types of blood cells). Bone marrow damage or failure. Excessive bleeding and multiple infections.

Severe anemia in skin

Pallor of face and palms, pruritus, jaundice, pale nail beds, pale mucous membranes, stomatitis, brittle nails, cheilitis (inflammation of the lips).

Severe anemia in cardiovascular

Palpitations, tachycardia, angina, systolic murmur, widened pulse pressure, intermittent claudication, CHF, possible MI

Morphine for sickle cell anemia

Patient controlled analgesic pump

Top priority

Prevention of hemorrhage and infection. Psychological support of pt and family is important when they are faced with this life threatening condition. Safety measures are priorities. Weakness and fatigue.

Sickle cell anemia

RBC elongates and hardens in sickle shape when O2 levels are low - short life span. Recessive inheritance. Painful crises with multiple infarctions. Hyperbilirubinemia (too much bilirubin in the blood).

Hypovolemia (decreased volume of circulating blood)

Rapid severe bleeding leads to anemia from blood loss, hypovolemia and potentially shock. May be from severe trauma to the blood vessels and massive hemorrhage or the blood loss may be more gradual as from a small bleeding peptic ulcer that causes a chronic blood loss.

hemolytic anemia

Red cells are destroyed prematurely in the body. Can be the result of genetic defects that affect cell structure, causing cells to disintegrate quickly. E.g. thalassemia (inherited) whereas others are acquired when erythrocytes are exposed to poisonous agents or bacterial toxins. Blood transfusion may be indicated.

Leukemia - kidneys

Renal pain, urinary stones and obstruction to flow of urine, and urinary tract infection.Large amounts of URIC ACID are released when white cells are destroyed by antileukemic drugs

Sickle cell gene

Sickle cell inherited from both parents. Erythrocytes contain more S than A.

Severe anemia

Tachypnea and tachycardia may develop due to the decreased ability of the blood to transport sufficient O2 to the tissues.

Polycythemia Vera

Too many RBC's

Emergency situation of aplastic anemia - bone marrow not making enough new blood cells.

Treatment must eliminate any identifiable underlying causes. Packed red cells and platelets are administered. Antibiotics given for identified infection. O2 is sometimes administered to pt with low erythrocyte counts. Bone marrow transplant (BMT). for under 45 years. Must be an identical human leukocyte antigen match.

Pernicious anemia

Vit B12 ingested in food>stomach lacks intrinsic factor due to antibody reaction > No B12 absorption in ileum> Vit B12 excreted> lack of B12 causes bone marrow to produce abnormal erythrocytes that do not function normally> Anemia

Polycythemia Vera - WBC

WBC numbers also increase but not to the degree that they do in leukemia. Disease considered a neoplastic disorder. Sluggish blood flow makes blood tend to develop clots. Blood pressure is elevated and heart hypertrophies. Hemorrhage is in areas of distended blood vessels.

Expected Outcomes

Within 1 month, patient will be able to perform hygiene, dressing and grooming activities without needing to rest between activities. Within 2 months pt will be able to carry out usual daily act without shortness of breath or fatigue. Pt will eat 3 nutritious meals daily incl iron, folic acid vit C and protein Pt will verbalize understanding of dietary and med regimen within 1 week

elderly

about 20% incidence of anemia among the elderly, mostly due to poor nutrition

Pain

analgesic as ordered - for headache or joint pain. Monitor for side effects.

high in Folic acid

asparagus, beef, fish, cabbage, brussels sprouts, broccoli, legumes, liver, eggs, whole grains.

NI for sickle cell anemia

avoid high altitudes, vigorous exercise and iced liquids maintain adequate fluid intake refrain from smoking causes vasoconstriction treat infections promptly adequate rest adequate pain relief Monitor intake and output O2 Avoid alcohol and recreatioal drugs

implementation - anemia

based on particular kind of anemia affecting the pt. Anemia from blood loss presents problems different from those related to chronic and possible incurable - aplastic (bone marrow does not make enough new blood cells) or hemolytic (body does not have enough healthy red blood cells) anemia.

home treatment

bed rest, fluids and analgesics.

Foods high in iron

beef, liver, blackstrap molasses, chicken liver, cooked oatmeal, cooked prunes, cooked shrimp, dried apricots, egg yolks, kidney beans, lean beef, lima beans, whole grains, prune juice, raisins, spinach and green leafy veg, turkey.

Diagnosis of Aplastic Anemia

blood count with differential. Bone marrow biopsy to rule out other disorders.

Severe anemia in eyes

blurred vision blue colored sclera, yellowing of conjunctiva or pale conjunctiva, retinal hemorrhage.

aplastic anemia

bone marrow does not make enough new blood cells

human T-lymphotropic virus 1 (HTLV-1)

causes human T-cell leukemia.

Suppressed bone marrow

causes suppression of the production of all blood cells - RBC, WBC, leukocytes et. Blood thicker, clotting. Give fluid, aspirin.

Complications of sickle cell anemia

cholecystitis (inflammation of the gallbladder), stroke, congestive HF, damage to all major organs. Leg ulcers from impaired circulation. Protect feet as wound ulcers tend to become difficult to heal.

hypochromic, microcytic anemia

decreased levels of hemoglbin (not enough color) and small (micro) cells. This type of anemia is typical of an iron deficiency anemia.

Shock

does not take a large blood loss to go into shock

Phlebotomy

drain blood - safest treatment for Polycythemia Vera

S/sx of Fe deficiency anemia

ecchymosis, petechiae, hemorrhage related to low platelet count also occur. Infection is frequent and may not cause an inflammatory response because of the very low leukocyte count. Frequent bleeding in the mouth.

S/sx of anemias

from causes other than rapid bleeding depend on whether the anemia is mild, moderate or severe. Mild - headache, palpitations, dyspnea on exertion. Hb 9.5 to 13g/dL Moderate - Hb 6 - 10g/dL may be brittle nails, sore tongue, pallor, chronic fatigue, headache and dizziness or faintness.

S/SX of severe anemia

general eyes skin cardiovascular Respiratory Gastrointestinal Musculoskeletal Neurologic

Severe anemia in neurologic

headache, dizziness, impaired thinking, irritability, depression, fatigue

Only drug to treat sickle cell anemia

hydroxyurea (Hydrea); Sodium cromoglycate

Stem cells

impairment or failure of bone marrow function leading to the loss of STEM CELLS is the cause of aplastic anemia. With aplastic anemia the bone marrow has decreased cells and increased fatty tissue.

Exposure to ionizing radiation

in relatively large doses is one factor that may cause the development of leukemia. another is exposure to certain chemicals, such as benzene, that are toxi to bone marrow.

Leukemia - 3 major effects

increased umbers of abnormal immature leukocytes; accumulations of these cells within the lymph nodes, spleen, and other organs. Eventual infiltration of the malignant cells throughout the organs of the body.

Phlebitis

inflammation of a vein

Chronic Lymphocytic leukemia (From lymphatic system)

is common in men over 50 and accounts for 1/3 of new cases of leukemia.

Benzene

is in lead-free gasoline. Be careful about breathing gasoline fumes and using household chemicals and pesticides.

Chronic myelogenous leukemia (from bone marrow)

is most common in young and middle aged adults. This progressses to the acute form and eventual death is common.

Malignant production of WBC

is the actual cause of the disease. DNA become damaged.

-emia

less than

Spleen

makes blood that goes to all systems

Secondary polycythemia

may develop in response to prolonged hypoxia and increased erythropoietin secretion. Not the same effects as primary.

Shock in elderly

may develop with smaller blood loss in elderly because of decreased vascular tone and impaired cardiac function.

-ic

means having the quality of or characterized by

Iron deficiency anemia

microcytic, hypochromic. Decreased hemoglobin production. Decreased dietary intake, malabsorption, blood loss. Only effects of anemia

Leukemia

mycloid leukemia - bone marrow; lymphoid leukemia - lymphatic system

hemolytic

not enough good RBC's

Monitor drug SE

nurses responsibility to monitor blood studies carefully for all pts who are receiving any drug that is potentially damaging to the bone marrow.

Chronic leukemias

often asymptomatic. Detected during regular phyical checkup and routine CBC.

Evaluation

outcomes being met? lab values are important when evaluating anemia pt. Equally important are data showing that problems are being resolved.

Diagnosis of polycythemia vera

phlebotomy (the safest) antineoplastic agents and radiation therapy are all used. As much as 500ml is drawn off in phlebotomy every 2 - 3 months.

Check all drugs

pt is receiving, in order to determine whether drug interaction might interfere with iron absorption.

Leukemia - symptoms of anemia

rapidly proliferating white cells apparently CROWD OUT developing red cells and platelets

Aplastic anemia - bone marrow transplant

rare - develop after viral infection as a reaction to a drug, or inherited tendency. Characterized by bone marrow depression and is thought to probably be an immune-mediated disease. Red cells, white cells and platelet levels are decreased. The toxic effects of certain substances can be responsible for aplastic anemia e.g benzene, insecticides, drugs such as sulfonamides, anticonvulsants, gold compounds used to treat rheumatoid arthritis and alkylating agents or antimetabolites used in chemotherappy

Sickle cell clump

red cells clump together occluding small blood vessels. Attempt is made to mobilize the sickle cells and to prevent damage to major organs. Infection is treated with appropriate antibiotics.

S/SX polycythemia vera

reddish face, deep-red purplish lips, fatigue, weakness, dizziness, headahe, enlarged spleen (splenomegaly), and congestive liver. Minor injury may result in excessive bleeding.

-cyte

refers to cells - normocyte - normal cells (size)

-chrom

refers to color - normochromic anemia - cells that are normal in color.

normo-

refers to normal

Anemia caused by failure in cell production

result of either deficiency of certain substances necessary for the formation of RBC's or results from abnormal function of bone marrow.

CBC and differential cell count

results are used to diagnose the presence of anemia.

Severe Anemia in general

sensitivity to cold, lethargy, weight loss

Chronic leukemia

slower disease progression. longer survival time.

Severe anemia in respiratory

tachypnea, orthopnea (breathlessness in the recumbent position), dyspnea at rest

Acute Leukemia

there is sudden, rapid growth of immature blast or stem cells, rapid progression of the disease, and a short survival if the disease is not treated.

pernicious anemia (study drugs cards)

treated by regular injections of B12 or by weekly use of intranasal form of cyanocobalamin (Nasobal) as the deficiency intrinsic factor prevents adequate absorption of this vitamin from food.

serious anemia

treated with blood transfusions, or iron supplementation IV, with iron dextran (Imferon), sodium ferrous gluconate, or iron sucrose.

normocytic and normochromic anemia

usually occurs as a result of sudden blood loss.

antigens

6 antigens - need to find match for in blood match for transfusions. Risk for infection and anemia