Anemia

medications for sickle cell disease

*Hydroxyurea: increases hemoglobin production which decreases the formation of sickled cells -Folic acid supplement -Antibiotics -Erythropoietin

Complications of sickle cell anemia

- Sickle cell crisis - Acute chest syndrome - Pulmonary Hypertension - Priapism - Stroke - Pneumonia

types of megaloblastic anemia

Folic acid deficiency Vitamin B12 deficiency

The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action?

Observe the client's stools and urine for blood

diagnostic test for pernicious anemia

Shilling test; pt given radioactive Vit B12; if not absorbed, will not show up in urine

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for?

Strict vegetarians are at risk for megaloblastic anemias, which are characterized by the presence of abnormally large, nucleated RBCs, if they do not supplement their diet with vitamin B12.

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition?

Takes over-the-counter iron supplements. When a client receives multiple transfusions and takes iron supplements, there may be a problem with iron overload.

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?

The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells.

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores?

There is a strong correlation between iron stores and hemoglobin levels

treatment for pernicious anemia

Vitamin B12 injections (IM)

What vitamin improves iron absorption?

Vitamin C (citrus juices/foods, strawberries, tomatoes, broccoli)

anemia

a deficiency of red blood cells

thrombocytosis

abnormally high platelet count

sickle cell crisis triggers

bleeding, infection, dehydration, fever, exposure to cold, stress

what decreases iron absorption?

dairy products and antacids

pancytopenia

deficiency of all types of blood cells

polycythemia

excess of red blood cells

signs and symptoms of anemia

fatigue, paleness, shortness of breath, anorexia

folate rich foods

green vegetables and liver

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?

hemoglobin S

what diagnostic test is performed to diagnose sickle cell disease in newborns?

hemoglobin electrophoresis

What triggers erythropoiesis?

hypoxia

reticulocytes

immature red blood cells

leukocytosis

increase in WBC

iron deficiency anemia

intake of dietary iron is inadequate for synthesis of hemoglobin

what is needed for B12 absorption?

intrinsic factor

most common type of anemia

iron deficiency

treatment for iron deficiency anemia

iron supplements (ferrous sulfate/gluconate) and dietary changes

what is needed for erythrocyte formation

iron, vitamin B12, folic acid, erythropoietin

pernicious anemia

lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream; no intrinsic factor

prevention of sickle cell crisis

-Drink at least 2 to 3 liters of liquids every day -Avoid high altitudes (planes) -Avoid strenuous activity -Avoid cold weather

vaccines essential for sickle cell disease patients

-Flu -Pneumococcal

oral iron supplements education

-best taken on empty stomach (1 hour before or 2 hours after meals) -stool will be dark in color or black -constipation may occur (eat foods high in fiber or take stool softener) -liquid iron preparations may stain teeth (drink through straw or place spoon in back of mouth; rinse mouth after)

signs and symptoms of sickle cell disease

-fatigue -pain -dehydration -weakness -jaundice -tachycardia

nursing priorities during sickle cell crisis

-hydration -pain management (warm compresses, NSAIDs/opioids, elevate affected joints) -rest -oxygen sat. monitoring

Types of Hypoproliferative Anemias

-iron deficiency anemia -megaloblastic anemia (low B12 and folic acid level) -aplastic anemia

daily Iron dietary intake

10-15 mg

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal).

lab values for iron deficiency anemia

Decreased Fe, hemoglobin, RBC, MCV

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?

Low ferritin level concentration

adverse effects of hydroxyurea

leukopenia, teratogenesis, Gi symptoms N/V

leukopenia

low WBC count

thrombocytopenia

low platelet count

food sources rich in iron

organ meats (liver), other meats, fish, poultry, beans, leafy green vegetables, raisins, molasses

What is sickle cell disease?

recessive disorder caused by inheritance of sickle hemoglobin gene; erythrocyte is rigid, sticky and sickle shaped

types of hemolytic anemia

sickle cell and thalassemia

what organ systems are most vulnerable to sickle cell disease thrombosis?

spleen, lungs, CNS

Where is intrinsic factor produced?

stomach

how long can it take to restore iron?

up to 1 year

risk factors for Vitamin B12/folic acid deficiency

vegan diet, Crohn's disease, gastrectomy, chronic antacid meds

Risks factors for Iron Deficiency Anemia

vegetarians, menstruation, pregnancy