Anemia for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
Anemia
Definition/Etiology:
- Definition
- ↓RBCs or ↓ Hemoglobin
- Women <12 & Men < 14
- Clinically = Hgb below 7 g/dL
- symptomatic
- Etiology
- Inadequate RBC production
- Iron deficiency, folate and vitamin B12 deficiency
- Chronic Kidney Disease
- Cancers
- Increased RBC destruction
- Transfusion reaction
- Sickle Cell Disease
- Enlarged Spleen
- Acute Blood loss
- Gi Bleeds
- Surgeries
- Trauma
- Inadequate RBC production
Pathophysiology:
- No matter what the cause we have the same results. Our organs are suffocating.
- The body responses to anemia by s increasing cardiac output and respiratory rate, redistribution of blood to sustain blood supply to the brain and heart through a reduction in blood supply to the skin, bowels, and kidneys, and increasing the kidney’s production of erythropoietin to stimulate erythropoiesis.
- Think of this as “cause and effect” response of the body. It opts to “sacrifice” the blood distribution to less vital places.
Noticing: Assessment & Recognizing Cues:
- Subjective
- Fatigue
- SOB/Activity intolerance
- Headache
- MS Changes (Severe)
- Objective
- Vitals
- ↑HR, ↓BP, ↓ 02 sat (late)
- Orthostatic → syncope
- Less they tolerate = worse they are
- Skin
- Pale? Cool? Jaundiced?
- Hepatosplenomegaly
- Usually seen in hemolytic anemia from destruction of RBCs and slow flow of liver
- Vitals
Interpreting: Analyzing & Planning:
- Labs – Transfuse + Cause
- Hemoglobin (12 & 14)
- Under 7 = transfuse
- Iron & Ferritin & folate
- Iron or B12 deficiency
- Urine & Stool
- Bleed somewhere?
- Hemoglobin (12 & 14)
- Diagnostics – Not as urgent and sometimes deferred to specialists so anticipate consults
- GI studies
- Bone Marrow Biopsy
Responding: Patient Interventions & Taking Action:
- ABCs & Underlying Cause
- 02 <92%
- Elevate HOB
- Pharmacology
- TRANSFUSION –
- Don’t forget consent
- Leukocyte depleted blood for immunosuppressed or frequent like sickle cell disease (Self vs non-self)
- Blood builders like Procrit (JW patients especially)
- TRANSFUSION –
- Nonpharmacological
- Frequent vitals
- Adjunct medical therapy
- hematologists
Reflecting: Evaluating Patient Outcomes:
- Monitor for Reaction (check your protocol)
- Febrile – Fever rise of 1 Degree C
- Allergic – Hives itching rash, wheezing →anaphylaxis
- Hemolytic – ↓BP, CP, Flank Pain, Shock/DIC
- Bacterial – High Fever & kidney involvement
- TACO (Transfusion-associated circulatory overload) – Signs/Sx Heart Failure
- Treatment pretty similar
- Always stop transfusion – blood back to lab
- Start NS (except TACO)
- Then look at symptoms
- Fever = Tylenol
- Allergy = IV Benadryl
- Shock = Pressors + ICU
- Infection – IV ABX
- Overload = Diuretics
Linchpins (Key Points):
- Notice
- Signs/Sx of Anemia and connect Etiology
- Interpret
- Labs FIRST
- Other diagnostics help with CAUSE.
- Example Hgb = transfusion
- Labs FIRST
- Respond
- Transfusion
- Look for questions asking about consent or what to do with blood if a patient has a reaction.
- Transfusion
- Reflect
- Patient tolerating?
- Fever? Chills? Wheezing? Flank Pain? Heart Failure? Shock? DIC?
- Notice these just get worse.
- Stay on top of vitals and lung sounds.
- Patient tolerating?
Transcript
References
- AACN, and Tonja Hartjes. AACN Core Curriculum for Progressive and Critical Care Nursing. Available from: Pageburstls, (8th Edition). Elsevier Health Sciences
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2020). Ace The Pccn! you can do it!: Study guide. Nicole Kupchik Consulting, Inc.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
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- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
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- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
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- Disorders of the Adrenal Gland
- Behavior
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- Preoperative Nursing
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- Legal and Ethical Issues
- Communication
- Understanding Society
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- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
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- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
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- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
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- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
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- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
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- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
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- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
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- Renal and Urinary Disorders
- Developmental Theories
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- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
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- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System