Nursing Care and Pathophysiology for Anemia
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Outline
Pathophysiology: Anemia is when there is a low red blood cell (RBC) count. This is caused by blood loss, a decrease in red blood cell (RBC) production or increased RBC destruction.
Overview
- ↓ Amount of RBCs or hemoglobin in blood
- ↓ Capacity of blood to carry oxygen
Nursing Points
General
- Types
- Iron-Deficiency
- Inadequate iron supply – 60% of anemias
- Pernicious
- Vitamin B12 deficiency
- Lack of Intrinsic Factor
- Aplastic
- ↓ Production of all blood cells in the bone marrow
- Sickle Cell Anemia – see Sickle Cell Anemia Lesson
- Iron-Deficiency
Assessment
- Pallor
- Fatigue
- Weakness
- Tachycardia
- Hypotension
- Angina
- Dyspnea
- ↓ Hgb, Hct, RBC levels
- ↓ MCV, MCH, Iron, B12 levels
- Schilling test (for Pernicious anemia)
- Spoon-like nails
- Pica – craving non-food substances like ice, dirt, clay, starch.
Therapeutic Management
- Assess for occult blood
- Monitory laboratory studies (Hgb, Hct)
- Increase iron intake in diet
- Green leafy vegetables
- Organ meat
- Provide Iron or B12 supplements
- Administer IM via Z-track method
- Take PO Iron on an empty stomach
- Limit visitors to patients with aplastic anemia
- Will also have ↓ WBCs
Nursing Concepts
- Oxygenation
- May require supplemental oxygen
- Monitor s/s poor oxygenation
- Assess for dyspnea
- Perfusion
- Monitor vital signs
- Assess for chest pain
- Nutrition
- If caused by nutritional deficiencies – provide supplements as ordered
- Educate patient on food choices
Patient Education
- Increased intake of iron or B12 containing foods
- Medication instructions for iron or B12 supplements
- Possible Neutropenic or Thrombocytopenic precautions in Aplastic Anemia
- Energy conservation techniques
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Transcript
Hey guys, my name is Brad, and welcome to nursing.com. In today’s video, we’re going to be discussing anemia. We’re going to discuss some of the pathophysiology related to anemia, some of the different types, as well as how we’re going to treat our patients.
Without further ado. Let’s dive in.
So speaking about the pathophysiology of anemia, anemia is a loss of oxygen carrying cells. That’s what anemia is. And we will remember that our oxygen carrying cell is the red blood cell. Now, how is the red blood cell able to carry oxygen? Well, let’s remember. I like to divide the red blood cell up into four sections. And remember that every one red blood cell contains four hemoglobin molecules, right? That’s why I like to break it up into fours. There are four hemoglobin molecules. And you will remember that hemoglobin is what is directly responsible for binding to oxygen to then carry this fresh oxygen to all the rest of the tissues and organs of the body, as well as binding to carbon dioxide to carry this waste product away from our tissues and organs to then be exhaled by the lungs. So in anemia, we have an overall loss of red blood cells, of these oxygen carrying cells. And it’s also important to remember that, basically, we have production of these red blood cells, which is also called erythropoiesis. Let me write that. Gosh, maybe I shouldn’t have written it. Erythropoiesis is the actual production of red blood cells and it occurs, it begins, in the bone marrow. This is the actual site of red blood cell production. And it’s also important to note, I’d like to think about it like a factory, right? It’s a bone marrow factory that makes red blood cells, okay, called erythropoiesis. And there are several things that are responsible, or needed, to make a red blood cell, right? We have things such as folate. Folate, being responsible for making our hemoglobin molecules that make our oxygen carrying cell. Also things such as iron, or vitamin B12. Vitamin B12 and iron are actually parts of the erythropoiesis cascade responsible for making red blood cells and any breakdown in this factory, in this system of operation, to make a red blood cell will result in anemia.
So what are some of the common types of anemia, right? There are several, the first here is iron deficiency anemia. Remember we mentioned how dietary intake of iron is key to being a part of that cascade of the creation of red blood cells, right, erythropoiesis? If you don’t have iron, you reduce the amount of red blood cells that you can create. Therefore, leading to anemia.
Pernicious anemia. This is another type that is actually related to dietary intake. In this instance, it’s related to the intake of vitamin B12. And we will remember from our previous slide, just like with iron, if we don’t have enough vitamin B12, which is an important part of the creation of red blood cells, then we cannot create as many red blood cells.
You also have something called hemolytic anemia. Now this is in instances, such as sickle cell anemia, that we see over here, right? This is an actual destruction, or malformation, of red blood cells. So in sickle cell anemia, instead of having a nice globular red blood cell with four hemoglobin molecules, we actually have a more sickle-shaped red blood cell. So you can imagine that instead of having four nice hemoglobin molecules, the actual structural changes that occur within a sickle cell red blood cell, reduces the overall amount of oxygen that you can carry. This causes anemia.
You also have more rare types of anemia, something like aplastic anemia. Remember how we said that it all starts in the bone marrow erythropoiesis. Well, it actually all starts with these stem cells within the bone marrow itself. I know I’m not an artist, forgive me, but in instances, such as aplastic anemia, which can often be things like auto-immune related, we actually have a breakdown in the stem cells themselves, which results in decreased red blood cell production.
And then of course you have anemia from blood loss, right? Hemorrhagic shock, GI bleed, and overall loss of red blood cells out of the body.
So what are some common assessment findings? Well, you can imagine if you have a reduced amount of oxygen carrying capacity in those forms of those red blood cells, if you can not carry as much oxygen as you normally would, you’re going to feel tired. You’re going to feel weak, faint, dizzy, short of breath. All of these are commonly associated in patients who have anemia and who can not carry as much oxygen to the tissues and organs of the body. Very common. Tachycardia and hypotension, maybe in instances, such as a GI bleed or hemorrhagic volume loss, right? You’re losing blood, you’re losing volume. Your blood pressure is going to drop, hypotension, and your heart rate is going to increase in an attempt to compensate.
Jaundice of the eyes and skin is also common. Remember if we have anemia or maybe instances such as hemolytic anemia, where we have an actual destruction of these red blood cells, what gets released as a result is something called bilirubin. You may remember that that’s a side product of the destroyed red blood cell. Bilirubin in essence is a yellow pigmented molecule. And this yellow pigment molecule gets deposited in the eyes and in the skin. And it comes through in the form of jaundice. That’s what jaundice is. It’s excessive bilirubin in the body. Cold hands, cold feet, low red blood cells, hematocrit, hemoglobin levels. All of these lab values that are associated with anemia, right? Total red blood cells, hemoglobin, all are going to be decreased in patients with anemia. And also low iron, low B12 levels, in instances, such as iron deficiency or B12, pernicious anemia.
So how we’re going to treat our patient with anemia will depend on the type of anemia that they have, of course. In iron deficiency anemia, we’re going to give iron, in pernicious anemia, where we have a loss of B12, we’re going to give B12. Both of these are going to correct these types of anemias. And hemolytic anemia, such as sickle cell, we’re pretty much looking at symptom management. With blood loss related anemias, you’re looking at blood transfusions, right? We want to stop whatever the cause of the bleed is. And then we want to transfuse red blood cells that the patient has lost and needs. And in instances, such as aplastic anemia, remember that we have that disruption in the stem cells, in the bone marrow, you’re pretty much looking at a bone marrow transplant as the only real solution to this. Unfortunately, there’s not a great success rate with these. And, unfortunately, you do usually end up reverting to symptom management on these anemias as well.
Regarding patient education. Again, it’s going to be really dependent on the type of anemia that a patient has, but the overall goal is to make sure that we’re trying to increase the oxygen carrying capacity of these cells, right? Promoting the consumption of green leafy vegetables, things that are high in iron, things that are high in folate, possibly B12 or iron supplementation. And also important to make sure that we educate our patients who have aplastic anemia on the importance of neutropenia precautions. You know, not only is a patient having a decreased amount of erythropoiesis and production of red blood cells, but these patients are also usually immunocompromised and more susceptible to infection.
So to recap, some key points related to anemia, remember that in anemia, you lose your oxygen carrying cells. These are the red blood cells. Make sure that you’re familiar with the different common types of anemia, right? And what causes them: iron deficiency anemia, we don’t have enough iron; pernicious anemia, we don’t have enough vitamin B12, et cetera. Make sure that you’re familiar with the assessment findings that we’re also going to see in patients who have anemia. And remember that these all stem back from the fact that we have less red blood cells, less oxygen carrying capacity. Understand the different types of therapeutic managements that we’re going to give for patients with anemia. And also understand that they are geared specifically at the type of anemia that a patient has, as well as the patient education, which we just discussed.
Guys, that was anemia. I hope that that helps you understand the concept a little bit better, and I hope that it helps you come test time. Guys, go out there and be your best selves today. And as always, happy nursing.
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