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Anemia Heart Failure Talk (2005-11-02)

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Anemia Heart Failure Talk (2005-11-02)

  1. 1. Anemia Presented by Manny Ramos RN, MSN
  2. 2. Crossmatching game for RBC laboratory test values <ul><li>Reticulocytes </li></ul><ul><li>Hematocrit </li></ul><ul><li>MCV </li></ul><ul><li>MCHC </li></ul><ul><li>MCH </li></ul><ul><li>Crossmatch items from this column that correspond correctly to the definitions in the other column </li></ul><ul><li>Ave. volume of individual RBCs </li></ul><ul><li>Number of immature RBCs/mm3 blood </li></ul><ul><li># of circulating RBCs/mm3 blood </li></ul><ul><li>calculated ave. weight of Hg/RBC </li></ul><ul><li>Ave. concentration or % of Hg/RBC </li></ul><ul><li>Packed vol. of RBCs in 100ml blood </li></ul>
  3. 3. Pathophysiology <ul><li>Decreased RBC production </li></ul><ul><li>Iron deficiency </li></ul><ul><li>Folic acid deficiency </li></ul><ul><li>Aplastic anemia </li></ul><ul><li>Increased RBC loss or destruction </li></ul><ul><li>sickle cell anemia </li></ul><ul><li>blood loss </li></ul><ul><li>infection </li></ul>
  4. 4. Iron deficiency anemia <ul><li>Causes: </li></ul><ul><li>inadequate dietary iron intake </li></ul><ul><li>Malabsorption: gastrectomy, chronic diarrhea, celiac sprue </li></ul><ul><li>increased iron needs: pregnancy and lactation </li></ul><ul><li>chronic occult blood loss: bleeding ulcers, GI inflammation, hemorrhoids, cancer, chronic hemoglobinuria </li></ul><ul><li>Menstrual blood loss </li></ul>
  5. 5. Iron Deficiency anemia <ul><li>Diagnostics: </li></ul><ul><li>Iron levels </li></ul><ul><li>Total iron-binding capacity (TIBC) </li></ul><ul><li>Serum Ferritin </li></ul><ul><li>Medications: </li></ul><ul><li>Iron supplements, oral or parenteral </li></ul><ul><li>Vit. C </li></ul>
  6. 6. Vit. B12 deficiency anemia <ul><li>Causes: </li></ul><ul><li>Pernicious anemia: lack of intrinsic factor </li></ul><ul><li>ileal resections, loss of pancreatic secretions, chronic gastritis </li></ul><ul><li>Strict vegetarians </li></ul><ul><li>Diagnostics: </li></ul><ul><li>Schilling test </li></ul><ul><li>Medications: </li></ul><ul><li>Vit. B12 parenteral </li></ul>
  7. 7. Folic acid deficiency anemia <ul><li>Inadequate intake: </li></ul><ul><li>Chronically malnourished </li></ul><ul><li>Older adults </li></ul><ul><li>Alcoholics </li></ul><ul><li>Drug addicted persons </li></ul><ul><li>Increased need: </li></ul><ul><li>Pregnant women: neural tube defects in fetus </li></ul><ul><li>Persons experiencing rapid growth </li></ul><ul><li>Malabsorption disorders: Celiac sprue </li></ul><ul><li>Persons taking methotrexate and other chemotherapy </li></ul>
  8. 8. Sickle cell anemia <ul><li>Pathophysiology: </li></ul><ul><li>Autosomal recessive genetic defect </li></ul><ul><li>Hypoxemia: abnormal HbS deoxygenated </li></ul><ul><li>crescent or sickle shape RBC </li></ul><ul><li>Sickled cells clump together </li></ul><ul><li>weakened RBCs, hemolyzed </li></ul><ul><li>shortened RBC life span </li></ul>
  9. 9. Sickle cell anemia <ul><li>Sickle cell crises arise from: </li></ul><ul><li>Hypoxia </li></ul><ul><li>Low environmental or body temperature </li></ul><ul><li>Excessive exercise </li></ul><ul><li>Anesthesia </li></ul><ul><li>Dehydration </li></ul><ul><li>Infection </li></ul><ul><li>Acidosis </li></ul>
  10. 10. Sickle cell crises <ul><li>Manifestations: </li></ul><ul><li>pallor, fatigue, jaundice, irritability </li></ul><ul><li>Painful swelling hands and feet, large joints, priapism, abdominal pain, stroke </li></ul><ul><li>Aplastic anemia </li></ul><ul><li>Blood pools in liver and spleen </li></ul><ul><li>Diagnostics: Sickle cell test </li></ul>
  11. 11. Interventions <ul><li>H ydration </li></ul><ul><li>O xygen </li></ul><ul><li>R est </li></ul><ul><li>P ain management </li></ul><ul><li>Treat precipitating factors </li></ul><ul><li>Folic acid supplementation </li></ul><ul><li>Blood transfusions </li></ul><ul><li>Genetic counseling </li></ul>
  12. 12. Thalassemia <ul><li>Inherited disorder of hemoglobin synthesis </li></ul><ul><li>alpha or beta chains of hemoglobin are missing or defective </li></ul><ul><li>Manifestations: </li></ul><ul><li>Minor: asymptomatic; mild anemia, splenomegaly, bronze skin, bone marrow hyperplasia </li></ul><ul><li>Major: severe anemia, heart failure, liver and spleen enlargement; fractures of long bones, ribs, vertebrae </li></ul><ul><li>Diagnostics: Hemoglobin electrophoresis </li></ul>
  13. 13. Acquired hemolytic anemia <ul><li>Causes: </li></ul><ul><li>Mechanical trauma to RBC: prosthetic heart valves </li></ul><ul><li>Autoimmune disorders </li></ul><ul><li>Bacterial or protozoan infection </li></ul><ul><li>Immune system-mediated responses </li></ul><ul><li>drugs, toxins, chemical agents, venoms </li></ul><ul><li>Manifestations: </li></ul><ul><li>Anemia </li></ul><ul><li>splenomegaly, jaundice, pathologic fractures </li></ul>
  14. 14. Glucose -6-Phosphate Dehydrogenase (G6PD) Anemia <ul><li>Hereditary defect in RBC metabolism </li></ul><ul><li>Direct oxidation of hemoglobin damages RBC </li></ul><ul><li>occurs when person exposed to stressors: aspirin, sulfonamides, Vitamin K derivatives </li></ul><ul><li>Manifestations: pallor, jaundice, hemoglobinuria, elevated reticulocyte count </li></ul><ul><li>Diagnostics: quantitative assay of G6PD </li></ul>
  15. 15. Aplastic anemia <ul><li>Bone marrow failure: decreased RBC, WBC, platelets </li></ul><ul><li>Marrow replaced with fat </li></ul><ul><li>Causes: idiopathic </li></ul><ul><li>Viral infections </li></ul><ul><li>stem cell damage from radiation </li></ul><ul><li>Exposure to chemicals </li></ul><ul><li>Certain antibiotics (chloramphenicol) </li></ul><ul><li>Chemotherapeutic drugs </li></ul>
  16. 16. Aplastic anemia <ul><li>Manifestations: vary with onset and severity of pancytopenia </li></ul><ul><li>Pallor, fatigue, headache, exertional dyspnea, tachycardia, heart failure </li></ul><ul><li>Bleeding due to low platelet levels </li></ul><ul><li>Fever, increased infection risk due to low WBC </li></ul><ul><li>Diagnostics: bone marrow exam </li></ul>
  17. 17. Aplastic anemia <ul><li>Interventions: </li></ul><ul><li>Removal of causative agent </li></ul><ul><li>Blood transfusions </li></ul><ul><li>Bone marrow transplant </li></ul>
  18. 18. Assignment <ul><li>Identify 3 priority nursing diagnoses for anemia and formulate nursing care plan for anemia </li></ul>

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