Mrs. Onyango presented to the hospital with chest pains, leg swelling, fatigue, shortness of breath, and dizziness. Tests found her hemoglobin level to be very low at 3.9g/dl, indicating severe anemia. She is currently receiving medications to treat the anemia, including iron supplements, and awaiting a blood transfusion.

1. • Mrs. Onyango was well until early February 2022 when she started feeling
bilateral chest pains and went to Ekwendeni mission hospital where she was
treated as an outpatient. At that time she was given Amoxicillin,
Paracetamol and Metronidazole. Later on she saw her left leg swelling,
fatigue, shortness of breaths and dizziness and she went back to Ekwendeni
mission hospital where she was referred to Mzuzu central hospital to
investigate the main cause of the clinical manifestations.

2. • At Mzuzu central hospital, upon checking the full blood count, it was
found that hemoglobin level was 3.9g/dl . The patient was given
Albendazole 400mg stat P.O. and she is currently on Paracetamol 1g 8
P.O., Ferrous sulphate 200mg 8hourly P.O. and is awaiting for blood
transfusion.

3. Presented by Panesi white
TO 2021 INTAKE NMT

4. BROAD OBJECTIVES
• By the end of the presentation, students should be able to gain
knowledge, attitude and skills in the management of Anemia

5. SPECIFIC OBJECTIVES
1. After questions and answers, learners must be able to define anemia
2. After pair work, learners must be able to classify anemia
3. Given any anemia related poster, learners should be able to describe
the pathophysiology of anemia
4. Provided with a case study, learners must be able to predict clinical
manifestations of anemia
5. Given any case study, learners should be able to develop nursing
care plan of a patient with anemia
6. After group discussion session, learner must be able to describe
medical management of a patient with anemia

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7. With the use of a case study, learners should be able to analyze some
of the complication of anemia

7. Introduction
• One of the function of red blood cells is transport oxygen and carbon
dioxide in and out of the body.
• Red blood cells contain a red pigment known as hemoglobin. Oxygen
binds to hemoglobin, and is transported around the body in that way.

8. RED BLOOD CELL

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• Anemia is not a specific disease state but a sign of an underlying disorder
• Anemia( An-without, emia-blood) is a decrease in the erythrocytes(red
blood cells) count, hemoglobin and or/ the volume of packed RBCs(
Hematocrit) resulting in a lower ability for the blood to carry oxygen to
body tissues.

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• It is a prevalent condition with many diverse causes such as blood
loss, impaired production of the erythrocytes, or increased destruction
of erythrocytes.
• Since RBCs transport oxygen, erythrocyte disorders can lead to tissue
hypoxia

13. PATHOPHYSIOLOGY OF ANEMIA

14. Production of Erythrocytes: Erythropoiesis
Figure 18.5

15. PATHOPHYSIOLOGY
• Stimulus: Hypoxia due to decreased RBC count, decreased
availability of oxygen to blood or increased tissue demanding for
oxygen
• This will cause the Kidney release hormone called erythropoietin
• The Erythropoietin stimulate red bone marrow to enhanced
erythropoiesis which leads to more red blood cells which will
eventually result in increased oxygen carrying ability of blood leading
to normal blood oxygen levels

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• In anemia; there is a decrease in RBCs, Hb or Hct level which leads to
diminished oxygen carrying capacity causing tissue hypoxia.

17. CAUSES OF ANAEMIA
1. DECREASED RBCs PRODUCTION
i. Deficient nutrients e.g. Iron and Folid acid
ii. Decreased erythropoietin
iii. Decreased iron availability
2. Blood loss
i. GI bleeding
ii. Acute trauma
iii. Rupture aortic aneurysm

18. 3. Increased RBCs destruction
A. Hemolytic
i. Medication e.g. methyldopa
ii. Sickle cell disease
iii. Incompatible blood

19. CLASSIFICATION OF ANEMIA
• Various types of anemia can be classified;
1. Morphology (cellular characteristics)
2. Etiology( cause)

20. • Morphologic classification is based on the erythrocyte size and color
• Etiologic classification is based related to the clinical conditions
causing anemia

21. Morphologic classification of Anemia
1. Normocytic anemia
2. Microcytic anemia
3. Macrocytic anemia

22. Classification of anemia based on etiology
1. Blood loss
2. Inadequate production of normal blood cells
3. Excess destruction of blood cells

23. TYPES OF ANEMIA
1. Iron deficiency anemia
2. Megaloblastic anemia
3. Pernicious anemia
4. Hemorrhagic anemia
5. Hemolytic anemia
6. Thalassemia anemia
7. Sickle cell anemia
8. Aplastic anemia

24. 1. IRON DEFICIENCY ANEMIA
• This is caused by deficient of iron in the body
• It can be precipitated by less intake of foods rich in iron or inability of
the small intestine to absorb iron.

25. 2. MEGALOBLASTIC ANEMIA
• The bone marrow produces unusually large, structurally abnormal,
immature red blood cells (megaloblasts)
• This is due to less intake of Vit-B12 and folic acid
• Red bone marrow produces abnormal RBC

26. 3. PERNICIOUS ANEMIA
• The body needs vitamin B12 to make red blood cells.
• A special protein called intrinsic factor(IF) binds vitamin B12 so that it
can be absorbed in the intestines.
• This protein is released by cells in the stomach. When the stomach
does not make enough intrinsic factor, intestines cannot properly
absorb vitamin B12.

27. 4. HEMORRHAGIC ANEMIA
• Excessive loss of RBC through trauma, stomach ulcers, menstruation

28. 5. HEMOLYTIC ANEMIA
• Hemolytic anemia is a disorder in which red blood cells are destroyed
faster than they can be made. The destruction of red blood cells is
called hemolysis
• RBC plasma membrane ruptures
• There are two causes
1. Inherited e.g. sickle cell anemia
2. Acquired e.g. drugs, blood transfusion reaction, infections

29. 6. THALASSEMIA ANEMIA
• An inherited blood disorder in which the body makes an abnormal
form of hemoglobin
7. SICKLE CELLANEMIA
• Hereditary blood disorder characterized by red blood cells that assume
an abnormal, rigid, sickle shape

30. 8. APLASTIC ANEMIA
• Destruction of red bone marrow
• Caused by toxins, radiation

31. RISK FACTORS
1. Poor socio economic class
2. Multiparity
3. Teenage pregnancy
4. Menstrual problem

32. CLINICAL MANIFESTATIONS
1. Pale skin or membranes
Results from reduced amounts of hemoglobin and reduced blood flow to
the skin
2. Jaundice
Occurs when hemolysis of RBCs results in an increased concentration
of serum bilirubin

33. 3. Dyspnea: The body requires more oxygen, but the fewer red blood
cells cannot keep up with the increased demand for oxygen
4. Fatigue: This is a result of decreased red blood cells in superficial
vessels which leads to reduced oxygen supply to the muscles.
5. Headache
6. Tachypnea

34. 7. Tachycardia
8. Low hemoglobin of <6g/Dl

36. 9. Brittle nails
10. Koilonychia (spoon shaped nails)

37. Brittle nails Spoon nail finger

38. INVESTIGATIONS
• Full blood count(FBC)
A. Hematocrit
• It is the proportion of the volume of blood sample that is occupied by
RBCs
• Men 42%-52%
• Women 36%-48%

39. B. Cell volume hemoglobin concentration
• It is the amount of hemoglobin per unit volume of blood(g/dL)
• Women 12g/dL-16g/dL
• Men 14g/dL-17g/dL

40. NURSING ASSESSMENT
SUBJECTIVE DATA
1. PAST HEALTHY HISTORY
• The nurse should enquire; recent blood loss or trauma, chronical liver
or renal disease(including dialysis), GI disease(ulcers or hemorrhoids),
infectious disease(HIV)
2. MEDICATIONS
• Use of aspirin, anticoagulants, oral contraceptives, omeprazole, herbal
products

41. 3. SURGERY OR OTHER TREATMENT
• Recent surgery, chemotherapy, radiation therapy
4. DIETARY HISTORY
• General dietary patterns, consumption of alcohol

42. 4. FUNCTIONAL HEALTH PATTERNS
• Family history of anemia, hematuria, bloody stools, hemoptysis and
shortness of breath with activity, recent or current pregnancy,
excessive menstrual period

43. OBJECTIVE DATA
1. INTEGUMENTARY
• Pale skin and mucus membranes, blue, pale white spoon shaped
fingernails, jaundice, nose or gingival bleeding
2. RESPIRATORY
• Tachypnea
3. CARDIOVASCULAR
• Tachycardia, postural hypotension, widened pulse pressure, bruits(esp.
carotid)

44. 4. GASTROINTESTINAL
• Hepatosplenomegaly
5. NEUROLOGIC
• Headache, roaring in the ears, confusion, impaired judgement

45. NURSING DIAGNOSIS
1. Activity intolerance related to weakness secondary to
decreased tissue oxygenation.
2. Imbalanced nutrition, less than body requirements, related
to inadequate intake of essential nutrients
3. Ineffective tissue perfusion related to inadequate blood volume or
hematocrit
4. Deficient knowledge related to lack of information about a
well-balanced diet and foods containing folic acid.

46. NURSING INTERVENTIONS
1. Oxygen therapy to maintain SaO2
• The recommended oxygen saturation is above 90%
2. Promote rest
3. Blood transfusion
• Anticipate the need for the transfusion of packed RBCs.
• Packed RBCs increase the oxygen-carrying capacity of the blood
4. Monitor vital signs, breath sounds and apical pulse
5. Fluid replacement; recommended fluid of choice is Hemacel

47. 5. Assess the client’s ability to perform activities of daily living (ADLs)
and the demands of daily living.
• Fatigue can limit the client’s ability to participate in self-care and
perform their role responsibilities in family and society, such as
working outside the home.

48. 6. Increased dietary intake of iron-rich foods
7. Oral or parenteral iron supplements
8. Increased dietary intake of foods containing vitamin B12 (e.g.
meats, eggs and dairy products)
9. Folic acid supplements

49. MEDICAL TREATMENT
• Ferrous sulphate 200mg 8 hourly P.0.
• Folid acid 5mg once a day P.O.
• Patients with anemia are given drugs like Albendazole(400mg p.o.
stat), corticosteroids(prednisolone 1mg/kg/day)

50. DISCHARGE PLAN
• Health education is the main focus during discharge and for the home
care.
1. Instruct the patient to consume iron-rich foods to help build-up
hemoglobin stores.
2. Iron supplements. Enforce strict compliance in taking iron
supplements as prescribed by the physician.
3. Follow-up. Stress the need for regular medical and laboratory
follow-up to evaluate disease progression and response to therapies
4. Reduction of alcohol consumption

51. COMPLICATIONS
1. Splenomegaly
2. Hepatomegaly
3. Heart failure
4. Angina pectoris
5. Stroke
6. Renal failure
7. cardiomegaly

52. ASANTE!!!

53. REFERENCES
• Ignatavacius, D. D., & Blair, M. (2016). Medical surgical nursing-
patient centered collaborative care (8th ed.). Elsevier.
• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014).
Medical surgical nursing-Assessment and management of clincal
problems (9th ed.). Elsevier.
• Smeltzer, S. C. (2010). Brunner and Suddart’s Textbook of medical-
surgical nursing (10th ed.). Elsevier.
• Tortora, G. J., & Derrickson, B. (2009). Principles of anatomy and
physiology (12th ed.). John wiley and sons.