Anemia

anemia, sickle cell anemia etc

1. ANEMIA Sudha.k Nursing tutor Govt school of nursing palakkad

2. Definition : is a condition in which deficiency of RBC , Hb , or both in the circulating blood.

3. Causes Iron deficiency anemia Vit B12 deficiancy Pregnancy Menstruation Intestinal disorders Esophageal disorders Hemolytic anemia Bone marrow disorder

4. Hypothyroidism Hemophilia Leukemia Chronic kidney disease Hookworm infestation Family history Old age

5. Types Normochromic normocytic anemia Hypochromic microcytic anemia Normochromic macrocytic anemia

6. Diagnoses Complete blood cell count Hb level Hematocrit level Bone marrow biopsy

7. Symptoms Pallor Tachycaria Irritability Fatigue Shortness of breath Numbness of the hands or feet Sore , beefy red tongue

8. Iron deficiency Signs and symptoms Glossitis Fissures – corner of the mouth Spoon shaped finger nails

9. COMPLICATIONS heart failure, paresthesias , and confusion. At any given level of anemia, patients with underlying heart disease are far more likely to have angina or symptoms of heart failure than those without heart disease.

10. NURSING DIAGNOSES Activity intolerance related to weakness, fatigue, and general malaise Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients • Ineffective tissue perfusion related to inadequate blood volume or hematocrit • Noncompliance with prescribed therapy

11. Aplastic anemia Definition Is blood disorder in which the bone marrow fails to produce the needed number of RBCs, results in pancytopenia .

12. Etiology Radiation and chemotherapy treatments Exposure to toxic elements-- exposure to benzene Use of certain drugs -- chloramphenicol Autoimmune disorder—immune system begins attacking healthy cells, involve stem cells in your bone marrow. Viral infection: that affect bone marrow eg ; hepatitis, ebstein – barr , cytomegaloblastic virus,and HIV. Pregnancy—immune system may attack yr bone marrow. Unknown factors Congenital

13. Pathophysiology Aplastic anemia can be congenital or acquired, idiopathic . Infections and pregnancy certain medications, chemicals, or radiation damage . Agents that regularly produce marrow aplasia include benzene and benzene derivatives Certain toxic materials, such as inorganic arsenic and several pesticides . Various medications

14. fatigue, pallor, dyspnea ). Purpura (bruising) repeated throat infections, cervical lymphadenopathy may be seen. Other lymphadenopathies and splenomegaly sometimes occur. Retinal hemorrhages are common.

15. SIGNS AND SYMPTOMS Fatigue and progressive weakness Shortness of breath Rapid or irregular heart rate Pale skin Infections Ecchymoses and petechiae Easy bruising

16. Nose bleeds Prolonged bleeding from cuts Skin rash Dizziness Head ache.

17. DIAGNOSTIC TESTS Blood tests: CBC, RBC, WBC, PATELECT Bone marrow biopsy: Total iron binding capacity(TIBC) and serum iron level: elevated, RBCs are not being produced

18. Therapeutic measures Blood transfusions Medications Bone marrow transplantation

19. Blood transfusions RBC PLATELETS

20. STEM CELL TRANSPLANT Is also called bone marrow transplant. Healthy stem cells from the donor are filtered from the blood. The healthy stem cells are injected i /v into your bloodstream, where they migrate to the bone marrow cavities and begin generating new blood cells. After the transplant, drugs to help prevent rejection of the donated stem cells are given.

21. IMMUNOSUPRESSENTS CYCLOSPORINE,antithymocyte globulin This helps bone marrow to recover and generate new blood cells. Corticosteroids prednisolone

22. BONE MARROW STIMULANTS Sargramostin Neupogen --WBC Neulasta Epogen -- RBC

23. Antibiotics and anti virals To prevent infections

24. SICKLE CELL ANEMIA Definition: Is a condition in which there are not enough healthy RBC to carry adequate oxygen. The RBC are very sensitive to O2 changes. Whenever there is decrease in O2 tension the cells become rigid and sticky and are shaped like sickles or crescent moons. Sickle cells are very rigid and easily cracked and broken. These cells can get stuck in small blood vessels which can slow or block blood flow and O2 to parts of the body. The result is congestion clumping and clotting.

25. PATHOPHYSIOLOGY As RBCs are broken the cellular contents spill out into the general circulation. The resulting increase in the bilirubin level causes jaundice . Gallstones may develop bz increased amounts of bile pigments. The spleen and liver may enlarge bz of the increase in retained cells and cellular materials Life span of the RBCs decreased. Sickled cells survive only about 10-to 20 days, an 80-90% decrease in cell survival.

26. Causes Autosomal recessive hereditary disorder.

27. Symptoms Anemia Episodes of pain Painful swelling of hands and feet Frequent infections Delayed growth Vision problems

28. Complications Stroke Acute chest syndromes Pulmonary hypertension Organ damage Blindness Leg ulcers Gallstones Priapism

29. Diagnostic measures Blood smear Sickledex test HB electrophoresis Lowered RBC Elevated WBC Decreased ESR

30. Therapeutic measures Sedation Analgesics Blood transfusion O2 therapy Large amounts of oral and I/V fluids to flush broken cell debris Antibiotics

31. Deferasirox to decrease the excess iron levels Hydroxyurea Bone marrow transplantation Self management

32. Life style and home remedies Folic acid Healthy diet Plenty of water Avoid extreme temperature

33. Ng mgt Avoid tight fitting clothing Avoid strenuous exercise Avoid Smoking , Alcoholic Encourage fluids Genetic counseling.

34. Idiopathic thrombocytopenic purpura ITP results from increased platelet destruction by the immune system. Any time platelet numbers reduced, risk for bleeding increases. It affects children b/w the age of 2 and 6.chronic ITP affects adults over age of 60

35. ITP occurs after an acute viral illness such as rubella, chickenpox, hepatitis, HIV, drug induced. It is related to immune system disorder. Abs –platelet destruction.

36. Signs &symptoms Petechiae , ecchymosis and bleeding from the mouth.,nose , GI tract, vital organs—brain. DIAGNOSIS Platelet count—less than 20,000/mm3 prolonged bleeding time. Platelet under microscope shows them to be small and immature. Immature platelets have life span for few hrs.

37. Therapeutic measures Admn of steroids Immune globulin be given. –to increase the blood count Chemotherapeutic drugs Spleen may be removed – bz it is the site of platelet destruction. Blood , platelet, and vitamin K transfusion

38. NG CARE AVOID TRAUMA Restrict activity Use electric razor Use soft toothbrush to clean teeth Avoid invasive procedures Avoid IM injections Maintain pressure on IV sites-5mts Avoid use of aspirin

39. Admn stool softners Move and turn patient gently Blow nose gently Consult with doctor abt whether sex/intercourse is safe

40. Intervention For Patient at risk of Infection Separate room Wash hands –all staff, patient Prevent visitors, staff with infections Not to handle flowers/ allergens Avoid use of indwelling catheters Aseptic technique Use acetaminophen--antipyretics