CVD for midwifery.pdf for the second year

Cardiovascular system for Medical surgical

1. NURSING MANAGEMENT OF
PATIENTS WITH CARDIOVASCULAR
DISORDERS
JemalB. (Msc)12/20/2024
1By: Jemal B.

2. CORONARY ARTERY DISEASE (CAD)
I- CORONARY ATHEROSCLEROSIS
is an abnormal accumulation of lipid or fatty
substances and fibrous tissue in the vessel wall.
These substances create blockages or narrow the vessel
in a way that reduces blood flow to the myocardium.
12/20/2024
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By: Jemal B.

3. Risk Factors
Non modifiable Risk Factors
Family history of coronary
heart disease
Increasing age
Gender (heart disease
occurs three times more
often in men than in
premenopausal women)
Race (higher incidence of
heart disease in African
Americans than in
Caucasians)
Modifiable Risk Factors
High blood cholesterol and
triglyceride level
Cigarette smoking, tobacco
use
Hypertension
Diabetes mellitus
Lack of estrogen in women
Physical inactivity
Obesity
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By: Jemal B.

4. Pathophysiology
Begins as fatty streaks, lipids that are deposited in the intima of the
arterial wall.
An inflammatory response happens.
T lymphocytes and monocytes infiltrate the area to ingest the lipids as a
result endothelial damage
; this causes smooth muscle cells within the vessel to proliferate and form
a fibrous cap over the dead fatty core(Lipids(Cholesterol).
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By: Jemal B.

5. These deposits, called atheromas or plaques, protrude
into the lumen of the vessel,
Resistance to blood flow
Myocardial ischemia chest pain
Atherosclerotic plaques may rapture and a fibrin
thrombus is formed myocardial infarction
….Pathophysiology
12/20/2024
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6. ….Pathophysiology
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7. ….Pathophysiology
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8. Clinical Manifestations
Angina pectoris (acute onset of chest pain due to
myocardial ischemia)
SOB
Nausea
Unusual fatigue
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9. Common types of Angina
a) Stable angina
Predictable and consistent pain of short duration,
easily relieved
Precipitated by effort or some activity (running,
walking, etc.)
Typical presentations are that of chest discomfort
b) Unstable angina "crescendo angina;“
symptoms occur more frequently and longer lasting
>10 min, more severe,
may not be relieved by rest/nitroglycerin12/20/2024
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By: Jemal B.

10. c) Refractory angina
severe incapacitating pain;
Do not respond to conventional therapy including drugs
and pt may suffer severe chest pain
d) Variant angina
Pain at rest usually at night
e) Silent angina
objective evidence of ischemia (such as ECG changes),
but patient reports no symptoms
…..Common types of Angina
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11. Diagnosis
History
Physical Examination
Serum lipid levels
Exercise stress test
ECG
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12. Prevention
Can be by the control of the following four
modifiable risk factors of CAD
Increased Cholesterol
Cigarette Smoking
DM
Hypertension
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By: Jemal B.

13. I.Controlling cholesterol level
Desired goal is to have low LDL and high HDL
values
The desired level of LDL depends on the patient:
< 160 mg/dL for patients with one risk factors
< 130 mg/dL for patients with two or more risk factors
< 100 mg/dL for patients with CAD
HDL > 40-60 mg /dL
…..Prevention
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By: Jemal B.

14. Non-Drug Management
Dietary measures
Weight reduction
Increased physical activity
Promoting cessation of tobacco use
Early detection and treatment of hypertension
Controlling DM
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15. Drug Management
Medications that decrease LDL, triglycerides and that
increase HDL
Niacin : Decreased blood lipids
lower LDL and triglyceride levels, and increase HDL
levels.
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By: Jemal B.

16. Fibric acids: primarily inhibits triglyceride synthesis.
Fenofibrate
Colofibrate
Bile acid sequestrates: lowers LDLs
Cholestryramine
Colesevelam
Colestipol HCL
……Drug Management
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By: Jemal B.

17. MYOCARDIAL INFARCTION
Coronary occlusion, heart attack, and MI are terms
used synonymously, but the preferred term is MI
MI refers to the process by which areas of myocardial
cells in the heart are permanently destroyed.
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By: Jemal B.

18. Causes:
Reduced blood flow in a coronary artery
Decreased oxygen supply and
Increased demand for oxygen
.....Myocardial Infarction
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19. Risk Factors
Hypercholesterolemia - high LDL, low HDL
Tobacco smoking, Alcohol, OCP
Air pollution: CO,
Advanced age
Gender (men)
Diabetes mellitus, Obesity (BMI >30kg/m²)
High blood pressure, Lack of physical activity
Family history of ischemic heart disease or MI
.....Myocardial Infarction
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By: Jemal B.

20. Pathophysiology
Atherosclerotic plaque in coronary artery
Plaques can become unstable, rupture, and
additionally promote a thrombus that occludes the
artery
As the cells are deprived of oxygen, ischemia
develops, cellular injury occurs, and over time, the lack
of oxygen results in Ischemic cascade: death of the
heart cells near the occlusion
Infarction or cell death
.....Myocardial Infarction
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By: Jemal B.

21. Ruptured
Myocardial
Infarction
12/20/202421 By: Jemal B.

22. Clinical Manifestations
Chest Pain
Occurs suddenly & not relieved by rest or nitrate
Locations: retrosternal, radiating to the neck, jaw, and arms or
to the back
May occur while the patient is active or at rest, asleep or walk
Commonly occurs in the early morning
Usually lasts for 20 minutes
Palpitations.
Heart sounds may include S3, S4, and new onset of a
murmur.
Increased jugular venous distention
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By: Jemal B.

23. ❑Shortness of breath
❑ Cool, pale, and moist skin.
❑ tachycardia and tachypnea.
❑Dysrhythmias
❑Anxiety, restlessness, light headedness
…..Clinical Manifestations
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24. Dx
❑PATIENT HISTORY: the description of the presenting
symptom (eg, chest pain) and the history of previous
illnesses and family health history, particularly of
heart disease.
❑ECG
❑LABORATORY TESTS: increased Creatine, increased
Myoglobin, increased Troponin
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25. Non-drug treatment (General
measures)
Bed Rest
Bowel
→ Constipation
Stool softener & Laxatives
Diet
Low fat, low Sodium , high fiber diet.
Sedation
↓Anxiety & ensures adequate sleep
Diazepam 5mg 3-4x/day , Additional dose at bed time
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By: Jemal B.

26. Goals:-
Minimizing myocardial damage
Preserving myocardial function
Preventing CC
Medical Management
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By: Jemal B.

27. Medical Management
Drug treatment(DACA):
Oxygen, 2-4 l/min, via facemask
PLUS
Nitroglycerin, 0.5mg, sublingual, every 5 min up to 3 doses.
PLUS
Acetylsalicylic acid, 160-325 mg. P.O. QID
PLUS
Diazepam, 5mg P.O. 3-4 times daily.
PLUS
Morphine, (for control of pain), 2-4 mg IV. every 5 min until the desired
level of analgesia is achieved or until unacceptable side effects occur.
PLUS
Heparin: For all patients with myocardial infarction (MI), 7500 units
subcutaneously every 12 hours BID until the patient is ambulatory12/20/2024
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By: Jemal B.

28. Followed by:
Warfarin, for at least 3 months
PLUS
Enalapril, 5 - 40 mg P.O. once or divided into two to three
doses daily
PLUS
Metoprolol, 5 mg I.V. every 2 to 5 min for a total of 3
doses
Medical Management
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By: Jemal B.

29. HEART FAILURE
❖HF, often referred to as congestive heart failure
(CHF), is the inability of the heart to pump sufficient
blood
❖to meet the needs of the tissues for oxygen and nutrients.
❑The term HF indicates myocardial heart disease
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By: Jemal B.

30. ❑Systolic heart failure- an alteration in ventricular
contraction.
❑Results when the ventricle is unable to contract forcefully during
systole to eject adequate amount of blood into the circulation
❑Diastolic heart failure- an alteration in ventricular filling
❑Occurs when the left ventricle is unable to relax adequately during
diastole resulting in decreased ventricular filling and inadequate CO
Classification of HF
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31. ❑Left sided HF: - results from left ventricle dysfunction,
❑which causes blood to back up through the left atrium and into
the pulmonary veins increasing pulmonary pressure.
❑cause pulmonary congestion & Edema
❑Right sided HF:- results from a diseased right ventricle (RV)
that causes back ward flow of blood to the right atrium (RA)
and venous circulation
❑causing peripheral edema, hepatomegally, spleenomegally,
congestion of the GI tract
…..Classification of HF
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By: Jemal B.

32. NYHA- Based on physical limitations
Class Description
Class INo limitation of physical activity; there are no symptoms
from ordinary activities
Class IISlight limitation of physical activity; the patient is
comfortable at rest or with mild exertion
Class IIIMarked limitation of physical activity; the patient is
comfortable only at rest
Class IVTotal limitation, any physical activity brings discomfort
and symptoms occur at rest
……Classification of HF
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By: Jemal B.

33. Stages of CHF- The American College of Cardiology
/American Heart Association
Stage A: patients who are at high risk for developing HF but without
structural heart disease or symptoms of HF E.g., patients with DM or Hth
Stage B: patients with structural heart disease but without symptoms of
HF
Stage C: Structural heart disease and symptoms of HF
Stage D: patients requiring special interventions (end-stage
heart failure)
……Classification of HF
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By: Jemal B.

34. ETIOLOGY
Main causes
CAD and/or Underlining factors
hypertension
Valvular heart disease
Hypoxia
Anemia (hematocrit < 25%)
Congenital heart disease
Compensatory mechanisms
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By: Jemal B.

35. Clinical Manifestations
Left Sided Heart Failure
Decreased CO
Fatigue, Decreased activity tolerance
Altered digestion
Oliguria
Nocturia
Angina (chest pain)
Tachycardia, palpitation
Pallor, Cool, clammy skin
weak pulse
Confusion, restlessness, Dizziness, anxiety, lightheadedness
Left lateral displacement of apical impulse
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By: Jemal B.

36. Clinical Manifestations….
Left Sided Heart Failure…
Pulmonary congestion
Cough - initially dry and nonproductive
Shortness of breath
Orthopnea
Adventitious breath sounds, (Crackles or wheezes)
Tachypnea
Decreased oxygen saturation
Murmurs
S
3/S
4
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37. 12/20/202437 By: Jemal B.

38. Because of systemic
congestion:
Jugular vein distension
Hepatomegally &
spleenomegally
Ascites
Anorexia, nausea,
abdominal pain
Dependent edema -legs &
sacrum
Nocturia &Oliguria
Weakness
Weight gain
Right Sided Heart Failure
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By: Jemal B.

39. 12/20/2024
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By: Jemal B.

40. Dx
History
Physical Examination
Chest X-ray
ECG
Echocardiogram
Pulse oximetry
Laboratory studies : serum electrolytes, blood
urea nitrogen (BUN), creatinine, complete blood
cell count (CBC)
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By: Jemal B.

41. FRAMINGHAM CRITERIA FOR THE DIAGNOSIS OF
HEART FAILURE
MAJOR CRITERIA
PND or orthopnea
neck vein distention
cardiomegaly
S3/gallop
Acute pulmonary edema
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By: Jemal B.

42. MINOR CRITERIA
Bilateral ankle edema
Night cough
Dyspnea on exertion
Hepatomegaly
Pleural effusion
Tachycardia(heart rate >120 beats/min)
The diagnosis of chronic heart failure requires the
simultaneous presence of at least 2 major criteria or 1
major criterion in conjunction with 2 minor criteria
….FRAMINGHAM CRITERIA ..
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43. Management
General Measures
Activity
❑Heavy physical labor is not recommended
❑Routine modest exercise for class I–III HF
within limits of symptoms
Diet
Low sodium diet (< 2g -3g /day)
Avoid excessive fluid intake
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44. Main Goals Of Therapy
To eliminate or reduce etiologic or contributing
factors
To reduce the workload on the heart (preload ,
contractility & after load)
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45. Pharmacologic therapy
1. ACE - inhibitors (ACE-Is):
Promotes vasodilatation & diuresis by decreasing
preload & after load
Include: captopril, enalapril, lisinopril
2.Hydralazine– Decreased systemic vascular
resistance
3.Beta blockers: reduce the constant stimulation of
the sympathetic nervous system E.g. propranolol
4.Digitalis e.g. digoxin 0.125, 0.25, 0.5 mg
-slow conduction through the atrioventricular node
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By: Jemal B.

46. 5. Diuretics: increase the rate of urine production and
the removal of excess extracellular fluid from the body
❑Thiazides e.g. chlorothiazide, hydrochlorothiazide
❑Loop diuretics e.g. furosemide (lasix)
❑Potassium sparing e.g. spironolactone
❑Combination agents e.g. spironolactone +
hydrochlorothiazide
….Pharmacologic therapy
12/20/2024
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By: Jemal B.

47. According to DACA of Ethiopia
First line
Digoxin 0.125-0.375 mg po daily
Plus
Furosemide , 40-240 mg, po divided in to 2-3 doses daily
Plus
Enalapril 5-40 mg po once or divided in to two dose daily
And/or
Spironolactone 25-100mg po once daily or divided into
two doses
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By: Jemal B.

48. Nursing Intervention
1. Maintaining normal body fluid
Evaluating degree of peripheral edema
Daily measurement of abdominal girth
Monitoring intake & out put and daily body weight
Restriction of sodium diets & fluid
Avoid diet high in fat/cholestrol
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49. 2. Improving activity tolerance
❑Avoid prolonged bed rest
❑Emotional & physical support to reduce oxygen consumption
❑Moderate physical exercise for a total of 30 min with 3-5
times per week
❑Monitoring patient’s response to activity
3. Maintaining skin integrity
❑Monitor signs of edema
❑Meticulous skin care
❑Pad bony prominences
❑Passive ROM to extremities every 4 hours to facilitate venous
return of the fluid
❑Turning & repositioning the patient every 2 hours
…..Nursing Intervention
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By: Jemal B.

50. 12/20/2024By: Jemal B.
50

51. Blood pressure is the product of cardiac output multiplied by peripheral
resistance. Cardiac output is the product of the heart rate multiplied by the
stroke volume.
HYPERTENSION
12/20/2024
51By: Jemal B.

52. HYPERTENSION
is a systolic blood pressure greater than 140 mm Hg
and a diastolic pressure greater than 90 mm Hg over
a sustained period, based on the average of two or
more blood pressure measurements taken in two or
more contacts with the health care provider after an
initial screening.
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By: Jemal B.

53. Classification Of Blood Pressure:
for Adults Age 18 and Older
Category Systolic BP (mmHg) Diastolic BP (mmHg)
Optimal <120 <80
Normal <130 <85
High normal 130-139 85-89
Stage 1 or Mild HTN 140-159 90-99
Stage 2 or Moderate HTN160-179 100-109
Stage 3 Severe HTN > 180 > 110
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By: Jemal B.

54. Types of hypertension
1. Primary (Essential) hypertension
❖Accounts for about 90-95% of all cases
❖Has no known causes
❖Onset usually between the age of 30 & 50 years
❖factors that may contribute for the development include:
Genetic predisposition: the exact mechanism has not been established
Environment:
Dietary salt intake and Salt sensitivity
Obesity
Occupation
Family size and crowding
Stress and increased serum lipid level
Pregnancy-induced hypertension: Toxemia of pregnancy
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By: Jemal B.

55. 2. Secondary hypertension
❖In 5-10 % of patients with hypertension, the hypertension
is secondary to identifiable disorder
❖Identifiable causes include:
Renal vascular & renal parenchymal disease
congenital abnormalities of aorta
Cushing syndrome
Brain tumors
Encephalitis
Medications
•Glucocorticoids
•Mineralocorticoids
•Sympathomimetic
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By: Jemal B.

56. Pathophysiology
Hypertension may be caused by one or more of the
following:
❑1. Increased sympathetic nervous system activity
❑2. Increased activity of renin-angiotensin-aldosterone
system
❑3. Decreased vasodilation of the arterioles
❑4. Structural and functional changes in the heart and blood
vessels
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By: Jemal B.

57. Clinical manifestations
Hypertension is often called “silent killer” because it is
frequently asymptomatic especially if the hypertension
is mild or moderate.
Headache: Is the most common symptom, Occurs in the
occipital region, Worsen on the morning on arising
kidneys involvment:
Nocturia
Increased BUN & serum creatinine level
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By: Jemal B.

58. Cerebrovascular involvement
Speech & vision alteration
Dizziness
Stroke
Weakness
Faintness (sudden fall)
Sudden hemiplegia
Vascular complications
Blurring of vision
Epistaxis
Occasionally, retinal changes
Hemorrhages
Cotton wool spots (small infarction)
….Clinical manifestations
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By: Jemal B.

59. Diagnosis
History
Physical Examination
Measuring blood pressure (at least 1week apart)
Ophthalmologic examination
Lab tests
U/A – e.g. urine catecholamine
Blood chemistries (level of Na
+
, K
+
, Cl
-
, LDL etc)
Creatinine, BUN
ECG, Echocardiography & chest X-ray
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By: Jemal B.

60. Management
The managements of hypertension include:
Lifestyle modifications
Pharmacologic therapy
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By: Jemal B.

61. Lifestyle Modifications
Weight reduction
Moderation of alcohol in take
Regular physical activity
Reduction of salt intake
Smoking cessation
Life style modifications are indicated for the person
with either border line or sustained hypertension
➢If the BP remains > 140/90mmHg after 3-6 months
of life style changes, drug therapy is indicated.
….Management
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By: Jemal B.

62. The DASH Diet
Grains and grain products 7–8gm/day
Vegetables 4–5gm/day
Fruits 4–5gm/day
Low fat or fat-free dairy foods 2–3gm/day
Meat, fish, poultry
Nuts, seeds, and dry beans 4–5gm/weekly
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By: Jemal B.

63. Goal-
Preventing death and complications by achieving
and maintaining the BP at 140/90 mmHg or lower
and
lower than 130/80 mmHg for people with DM &
chronic kidney diseases.
Pharmacologic/drug therapy
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By: Jemal B.

64. Pharmacologic/drug therapy
Vasodilating drugs
hydralazine
β-adrenergic blocking drugs
Atenolol
Metoprolol
Propranolol
Anti adrenergic drugs (centrally acting)
Methyldopa
Alpha (α)-adrenergic blocking drugs
doxazosin
Prazosin
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By: Jemal B.

65. Calcium channel blockers: Nifidipine, Verapamil, Diltiazem
ACE I inhibitors: Captopril , Enalapril, Lisinopril
Angiotensin II receptor antagonists: Valsartan , Losartan,
Irbesartan
Diuretics: Furosemide (Lasix), Hydrochlorothiazide
….Pharmacologic
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By: Jemal B.

66. DACA of Ethiopia
drugs used as first step agents
Diuretics
Beta Blockers
Calcium antagonists
ACE-Is
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By: Jemal B.

67. First line drugs for non-emergency conditions
Hydrochlorothiazide, 12.5-50 mg/day PO And/or
Nifedipine 10-40 mg, PO TID And/or
Propranolol 40-160 mg PO divided in to 2-4 doses
Alternative
Enalapril, 2.5-40 mg PO, once or divided in to two doses
daily And/or
Methyldopa, 250-2000 mg PO in divided doses. OR
Hydralazine, 10-20 mg, slow IV can be given in severe
hypertension. OR
Atenolol, 50 – 100 mg p.o daily
…..DACA of Ethiopia
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68. Hypertensive Crises
Blood pressure elevation to such degree can
cause vascular damage, encephalopathy, retinal
hemorrhage, renal damage and death.
1 –2% of the hypertensive population develop
this complication.
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By: Jemal B.

69. HYPERTENSIVE EMERGENCY
❑is hypertension with acute impairment of one or more
organ systems in which there is acute impairment of
target organ
❑It generally occurs at the blood pressure is severely
elevated [180 or higher for systolic pressure or 120 or
higher for diastolic pressure], ,
❑but can occur at even lower levels in patients whose blood
pressure had not been previously high
❖ In these conditions, the blood pressure should be
lowered aggressively over minutes
❑Progressive end-organ dysfunction.
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70. HYPERTENSIVE EMERGENCY
❑The nurse may think that taking vital signs every 5
minutes check vital signs at 15 or 30 minutes intervals if
the situation is more stable.
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71. HYPERTENSIVE URGENCY
❑urgency is a situation where the blood pressure levels
exceeding 180 systolic OR 110 diastolic but there is no
associated organ damage.
❑No progressive target-organ dysfunction
❑Treatment of hypertensive urgency requires readjustment
and/or additional dosing of oral medications,
❑but most often does not necessitate hospitalization for rapid
blood pressure reduction
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By: Jemal B.

72. Clinical Manifestation
The eyes: may show retinal hemorrhage
The brain: headache, vomiting, and/or subarachnoid or
cerebral hemorrhage
shows manifestations of increased intracranial pressure
The kidneys: hematuria, proteinuria, and acute renal
failure
CVS: Patients will usually suffer from left ventricular
dysfunction
Other : Chest pain, Arrhythmias, Epistaxis, Dyspnea,
Faintness or vertigo, Severe anxiety
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73. Treatment of Hypertensive Emergency
❑Hydralazine, 5 mg IV every 15-min should be given
until the mean arterial
❑blood pressure is reduced by 25% (within minutes to 2
hours),
❑furosemide, 40 mg IV can be used according to
blood pressure response
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By: Jemal B.

74. Treatment of Hypertensive Urgency
❑Nifedipine, 20-120 mg p.o in divided doses per day
could be used. OR
❑Captopril, 25-50 mg p.o three times daily
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By: Jemal B.

75. Nursing Interventions
❑Improving activity tolerance
❑Alleviating pain:
❑encourage/maintain bedrest during acute phase.
provide/recommend nonpharmacological measures
❑Patient education about lifestyle modifications
❑Compliance to therapeutic regimens
❑Nutritional advice
❑Avoiding potential complication
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76. RBC Disorders
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77. ANEMIA
Anemia is a qualitative or quantitative deficiency of
hemoglobin, in red blood cells that transports oxygen.
It is a lower-than-normal number of red blood cells, usually
measured by a decrease in the amount of hemoglobin.
Is the most common disorder of blood which leads to hypoxia
in organs.
Not specific disease but a sign of underlying disorder.
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78. Potential causes
1.Loss of RBCs—bleeding, (eg. GIT, uterus, nose, or wound)
2.Decreased production of RBCs (ineffective
erythropoiesis):.
3.Hemolysis: overactive spleen (e.g. hypersplenism) or
production of abnormal RBCs (eg, sickle cell anemia)
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79. Specific Types Of Anemia
1. Vitamin B12/ Cobalamin Deficiency Anemia
Also called Pernicious anemia
Vitamin B12 is essential for normal nervous system function
and blood cell production.
For vitamin B12 to be absorbed by the body, it must bind to
intrinsic factor, a protein secreted by cells in the stomach.
➢Source: Dairy products, eggs, fish, meat, and poultry
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80. Causes
Diet low in vit B12 (e.g. strict vegetarian)
Chronic alcoholism
Abdominal or intestinal surgery
Intestinal malabsorption disorders
Tape worm
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81. 2. Folate-deficiency Anemia
Referred to as megaloblastic anemia
Folate, also called folic acid, is necessary for RBC formation
and growth.
Folate is not stored in the body in large amounts,
Occurs in about 4 out of 100,000 people.
➢Source: Green leafy vegetables and liver.
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12/20/2024By: Jemal B.

82. Cause/Risk factors
Poor dietary intake of folic acid
Eating overcooked food
Malabsorption diseases
Certain medications e.g. phenytoin
Third trimester of pregnancy
Alcoholism
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83. 3. Iron Deficiency Anemia
it is the most common form of anemia
Decrease number of RBC in blood result too little
iron.
RBCs are not providing adequate oxygen to body
tissues.
Source: meat (liver), fish andpoultry
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84. Causes
Too little iron in the diet
Poor absorption of iron by the body
Loss of blood (including from heavy menstrual bleeding)
Risky groups
♣Women of child-bearing age
♣Pregnant or lactating women
♣Infants, children, and adolescents in rapid growth
♣People with a poor dietary intake of iron
♣Blood loss: peptic ulcer, long term ASA use, colon ca
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85. 4. Hemolytic Anemia
Inadequate number of circulating RBCs caused by
hemolysis greater than erythropoiesis.
The bone marrow is unable to compensate for premature
destruction.
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86. Causes
➢Abnormal hemoglobin: Sickle cell anemia, Thalassemia
➢Enzyme deficiencies: Glucose-6-phosphate dehydrogenase
deficiency
➢Transfusion reaction
➢Autoimmune hemolytic anemia
➢Infection: malaria
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87. Normal and Sickle shaped RBC
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88. 5. Idiopathic/Aplastic Anemia
Also called pancytopenia
Is a failure of the bone marrow to properly form all
types of blood cells
Results from injury to the stem cell
Cause is unknown, but is thought to be an
autoimmune process.
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89. Common Clinical Manifestation Of Anemia
Paleness
Yellow eyes/skin
Fatigue
Breathlessness
Rapid heart rate
Delayed growth and puberty
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▪Susceptibility to infections
▪Ulcers on the lower legs
▪Jaundice
▪Bone pain
▪Fever

90. Assessment and Diagnostic Findings
Physical Exam & history
CBC
Hgb concentration, Hct,
ESR, folate level, serum vit B12
Iron tests (serum level, binding capacity, % saturation)
Bone marrow aspiration and biopsy
Elevated bilirubin
Erythropoietin levels
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91. Criteria Of Anemia In Adults
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Factor Women Men
RBC x 10
6
cells/mcL< 4.0 < 4.5
Hgb (g/dl) < 12 < 14
HCT (%) < 37 < 40

92. Treatments For Anemia
Treatment depends on severity and the cause.
Treatment goals:
➢To get RBC counts or Hgb levels back to normal
➢To treat the underlying cause of the anemia
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93. Iron deficiency anemia
Iron supplements- for several months or longer
If the underlying cause of iron deficiency is loss of blood,
the source of bleeding must be located and stopped.
Food rich in iron: Meat, poultry, fish, eggs, dairy products, or
iron-fortified foods.
Ferrous sulfate :300mg PO TID for 4-6 months
Prophylactic therapy: pregnancy, sever hemolytic anemia,
in patients with dialysis
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94. Management …
Vit B12 Deficiency: is treated with which is given parentraly
Initial dose: 30 mcg IM daily for 5 to 10 days Maintenance dose: 100 to
200 mcg IM monthly.
Prophylactic therapy is indicated in patients with Total
gastrectomy and Ileal resection
Folate deficiency
Dose: Folic acid 5 mg Po daily
Prophylactic therapy is indicated in pregnancy, sever hemolytic
anemia, in patients with dialysis, and premature newborns
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95. Anemia Of Chronic Disease
It can be focused on treating the underlying disease.
Iron and vitamin supplements don't help
If symptoms become severe, a blood transfusion or
injections of synthetic erythropoietin, may help stimulate
RBC production.
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96. Sickle Cell Anemia
Rx for this incurable anemia include:
♣Cancer drug hydroxyurea (Droxia)
♣A bone marrow transplant
♣Blood transfusions
➢Supportive:
♣Administration of oxygen
♣Pain-relieving drugs
♣Oral and intravenous fluids
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97. Prevention Of Anemia
➢Eat foods high in iron
➢Make sure to consume enough folic acid and vit. B12
➢“Don't drink coffee or tea with meals”.
➢Talk to doctor about taking iron pills (supplements):
ferrous and ferric.
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98. Thank you!!
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By: Jemal B.