Severe Anemia

7/31/2019 Severe Anemia

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Severe

Anemia


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INTRODUCTION 1

Patients Profile . 4

Patients History 5 Physical Assessment ... 6

ANATOMY AND PHYSIOLOGY.. 7

PATHOPHYSIOLOGY.. 16

MEDICAL MANAGEMENT ..17

Diagnostic Exams ..... 18

Laboratory Exams .. 24

NURSING CARE PLAN 32


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Introduction

Anemia, per se, is not a specific disease but asign of an underlying disorder. It is by far the mostcommon hematologic condition. Anemia, a condition

in which the hemoglobin concentration is lower than

normal, reflects the presence of fewer than normalRBCs within the circulation. As a result, the amount

of oxygen delivered to the body tissues is also

diminished.


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Three broad etiologic categories:

Loss of RBCs

Decreased production of RBCs

Increased destruction of RBCs


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Iron deficiency anemia typically resultswhen the intake of dietary iron is inadequate

for hemoglobin synthesis. The body can storeabout one fourth to one third of its iron,and it is not until those stores are depletedthat iron deficiency anemia actually begins to

develop. Iron deficiency anemia is the mostcommon type of anemia in all age groups,and it is the most common type of anemia inthe world.


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The most common cause of iron deficiency in menand post menopausal women is bleeding (fromulcers, gastritis, inflammatory bowel disease, or

gastrointestinal tumors). The most common cause ofiron deficiency anemia in pre menopausal women ismenorrhagia (excessive menstrual bleeding) andpregnancy with inadequate iron supplementation.

Patients with chronic alcoholism often have chronicblood loss from the gastrointestinal tract, whichcauses iron loss and eventual anemia. Other causesinclude iron malabsorption, as is seen after

gastrectomy or with celiac disease.


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Patients with iron deficiency primarily havethe symptoms if anemia. If the deficiency issevere or prolonged, they may also have a

smooth, sore tongue, brittle and ridged nails,and angular cheilosis (an ulceration of thecorner of the mouth). These signs subsideafter iron replacement therapy. The health

history may be significant for multiplepregnancies, gastrointestinal bleeding, andpica (a craving for unusual substances, suchas ice, clay, or laundry starch).


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Patients Profile

Name: E., D. V. L.

Address: Pila, Laguna

Gender: Female

Age: 42

Civil Status: Married

Birthdate: October 18, 1968

Birthplace: Pila, LagunaOccupation: Housewife

Nationality: Filipino

Religion: Catholic


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Admission Date: June 25 ,2011

Admission Time: 5:33 PM

Hospital: Laguna Provincial

HospitalAdmitting

Physician:

Dr. T

AttendingPhysician: Dr. L

Medical Diagnosis: G3P3 (3003) AUB,

Severe Anemia


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HISTORY ADMISSION

History of Present Illness

1 month prior to admission, the patient

experienced prolonged menses. 1 pad per

day and fully soaked for 1 month straight.

A day prior to admission, the patient

developed extreme weakness, thus

admitted to the institution.

Past Health History

No history of admission by any illness

possible.

Does not take any maintenance pills.

Does not take any multivitamins.

Social History

A housewife.The patient is not taking tobacco.

Not taking alcohol.

Her husband does not take any tobacco

nor alcohol

Family History

The patient have no history of

hyper/hypotension, diabetes mellitus,

respiratory problems and others.

No history of congenital disorders.

Maternal History

The patient is G3 P3 (3003).

Her LMP is May 20, 2011

All siblings are born alive via NSVD.


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History of Present Illness

1 month prior to admission, the patient

experienced prolonged menses. 1 pad per

day and fully soaked for 1 month straight.

A day prior to admission, the patient

developed extreme weakness, thus

admitted to the institution.


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Past Health History

No history of admission by any illness

possible.

Does not take any maintenance pills.

Does not take any multivitamins.


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Social History

A housewife.

The patient is not smoking.

Not taking alcohol. Her husband does not take any tobacco

nor alcohol


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Family History

The patient have no history of

hyper/hypotension, diabetes mellitus,

respiratory problems and others.

No history of congenital disorders.


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Maternal History

The patient is G3 P3 (3003).

Her LMP is May 20, 2011.

All siblings are born alive via NSVD.


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Physical Assessment

GENERAL SURVEYCooperative attitude and behavior.Erect

posture, coordinated, smooth and steady

gait.Weakness and fatigue noted.Speech is

clear and moderately paced.Peripheral

numbness noted.V/S taken and recorded as

ff.: BP = 90/60 mmHg, PR = 81 bpm, RR =

19 cpm, T=36.6O


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Physical Assessment SKIN, HAIR AND NAILS

Skin is pale, dry, intact, smooth and without

lesions,

Skin pinched easily and immediately returns

to its original position.Hair is natural and evenly distributed.

Nails are pale and thick.Capillary refill is more

than 2 seconds.


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Physical Assessment EYES

Reflection of light is symmetric.

Eye movement is smooth and symmetricthroughout all nine directions.

Pale conjunctiva, clear and free of swelling or

lesion.Cornea is transparent.

Iris is round and evenly colored.

Constriction noted for papillary response.


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Physical Assessment

EARS

Ears are equal in size bilaterally.

Smooth with no lesions.Color is consistent with facial color.

No tenderness or discharge noted.


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Physical Assessment

HEAD AND NECKScalp is symmetric, round, hard and

smooth.

Face is symmetric.Neck is smooth, and can control

movement.

No enlargement or lesions noted


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Physical Assessment

MOUTH, THROAT, NOSE AND SINUS

Pale lips, No lesions noted.

Tongue is red.

Uvula hangs freely, tonsils present and not enlarged.

Nasal structure is smooth and symmetric.No tenderness noted.

Patency of nostrils is good.

Bright light seen on sinuses during

transillumination.


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Physical Assessment

THORACIC AND LUNGScapulas are symmetric and not

protruding.

Thorax appears symmetric.Chest expansion is normal.

Normal breath sounds.

No adventitious sounds noted.


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Physical Assessment

HEART

No blowing, swishing or other sounds heard

during auscultation.

No murmurs noted.


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Physical Assessment

ABDOMEN

Color is pale.

No lesions and rashes noted.

Symmetric.

Bowel sound is 7 and normal.


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ANATOMY

AND

PHYSIOLOGY


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CIRCULATORY SYSTEM


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LYMPATHIC SYSTEM


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FEMALE REPRODUCTIVE

SYSTEM


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MENSTRUAL CYCLE


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PATHOPHYSIOLOGY

difi bl


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Tissue breaks down

and sloughs from

uterus

Non modifiable:

Age

Gender

Hereditary

Marked changes in estrogen and

progesterone level

Lost cyclic endometrial stimulation that

arises from an/ovulatory cycle

Modifiable: Lifestyle Hormones

Malignancy

Proliferation w/out periodic

shedding causes the

endometrium to outgrow its

blood supply

Enlarged uterusStimulation of endometrial

growth


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Subsequent healing of the

endometrium is irregular and

dyssynchronous

Decreasedhemoglobin

level

(+) pallor

Muscleweakness

Chronic stimulation of higher

level of estrogenLeads to episode of frequent

heavy bleeding

Dec. oxygen,carrying capacity

of the blood

Reduction in amountof oxygen available

to the tissues

Tissue hypoxia

Easyfatigability


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MEDICAL

MANAGEMENT


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DIAGNOSTIC EXAMINATIONS


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ULTRASOUND A pelvic ultrasound is used to determine the shape, size, and

position of organs in the pelvis, and can detect tumors, cysts,stones in the urinary tract, or extra fluid in the pelvis, and help findthe cause of symptoms such as pelvic pain, urinary problems, orabnormal menstrual bleeding.

Impression:Slightly enlarged uterus with heterogeneous echotexture.

Thickened endometrium.

Unremarkable = ovaries, cervix and posterior cul de sac.


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NUTRITIONAL THERAPY

Diet as tolerated - patient is on DAT diet as ordered, for her

to supplement all the nutrients she needs before and after theblood transfusion. This was prepared to reduce the risk ofiron deficiency anemia .advise the patient to take iron richfoods. Iron rich foods such as:

Dark, leafy greens (spinach, collards) Dried fruit (prunes, raisins)

Iron-enriched cereals and grains (check the labels)

Beans, lentils, chick peas and soybeans

Artichokes


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INTRAVENOUS FLUID THERAPY IV therapy is the fastest way to deliver fluids and medications

throughout the body. It is used to establish or maintain a fluid orelectrolyte balance and to administer continuous or intermittentmedication. The patient was infused with D5LR (1L x 8 ) which is ahypertonic solution; its action is to pull the fluids from the interstitial andintravascular compartments to the blood vessels, thus, lessening the riskfor hypovolemic shock.

The patient was also hooked with Plain Normal Saline Solution

(1L KVO) as Blood Transfusion mainline, it is an isotonic solution whichis used because they don't move water in or out of the cell- meaning theyare most compatible with human blood as opposed to hypertonic andhypotonic solutions. It is also used after blood transfusion because it isthe only compatible diluent after transfusion. Its sole content of Sodiumand Chloride does not cause blood reactions and hemolysis that may be

dangerous to the client.


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LABORATORY EXAMINATIONS


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COMPLETE BLOOD COUNT

Normal

Values

Result

(June 25)

Result

(June 26)

Remarks Clinical

Significance

Hemoglobin (11.515.5

g/dL)

6.0 10.2 Decreased Due to

excessive blood

loss; Decreasedin anemia,

hemorrhage,

and hemolytic

reactions;


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COMPLETE BLOOD COUNTNormal

Values

Result

(June25)

Result

(June26)

Remarks Clinical

Significance

Hematocrit 36- 48% 18% 30% Decreased Due to excessive

blood loss; Defines

the volume of

hemoglobin perRBC; used to

determine the color

or concentration of

hemoglobin per

RBC


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Values

Result

(June25)

Result

(June26)

Remarks Clinical Significance

Platelet 150,00 -400,000/mm3

764 - Abnormalconditions

of excessbleeding

or clotting.

Increased in

leukemia and in

response toinfection,

inflammation,

and dehydration;


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COMPLETE BLOOD COUNTNormal Values Result

(June25)

Result

(June26)

Remarks Clinical

Significance

White

Blood

Cells

4,500-

11,000/mm312300 - Increased Indication

that

infection is

present.

CO OO CO


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Normal

Values

Result

(June25)

Result

(June26)


Segmenters

/

Neutrophils

45-75% 62 - Normal A stained slide of the bloodis needed to perform the

differential. The percentages

of the different WBCs areestimated, and the slide is

microscopically checked for

abnormal characteristics in

WBCs, RBCs, and platelets.



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NormalValues Result(June25)

Result(June

26)

Remarks ClinicalSignificance

Eosinophils 0-6% 4% - Normal

Lymphocytes 20-50% 29% - NormalMonocytes 1-10% 05% - Normal



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Normal

Values

Result

(June

25)

Result

(June

26)


Red

Blood

Cells

(4.2-5.4

x106)2.62 - Decreased Indication that

anemia is present;

Decreased in anemia;

increased in

dehydration,

polycythemia




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Normal

Values

Result

(June

25)

Result

(June

26)


Mean

Corpuslucar

Volume

81-96% 86 - Normal




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Normal

Values

Result

(June25)

Result

(June26)


Mean

Corpuscular

Hemoglobin

27.5 -

33.5

pg/cell

22 - Indicate

small

(microcyt

ic) inaverage

size and

volume

of each

RBC

Measures the average

size or volume of each

RBC: small size

(microcytic) in iron-deficiency anemia;

large size (macrocytic)

typical of pernicious

anemia



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Normal

Values

Result

(June

25)

Result

(June

26)

Remarks Clinical

Significance

MeanCorpuscular

HemoglobinConcentration

33-

36g/dL

26.5 - Indicate(hypochromi

cconcentration of

hemoglobin)in microcytic

anemia

Measures the

weight of

hemoglobin perRBC; useful in

differentiating

types of anemia

in a severely

anemic patient




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Values

Result

(June25)

Result

(June26)

Remarks Clinical

Significance

Mean Platelet

Volume

5.0 15.0fL 6.4 - Normal

Red Blood CellDistribution Width

11-14.5% 14.1 - Normal

Platelet

Distribution Width

9-13fL 10.0% - Normal

CLINICAL BLOOD CHEMISTRY


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June 27,

2011

Normal

Values

Result Remarks Clinical

Significance

Sodium 135-148

mEq/L

144.3 Normal Increased in dehydration

and diabetes insipidus;

decreased in overload of IV

fluids, burns,diarrhea, or

vomiting



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June 27,

2011

Normal

Values


Significance

Potassium 3.5-5mEq/L

3.93 Normal Increased in renal failure,extensive cell damage, and

acidosis; decreased in

vomiting, diarrhea, and

excess administration of

diuretics or IV fluids



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June 27,

2011

Normal

Values


Significance

BiochanCreatinine

UV

0.6-1.2mg/dL

0.61 Normal Produced at a constant rateand excreted by the kidney;

increased in kidney disease



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June 27,

2011

Normal

Values


Significance

BUNKinetic UV

(Blue)

7-18

mg/dL

4.0 Decreased

Increased in renal disease

and dehydration; decreased

in liver damage and

malnutrition

BLOOD TRANSFUSION


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Blood transfusion is an intervention used to replace active blood

loss from the body. The type of blood used for the patient is 1 unit

of PRBC for replacement of RBC loss. The patients V/S should be

checked every 1 hour to monitor transfusion reactions such as

fever, hypotension, tachycardia, etc. The drop factor of blood

transfusion is 10 gtts./min. with side drip of PNSS 1L.

Dipenhydramine 1 capsule 30 ml was taken prior to BT as an anti histamine.

Cross matched Blood type: A

Blood transfusion started: 6-26-11 > 4:30am

removed: 6-26-11 > 10:30pm

BLOOD TRANSFUSION


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DRUG STUDY

DRUG ACTION INDICATION

CONTRAINDICATION

ADVERSEREACTION

NURSINGCONSIDERATION


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GENERIC NAME:

Mefenamic acid

BRAND NAME:

Ponstan, Ponstel

CLASSIFICATION:

central nervous

system agent;

analgesic; nsaid;

antipyretic

DOSAGE, ROUTE &FREQUENCY:

Acute Pain

Adults and Children(14 yr or age and

older)

PO 500 mg, followed

by 250 mg every 6 h

as needed. Usually

not used more than 1

wk.

PrimaryDysmenorrheaAdults and Children

(14 yr of age andolder)

PO 500 mg, followed

by 250 mg every 6 h

starting with onset of

bleeding and

associated

symptoms.

Relief of

pain

including

muscular,

rheumatictraumatic,

dental,

post-op

and

postpartu

m pain,

headachemigraine,

fever,

dysmenor

rhea

Aspirin-

like drug

that has

analgesic

antipyretic, & anti-

inflammat

ory

activities

Patients in

whom aspirin,

iodides, or

any NSAID

has causedallergic-type

reactions;

preexisting

renal disease;

active

ulceration orchronic

inflammation

of GI tract.

PRECAUTION:

If rash occurs,

Administration

should bestopped

,asthmatics,

Hx of liver and

kidney disease

ADVERSE

RXN:GI discomfort,

diarrhea or

constipation,

gas pain,

nausea,

vomiting,

drowsiness

Assessment & Drug Effects

Assess patients who develop

severe diarrhea and vomiting for

dehydration and electrolyte

imbalance.

Lab tests: With long-term therapy(not recommended) obtain

periodic complete blood counts,

Hct and Hgb, and kidney function

tests.

Patient & Family Education

Discontinue drug promptly

if diarrhea, dark stools,

hematemesis, ecchymoses,epistaxis, or rash occur and do

not use again. Contact physician.

Notify physician if persistent GI

discomfort, sore throat, fever, or

malaise occur.

Do not drive or engage in

potentially hazardous activities

until response to drug is known.

It may cause dizziness and

drowsiness.

Monitor blood glucose for loss of

glycemic control if diabetic.

Do not breast feed while taking

this drug without consulting

physician.


CONTRAINDICATION

ADVERSEEFFECT



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GENERICNAME:Ferrous

Sulfate

BRAND

NAME:CLASSIFICATION: IronSupplement

DOSAGE,ROUTE &FREQUENCY:

ORALADULTS,

ELDERLY:

2-3

mg/kg/day or

50-100mg

elemental

iron 2

time/day upto 100mg 4

time/day.

CHILDREN:

3 mg/kg/day

elemental

iron in 1-3

divided

doses.

Ferrous

Sulfate is an

essential

component in

the formation

of hemoglobin,myoglobin and

enzymes. It is

necessary for

effective

erythropoiesis

and transport

or utilization of

oxygen

The

prevention

or

treatment

of irondeficiency

anemia

due to

inadequate

diet,

malabsorpt

ionpregnancy,

and blood

loss.

Ferrous sulfate

(or other oral iron

products) are

considered

contraindicated in

patients withhemosiderosis,

hemochromoto-

sis, hemolytic

anemias, or

known

hypersensitivity to

any component of

the product.Because of the GI

irritating

properties of the

drugs, oral iron

products are also

considered

contraindicated

by someclinicians in

patients with GI

ulcerative

diseases

Side Effects ofFerrous SulfateMild, transient

nausea

Heartburn

AnorexiaConstipation

Diarrhea

AdverseReactions ofFerrous SulfateLarge doses

may aggravatepeptic ulcer,

regional

enteritis, and

ulcerative colitis.

Severe Iron

Poisoning:

Vomiting Severe

abdominal painDiarrhea

Dehydration

Hyperventilation

Pallor or

cyanosis

cardiovascular

collapse

Store all forms at room

temperature.Give between meals

with water but may give with

meals if gastrointestinal

discomfort occurs.Transient

staining of mucous membranes

and teeth will occur with liquid

iron preparation. To avoid, place

liquid on the back of the tongue

with dropper or use straw.Avoid

simultaneous administration of

antacids or tetracycline.Do not

crush sustained-release

preparations.Eggs and milk

inhibit absorption.Monitor serumiron, total iron-binding capacity,

reticulocyte count, hemoglobin,

and ferritin.Monitor daily pattern

of bowel activity and stool

consistency.Assess for clinical

improvement, record of relief of

symptoms (fatigue, irritability,

pallor, paresthesia, and

headache).Patient Teachingsfor Clients Taking FerrousSulfateExpect stools to darken incolor.If gastrointestinal

discomfort occurs, take after

meals or with food.Do not take

within 2 hours of antacids

because it prevents absorption.


CONTRAINDICATION

ADVERSEREACTION



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GENERICNAME:

Cefuroxime

BRAND NAME:

Ceflin

CLASSIFICATION:

Antibiotic , anti

infective

DOSAGE:

500 mgROUTE

PO

FREQUENCY:

Three times a

day

Exerts

anti

bacterial

activity

byinhibition

of

bacterial

cell wall

synthesis

in

susceptible

species

Effective

in

treatment

of

penicillinase

producing

gonorrhea

, treats

bone, joint

infection,

tonsillitis,pharyngitis,

and also

used in

surgical

prophylaxi

s

Contraindic

ated in

patients

with a

known

allergy to

cephalospor

in group of

antibiotics.

nausea, vomiting,

stomach pain, mild

diarrhea, gas, upset

stomach;

cough, stuffy nose;

stiff or tight muscles,muscle pain;

joint pain or swelling;

headache,

drowsiness;

feeling restless,

irritable, or

hyperactive;

white patches orsores inside your

mouth or on your

lips;

unusual or

unpleasant taste in

your mouth;

diaper rash in an

infant taking liquid

cefuroxime;

mild itching or skin

rash; or

vaginal itching or

discharge.

Question for history of allergies,

particularly cephalosporins and

penicillins.

: Give without regards to meals. If GI

upset occurs give with food or milk.

Avoid crushing tablets due to bitter taste

Suspension must be given with food.: Intramuscular injections must be

administered deep IM to minimize

discomfort.

Assess mouth for white patches on

mucous membranes and tongue.

Monitor bowel activity and stool

consistency carefully.

Mild GI effects may be tolerable but

increasing severity may indicate onset

of antibiotic-associated colitis.Monitor input and output and renal

function reports for nephrotoxicity.

Be alert for superinfection: severe

genital or anal pruritus, abdominal pain,

severe mouth soreness, moderate to

severe diarrhea

Patient Teachings for Clients Taking

Discomfort may occur with IM injection.

Doses should be evenly spaced.

Continue antibiotic therapy for full length

of treatment.

May cause GI upset (may take with food

or milk).

DRUG ACTION INDICATION CONTRAINDICATION

ADVERSEREACTION



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Generic Name:

Diphenhydramin

e HCL

Brand Name:

Benadryl

Classification:Antihistamine

Dosages and

Route: CapAdult & childn12yr25-50 mgtid-qid. SyrAdult & childn12yr12.5-25

mg qid. Childn 6yr-

Severe Anemia

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