7/31/2019 Severe Anemia
1/62
Severe
Anemia
7/31/2019 Severe Anemia
2/62
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
7/31/2019 Severe Anemia
3/62
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.
7/31/2019 Severe Anemia
4/62
Three broad etiologic categories:
Loss of RBCs
Decreased production of RBCs
Increased destruction of RBCs
7/31/2019 Severe Anemia
5/62
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.
7/31/2019 Severe Anemia
6/62
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.
7/31/2019 Severe Anemia
7/62
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).
7/31/2019 Severe Anemia
8/62
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
7/31/2019 Severe Anemia
9/62
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
7/31/2019 Severe Anemia
10/62
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.
7/31/2019 Severe Anemia
11/62
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.
7/31/2019 Severe Anemia
12/62
Past Health History
No history of admission by any illness
possible.
Does not take any maintenance pills.
Does not take any multivitamins.
7/31/2019 Severe Anemia
13/62
Social History
A housewife.
The patient is not smoking.
Not taking alcohol. Her husband does not take any tobacco
nor alcohol
7/31/2019 Severe Anemia
14/62
Family History
The patient have no history of
hyper/hypotension, diabetes mellitus,
respiratory problems and others.
No history of congenital disorders.
7/31/2019 Severe Anemia
15/62
Maternal History
The patient is G3 P3 (3003).
Her LMP is May 20, 2011.
All siblings are born alive via NSVD.
7/31/2019 Severe Anemia
16/62
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
7/31/2019 Severe Anemia
17/62
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.
7/31/2019 Severe Anemia
18/62
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.
7/31/2019 Severe Anemia
19/62
Physical Assessment
EARS
Ears are equal in size bilaterally.
Smooth with no lesions.Color is consistent with facial color.
No tenderness or discharge noted.
7/31/2019 Severe Anemia
20/62
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
7/31/2019 Severe Anemia
21/62
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.
7/31/2019 Severe Anemia
22/62
Physical Assessment
THORACIC AND LUNGScapulas are symmetric and not
protruding.
Thorax appears symmetric.Chest expansion is normal.
Normal breath sounds.
No adventitious sounds noted.
7/31/2019 Severe Anemia
23/62
Physical Assessment
HEART
No blowing, swishing or other sounds heard
during auscultation.
No murmurs noted.
7/31/2019 Severe Anemia
24/62
Physical Assessment
ABDOMEN
Color is pale.
No lesions and rashes noted.
Symmetric.
Bowel sound is 7 and normal.
7/31/2019 Severe Anemia
25/62
ANATOMY
AND
PHYSIOLOGY
7/31/2019 Severe Anemia
26/62
CIRCULATORY SYSTEM
7/31/2019 Severe Anemia
27/62
7/31/2019 Severe Anemia
28/62
7/31/2019 Severe Anemia
29/62
LYMPATHIC SYSTEM
7/31/2019 Severe Anemia
30/62
FEMALE REPRODUCTIVE
SYSTEM
7/31/2019 Severe Anemia
31/62
MENSTRUAL CYCLE
7/31/2019 Severe Anemia
32/62
7/31/2019 Severe Anemia
33/62
PATHOPHYSIOLOGY
difi bl
7/31/2019 Severe Anemia
34/62
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
7/31/2019 Severe Anemia
35/62
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
7/31/2019 Severe Anemia
36/62
MEDICAL
MANAGEMENT
7/31/2019 Severe Anemia
37/62
DIAGNOSTIC EXAMINATIONS
7/31/2019 Severe Anemia
38/62
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.
7/31/2019 Severe Anemia
39/62
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
7/31/2019 Severe Anemia
40/62
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.
7/31/2019 Severe Anemia
41/62
LABORATORY EXAMINATIONS
7/31/2019 Severe Anemia
42/62
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;
7/31/2019 Severe Anemia
43/62
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
7/31/2019 Severe Anemia
44/62
COMPLETE BLOOD COUNTNormal
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;
7/31/2019 Severe Anemia
45/62
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
7/31/2019 Severe Anemia
46/62
Normal
Values
Result
(June25)
Result
(June26)
Remarks Clinical Significance
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.
COMPLETE BLOOD COUNT
7/31/2019 Severe Anemia
47/62
NormalValues Result(June25)
Result(June
26)
Remarks ClinicalSignificance
Eosinophils 0-6% 4% - Normal
Lymphocytes 20-50% 29% - NormalMonocytes 1-10% 05% - Normal
COMPLETE BLOOD COUNT
7/31/2019 Severe Anemia
48/62
Normal
Values
Result
(June
25)
Result
(June
26)
Remarks Clinical Significance
Red
Blood
Cells
(4.2-5.4
x106)2.62 - Decreased Indication that
anemia is present;
Decreased in anemia;
increased in
dehydration,
polycythemia
COMPLETE BLOOD COUNT
COMPLETE BLOOD COUNT
7/31/2019 Severe Anemia
49/62
Normal
Values
Result
(June
25)
Result
(June
26)
Remarks Clinical Significance
Mean
Corpuslucar
Volume
81-96% 86 - Normal
COMPLETE BLOOD COUNT
COMPLETE BLOOD COUNT
7/31/2019 Severe Anemia
50/62
Normal
Values
Result
(June25)
Result
(June26)
Remarks Clinical Significance
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
COMPLETE BLOOD COUNT
7/31/2019 Severe Anemia
51/62
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
COMPLETE BLOOD COUNT
COMPLETE BLOOD COUNT
7/31/2019 Severe Anemia
52/62
COMPLETE BLOOD COUNTNormal
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
7/31/2019 Severe Anemia
53/62
CLINICAL BLOOD CHEMISTRY
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
CLINICAL BLOOD CHEMISTRY
7/31/2019 Severe Anemia
54/62
CLINICAL BLOOD CHEMISTRY
June 27,
2011
Normal
Values
Result Remarks Clinical
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
CLINICAL BLOOD CHEMISTRY
7/31/2019 Severe Anemia
55/62
CLINICAL BLOOD CHEMISTRY
June 27,
2011
Normal
Values
Result Remarks Clinical
Significance
BiochanCreatinine
UV
0.6-1.2mg/dL
0.61 Normal Produced at a constant rateand excreted by the kidney;
increased in kidney disease
CLINICAL BLOOD CHEMISTRY
7/31/2019 Severe Anemia
56/62
CLINICAL BLOOD CHEMISTRY
June 27,
2011
Normal
Values
Result Remarks Clinical
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
7/31/2019 Severe Anemia
57/62
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
7/31/2019 Severe Anemia
58/62
DRUG STUDY
DRUG ACTION INDICATION
CONTRAINDICATION
ADVERSEREACTION
NURSINGCONSIDERATION
7/31/2019 Severe Anemia
59/62
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.
DRUG ACTION INDICATION
CONTRAINDICATION
ADVERSEEFFECT
NURSINGCONSIDERATION
7/31/2019 Severe Anemia
60/62
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.
DRUG ACTION INDICATION
CONTRAINDICATION
ADVERSEREACTION
NURSINGCONSIDERATION
7/31/2019 Severe Anemia
61/62
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
NURSINGCONSIDERATION
7/31/2019 Severe Anemia
62/62
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-
Top Related