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Nursing Care Plan for Anemia

Pathophysiology

Anemia is the lack of enough healthy red blood cells (RBC) or hemoglobin (HGB), which is the part of the red blood cell that binds oxygen to the blood. This lack of HGB restricts the amount of oxygen available to create energy within the cells (ATP). This decrease in oxygenation (hypoxia) results in altered pH and can lead to damage of organ systems including cardiac, respiratory and renal disease.

Etiology

There are many causes for anemia to develop including bone marrow disorders and chronic diseases.

  • The most common type of anemia is iron-deficiency anemia which is caused by pregnancy, significant blood loss over time as with heavy menstruation.
  • In aplastic anemia, the bone marrow fails to produce an adequate amount of red blood cells.
  • Hemolytic anemia develops when RBCs are destroyed, often by infection or autoimmune disorders
  • Sickle Cell anemia is a genetic disorder in which the RBCs are misshapen (sickle-shaped) causing clots and poor perfusion.

Desired Outome

Treat the underlying cause of anemia and return to normal counts of RBCs and HGB.

Anemia Nursing Care Plan

Subjective Data:

  • Fatigue / weakness
  • Dizziness
  • Shortness of breath
  • Chest pain
  • Headache

Objective Data:

  • Pale or yellowish skin
  • Bleeding / hemorrhage
  • Syncope
  • Hypotension
  • Tachycardia
  • Abnormal labs (CBC = decreased RBC and HGB)

Nursing Interventions and Rationales:

  1. Assess for and control obvious signs of bleeding: External bleeding, Heavy menstruation (>1 pad per hour), GI bleed
    • Excessive loss of blood results in decreased oxygenation and poor perfusion.
  2. Perform 12-lead ECG
    • Decreased blood volume causes tachycardia and arrhythmias. Monitor for ST depression and QT prolongation.
  3. Replace fluid volume per facility protocol: IV fluids, Blood transfusion for HGB <8 (per protocol and provider)
    • For blood loss of >40% volume, immediate transfusion is required
  4. Monitor diagnostic testing: Lab values, CT scans for possible liver or spleen lacerations, Fecal occult blood - non-invasive test to determine if there is a potential GI bleed
    • Abnormal lab values help determine the cause of anemia and a plan of treatment.
      Lab values to monitor closely:

      HGB (Normal 12-15 g/dL females; 13.5 - 16.5 g/dL males)

      B12 (Normal 2 - 20 ng/mL)

      Ferritin (Normal 20-300 ng/mL) - the protein that stores iron

      Iron (Normal 50-175 ug/dL)
  5. Monitor oxygen saturation and administer oxygen as necessary: If SpO2 is <94%, deliver oxygen via nasal cannula at 2L/min and increase as needed
    • Lack of HGB reduces oxygenation and leads to hypoxia which causes damage to tissues and vital organs.
  6. Administer medications
    • Pantoprazole (GI bleed) - helps reduce acid and stop bleeding of peptic ulcers

      IV fluids and electrolytes as necessitated by lab values

      B12 injections or oral supplements - for B12 deficiency

      Erythropoietin is a hormone that may be given to treat anemia caused by chemotherapy or chronic kidney disease that stimulates production of red blood cells in the bone marrow
  7. Provide nutritional education: Increase green leafy vegetables, Incorporate foods high in vitamin C, Intake of red meat, lamb, poultry and venison as well as fish and shellfish Intake of seafood and shellfish, Limit or avoid intake of foods high in calcium
    • Leafy greens such as spinach, kale and chard are high in iron and folate

      Vitamin C assists in the absorption of iron. Good choices include oranges, red peppers and strawberries

      All meats and most fish and shellfish contain heme iron

      Calcium-rich foods such as raw milk, yogurt, cheese and broccoli are high in calcium, which binds with iron and prevents absorption

References

Date Published - May 16, 2017
Date Modified - Oct 31, 2018