Anemia Nursing Management

Introduction

Anemia, a common blood disorder, occurs when the body lacks enough healthy red blood cells or hemoglobin to carry adequate oxygen to the body’s tissues. It can result from various underlying causes, including nutritional deficiencies, chronic diseases, genetic factors, or blood loss.

Anemia can manifest with symptoms such as fatigue, weakness, shortness of breath, pale skin, and dizziness, impacting the individual’s quality of life and overall well-being. Nursing management of anemia involves comprehensive assessment, collaboration with healthcare providers, patient education, and implementing interventions aimed at addressing the underlying cause, managing symptoms, and promoting optimal health outcomes.

The origin of anemia hinges on whether it is hypoproliferative or hyperproliferative. Hypoproliferative anemias are marked by a corrected reticulocyte count of < 2% and are further categorized based on mean corpuscular volume (MCV) into microcytic anemia (MCV <80 fl), normocytic anemia (MCV 80 to 100 fl), and macrocytic anemia (MCV >100 fl). Conversely, hyperproliferative anemia refers to a corrected reticulocyte count of >2% (Xiao, 2022).

The gravest complications of severe anemia stem from tissue hypoxia. Shock, hypotension, or coronary and pulmonary insufficiency may arise, particularly in older adults with preexisting pulmonary and cardiovascular conditions (Young, 2018).

Nursing priorities for patients with anemia may include:

  1. Monitoring hemoglobin and hematocrit levels to assess the severity of anemia and response to treatment.
  2. Identifying and addressing the underlying cause of anemia, such as nutritional deficiencies, chronic diseases, or blood loss.
  3. Administering blood transfusions or iron supplementation as prescribed to replenish depleted red blood cells and improve oxygen delivery to tissues.
  4. Educating patients about dietary modifications and lifestyle changes to manage and prevent anemia recurrence.
  5. Monitoring for signs and symptoms of complications related to anemia, such as fatigue, weakness, shortness of breath, and dizziness, and providing appropriate interventions.
  6. Collaborating with other healthcare professionals, such as dietitians and hematologists, to optimize patient care and outcomes.

Nursing assessment for anemia includes gathering subjective and objective data:

Subjective data:

  • Exertional discomfort or dyspnea
  • Abnormal heart rate or blood pressure response
  • Generalized weakness
  • Deconditioned state
  • Sedentary lifestyle
  • Inaccurate follow-through of instructions
  • Questioning healthcare team members
  • Verbalized inaccurate information
  • Exertional discomfort or dyspnea
  • Inability to maintain usual physical activity
  • Increased rest requirements
  • Reports of fatigue and lack of energy
  • Verbalized fatigue

Objective data:

  • Decreased mentation, restlessness
  • Palpitations
  • Tingling in extremities, intermittent claudication
  • Delayed wound healing
  • Changes in vital signs
  • Diminished peripheral pulses and capillary refill
  • General pallor

Assessment related to the cause of anemia:

  • Lack of resources
  • New condition or treatment
  • Unfamiliarity with the disease condition
  • Bone marrow malfunction
  • Marrow replacement with fat in aplastic anemia
  • Inflammatory response
  • Vaso-occlusive nature of sickling (sickle cell anemia)
  • Decreased hemoglobin and hematocrit levels.
  • Decreased hemoglobin and diminished oxygen-carrying capacity of blood
  • Imbalance between oxygen supply and demand
  • Reduced energy stores
  • Complexity of treatment
  • Lack of recall

Nursing goals and expected outcomes for a client with anemia may include:

  1. The client will verbalize their understanding of energy conservation principles.
  2. The client will report reduced fatigue, demonstrating increased energy and ability to perform desired activities.
  3. The client will identify factors that exacerbate activity intolerance.
  4. The client will report the ability to perform the required activities of daily living.
  5. The client will identify methods to alleviate activity intolerance.
  6. The client will verbalize their understanding of their disease process, diagnostic procedures, potential complications, and treatment plan.
  7. The client will identify causative factors contributing to anemia.
  8. The client will initiate the necessary behaviors or lifestyle changes to manage anemia effectively.
  9. The client will have a reduced risk of infection, as demonstrated by the absence of fever, a normal white blood cell count, and the implementation of preventive measures such as proper hand hygiene.
  10. The client’s vital signs will be within the normal range.
  11. The client will have a reduced risk of bleeding, as evidenced by normal or adequate platelet levels and the absence of bruises and petechiae.
  12. The client will demonstrate improved tissue perfusion, indicated by stable vital signs, strong and palpable peripheral pulses, adequate urine output, and absence of pain.

Nursing interventions and actions for patients with anemia aim to enhance tolerance to activity and manage fatigue. These interventions include:

  1. Assess manifestations of activity intolerance and ask the client to rate perceived exertion on a scale of 0-10.
  2. Evaluate the specific cause of fatigue, considering tissue hypoxia from normocytic anemia and other related medical problems.
  3. Assess the client’s ability to perform activities of daily living and the demands of daily life.
  4. Assess the risk of falling and implement applicable strategies to prevent injuries, particularly among older adults with anemia.
  5. Evaluate the emotional response to limitations in physical activity and provide appropriate support and counseling.
  6. Conduct a timed up-and-go test (TUG) to assess reductions in mobility among older adults.
  7. Monitor pulse oximetry and inform the healthcare provider if oxygen saturation is 92% or less, indicating the need for supplementary oxygen.
  8. Monitor hemoglobin, hematocrit, red blood cell (RBC) counts, and reticulocyte counts to evaluate the progression or deterioration of anemia.
  9. Encourage deep breathing techniques and administer oxygen as prescribed to improve oxygen delivery to tissues.
  10. Assist the client in developing a schedule for daily activity and rest, emphasizing the importance of frequent rest periods to conserve energy reserves.

Initiating health teachings and patient education for individuals with anemia is crucial for understanding the condition, its causes, and treatment options. Here are some key interventions:

  1. Assess the client’s current knowledge of the diagnosis, disease process, possible causes, and treatment options to plan individualized teaching sessions.
  2. Evaluate the client’s and family’s understanding of medical vocabulary related to anemia and its associated terms.
  3. Assess resources, including finances, and the ability to obtain and prepare food, which can impact dietary choices and nutritional intake.
  4. Explain the importance of diagnostic procedures such as complete blood count and bone marrow aspiration, and discuss the possibility of referral to a hematologist for further evaluation.
  5. Educate the client about hematological vocabulary and the functions of blood elements like white blood cells, red blood cells, and platelets.
  6. Instruct the client to avoid known risk factors for anemia, such as alcoholism, exposure to toxic chemicals, dietary deficiencies, and certain medications.
  7. For clients with aplastic anemia, explain the importance of avoiding blood transfusions from prospective marrow donors to prevent donor marrow rejection.
  8. Emphasize the need for rapid human leukocyte antigen (HLA) typing for potential related donors in clients requiring hematopoietic stem cell transplantation.
  9. Discuss immunosuppressive therapy as the treatment of choice for clients without HLA-matched donors and/or older than 40 years of age.
  10. Explain that allogeneic hematopoietic stem cell transplantation is the standard treatment for clients younger than 40 years old with HLA-identical related donors.

Preventing infection risk and promoting infection control are essential aspects of care for individuals with anemia. Here are some nursing interventions and actions:

  1. Assess for local or systemic signs of infection, such as fever, chills, swelling, pain, and body malaise, as opportunistic infections can easily develop, especially in immunocompromised clients.
  2. Monitor the white blood cell (WBC) count to detect any abnormalities that may indicate an increased risk of infection, such as leukopenia or neutropenia.
  3. Instruct the client to report signs and symptoms of infection immediately, such as fever or chills, as prompt treatment may be necessary.
  4. Anticipate the need for antibiotic, antiviral, and antifungal therapy if infection is suspected or confirmed, as these agents are effective in killing infections.
  5. Advise the client to avoid contact with people who have existing infections to prevent exposure to pathogens, especially during periods of immunocompromise.
  6. Provide a private room for protective isolation if the client is hospitalized and at significant risk for infection, particularly if the absolute neutrophil count is low.
  7. Instruct the client to avoid consuming raw fruits and vegetables and uncooked meat, as these food items can harbor bacteria and pose a risk of infection, especially for those with neutropenia or receiving immunosuppressive therapy.

Preventing bleeding risk and improving tissue perfusion are crucial aspects of managing anemia. Here are nursing interventions and actions to address these concerns:

  1. Assess the skin for bruises and petechiae, which can indicate thrombocytopenia or other bleeding disorders, and monitor vital signs carefully, including pulses, for signs of diminished perfusion.
  2. Monitor skin for signs of coolness, pallor, cyanosis, diaphoresis, and delayed capillary refill, which may indicate diminished circulation and hypoxia.
  3. Assess for any frank bleeding from the nose, gums, vagina, or urinary or gastrointestinal tract, as these are common sites for spontaneous bleeding in individuals with anemia.
  4. Monitor platelet count regularly, as a low platelet count increases the risk of bleeding, and monitor stool and urine for occult blood to identify the site of bleeding.
  5. Note changes in level of consciousness and reports of headache, dizziness, and sensory or motor deficits, which may indicate compromised perfusion to the central nervous system.
  6. Assess lower extremities for skin texture, edema, and ulcerations, especially around the ankles, as reduced peripheral circulation can lead to tissue changes and delayed healing.

Assessing and monitoring for potential complications in patients with anemia is crucial for early detection and intervention. Here are key actions for nurses to take:

  1. Monitor the patient’s vital signs regularly, including heart rate, blood pressure, respiratory rate, and oxygen saturation, to assess cardiovascular function and detect any abnormalities or signs of cardiac complications.
  2. Assess for signs of impaired tissue perfusion, such as delayed wound healing, skin pallor, cool extremities, or cognitive changes, to identify tissue hypoxia and intervene promptly.
  3. Conduct routine laboratory tests, including complete blood count (CBC), iron studies, and additional tests specific to the underlying cause of anemia, to monitor hemoglobin levels, assess iron stores, and evaluate response to treatment.
  4. Evaluate organ function through laboratory tests, such as renal function tests and liver function tests, to detect any impairment or worsening of organ status that may result from anemia or its underlying causes.
  5. Monitor for signs and symptoms of infections, such as fever, changes in respiratory status, localized signs of inflammation, or increased white blood cell count, to detect and manage infections early.
  6. Educate patients about signs and symptoms to watch for, including fatigue, dizziness, shortness of breath, changes in wound healing, or signs of infection, to empower them to recognize and report potential complications promptly.
  7. Administering medications and providing pharmacologic support are essential aspects of managing anemia. Medications such as iron supplements, vitamin B12 injections, or erythropoiesis-stimulating agents (ESAs) may be prescribed depending on the specific type of anemia. Regular monitoring of patients’ response to medication and managing medication side effects are also important nursing responsibilities

Regular monitoring of laboratory parameters is essential in evaluating and managing patients with anemia.

These tests help healthcare professionals assess the severity of anemia, identify its underlying causes, and track the response to treatment. Here are common laboratory studies and diagnostic procedures used in the evaluation of patients with anemia:

Laboratory Studies:

  1. Complete Blood Count (CBC): Measures hemoglobin, hematocrit, red blood cell count, white blood cell count, and platelet count.
  2. Peripheral Blood Smear: Microscopic examination of a blood sample to assess the size, shape, and appearance of red blood cells, white blood cells, and platelets.
  3. Reticulocyte Count: Determines the percentage of reticulocytes (immature red blood cells) in the blood, indicating the bone marrow’s ability to produce new red blood cells.
  4. Serum Iron, Ferritin, and Transferrin Saturation: Measures iron levels and evaluates iron stores in the body, particularly in cases of iron deficiency anemia.
  5. Vitamin B12 and Folic Acid Levels: Determines the levels of these vitamins to assess deficiencies that can lead to anemia.
  6. Erythropoietin Level: Measures the level of erythropoietin, a hormone that stimulates red blood cell production, helpful in evaluating anemia related to kidney disease.
  7. Coagulation Studies: Assess the blood’s ability to clot and evaluate potential bleeding disorders that may contribute to anemia.

Diagnostic Procedures:

  1. Bone Marrow Aspiration and Biopsy: Involves taking a sample of bone marrow to examine the cellular composition, assess the bone marrow’s ability to produce red blood cells, and identify any abnormalities or disorders.
  2. Upper and Lower Endoscopy: Procedures used to visualize the gastrointestinal tract and identify potential sources of bleeding that could lead to anemia.
  3. Imaging Studies (e.g., ultrasound, CT scan, MRI): Used to evaluate the organs and tissues for abnormalities or sources of bleeding that may cause anemia.
  4. Genetic Testing: In certain cases, genetic testing may be performed to identify inherited disorders associated with anemia, such as thalassemia or sickle cell disease. Regular monitoring and interpretation of these laboratory and diagnostic tests are essential for effective management of anemia and prevention of complications.

Conclusion

In conclusion, the nursing management of anemia plays a crucial role in identifying, assessing, and addressing this prevalent blood disorder. Through diligent assessment and collaboration with healthcare teams, nurses can provide personalized care plans tailored to each patient’s unique needs. By implementing interventions to manage symptoms, address underlying causes, and promote patient education and self-care, nurses empower individuals with anemia to better manage their condition and improve their quality of life. With a holistic approach and patient-centered care, nurses contribute significantly to the overall well-being and health outcomes of individuals living with anemia.

Read more: Nursing Care Plans

Read more: Hemophilia Nursing Management

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