Which is an appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia

Anemia Nursing Care Plans Diagnosis and Interventions

Anemia NCLEX Review and Nursing Care Plans

Anemia is a medical condition wherein a person lacks sufficient RBC count, hemoglobin, and hematocrit values resulting in a reduced oxygen-carrying and transport capacity of the blood to the body’s vital tissues.

There are numerous forms and representations of anemia, each with its own variability and cause. Anemia can be short or long-term and can range from mild to severe cases. If anemia is suspected, consult the doctor immediately, for it could be a warning sign of an underlying serious illness or disease.

Treatments for anemia could be achieved by practicing a varied healthy diet, taking certain drugs and supplements, and performing urgent medical procedures, which could improve a person’s response towards this serious illness.

Types of Anemia

1. Hypoproliferative Anemia – this type of anemia is determined by diminished or ineffective erythropoiesis, as evidenced by a reduced reticulocyte count. Second, the use of medications and chemical agents results in bone marrow destruction, leading to a lack of erythrocyte production.

Examples of hypoproliferative anemia are the following:

• Vitamin Deficiencies anemia (e.g., Iron deficiency anemia, Vitamin B12 or folate deficiency, Anemia of chronic disease, aplastic anemia, etc.)

2. Hemolytic Anemia – this anemia is due to hemolysis of the red blood cells, causing hemoglobin to be released into the plasma. It can also be due to trauma or injury inflicted to the RBC membrane that causes liberation of its contents.

When there is increased erythrocyte destruction, anticipate the development of tissue hypoxia and the production of erythropoietin as a compensatory response of the body. EPO stimulates RBC production, and the effect is an increase in reticulocyte count.

Reticulocytes are immature red blood cells, and due to their lack of biconcave shape, their stability cannot be guaranteed in the sheer stress it would be subjected to in the blood circulation.

Examples of hemolytic anemia are the following:

• Sickle cell anemia
• Anemia due to intrinsic causes (e.g., hereditary spherocytosis, G6PD deficiency, Sickle cell anemia, HbC disease, etc.)
• Anemia due to extrinsic causes (e.g., lead poisoning, hypersplenism, spur cell hemolytic anemia, autoimmune diseases, etc.)

Signs and Symptoms of Anemia

• Fatigue
• Dyspnea or shortness of breath
• Tachycardia
• Visible signs of weakness/lethargy
• Tissue hypoxia
• Headaches

Causes of Anemia

Based on the following indicators, it is usually feasible to determine whether anemia is caused by the destruction or decreased production of erythrocytes.

• Manner of proliferation – If there is an increase in infiltration and production of immature red blood cells in the bone marrow, it could indicate certain kinds of anemia. And the process by which they develop can be seen in the bone marrow biopsy.
• Bone Marrow response – the BM compensates for the decrease in erythrocyte level, hence the increase in the production and release of reticulocytes in the blood circulation.
• Erythrocyte destruction – intravascular hemolysis resulting from RBC destruction can indicate anemia of certain origins (intrinsic or extrinsic), and this is made possible by the presence of end products within the blood circulation.

Risk Factors of Anemia

• Nutrient-deficient status
• Menstruation
• Chronic ailments
• Pregnancy
• Intestinal disorders (e.g., Celiac disease, Crohn’s disease)
• Genetics
• Exposure to chemicals
• Alcoholism

For initial investigation, laboratory tests for blood may be employed for such as measurements of:

• Hematocrit, Hemoglobin, Reticulocyte count, as well as the RBC indicators (e.g., mean corpuscular volume, red cell distribution width) to evaluate and confirm suspected cases of anemia
• Complete blood count – This blood test measures a wide range of blood components. And the remaining CBC parameters are useful to determine whether anemia is associated with another hematologic condition. Abnormal findings may indicate an infection or condition not entirely linked to anemia; hence, it is important to assess the patient’s blood profile.
• Iron studies – This is a common anemia screening test and is useful in determining its possible cause (e.g., iron overload, iron deficiency, response, etc.). Iron studies include total-iron binding capacity, ferritin, percent saturation, serum iron level, folate, and serum vitamin B12 determination.

Treatment for Anemia

Treatment of anemia usually depends on the type of anemia and its cause. However, the universal treatment scheme is through careful medical management and supportive therapy.

1. Blood transfusions. As a result of a decrease in circulating red blood cells or blood volume, patients with severe hemolysis may require a blood transfusion.
2. Use of nutritional supplements. The proper use of nutritional supplements should be explained to the patient and his/her family, as excessive intake will not help to improve anemic symptoms.
3. Administration of intravenous fluids
4. Medications such as anti-anemic drugs

Prevention of Anemia

The following are measures to prevent anemia, especially in highly vulnerable patient groups:

• Take vitamins that contain iron.
• Practice good dietary intake.
• Eat plenty of vitamin C-rich foods. such as citrus fruits and fresh raw vegetables.

Anemia Nursing Diagnosis

Nursing Care Plan for Anemia 1

Fatigue

Nursing Diagnosis: Fatigue related to lack of oxygen-carrying capacity of blood due to decreased hemoglobin levels, secondary to anemia, as evidenced by increased rest needs, dyspnea or pain during exercise, and verbalized exhaustion.

Desired Outcome: The patient will express comprehension of energy conservation.

Nursing Care Plan for Anemia 2

Risk for Bleeding

Nursing Diagnosis: Risk for Bleeding related to loss of red blood cells, secondary to anemia

Desired Outcome: The patient will have normal platelet levels with the absence of bleeding, bruising and petechiae.

Nursing Care Plan for Anemia 3

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to a mismatch in the supply and demand of oxygen, secondary to anemia, as evidenced by a sedentary lifestyle, a general lack of strength, lethargy, a decrease of physical and physiologic adaptation.

Desired Outcome: The patient will have the ability to carry out daily routines.

Nursing Care Plan for Anemia 4

Risk for Infection

Nursing Diagnosis: Risk for Infection related to reduced internal defenses, secondary to anemia as evidenced by compromised status, presence of fever, and abnormal laboratory findings.

Desired Outcomes:

• The patient will practice preventative actions such as hand washing to lower the risk of infection
• The patient will demonstrate improved wellness as indicated by the absence of fever and within the normal WBC count.

Nursing Care Plan for Anemia 5

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to inadequate resources and information with the condition secondary to anemia, as evidenced by verbalizations on the lack of understanding of the disease, inability to follow directions, constant inquiries, and conveyed incorrect information.

Desired Outcome: The patient will be able to explain his/her own illness and treatment options verbally.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.