Anemias - ANEMIAS(IRON DEFICIENCY PERNICIOUS APLASTIC...

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ANEMIAS (IRON DEFICIENCY, PERNICIOUS, APLASTIC, HEMOLYTIC) Anemia is a symptom of an underlying condition, such as loss of blood components, inadequate elements, or lack of required nutrients for the formation of blood cells, that results in decreased oxygen-carrying capacity of the blood. There are numerous types of anemias with various causes. The following types of anemia are discussed here: iron deficiency (ID), the result of inadequate absorption or excessive loss of iron; pernicious (PA), the result of a lack of the intrinsic factor essential for the absorption of vitamin B 12 ; aplastic, due to failure of bone marrow; and hemolytic, due to red blood cell (RBC) destruction. Nursing care for the anemic patient has a common theme even though the medical treatments vary widely. CARE SETTING Treated at the community level, except in the presence of severe cardiovascular/immune compromise. RELATED CONCERNS AIDS Burns: thermal/chemical/electrical (acute and convalescent phases) Cancer Cirrhosis of the liver Heart failure: Chronic Psychosocial aspects of care Renal failure: acute Renal failure: chronic Rheumatoid arthritis Pulmonary tuberculosis (TB) Upper gastrointestinal/esophageal bleeding Patient Assessment Database ACTIVITY/REST May report: Fatigue, weakness, general malaise Loss of productivity; diminished enthusiasm for work Low exercise tolerance Greater need for rest and sleep May exhibit: Tachycardia/tachypnea; dyspnea on exertion or at rest (severe or aplastic anemia) Lethargy, withdrawal, apathy, lassitude, and lack of interest in surroundings Muscle weakness and decreased strength Ataxia, unsteady gait Slumping of shoulders, drooping posture, slow walk, and other cues indicative of fatigue CIRCULATION May report: History of chronic blood loss, e.g., chronic gastrointestinal bleeding, heavy menses (ID); angina, heart failure (HF) (due to increased cardiac workload) History of chronic infective endocarditis Palpitations (compensatory tachycardia) May exhibit: Blood pressure (BP): Increased systolic with stable diastolic and a widened pulse pressure; postural hypotension Dysrhythmias, electrocardiogram abnormalities, e.g., ST-segment depression and flattening or depression of the T wave; tachycardia Throbbing carotid pulsations (reflects increased cardiac output as a compensatory mechanism to provide oxygen/nutrients to cells) Systolic murmur (ID) Extremities (color): Pallor of the skin and mucous membranes (conjunctiva, mouth, pharynx, lips) and nailbeds, or grayish cast in black patients; waxy, pale skin (aplastic, PA) or bright lemon yellow (PA)
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Sclera blue or pearl white (ID); jaundice (PA) Capillary refill delayed (diminished blood flow to the periphery and compensatory vasoconstriction) Nails brittle, spoon-shaped (koilonychia) (ID) EGO INTEGRITY May report: Negative feelings about self, ability to handle situation/events May exhibit: Depression ELIMINATION May report: History of pyelonephritis, renal failure Flatulence, malabsorption syndrome (ID) Hematemesis, fresh blood in stool, melena Diarrhea or constipation Diminished urine output May exhibit:
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