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Know the clinical manifestations and ND for anemia·Pallor (decrease hemoglobin, blood flow to skin)·Jaundice (increase concentration of serum bilirubin)·Pruritus (increased serum and skin bile salt concentration)Cardiovascular Manifestations·Additional attempts by the heart and lungs to provide adequate O2 to the tissues·Cardiac output maintained by increasing the heart rate and stroke volumable 30-3Manifestations of AnemiaBody SystemSEVERITY OF ANEMIAMild (Hgb 10-12 g/dL[100-120 g/L])Moderate (Hgb 6-10 g/dL [60-100 g/L])Severe (Hgb <6 g/dL [<60 g/L])IntegumentNoneNonePallor, jaundice,*pruritus*EyesNoneNoneIcteric conjunctiva and sclera,*retinal hemorrhage, blurred visionMouthNoneNoneGlossitis, smooth tongueCardiovascularPalpitationsIncreased palpitations, “bounding pulse”Tachycardia, increased pulse pressure, systolic murmurs, intermittent claudication, angina, heart failure, myocardial infarctionPulmonaryExertional dyspneaDyspneaTachypnea, orthopnea, dyspnea at restNeurologicNone“Roaring in the ears”Headache, vertigo, irritability, depression, impaired thought processes
GastrointestinalNoneNoneAnorexia, hepatomegaly, splenomegaly, difficulty swallowing, sore mouthMusculoskeletalNoneNoneBone painGeneralNone or mild fatigueFatigueSensitivity to cold, weight loss, lethargyND:Fatigue, imbalanced nutrition, ineffective health managementKnow normal values of CBC- Hgb, Hct, RBC, PLTS, WBC Hbg female – 13.2-17,3Hbg male – 11.7-15.5Hct female – 39-50%Hct male – 35-47%RBC <33Platlets 150-400 x 10^3WBC 4.0-11.0 x 10^3Know foods high in iron and be able to teach patients why they still need supplements Nutritional TherapyNutrients for ErythropoiesisRole in ErythropoiesisFood SourcesCobalamin (Vitamin B12)RBC maturationRed meats, especially liver, eggs, enriched grain products, milk and dairy foods, fishCopperMobilization of iron from tissues to plasma*Shellfish, whole grains, beans, nuts, potatoes, organ meatsFolic AcidRBC maturationGreen leafy vegetables, liver, meat, fish, legumes, whole grains, orange juice, peanuts, avocadoIron
Hemoglobin synthesisLiver and muscle meats, dried fruits, legumes, dark green leafy vegetables, whole-grain and enriched bread and cereals, beansNiacinRBC maturationPeanut butter, beans, meats, avocado; enriched and fortified grainsPantothenic Acid (Vitamin B5)Heme synthesisMeats, vegetables, cereal grains, legumes, eggs, milkPyridoxine (Vitamin B6)Heme synthesisMeats, fortified cereals, whole grains, legumes, potatoes, cornmeal, bananas, nutsRiboflavin (Vitamin B2)Oxidative reactionsMilk and dairy foods, enriched bread and other grain products, salmon, chicken, eggs, green leafy vegetablesVitamin EHeme synthesis. Protection against oxidative damage to RBCsVegetable oils, meat, eggs, wheat germ, whole-grain products, seeds, nuts, peanut butterAmino AcidsHeme and plasma membrane synthesisEggs, meat, milk and milk products (cheese, ice cream), poultry, fish, legumes, nuts, tofuAscorbic Acid (Vitamin C)Conversion of folic acid to its active forms, aids in iron absorption