anemia-170709121059

1. Practice teaching on Anemia Presented by: Mr. Hari singh nagar M. Sc Nursing 1styear

2. Anemia

3. Objectives After completion of the class students will be able to • Introduce the anemia. • Define anemia • Enlist the Causes of Anemia • Enlist the classification of anemia • Enlist the types of anemia • Enlist the Pathophysiology of Anemia • Explain the clinical manifestation of Anemia • Enlist the diagnostic evaluation of anemia

4. Objectives • Explain the management of anemia. • Enlist the complication of anemia. • Explain the nursing management of the anemia.

5. Introduction It is a major killer disease in India. Statistics reveal that every second Indian women is anemic. One in every five menstrual deaths is directly due to anemia. It affects both the adults and children of both sexes, although pregnancy women and adolescent girls are most susceptible and most affected by the disease.

6. Definition • It is a condition in which the hemoglobin concentration is lower then the normal. As a results, the amount of oxygen delivered to body tissue is diminished.

7. Normal value of Hb men 13.5-16.5gm/100ml female 12-15gm/100ml

10. Causes of anemia

11. Causes of Anemia Increase loss Increase requirements Decrease intake Decrease absorption

13. Risk Factor for Anemia Low socio economic status Teenage pregnancy Menstrual problem Multiparty

14. Classification of Anemia 1. On the basis of cause Bleeding (blood loss) Hypoproliferative anemia (inadequate production of normal blood cells) Hemolytic (destruction of blood cells) • • •

15. Classification of Anemia 2. On the basis of morphology Microcytic – If the cells are smaller than normal, e.g. iron deficiency anemia, anemia of chronic disease, thalassemia. Normocytic – if cells are in normal size, e.g.- acute blood loss, anemia of chronic disease, hemolytic anemia, Aplastic anemia. Macrocytic - if they are larger than normal, e.g.-Megaloblastic anemia • • •

16. Types of Anemia 1. Iron deficiency anemia – it is caused by a lack of iron. It develop when body store of iron drops too low to support normal RBCs production. women are at risk, for menstrual blood flow and growing fetus. 2. Anemia of chronic disease – it is a chronic disease of inflammation, infection and malignancy cause this type of anemia. 3. Thalassemia – it is a genetic disorder that is characterized by abnormal formation of hemoglobin it results in inadequate oxygen transport and destruction of RBCs which leads to anemia.

17. Types of Anemia 4. Aplastic anemia – it is a rare disease in which the bone marrow and hematopoietic stem cells that are damaged leads to pancytopenia (deficiency of all three cellular components of the blood such as red cells, white cells, and platelets). 5. Megaloblastic or folic acid deficiency anemia - in this condition the bone marrow usually produce large, abnormal and immature RBCs. It results from inhibition of DNA synthesis during RBCs production so it leads to continuing cell growth without division.

18. Types of Anemia 6. Pernicious anemia - it occurs when the intestine can’t properly absorb vitamin B12. 7. Sickle cell anemia – it is characterized by RBC that assume the abnormal, rigid, sickle shape. It results from the presence of mutated form of a Hb.

19. Thalasemia

24. P/P of pernicious anemia Normal gastric mucosa secrete a substance called intrinsic factor necessary for absorption of vit.B12in ilieum. If defect exists in mucosa intrinsic factor may not be secreted Orally ingested vitamin B12is not absorbed. Vitamin B12is necessary for the normal DNA synthesis in maturing RBCs. Pernicious anemia

25. Clinical manifestations Easy fatigue and loss of energy Hypotension, rapid heart rate when exercise Shortness of breath and headache in exercise. Difficulty in concentration. Dizziness, insomnia, leg cramps Pale skin, changes in stool color. Spleenomegaly • • • • • • •

26. Diagnostic evaluation of anemia • History • Physical examination • Complete blood count • Others – Stool Hb test

27. Diagnostic evaluation of anemia Iron,, Folate, Vitamin b12, bilirubin. Hb electrophoresis Reticulocyte count Bone marrow biopsy

28. Management Of anemia 1. Blood transfusion – specially RBCs transfusion. 2. Iron supplements – oral ferrous sulphate, parenteral iron therapy. 3. Nutritional therapy and dietary consideration – vitamin b12 rich diet, iron rich diet, and folic acid rich diet to be provided to the patient. 4. Spleenectomy – removal of spleen. 5. Bone marrow and stem cell transplantation – to enhance the production of RBCs, WBC, platelets.

29. Management Of anemia 6. Activity restriction – minimizes the activity, curtailing the exercise ( running on the grass rather then the concrete). Running on the hard surface develop the hemoglobinuria.

30. Management Of iron deficiency anemia Correction of chronic blood loss Oral or parenteral iron therapy  Oral ferrous sulfate  Iron dextran or iron sorbitex parenteral therapy • •

31. Management Of pernicious anemia Parenteral replacement with hydroxycobalamine or cyanocobalamine is necessary by IM injection every month. •

32. Management Of folic acid deficiency anemia The goal is to identify and treat the cause of the folate deficiency. • You may receive folic acid supplements by mouth or through a vein. If you have low folate levels because of a problem with your intestines, you may need treatment for the rest of your life. • Diet changes can help boost your folate level. Eat more green, leafy vegetables and citrus fruits.

33. Management Of aplastic anemia Bone marrow transplantation Immunosuppressive treatment Androgens to stimulate bone marrow regeneration Platelet and RBCStransfusion • • • •

34. Management Of thalasemia Blood transfusion iron chelation therapy Folic acid supplements BMT Spleenectomy • • • • •

35. Management Of sickle cell anemia Promote adequate oxygenation Blood transfusion Spleenectomy Butyrate and hydroxyurea • • • •

36. Complication of Anemia • Hypoxia • Severe fatigue • Physical & mental growth retardation • Neurologic damage • Heart problem – irregular heart rate, heart enlargement, heart failure • Pregnancy complication – premature birth • Death

37. Nursing Management

38. 1. Nursing diagnosis - Imbalanced nutrition less then body requirement related to inadequate intake of essential nutrients as evidenced by skin integrity, color and body weight. • Goals: Improve nutrition level • Intervention: • A healthy diet should be encouraged. • Avoid alcoholic beverages. • Dietary teaching session should be individualized including culture aspect related to food preference and food preparation.

39. 2. Nursing diagnosis – activity intolerance related to low level of Hb in body as evidenced by the weakness, fatigue and malaise. • Goal: Improve the activity intolerance • Intervention: assist the patient to prioritize the Activities and a establish balance between the activity and rest that is realistic and feasible from the patient perspectives. • • Patient with chronic anemia need to maintain some physical activity and exercise to prevent the deconditioning that results from the inactivity.

40. 3. Nursing diagnosis – ineffective tissue perfusion related to less blood volume as evidenced by skin color (pallor). • Goal: Improve tissue perfusion. • Intervention: • The nurse monitor the vital sign closely. • lost volume replaced with blood transfusion or IV fluids. • Supplemental oxygen may be necessary but it is rarely needed on a long term basis. • Other medication such as antihypertensive agent may be needed to be adjusted.

41. 3. Nursing diagnosis – ineffective tissue perfusion related to less blood volume as evidenced by skin color (pallor). • Goal: Improve tissue perfusion. • Intervention: • The nurse monitor the vital sign closely. • lost volume replaced with blood transfusion or IV fluids. • Supplemental oxygen may be necessary but it is rarely needed on a long term basis. • Other medication such as antihypertensive agent may be needed to be adjusted.

42. Research related to Anemia Sanjeev M Chaudhary conducted a cross sectional study of anemia among adolescent Females in the Urban Area of Nagpur. Sample consisted of 296 adolescent females (10–19 years old). Major finding of the study reveals that the prevalence of anemia was found to be 35.1%. This study concluded that a high prevalence of anemia among adolescent females was found, which was higher in the lower socio-economic strata and among those whose parents were less educated. Mean height and weight of subjects with anemia was significantly less than subjects without anemia.

43. Summary

44. References • “Joyce M. Black Jane Hokanson” medical surgical nursing,7thedition, Elsevier publication, volume 1,page no. 619-651 • “Suddarth’s & burnner” text book of medical surgical nursing, twelfths edition, Wolters publication, Page no. 910-927 • “Saunders” comprehensive review for the NCLEX RN examination, fifth edition, elsevier publication, page no. 520-522