Nursing Care Plan for Anemia

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Pathophysiology

Anemia is the lack of enough healthy red blood cells (RBC) or hemoglobin (HGB), which is the part of the red blood cell that binds oxygen to the blood. This lack of HGB restricts the amount of oxygen available to create energy within the cells (ATP). This decrease in oxygenation (hypoxia) results in altered pH and can lead to damage of organ systems including cardiac, respiratory and renal disease.

Etiology

There are many causes for anemia to develop including bone marrow disorders and chronic diseases.

  • The most common type of anemia is iron-deficiency anemia which is caused by pregnancy, significant blood loss over time as with heavy menstruation.
  • In aplastic anemia, the bone marrow fails to produce an adequate amount of red blood cells.
  • Hemolytic anemia develops when RBCs are destroyed, often by infection or autoimmune disorders
  • Sickle Cell anemia is a genetic disorder in which the RBCs are misshapen (sickle-shaped) causing clots and poor perfusion.

Desired Outcome

Treat the underlying cause of anemia and return to normal counts of RBCs and HGB.

Anemia Nursing Care Plan

Subjective Data:

  • Fatigue / weakness
  • Dizziness
  • Shortness of breath
  • Chest pain
  • Headache

Objective Data:

  • Pale or yellowish skin
  • Bleeding / hemorrhage
  • Syncope
  • Hypotension
  • Tachycardia
  • Abnormal labs (CBC = decreased RBC and HGB)

Nursing Interventions and Rationales

  • Assess for and control obvious signs of bleeding
    • External bleeding
    • Heavy menstruation (>1 pad per hour)
    • GI bleed

 

Excessive loss of blood results in decreased oxygenation and poor perfusion.

 

  • Perform 12-lead ECG

 

Decreased blood volume causes tachycardia and arrhythmias. Monitor for ST depression and QT prolongation.

 

  • Replace fluid volume per facility protocol
    • IV fluids
    • Blood transfusion for HGB <8 (per protocol and provider)

 

For blood loss of >40% volume, immediate transfusion is required

 

  • Monitor diagnostic testing
    • Lab values
    • CT scans for possible liver or spleen lacerations
    • Fecal occult blood – non-invasive test to determine if there is a potential GI bleed

 

Lab values to monitor closely:

  • HGB (Normal 12-15 g/dL females; 13.5 – 16.5 g/dL males)
  • B12 (Normal 2 – 20 ng/mL)
  • Ferritin (Normal 20-300 ng/mL) – the protein that stores iron
  • Iron (Normal 50-175 ug/dL)

 

  • Monitor oxygen saturation and administer oxygen as necessary
    • If SpO2 is <94%, deliver oxygen via nasal cannula at 2L/min and increase as needed

 

Lack of HGB reduces oxygenation and leads to hypoxia which causes damage to tissues and vital organs.

 

  • Administer medications

 

  • Pantoprazole (GI bleed) – helps reduce acid and stop bleeding of peptic ulcers
  • IV fluids and electrolytes as necessitated by lab values
  • B12 injections or oral supplements – for B12 deficiency
  • Erythropoietin is a hormone that may be given to treat anemia caused by chemotherapy or chronic kidney disease that stimulates production of red blood cells in the bone marrow

 

  • Provide nutritional education
    • Increase green leafy vegetables
    • Incorporate foods high in vitamin C
    • Intake of red meat, lamb, poultry and venison as well as fish and shellfish
    • Intake of seafood and shellfish
    • Limit or avoid intake of foods high in calcium

 

  • Leafy greens such as spinach, kale and chard are high in iron and folate
  • Vitamin C assists in the absorption of iron. Good choices include oranges, red peppers and strawberries
  • All meats and most fish and shellfish contain heme iron
  • Calcium-rich foods such as raw milk, yogurt, cheese and broccoli are high in calcium, which binds with iron and prevents absorption

 


References

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Video Transcript

All right guys, let’s work through an example Nursing Care Plan for a patient with anemia. So again, we’re just gonna use a hypothetical patient and we’re going to assume that anemia in general is their main problem. Now there’s a lot of different types of anemia. We’re gonna kind of focus on generic anemia. Maybe iron deficiency, B12 pernicious anemia issues. I’m not really gonna worry about sickle cell specifically because there’s so many other issues with that. So just think general anemia. So what kind of signs and symptoms are we going to see if somebody has anemia? Well, first things first, we know they’re going to have a low H/H. I mean it’s really the biggest definition of anemia. We’re going to see low hemoglobin. We might even see low red blood cells. And again, depending on the, cause we might see low iron levels are possibly low B12 levels, right?

So we’ve got some lab values. We can definitely look out for this patient with anemia. We also know that another cause of anemia might actually be bleeding. So we may be able to see those signs of bleeding or hemorrhage in that patient that has an amia. And then how’s this patient gonna feel? What are they going to tell you? They’re going to be tired for sure. They could definitely have fatigue. They might even be a little bit short of breath. They might even report some chest pain. Again, just depending on the severity. Maybe some dizziness, right? When you don’t have enough oxygen carrying capacity. Right? That’s the big issue. I can not carry oxygen like I’m supposed to. So I might even see low O2 levels. But essentially, remember oxygen saturation is just the percentage of the hemoglobin. You have that saturated.

So you can have a 100% saturation but still not be doing well because you don’t have enough hemoglobin. Right? What happens to my blood pressure. If I’m bleeding really bad, I might have low blood pressure. I might have a high heart rate to compensate. So all these things are things that you might see in a patient with anemia. Their skin might be Pale. I mean, if you don’t have enough blood, you definitely not going to be pink. Right? So all these things are possible signs. Again, when you’re doing this step of assessing, gathering all data, you’re also gonna want to look at everything else that’s going on with your patient, your urine output and your bowel sounds and things like that. But for this case, in step two is when we analyze and we say this is the important information.

And so we’re just going to focus on that relevant information for now. So you get to your analyze step, you pick out the information that actually is abnormal and tells you that something is going wrong. So what’s a big problem here? Well, we know that low hemoglobin levels equal decreased oxygen carrying capacity, right? So that’s gonna cause a lot of problems in our patient. They’re gonna have difficulty oxygenating if they’re bleeding, if they actually have blood loss. And that’s why they’re so anemic, obviously that can cause them perfusion issues and really just not having enough blood cells as a whole causes a lot of perfusion issues. Right? What can be improved? Well, we can increase their iron levels, right? Or increase their B12 levels if that’s part of the problem. 

So what’s a big priority here? Well, we always go airway, right?  Airway, breathing, circulation. So I’m going to go with this oxygenation issue is probably our biggest one. We need to make sure we’re getting oxygen out to our body, out to our tissues. And that’s probably the most important thing I need to worry about with a patient with anemia. And of course if they’re bleeding, that perfusion issue is going to become a huge issue as well. So now we can ask our how questions again, how we know it’s a problem. This is where we just data link. We start identifying what data tells us that we have specific problems and then we start to decide how we’re going to address it. So what are we going to do for this patient? We have a patient with anemia. We’re definitely gonna monitor their CVC, right? We want to know what their h and h is, what their, uh, red blood cell levels are.

If those levels are low enough, we’ll probably transfuse blood cells, right? I’m probably gonna give him a transfusion. We’re going to definitely monitor their O2 sats, and possibly even give O2 if it seems like it’s a necessary step. Now remember we said this patient has chest pain, so anytime you have a patient with chest pain, you want to make sure that you’re assessing those pain details and possibly even getting a 12 lead just to make sure that it’s not actually cardiac in nature. Right? If they’re bleeding out, we obviously want to transfuse, but even just giving them some IV fluids can help kind of perk them up a little bit, give them a little bit more energy. What else can we assess? We can assess their iron levels and there’d be 12 levels, right? And then we can also give iron and B12 if necessary.

We can give supplements for that. So especially if that’s the cause, we always want to address the cause of the problem. And then especially again, if these are the cause, we can definitely educate the patient, right? There’s foods that they can eat, there’s definitely things they can do in their diet. So how do I know it gets better? Remember, evaluate always links back to your data. So whatever I told you is a problem is also going to be what tells you if it gets better. So we’re going to see that h and h come back up. Um, we’re possibly going to see iron and B12 levels come back up. Our patient who was super fatigued before is going to be less fatigued, right? They’re going to tell you they feel better. They can do more things. Our oxygen levels are gonna improve. All of these things are going to all these things that told us it was a problem are going to be the things that also tell us that it’s better.

So next step is translate. Get it into the terms that you need to use so that you can concisely communicate what the problem is. So we prefer the high level nursing concepts because I feel like it gives you a bigger picture of what’s going on with your patient. So, number one, we already said our priority here is oxygenation. We know this patient’s going to have trouble carrying oxygen. And so we need to make sure we improve that ability to carry oxygen so they can get oxygen out to their second. I think, like I said, we’ll probably go with perfusion. Lack of red blood cells is always a problem, whether it’s from bleeding or anemia. So we need to be able to perfuse the rest of our body and get that blood flow where it needs to go. And then at this point, when it comes to a third priority, I really like looking at the idea that this iron and B12 can make a huge difference in this patient, especially if that’s the source of their problem.

So I’m just going to say nutrition. You could also possibly say patient education because there’s a lot of education you can do. But I’m gonna focus specifically on some of those foods that they need to eat. So last step is we transcribe, we take our priorities, we get everything on paper, and we link everything together. So again, this is how we see, you know, what’s the problem and how do I know, what am I going to do about it? Why and what do I expect to find? So you’re lining everything up so you can really see a big picture. So we said our priorities are oxygenation, perfusion, and nutrition. So what’s the data that tells us that we are probably having an issue with oxygenation? Well, low H&H, we know that’s what helps us carry oxygen. That hemoglobin. We might have a low SpO2. Our patient’s probably really tired and they might even be short of breath.

All of this is telling me that there’s an oxygenation issue with my patient. So what am I going to do? I’m going to monitor their oxygen and I’m probably going to give oxygen if necessary, right? So why? We know, again, low hemoglobin makes oxygen carrying difficult and giving that oxygen can help improve delivery out to the body, to the tissues. So again, our data is what helps tell us what our expected outcomes should be. So what’s our expected outcome? Keep that oxygen up right? Keep their oxygen levels as high as we want them. So I say 92% that’s pretty standard. But whatever your goal is to maybe your providers specifically wants 95%, maybe your patient has other problems and we’re really only aiming for 88 or 90. So just make sure that you know what the goal is for your patient. So looking at perfusion, especially when we’re considering a patient with a lack of red blood cells. They’re showing dizziness or chest pain, that tells me that they’re having lack of perfusion to their heart, lack of perfusion to their brain.

They might be Pale so they’re not perfusing their skin and they might even actually have bleeding or hemorrhage, which tells me that’s a perfusion issue, right? So what am I going to do? Monitor that CBC and I’m probably going to end up transfusing blood again. I write prn, but of course this is something you would need an order for. So please just notify the provider. Hey, their H/H is really low and they’re really dizzy. I really think we need to start transfusing. IV Fluids can also help again just to increase that blood volume. And then of course, assess for bleeding and stop the bleeding if there is some stop the bleeding. So again, we just want to be able to evaluate that H/H progress, increased circulating blood volume and stop the bleeding. So again, our expected outcome is that we show him the signs of improved perfusion.

So that means we have less dizziness, less chest pain, their skin becomes more pink, they’re no longer bleeding, their red blood cells go up, right? So all of these things that we saw as a problem will be improved. That’s what would our expected outcomes are. So nutrition, again, we said the iron and B12 is what really plays in here. If you’ve got something like iron deficiency anemia or pernicious anemia, we know that’s the problem, right? So interventions, we’re going to educate the patient on their diet options, assess those levels, um, and possibly give supplements as ordered because we know there are certain foods that can improve. There’s things that are high in iron and high in B12 that can help improve those symptoms. And then also of course, if this is the cause of the anemia, then we’re helping to treat the cause as well. So expected outcomes get those iron and B12 levels up.

And of course, anytime we include any education intervention, we want the patient to verbalize or demonstrate, right? So patient will verbalize two foods they can add to their diet that are high in iron or high in B12 depending on what they need. So that’s our big picture for this patient with anemia. Remember we’re talking about kind of a hypothetical, isolated, anemia problem. So if you have a patient who has anemia, but they also have all these other issues like trauma, of course you’re gonna have other priorities, you’re gonna need to fit everything in together. You’re definitely going to need to look at that holistic big picture for your patient. So let’s just remember the five steps for writing an awesome care plan. You’re going to collect all of your information, all of your assessment data, normal, abnormal, everything. And then you’re going to analyze that information, decide what’s important, what tells you that you actually have a problem with your patient, and then you’re going to prioritize those problems.

Again, you might have multiple issues going on. Um, and so you’re going to want to really look at those as a whole and make some decisions about what is your highest priority. Then you can ask your how questions that helps you to plan your interventions and figure out what you’re going to need to look for and then translate those into whatever terms that you need. Now if you’re in clinical practice and you’re not in school and you don’t have to use a certain form, your medical record doesn’t require a certain documentation. This step might be as simple as just writing a couple of words on paper, right? But make sure that you’ve at least gotten it into concise terms so that you can quickly and easily communicate what your major issues are for your patient and kind of keep yourself on track and then transcribe.

I always say, get it on paper. If you have a specific form or template you have to use, use that. If not, literally just jot down, you know, O2 perfusion nutrition and get those things in your head so that you can have a specific plan in mind for your patient. All right guys, so that was a quick nursing care plan for an Amia. I hope that was helpful. Make sure that you check out all of the other examples in this course as well as our nursing care plan library and I go out and be your best self today and as always, happy nursing.

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