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Objectives

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
General Objectives:
At the end of the case presentation, the participants
will be able to acquire the necessary knowledge, skills
and attitude in delivering compassionate and
competent nursing care for patients diagnosed with
Specific Objectives:

At the end of this case presentation, the participant


will be able to:
2. Define and familiarize severe anemia.
3. Know the different drugs and their actions and
perform necessary nursing responsibilities for
each drug.
4. Discuss the etiology, anatomy and physiology of
the blood.
5. Trace the pathophysiology of severe anemia and
identify clinical manifestations and risk factors of
the said disease.
6. Identify the medical and surgical management
appropriate for the disease.
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Introduction

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
If you’re like most people who beat up on the snooze
button each morning, an earlier bedtime is the way to end
your energy crisis. But if no amount of rest helps, it may
not be sleep that your body is craving. You may have a
form of anemia. If you have anemia, people may say you
have tired blood. That's because anemia — a condition in
which there aren't enough healthy red blood cells to carry
adequate oxygen to your tissues — can make you feel
tired. Anemia saps your energy by depriving your cells of
oxygen. This happens when your blood has too few red
blood cells or too little hemoglobin that transports
oxygen through the bloodstream. Without oxygen, no
living cell can survive. Without a specialized system of
oxygen transport to cells, no complex multi-cellular
organism which carry oxygen to and carbon dioxide away
from the thirty trillion cells of the human body are basic
requirements for health and itself.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Anemia is a common blood disorder. Women and people
with chronic diseases are at increased risk of the
condition. Some people learn that their hemoglobin is
low, which indicates anemia, when they go to donate
blood. Low hemoglobin may be a temporary problem
remedied by eating more iron-rich foods or taking a
multivitamin containing iron. However, it may also be a
warning sign of blood loss in your body that may be
causing you to be deficient in iron. If you're told that you
can't donate blood because of low hemoglobin, ask your
doctor if you should be concerned. If you suspect you
have anemia, see your doctor. Anemia can be a sign of
serious illnesses. Treatments for anemia range from
taking supplements to undergoing medical procedures
and even just eating healthy varied diet.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
There are many forms of anemia, each with its own cause.
Anemia can be temporary or long term, and it can range from
mild to severe. See your doctor if you're feeling fatigued for
unexplained reasons, especially if you're at risk of anemia. Some
anemias, such as iron deficiency anemia, are common. But don't
assume that if you're tired, you must be anemic. Fatigue has
many causes besides anemia. Anemia can be a symptom of
many different serious problems, including cancer. Anemia is a
great problem globally and worse in developing countries, but it
is by no means absent in industrialized nations and millions of
Filipinos suffer from anemia, which is serious and is usually
caused by blood loss from an injury or hemorrhage and the
demands of pregnancy. Approximately 43.9% Filipinos pregnant
women are estimated to develop anemia, while many are
unreported. Anemia can occur during pregnancy due to low
levels of iron and folic acid (folate) and changes in the blood.
During the first 6 months of pregnancy, the fluid portion of a
woman’s blood (the plasma) increases faster than the number of
red blood cells. This dilutes the blood and can lead to anemia.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Anemia affects many body systems. It can also lead to many
complications. This is the goal of health care providers, to
prevent any occurrence of complications. Ultimately, it is
hoped that with timely intervention to control this
complication of anemia, improved patient outcomes on in
terms of morbidity and mortality will be achieved.
As future nurses, we could help our patients by having a deep
understanding of the disease, that we may learn the proper
interventions for anemia patients. In this way, we could render
quality health care for them. By having a wide understanding
of the disease, we could impart teachings on how we could
prevent anemia. It is our responsibility to render information
and impart health teachings to improve the conditions of our
patients to the best of our abilities. One of the characteristics
that we should have is to be informative and only through a
keen study of disease such as this way will help us to gain all
the information we need to learn. May this case study served
its purpose through the help of our Lord, Jesus Christ.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Vital
Information

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Name: Y.C.
Age: 35
Sex: FEMALE
Civil Status: MARRIED
Religion: ROMAN CATHOLIC
Nationality: FILIPINO
Date of Birth: JUNE 27, 1973
Place of birth: GUIMARAS
Provincial Address: LINAMPONGAN, PONTEVEDRA CAPIZ
Date and time admitted: NOVEMBER 27, 2008; 1:55 AM
Ward: OUR LADY OF LOURDES WARD (FEMALE MEDICAL
WARD)
Chief Complaint: DYSPNEA
Diet: DIET AS TOLERATED (DAT)
Admitting Diagnosis: SEVERE ANEMIA 2° VAGINAL
BLEEDING 2°RETAINED PLACENTAL
FRAGMENTS
Attending Physician: DR. M.B., DR. N.C. AND DR. R.B.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
G E.G. J.G. A.F. R.F

E
N
O
G C.G.
67y.o.
M.G.

R
57y.o.

A
Y.C.
35y.o.
Sever
e

M
Anem
ia

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing
History

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
A. History of Present Illness

2 weeks prior to admission, patient was noted to have


generalized edema, allegedly consulted with local medical
doctor and given unrecalled medications. And a week of
continuous usage of medications her edema diminished so
they stop the medications and didn’t seek for further medical
advices. 6 days pta, patient delivered a baby via NSVD at
home with a midwife’s assistance. She had a minimal vaginal
bleeding and can only consume 1 pad of maternal napkin per
day. A day before admission, she experienced difficulty in
breathing at around 1 in the morning and that’s when they
decided to bring her to St. Anthony College Hospital.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
B. Past Health Problem/Status

According to her it was her 1st time to be hospitalized even


thought she had given birth 3 times and had a miscarriage.
She also has no known allergy of any kind. She never had a
serious illness like this before to be brought to the hospital.
She said that she had occasional influenza, dysmenorrheal,
stomachache and headache but worse than those, none.

C. Family History Illness

Y.C. is the only child of her parents. And both sides have no
known serious illness. The most common cause of death
among their family is old age.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
C. Family History Illness

Her records state that she had been pregnant 4 times and
delivered 3 times (G4P3). 3 of the 4 were full term, one
miscarriage and with 3 living children (3013). All her full term
children were delivered via Normal Spontaneous Vaginal
Delivery (NSVD) at home assisted by midwife. She had a
prenatal check for her latest pregnancy to the local medical
doctor and was given unrecalled medications for edema.

Patterns of Functioning
Breathing Patterns
– Her usual RR ranges from 20 to 24 breaths per minute and
she has a normal and calm manner of breathing.

Circulation Patterns
– Her usual BP is equal to 110/80 mm Hg accompanied by her
AR that ranges from 70 to 75 beats per minute and PR of 65- 70
beats per minute.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Brief Social, Cultural and Religious Background

a. Educational Background
– She is a high school graduate.

b. Occupation
– None, she’s a plain housewife and a full time mother.

c. Religious Practices
– She is a solid Roman Catholic who hears mass every
Sunday and on special days like fiesta, Christmas and her
birthday. She also prays rosary when she finds time.

d. Economic Status
– They are a member of the middle Class.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
C li n i ca l
Clinical
assessment
assessment

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
1. Vital Signs (Upon Admission)
T: 36.3 ° C
AR: 110 beats per minute
BP: 160/100 mm Hg
RR: 30 breaths per minute

2. Height: 5’ 3”
Weight: 65 kg (121 pounds)

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
3. Assessment (Cephalocaudal)
A. General Appearance
-appears to be pale, weak and restless; in a semi-
fowler’s position.

B. Skin, Hair and Nails


-with brown complexion, dry skin and poor skin turgor ;
with black hair, adequate in amount but sticky in texture and
there are presence of dandruff in the scalp; nails are
untrimmed and dirty.

C. Face and Lymphatics


-has a clean face and no palpable mass noted.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
D. Eyes, Ears, Nose, Mouth and Throat
-PERRLA, no discharges noted.
-no discharge noted, hearing acuity is good and
ears are well cleaned.
-no discharge noted nor signs of rashes.

E. Neck and Upper Extremities


-no palpable mass; carotid pulse is palpable;
without lesions.
-has difficulty in moving the right arm and
positive pain because of an IV cutdown (right radial
artery site); no lesions.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
F. Chest, Breast and Axilla
-no tenderness and pain in chest; there is no .
-no palpable mass and discharges noted in the
breasts.
-no mass noted and no enlargement of lymph
nodes in the axilla.

G. Respiratory System
-normal respiratory sound is heard during
auscultation.

H. Cardiovascular System
-normal heart rhythm; no complain of chest pain.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
I. Gastrointestinal System
-no complaint of stomachache was
made; was not able to defecate for 5
days.

J. Genito – urinary System


-with offensive odor.

K. Musculoskeletal System
-positive weakness but to prefer to
walk around and sit; has a limited ROM.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
4. General Appraisal:
a. Speech
-can talk loudly and clearly.

b. Language
-can fluently speak Hiligaynon and a little of Tagalog.

c. Hearing
-she can hear clearly and can comprehend well.

d. Mental Status
-conscious and coherent.

e. Emotional Status
-anxious about her condition, how are they going to pay
her hospital bills and stated that she misses her children
so much.
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Textbook
discussion

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
of
Definition
anemia

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Anatomy and
physiology

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Signs and
symptoms

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
pathophysiology

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Diagnostic
examination

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Chemistry

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Hematology

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
X-ray
X-ray Request: Chest AP (Sitting) 11-27-08
Findings:
The upper lobe vascular markings are prominent
Haziness noted in the right lung base
The trachea is at midline
The cardiac shadow is enlarged with CTR of 0.63
There is bulging of the left pulmonary artery conus
The right pulmonary artery is also prominent
There is straightening of the cardiac waist line
The left hemi diaphragm and costophrenic sulcus are poorly evaluated in
this study
The rest of the visualized soft and osseous structures are unremarkable

Impression:
Pulmonary Congestion
Right Basal Pneumonia
Cardiomegaly with Multichamber Enlargement
Prominent Pulmonary Arteries

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
X-ray

X-ray Request: Abdomen Supine & Upright 11-27-08


Findings:
A segment of the bowel loop in the left hemi abdomen is
prominent
There is no evidence of differential air fluid level
The renal and psoas shadows are partially visualize due to
overlying bowel loops
The rest of the visualize soft and osseous structures are
unremarkable

Impression:
Segmental Ileus

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Ultrasound
Findings:
Kidneys:
The Right kidney measure approximately
Coronal=90.1x42.5x47.8mm (LWT) with a cortical thickness
of 13.7mm
Both kidneys exhibit slightly hyperreflective parenchymal
echopattern
The central echo complex of both kidneys are not s eparated
There is no lithiasis in both kidneys
There is minimal perirenal fluid at the superior pole of the right
kidney measuring 8.4mL in thickness

Urinary Bladder:
The urinary bladder is partially filled. There is a foley catheter
balloon within the urinary bladder. There is no intraluminal
lithiasis.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Ultrasound

Pelvis:
The antevertid uterus measures 132x80.4mm (LxAP)
The borders are defined
Heterogenous structures is noted within the uterine
cavity measuring 78.4x22.2 to 28mm (LxAP)
The cervix measures 29.9mm
There is fluid in the posterior Culde sac approximately
39.6mL
The adrexae are obscuired by the bowel loops
The anterior abdominal wall appears thickened and
edematous
There is no fluid in the Monson’s Pouch

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Ultrasound

Impression:
Slightly hyperreflective renal parenchyma,
both kidneys suggestive of bilateral
diffuse renal parenchymal disease
S/P foley catheter insertion
Thick anterior abdominal wall, this could
be subcutaneous edema
Enlarged anteverted uterus with
hetetogenous structure within the uterine
c a v i t y. T h i s c o u l d b e r e t a i n e d p l a c e n t a
tissue
Minimal fluid in the posterior culdesac
Minimal perirenal fluid, right kidney

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Ultrasound
Findings: 11-28-08
Liver:
The liver is not enlarged
The boarders are well-detained
The intra hepatic ducts are not dilated
The parenchyma have homogenous echopattern with increased
parenchymal echogenicity
The common duct measures 3mm
The portal vein measures 3.8mm
The hepatic vein measure 12.0 to 13.0mm (N=4 to 5mm)
There is no fluid in the Monson’s Pouch

Gallbladder:
The Gallbladder is normal in size measuring approximately
61.0x38.3x28.9mm (LWH) with a volume of 35.4mL
It has smooth walls
The Gallbladder walls has a thickness of approximately 3.6 to 5.3mm
No intraluminal echoes seen

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Ultrasound

Impression:
Fatty liver with hepatic congestion
Thick gallbladder walls could be
due to:
Cholecystitis
Hypoalbuminemia
Hepatitis

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Urinalysis 11-27-08

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Urinalysis

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ABG 11-27-08; 08:40 AM

Interpretation: Respiratory Alkalosis with Partial


Compensation

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ABG 11-27-08; 09:30 PM

Interpretation: Respiratory Alkalosis with Partial


Compensation

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Cross-Matching

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Blood Transfusion

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Medical
management

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Anemia may be sign of a curable GI cancer or of uterine fibroid tumors.
Stool specimen should be tested for occult blood. People 50 yeas of age
o older should have periodic colonoscopy, endoscopy, or x-ay
examination of the GI tract to detect ulcerations, gastritis, polyps, or
cancer. Several oral preparations—ferrous sulfate, ferrous gluconate,
ferrous fumarate—are available for treating iron deficiency anemia. The
hemoglobin level may increase in only few weeks, and the anemia can
be corrected in a few months. Iron store replenishment takes much
longer, so it is important that the patient continue iron for as long as 6-
12 months. Vitamin C facilitates the absorption of iron.
In some cases, oral iron is poorly absorbed or poorly tolerated, or
iron supplementation is needed in large amounts. In these situations, IV
o intramuscular (IM) administration of iron dextran may be needed.
Before parenteral administration of a full dose, a small test dose should
be administered parenterally to avoid the risk of prophylaxis with either
IV or IM injections. Emergency medications should be close at hand. If
no signs of allergic reaction have occurred after 30 minutes, the
remaining dose of ion may be administered. Several doses are required
to replenish the patient’s iron stores.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Pharmacologic
therapy

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Documentation of the etiology of anemia is
essential in the selection of therapy. All
microcytic anemias are not caused by iron
deficiency; some are iron-overloading
disorders. Similarly, all megaloblastic anemias
are not associated with either vitamin B-12
deficiency or folic acid deficiency. Hereditary
hemolytic disorders do not improve with
corticosteroid therapy.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nutritional therapy

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Iron deficiency anemia is prevalent in geographic
locations where little meat is in the diet. Many of
these locations have sufficient dietary inorganic iron
to equal the iron content in persons residing in
countries in which meat is eaten. However, heme iron
is more efficiently absorbed than inorganic food iron.
A strict vegetarian diet requires iron and vitamin B-12
supplementation.
Folic acid deficiency occurs among people who
consume few leafy vegetables.
Coexistence of iron and folic acid deficiency is
common among Third World nations.

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Surgical
management

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Surgery is useful to control bleeding in patients who are
anemic. Most commonly, bleeding is from the gastrointestinal
tract, the uterus, or the bladder. Patients should be
hemodynamically stable before and during surgery. A blood
transfusion may be needed.

Splenectomy is useful in the treatment of autoimmune


hemolytic anemias and in certain hereditary hemolytic
disorders (ie, hereditary spherocytosis and elliptocytosis,
certain unstable Hb disorders, pyruvic kinase deficiency).
Improvement in survival rates has been reported in patients
with aplastic anemia, but splenectomy is not the preferential
therapy. Leg ulcers have shown improvement in some patients
with thalassemia. Prior to splenectomy, patients should be
immunized with polyvalent pneumococcal vaccine. Preferably,
this should be administered more than 1 week prior to surgery.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Bone marrow and stem cell transplantation have
been used in patients with leukemia, lymphoma,
Hodgkin disease, multiple myeloma,
myelofibrosis, and aplastic disease. Survival
rates improved, and hematologic abnormalities
were corrected. Allogeneic bone marrow
transplantation successfully corrected
phenotypic expression of sickle cell disease and
thalassemia and provided enhanced survival in
patients who survive transplantation.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Dilation and evacuation (also sometimes called dilation and
extraction) literally refers to the dilation of the cervix and
surgical evacuation of the contents of the uterus. It is a
method of abortion as well as a therapeutic procedure used
after miscarriage to prevent infection by ensuring that the
uterus is fully evacuated. It is commonly referred to as a D&E.
The first step in a D&E is to dilate the cervix. This is often
begun about a day before the surgical procedure. Enlarging
the opening of the cervix enables surgical instruments such
as a curette or forceps to be inserted into the uterus.
The second step is to remove the fetus. Either a local
anesthetic or general anesthesia is given to the woman.
Forceps are inserted into the uterus through the vagina and
used to separate the fetus into pieces, which are removed one
at a time. Lastly, vacuum aspiration is used to ensure no fetal
tissue remains in the uterus (such tissue can cause serious
infections in the woman). The pieces are also examined to
ensure that the entire fetus was removed.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Va c u u m A s p i r a t i o n . T h e c l i n i c i a n m a y f i r s t u s e a
local anesthetic to numb the cervix. Then, the
clinician may use instruments called "dilators" to
open the cervix, or sometimes medically induce
d i l a t i o n w i t h d r u g s . F i n a l l y, a s t e r i l e c a n n u l a i s
inserted into the uterus and attached via tubing to
the pump. The pump creates a vacuum which
empties uterine contents.
After a procedure for abortion or miscarriage
treatment, the tissue removed from the uterus is
examined for completeness. Expected contents
include the embryo or fetus as w ell as the
decidua, chorionic villi, amniotic fluid, amniotic
membrane and other tissue.
Post-treatment care includes brief observation in
a recovery area and a follow -up appointment
a p p r o x i m a t e l y t w o w e e k s l a t e r.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
prevention

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Many types of anemia can't be prevented. However, you can help
avoid iron deficiency anemia and vitamin deficiency anemias by eating
a healthy, varied diet that includes foods rich in iron, folate and vitamin
B-12.
The best sources of iron are beef and other meats. Other foods rich
in iron include beans, lentils, iron-fortified cereals, dark green leafy
vegetables, dried fruit, nuts and seeds. Folate, and its synthetic form,
folic acid, can be found in citrus juices and fruits, dark green leafy
vegetables, legumes and fortified breakfast cereals. Vitamin B-12 is
plentiful in meat and dairy products. Foods containing vitamin C, such
as citrus fruits, help increase iron absorption.
Eating plenty of iron-containing foods is particularly important for
people who have high iron requirements, such as children — iron is
needed during growth spurts — and pregnant and menstruating
women. Adequate iron intake is also crucial for infants, strict
vegetarians and long-distance runners.
Doctors may prescribe iron supplements or multivitamins containing
iron for people with high iron requirements. But iron supplements are
appropriate only when you need more iron than a balanced diet can
provide. Don't assume that if you're tired that you simply need to take
iron supplements. Overloading your body with iron can be dangerous.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Concept
map

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
2. Imbalanced nutrition less
8. Ineffective health 1. Impaired gas exchange
related to altered oxygen
than body requirements
maintenance related to carrying- capacity of the blood. related to inability to absorb
deficient knowledge •(+) DOB nutrients.
regarding nutrition in •AR: 110 beats/min •(+) paleness and weakness
pregnancy. •RR: 30 breaths/min • RBC = 2.10
•BP: 160/100 mmHg • Hgb = 60
•Doesn’t know proper foods •Easily irritated • Hct = 0.18
to eat. •(+) paleness and weakness • Urea = 10.99
•Doesn’t take supplements. • RBC = 2.10 • Albumin = 21.8
• Hgb = 60
•Doesn’t take precautions for • Hct = 0.18
• Direct HDL = 0.33
her baby and herself. • LDL = 1.29
• O2 Sat. = 50.1%
• Potassium = 3.01
3. Activity intolerance
7. Self Care Deficit related to imbalance
related to decreased between oxygen supply and
strength. demand.
•Sticky hair, (+) •AR: 110 beats/min
dandruff •RR: 30 breaths/min
•BP: 160/100 mmHg
•Untrimmed and dirty •Limited ROM
nails •(+) paleness and weakness
•(+) Body odor • RBC = 2.10
• Hgb = 60
6. Constipation • Hct = 0.18
related to decreased • O2 Sat. = 50.1%
fluid intake and daily 5. Hyperthermia related
4. Infection related to inadequate
activity. to invasion of secondary defenses.
•Limit to 1.5 L/day pathogens. •T = 38.9
•T = 38.9°C • RBC = 2.10
•Wasn’t able to defecate •Flush skin and warm to • Hgb = 60
for 5 days. touch • Hct = 0.18
•(+) paleness and • Neutrophils = 86.0 • WBC = 15.6
weakness • Lymphocytes = 14.0 • Neutrophils = 86.0
•Often sitting •CXR = Right Basal • Lymphocytes = 14.0
Pneumonia •CXR = Right Basal Pneumonia
•Ux = Bacteria = Many •Ux = Bacteria = Many
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Nursing
management

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Preventive education is important, because anemia is common in
menstruating and pregnant women. Food sources high in iron include
organ meats (beef or calf’s liver, chicken liver), other meats, beans
(black, pinto, and garbanzo), leafy green vegetables, raisins, and
molasses. Taking iron-rich foods with a source of Vitamin C enhances
the absorption of iron.
Nutritional counseling can be provided for those whose usual diet is
adequate. Patients with a history of eating fad diets or strict vegetarian
diets are counseled that such diets often contain inadequate amount of
absorbed iron. Encourage the patient to continue iron therapy as long
as it is prescribed, although the patient may no longer feel fatigued.
Iron is best absorbed in empty stomach, the patient is instructed to
take the supplement an hour before meals. Iron supplements are usually
given in oral forms, typically as ferrous sulfate. Most patients can use
the less expensive, more standard forms of ferrous sulfate. Tablets with
enteric coating may be poorly absorbed and should be avoided. Many
patients have difficulty tolerating ion supplements because of GI side
effects (primarily constipation, but also camping, nausea, and vomiting).
Some iron formulations are design to limit nausea and gastritis. Specific
patient teaching aids can assist patients with the use of ion
supplements.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
If taking iron in an empty stomach causes gastric
distress, the patient may need to take it with meals.
However, doing so diminishes iron absorption by as
much as 50%, thus prolonging the time required to
replenish ion stores. Antacids or dairy products
should not be taken with iron, because they greatly
diminish its absorption. Polysaccharide iron complex
forms that have less GI toxicity are also available, but
they are more expensive.
Liquid forms of iron that cause less GI distress are
available. However, they can stain the teeth; the
patient should be instructed to take his medication
through a straw, to rinse the mouth wit water, and to
practice good oral hygiene.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
D r ug
study

71
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Methergin
Dosage: 1 amp IM
Pharmacologic class: Exogenous hormone
Therapeutic class: Lactation stimulant, Oxytocic

Mechanism of Action
Chemical effect: Causes potent and selective stimulation of
uterine and mammary gland smooth muscle.
Therapeutic effect: Induces labor and milk ejection and r
educes postpartum bleeding.

Indications:
-To induce or stimulate labor.
-To reduce postpartum bleeding after expulsion of
placenta.
-Uterine hemorrhage
-Incomplete or inevitable abortion.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contrainidications:
-Pregnancy; first and second stage of labor and before
crowning of the head
-Severe hypertension
-Preeclampsia and eclampsia
-Occlusive vascular disease
-Sepsis

Adverse Recations:
CNS:
Dizziness, headache, seizures, .hallucinations,
CVA with IV use.

CV:
Hypertension, transient chest pain, palpitations,
hypotension, thrombophlebitis.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
EENT:
Tinnitus, nasal congestion.
GI: nausea, vomiting, diarrhea, foul taste.

GU:
Hematuria
Musculoskeletal: leg cramps

Resp:
Dyspnea

Skin:
Diaphoresis

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilties:
-Monitor and record blood pressure, pulse rate
and uterine response; report in sudden change in
vital signs, frequent periods of uterine relaxation,
and character and amount of vaginal bleeding.
-Monitor contractions, which may begin
immediately.
-Contractions may continue for up to 3 hours
or more after I.M. use.
-Monitor fluid intake and output.
-Antidiuretic effect may lead to fluid overload,
seizures, and coma.

75
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Iberet Folic
Dosage: 1 tab bid (8 am-6 pm)
Pharmacologic class: Oral Iron supplement
Therapeutic class: Hematinic

Mechanism of Action
Chemical effect: Provides elemental iron, an essential
component in formation of hemoglobin.
Therapeutic effect: Relieves iron deficiency.

Indications:
Treatment and prevention of iron deficiency and
concomitant folic acid deficiency with associated
deficient intake or increase need for vitamin B-
complex.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Thalassemia
-Sideroblastic anemia
-Hemochromatosis
-hemosedirosis

Adverse effects:
GI:
Anorexia, black stools, constipation, diarrhea,
epigastric pain, nausea, vomiting.

Nursing Responsibilities:
-Obtain baseline assessment of patient’s iron
deficiency before starting therapy.
-Evaluate hemoglobin level, hematocrit, and
reticulocyte count during therapy.

77
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Kalium Durule
Dosage: 1 tab tid p.c. (8am-12nn-6pm)
Pharmacologic class: Potassium supplement
Therapeutic class: Minerals, Vitamins

Mechanism of Action
Chemical effect: Aids in transmitting nerve impulses,
contracting cardiac and skeletal muscle, and
maintaining intracellular tonicity, cellular metabolism,
acid-base balance, and normal renal function.
Therapeutic effect: Replaces and maintains potassium
level.

Indications:
-Hypokalemia.
-As prophylaxis during treatment with diuretics.

78
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
Renal insufficiency
Hyperkalemia
Untreated Addison’s disease
Stricture of the esophagus
Heart/ kidney disease
Pregnancy and lactation

Adverse effects:
CNS:
Flaccid paralysis, listlessness, mental
confusion, paresthesia of limbs, weakness or
heaviness of legs.
 
CV:
Arrhythmias, cardiac arrest, ECG changes,

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
CV:
Arrhythmias, cardiac arrest, ECG changes, heart
block.

GI:
Abdominal pain, diarrhea, hemorrhage, nausea,
obstruction, perforation, ulcerations, vomiting.

Nursing Responsibilities:
-Monitor ECG, renal function, fluid intake and output,
and potassium, creatinine, and BUN levels.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Pen G. Na
Dosage: 1 million “u” IV Q6h ANST (8-2)
Pharmacologic class: Natural penicillin
Therapeutic class: Rapid-acting antibiotic

Mechanism of Action
Chemical effect: Inhibits cell wall synthesis during
microorganism multiplication.
Therapeutic effect: Kills susceptible bacteria.

Indications:
-Moderate to severe systemic infections.
-To prevent post streptococcal rheumatic fever and
glomeruloneprhitis
-Bacterial endocarditis.
-Mild cases of streptococcal pharyngitis and skin
structure infections.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Hypersensitivity to penicillins.

Adverse effects:
CNS:
Neuropathy, seizures
 
CV: Thrombophlebitis
 
Hematologic: hemolytic anemia, leucopenia,
thrombocytopenia
 
Musculoskeletal: Arthralgia
 
Other: Hypersensitivity reactions, overgrowth
of nonsusceptible organisms, pain at
injection site, vein irritation.
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
-Before giving drug, ask patient about allergic
reactions to penicillin.
-Obtain specimen for culture and sensitivity
tests before giving first dose. Therapy may
begin pending results.
-Observe patient closely. With large doses and
prolonged therapy, bacterial or fugal
superinfection may occur, especially in
elderly, debilitated, or immunosuppressed
patients.
-Assess renal, cardiac and vascular condition
with physical exams and laboratory testing.
-Assess risk of fluid overload or electrolyte

83
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Moriamin Forte
Dosage: 1 cap OD
Pharmacologic class: Folic Acid Derivatives
Therapeutic class: Vitamin

Mechanism of Action
Chemical effect: Stimulates normal erythropoiesis and
neucloprotein synthesis.
Therapeutic effect: Nutritional supplement.

Indications:
-To maintain health
megaloblastic or macrocytic anemia caused by folic acid or
other nutritional deficiency, hepatic disease, alcoholism,
intestinal obstruction, excessive hemolysis.
-Nutritional supplement
-To test folic acid deficiency in patients with megaloblastic
anemia without masking pernicious anemia.

84
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
Contraindicated in patients with vitamin B12
deficiency or undiagnosed anemia

Adverse effects:
CNS:
General malaise
 
GI:
Anorexia, bitter taste, flatulence, nausea.
 
Respiratory: Bronchospasm,
 
Other:
Allergic reactions

85
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
- Assess patient’s folic acid deficiency
before starting therapy
-Evaluate CBC and assess patient’s
physical status throughout therapy.

86
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Aldazide
Dosage: 1 tab bid
Pharmacologic class: Mineralocorticoid Receptor
Antagonist
Therapeutic class: Potassium-sparing diuretic

Mechanism of Action
Chemical effect: Antagonizes aldosterone in distal tubule
Therapeutic effect: Promotes water and sodium excretion and
hinders potassium excretion, lowers blood pressure, and
helps to diagnose primary hyperaldosteronism.

Indications:
-Essential hypertension, edema, CHF, liver cirrhosis,
nephrotic syndrome, idiopathic edema.
-Management of edema, antihypertensive, diagnosis of
primary hyperaldosteronism, treatment of diuretic- induced
hypokalemia

87
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Acute renal insufficiency
-Significant renal impairment
-Anuria
-hyperkalemia

Adverse effects:
CNS:
Headache, drowsiness, lethargy, confusion,
ataxia

GI:
Diarrhea, gastric bleeding, ulceration,
cramping, gastritis, vomiting

GU:
Impotence, menstrual disturbances
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Hematologic:
Agranulocytosis

Metabolic:
Hyperkalemia, hypernatremia, mild acidosis,
dehydration

Skin:
Urticaria, hirsutism, maculopapular eruptions,
erythematous rash

Other:
Drug fever, gynecomastasia, breast soreness.

Nursing Responsibilities:
Monitor electrolyte levels, fluid intake and
output, weight, and blood pressure.
89
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Tarka
Dosage: 1 tab OD
Pharmacologic class: Calcium channel blocker
Therapeutic class: Antianginal, antiarrhythmic,
antihypertensive

Mechanism of Action
Chemical effect: Not clearly defined; inhibits calcium ion
influx across cardiac and smooth muscle cells,
thus decreasing myocardial contractility and oxygen
demand. Drug also dilates coronary arteries and
arterioles.
Therapeutic effect: Relieves angina, lowers blood
pressure, and restores normal sinus rhythm.

Indications:
Essential Hypertension

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
Cardiogenic shock, 2nd and 3rd degree AV block
and sick sinus syndrome except in patients
with a functioning artificial pace maker, atrial
fibrillation/ flutter.
History of angioedema associated with
administration of an ACE inhibitor, pregnancy,
lactation.

Adverse effects:
CNS:
Asthenia, dizziness, headache
 
CV:
AV block, bradycardia, heart failure, peripheral
edema, transient hypotension, ventricular
fibrillation, ventricular asystole
91
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
GI:
constipation, nausea
 
Resp:
Pulmonary edema
 
Skin:
Rash

Nursing Responsibilities:
-Monitor blood pressure at start of therapy
and during dosage adjustments

92
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Paracetamol
Dosage: 300 mg IVTT q 4hrs. PRN T<37.8°C
Pharmacologic class: Para-aminophenol Derivatives
Therapeutic class: Nonopioid Analgesic, Antipyretic

Mechanism of Action
Chemical effect: May produce analgesic effect by
blocking pain impulses by inhibiting prostaglandin
or pain receptor sene-sitizers. May relieve fever by
acting hypothalamic heat- regulating center.
Therapeutic effect: Relives pain or fever

Indications:
-Fever

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Previous hypersensitivity products containing
alcohol, aspartame, saccharine sugar, or
tartrazine, should be avoided in patients who
have hypersensitivity or intolerance to this
compounds

Adverse effects:
GI:
Hepatic failure, hepatoxicity (overdose)
 
GU:
Renal failure (high doses/ chronic use)
 
Skin:
Rash, urticaria
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
-Assess fever and note for the presence of
associated signs, such as diaphoresis,
tachycardia and malaise
-Check and monitor patient’s temperature
before and after giving the medication
-Tell patient to report any adverse reaction
that may occur
-Before giving the medication intravenously,
check first the patency of the IV site
-Observe patient during administration of
the drug

95
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Zinnat
Dosage: 500 mg 1 tab BID
Pharmacologic class: Second- generation
Cephalosporin
Therapeutic class: Antibiotic

Mechanism of Action
Chemical effect: Bind to bacterial cell wall membrane,
causing cell death
Therapeutic effect: Bactericidal action

Indications:
-Lower & upper resp tract infections, Genito- Urinary
Tract infections, gonorrhea including acute
uncomplicated gonococcal urethritis & cervicitis.

96
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Hypersensitivity to cephalosporins.
-Hypersensitivity to penicillins.
-Pseudomembranous colitis.
-Diabetics & phenylketonurics.

Adverse effects:
CNS:
Seizures (high doses)
 
GI:
pseudomembranous colitis, nausea, vomiting,
cramps
 
Skin:
Rashes, urticaria
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
-Assess patient for infection at beginning
and after therapy.
-Before initiating therapy, obtain a history to
determine previous use and reactions to
penicillins or cephalosporins
-Obtain specimens for culture and sensitivity
before I nitiating therapy

98
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Furosemide
Dosage: (Lasix) 20 mg STAT
Pharmacologic class: Loop Diuretic
Therapeutic class: Anti-hypertension

Mechanism of Action
Chemical effect: Inhibits sodium and chloride
reabsorption at proximal and distal tubules and
ascending loop of henle.
Therapeutic effect: Promotes water and sodium
excretion

Indications:
-Acute Pulmonary Edema
-Heart failure and chronic renal impairment
-Hypertension
-Hypercalcemia

99
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Contraindicated in patients hypersensitive to
drug or any of its components and in dose with
anuria
-Use cautiously in patients with hepatic
cirrhosis
-Patients with allergy to sulfonamide may also
be allergic to furosemide

Adverse effects:
CNS:
Dizziness, fever, headache, paresthesia,
restlessness, vertigo and weakness

CV:
Orthostatic hypotension, thrombophlebitis
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
EENT
Blurred or yellow vision, transient deafness

GI
Abdominal discomfort, anorexia, constipation,
diarrhea, pancreatitis, vomiting

GU
Azothemia, frequent urination, nocturia,
olyguria, polyuria

Hematologic
Agranulocytosis, anemia, aplastic anemia,
leucopenia, thrombocytopenia

Hepatic
hepatic dysfunction
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Metabolic
Asymptomatic hyperurecemia: fluid and
electrolyte imbalances, including dilutional
hyponatremia, hypocalcemia,
hypomagnecemia

Nursing Responsibilities:
-Monitor weight, peripheral edema, breath
sounds, blood pressure, fluid intake and
output, and electrolyte, glucose, BUN, and
Carbon dioxide level
-Monitor uric acid level, especially if patient
has history of gout
-Be alert for adverse reactions and drug

102
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Metronidazole
Dosage: 500 mg, 1 tab, q 8° 8am-4pm-12mn
Pharmacologic class: Nitroimidazole
Therapeutic class: Antibacterial, Antiprotozoal,
Amebicide

Mechanism of Action
Chemical effect: Direct acting trichomonacide and
amebicide that works at both intestinal and
extraintestinal sites
Therapeutic effect: Hinders growth of selected
organisms, including most anaerobic bacteria and
protozoa

Indications:
-Amebic hepatic abscess
-Intestinal amebiasis

103
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
-Trichomoniasis
-Refractory trichomoniasis
-Bacterial infections caused by anaerobic microoragnisms
-To prevent postoperative infections in contaminated or
potentially contaminated colorectal surgery
-Inflammatory papules and pustules of acne rosacea
-Pelvic inflammatory disease
-Bacterial vaginosis
-Active crohn’s disease
-Helicobacter pylori with peptic ulcer disease

Contraindications:
-Contraindicated in patients hypersensitive to drug and
other nitroimidazole derivatives
-Use cautiously in patients receiving hepatotoxic drugs
and in patients with history of blood discrasia or CNS
disorder, retinal or visual field changes, hepatic disease,
or alcoholism

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Adverse Effects:

CNS
Ataxia, confusion, depression, drowsiness, fatigue,
fever, headache, incoordination, insomnia, irritability,
neuropathy, paresthesia of limbs, psychic stimulation,
restlessness, seizures, sensory neuropathy, vertigo
and weakness

CV
Edema, flattened T-wave, flushing, thrombophlebitis

EENT
Eye tearing

105
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
GI
Abdominal cramping, anorexia, constipation,
diarrhea, dry mouth, metallic taste, nausea,
proctitis, stomatitis and vomiting

GU
Cystitis, darkened urine, dry vagina and
vulva, dyspareunia, dysuria, incontinence,
polyuria, pyuria, sense of pelvic pressure

Hematologic
-neutropenia, thrombocytopenia, transient
leukopenia

106
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
-Assess patient’s infection before therapy and
regularly thereafter to monitor drug effectiveness
-Watch carefully for edema
-IV infusion may caused thrombophlebitis at site;
observe closely
-Assess skin or severity, areas of rosacia before and
after therapy, and any local adverse reactions

107
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Dulcolax
Dosage: 1 suppository per rectum
Pharmacologic class: Diphenylmethane Derivative
Therapeutic class: Stimulant Laxative

Mechanism of Action
Chemical effect: Increases peristalsis, probably by
acting directly on smooth muscle of intestine. May
irritate musculature, stimulate colonic intramural
plexus, and promote fluid accumulation in colon and
small intestine.
Therapeutic effect: Relieves constipation.

Indications:
-Chronic constipation; preparation for childbirth,
surgery, or rectal or bowel examination

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Contraindications:
-Contraindicated in patients hypersensitive to
drug or other penicillins and in dose with a
history of amoxicillin-related cholestatic jaundice
or hepatic dysfunction.
-Use cautiously in patients with other drug
allergies, especially to cephalosporin, and those
with mononucleusis or hepatic impairment

Adverse effects:
CNS
Agitation, anxiety, behavioral changes,
confusion, dizziness, insomnia

GI
Abdominal pain, black “hairy” tongue, diarrhea,
enterocolitis, gastritis, glossitis, indigestion,
nausea, stomatitis and vomiting
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
GU
Vaginal candidiasis, vaginitis

Hematologic
Agranulocytosis, anemia, eosinphilia,
leucopenia, thrombocytopenia,
thrombocytopenic purpura

Nursing Responsibilities:
-Before therapy begins, assess patient’s
infection, ask about past allergic reactions
to penicillins, and obtain specimen for
culture and sensitivity test.
-Be alert for adverse reactions and drug
interactions.
-Monitor hydration status if adverse GI
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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Contraindicated in patients hypersensitive to drug and in dose
with rectal bleeding, gastroenteritis, intestinal obstruction, or
symptoms of appendicitis or acute surgical abdomen, such as
abdominal pain, nausea or vomiting

Adverse effects:
GI
Abdominal cramps, burning sensation in rectum (with
suppositories), diarrhea (with high doses), laxative dependents
(with long-term or excessive use), nausea, protein-losing
enteropathy (with excessive use), vomiting

Metabolic
Alkalosis, fluid and electrolyte imbalance, hypokalemia

Musculoskeletal
Muscle weakness ( with excessive use), tetany

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
-Obtain history of bowel disorder, GI status,
fluid intake, nutritional status, exercise
habits, and normal patterns of elimination
-Monitor effectiveness by checking frequency
and characteristics of stools
-Be alert for adverse reactions and drug
interactions
-Auscultate bowel sounds at least once per
shift

112
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Oxytocin
Dosage: 20 “u” incorporate to PNSS 1L
Pharmacologic class: Exogenous Hormone
Therapeutic class: Lactation Stimulant, Oxytocic

Mechanism of Action
Chemical effect: Causes potent and selective stimulation of
uterine and mammary gland smooth muscle.
Therapeutic effect: Induces labor and milk ejection and
reduces postpartum bleeding

Indications:
To induce or stimulate labor
To reduce postpartum bleeding after expulsion of placenta
Incomplete or inevitable abortion
Oxytocin challenge test to assess fetal distress in high-risk
pregnancies greater than 31 weeks gestation

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
Contraindicated in patients hypersensitive to drug or any of its
components. Also contraindicated in cephalopelvic disproportion
or delivery that requires conversion, as in transverse lie; in fetal
distress when delivery is not imminent; in prematurity; in other
obstetric emergencies; and in severe toxemia, hypertonic uterine
patterns, total placenta previa, or vasa previa

Adverse effects:
Maternal

CNS
Coma form water intoxication, seizures, subarachnoid
hemorrhage from hypertension

CV
Arrhythmias; hypertension; increased hear rate,
systemic venous return, and cardiac output

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
GI
Nausea and vomiting

GU
Abruptio placentae, increased uterine motility, impaired uterine
blood flow, pelvic hematoma, tetanic uterine contractions,
uterine rupture

Hematologic
Afibrinogenemia (may be related to postpartum bleeding)

Fetal
CV
Bradycardia, PVCs, tachycardia

Hematologic
Hyperbilirubilinemia

Respiratory
-anoxia, asphysia

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
-Assess patient’s condition before starting therapy and
regularly thereafter
-Monitor and record uterine contractions, heart rate,
BP, intrauterine pressure, fetal heart rate, and blood
loss every 15 minutes.
-Be alert for adverse reactions and drug interactions
-Monitor fluid intake and output. Antidiuretic effect
may lead to fluid overload, seizures, and coma

116
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Sodium bicarbonate
Dosage: 1 amp. slow IV STAT
Pharmacologic class: Alkalanizer
Therapeutic class: Ion Buffer, Oral Antacid

Mechanism of Action
Chemical effect: Restores body’s buffering capacity and
neutralizes excess acid.
Therapeutic effect: Restores normal acid-base balance and
relieves acid indigestion.

Indications:
-Adjunct to advanced cardiovascular life support during
cardiopulmonary resuscitation
-Severe metabolic acidosis
-Less urgent metabolic acidosis
-Urine alkalization
Antacid

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Contraindicated in patients with metabolic or
respiratory alkalosis; patients who are losing
chlorides from vomiting or continuous GI suction;
patients taking diuretics known to produce
hypochloremic alkalosis; and patients with
hypocalcemia in which alkalosis may produce tetani,
hypertension, seizures, or heart failure. Oral Sodium
bicarbonate is contraindicated in patients with acute
ingestion of strong mineral acids.
-Use cautiously in patients hypertension, heart failure
or other edematous or sodium-retaining conditions
or renal insufficiency.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Adverse effects:
GI
Belching, flatulence, gastric distention

Metabolic
Hypernatremia, hyperosmolarity (with overdose),
hypokalemia, metabolic alkalosis

Other:
Irritation and pain at injection site

119
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
-Assess patients condition before starting therapy
and regularly thereafter to monitor drug’s
effectiveness
-To avoid risk of alkalosis, obtain blood pH, PaO2,
PaCO2, and electrolyte level
-If Sodium bicarbonate is being used to produce
alkaline urine, monitor urine pH (should be greater
than 7) q 4 to 6°
-Be alert for adverse reactions and drug interactions

120
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Lanoxin
Dosage: 0.25 mg, 1 tab, OD 8am
Pharmacologic class: Cardiac Glycoside
Therapeutic class: Anti-arrhythmic, Inotropic

Mechanism of Action
Chemical effect: Inhibits sodium-potassium-activated
adenosine triphosphatase, thereby promoting
movement of calcium form extracellular to intracellular
cytoplasm and strengthening myocardial contraction
Therapeutic effect: Strengthens myocardial contractions
and slows conduction thru SA and Av nodes.

Indications:
-Heart failure
-Paroxysmal supraventricular tachycardia
-Atrial fibrillation
-Flutter

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications:
-Contraindicated in patients hypersensitive to drug or
any of its components and in dose with digoxin-
induced toxicity, ventricular fibriltion, or ventricular
tachycardia unless caused by heart failure
-Use cautiously in patients with acute MI, incomplete
AV block, sinus bradycardia, PVCs, chronic
constrictive pericarditis, hypertrophic
cardiomyopathy, renal insufficiency, severe
pulmonary disease, or hypothyroidism.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Adverse effects:
CNS
Agitation, dizziness, fatigue, generalized muscle
weakness, hallucinations, headache, malaise,
paresthesia, stupor and vertigo

CV
Arrhythmias, heart failure, hypotension

EENT
Blurred vision, diplopia, light flashes, photo phobia,
yellow-green halos around visual images

GI
Anorexia, diarrhea, nausea and vomiting

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Nursing Responsibilities:
-Monitor potassium level carefully.
-Monitor effectiveness by taking apical pulse
for 1 full minute before giving a dose.
-Evaluate ECG, and regularly assess patient’s
cardiopulmonary condition for signs of
improvement.
-Look for adverse reactions and drug
interactions.

124
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Drug: Atrovent
Dosage: 1 neb q6° 4am-10am-4pm-10pm
Pharmacologic class: Anticholinergic
Therapeutic class: Bronchodilators

Mechanism of Action
Chemical effect: Inhibit vagally mediated reflexes by
antagonizing acetylcholine.
Therapeutic effect: bronchospasms and symptoms of
seasonal allergic rhinitis.

Indications:
To prevent or threat bronchospasm in patients with
reversible obstructive airway disease

125
12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Contraindications
- To patients with cardiovascular disorders (including
coronary insufficiency and hypertension)
-Patients with Hypertyroidism or DM and those who
are unusually responsive to adrenergies.

Adverse effects
CNS
Tremor, nervousness, dizziness, insomnia, headache,
hyperactivity, weakness, CNS stimulation, malaise.

CV
Tachycardia, palpitation, hypertension.

EENT
Dry and irritated nose and throat with inhaled form,
nasal congestion, epistaxis, hoarseness.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
GI
Heartburn, nausea, anorexia, altered taste, increased appetite.
Metabolic- hypokalemia.

Musculuskeletal
Muscle cramps.

Respiratory
Bronchospasm, cough, wheezing, dyspnea, bronchitis,
increase sputum

Nursing Responsibilities:
- Monitor closely for signs and symptoms for toxicity.
- Warn patient about risk of paradoxical
bronchospasm and to stop drug immediately after it
occurs.
- Teach patient to perform oral inhalation correctly.

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medimap

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Anemia is a condition Signs and Symptoms
Risk Factors in which your blood • Weakness
•Poor diet has a lower than • Pale skin
•Intestinal disorders. normal number of red • A fast or irregular
•Menstruation. blood cells. This heartbeat
•Pregnancy condition also can • Shortness of breath
•Chronic conditions occur if your red • Chest pain
•Family history blood cells don’t • Dizziness
Medical contain enough • Cognitive problems
Management • Numbness or
Ferrous sulfate, ferrous coldness in your
gluconate, ferrous extremities
fumarate are often • Headache
prescribed in treating Nursing Management
iron deficiency anemia.
Vitamin C is Preventive education is
recommended also important, because
because it helps in anemia is common in
facilitating in the menstruating and
absorption of iron.
Pathophysiology pregnant women.
Delivery placental Nutritional counseling can
fragments has been Complication be provided for those
retained in the uterus whose usual diet is
• Heart problems adequate. Patients with a
preventing contraction of
the uterus dilatation of
• Problems history of eating fad diets
the blood vessels in the during or strict vegetarian diets
uterus heavy bleeding pregnancy are counseled that such
(PPH) decreasing RBC, diets often contain
• Growth inadequate amount of
Hgb and Hct Severe
Anemia problems absorbed iron.
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Nursing
Care plan

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Discharge
planning

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Medication:
Proper compliance with the medication prescribed to the
patient will limit the progression of her condition.
MoriamenForte 1 cap OD – Vitamin
Iberet Folic Acid 1 tab BID pc – Hematinic
Aldazide 1 tab OD – Potassium- sparing Diuretic
Kalium Durule 1 tab BID x 3 days (to consume 6 tabs only)
– Minerals, Vitamins

Exercise and Activity:


Emphasize the need to maintain regular exercise and
activities; to maintain muscle strength and motility, to help
prevent bone demineralization, to decrease protein
breakdown and to promote good circulation of the body
system. However, avoid contact sports, crowds, and persons
with respiratory infections. Passive exercise like breathing
can also help the patient to feel calm and comfortable.

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Treatment:
Iron Deficiency Anemia can cause death if severe and prolonged,
early detection of it is very important. After the cause of her vaginal
bleeding was removed through surgery all she needs for treatment is
to comply with her medications. But in cases where iron deficiency
anemia persists blood transfusions can help replacing iron and
hemoglobin quickly.

Home Teaching:
Teach the patient/folks the importance of monitoring
the progress and compliance with the treatment
regimen.
Patient needs ongoing education and reinforcement on
the multiple dietary requirement she needs.
Patient needs health promotion activities and health
screening.
Emphasize to the patient the importance of having
regular check-up to know her present condition.

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Out patient Follow-up
After discharged, patient may go to clinic for follow-up
check-up after a week.
As part of this follow-up care, she should receive blood
test to check for the level of her RBC and Hgb.

Diet:
Encourage intake of high biologic value protein foods
such as eggs, dairy products and meats (causes
positive nitrogen balance needed for growth and
healing).
Encourage high calorie and high iron containing foods
like liver, red meat, seafood, poultry, eggs, beans and
peas, dark green leafy vegetables — such as spinach
— and raisins, nuts, and seeds.
ØEncourage the patient to adhere to fluid restrictions. Suggest that
she suck on ice chips or hard candies to relieve thirst.

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Sexuality and Spirituality
Sexual intercourse is not advisable as it may be may
have a complication on the condition of the patient.
Encourage a closer relationship with God through
praying and attending any religious activity that we
have.

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evaluation

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
acknowledgements

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
We w i l l n o t b e a b l e t o f i n i s h t h i s c a s e
presentation without the help of those
people who sincerely gave their support to
u s. We w ou ld like t o th an k a ll t h e peo ple
who generously gave their time, ideas and
resources for the success of this
presentation.
THANKS………
To t h e f a m i l y o f o u r c h o s e n p a t i e n t ,
e s p e c i a l l y t o Y. C . , f o r t h e i r t i m e , a n d f u l l
participation.
To a l l o u r c l i n i c a l i n s t r u c t o r s w h o
gave us freedom and the challenge to
discover on our own what life would
need in this kind of profession.
To M s . M a u r e e n N . P a t r i c i o , o u r
beloved adviser in the clinical area, to
Mrs. Katherine C. Bengan, Mrs. Pearl
J12/18/08
oy A. Degom a PRESENTATION:
A CASE a n d “SEVERE
M sANEMIA”
. F l o r a M ay R138.
To Dr. Nora B. Cambas for sharing her time
and expertise as our Guest Speaker in today’s
event.
To the staff of St. Anthony College Hospital
who supported us and make us feel warmth.
To our dean, Sr. Edith Bagayaua, D.C. and to
our clinical coordinator, Mrs. Suzette Vela for
making this event possible.
To our dearest class adviser, Mrs. Stella
Cordenillo, who never cease to remind us the
importance of studying.
To our few Group mates whose heart, mind
and soul is certain to make this Case
Presentation on Severe Anemia be informative
and possible.
To all our classmates and friends, who
generously share their knowledge to us, whose
friendship,
12/18/08 inspiration, and
A CASE PRESENTATION: “SEVERE ANEMIA” support we
139
GOD Almighty, the GREAT
And finally, to
PHYSICIAN and the AUTHOR OF LIFE,
from whom wisdom comes. We thank HIM for
guidance and strength.

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12/18/08 A CASE PRESENTATION: “SEVERE ANEMIA”
Thank You!
**God bless us all**

-Group 1

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