Anemia Nursing Care Management - A Study Guide

7/15/2018 Anemia Nursing Care Management: A Study Guide
Anemia
By Marianne Belleza, RN - September 16, 2016
Mary works as a waitress in a restaurant for night shifts. For the entire shift, Mary stands and
roams around the dining place to assist customers. In the morning, she sleeps the entire day
away and can hardly have a meal. She started to notice her pallor three months into her job. She
also gets tired easily and feels palpitations after a tiring shift. Once, she had difficulty in breathing
and had to be rushed to the emergency room to be treated.
Contents [hide]
1 Description
2 Classification
3 Pathophysiology
3.1 Hypoproliferative Anemia
3.2 Hemolytic Anemia
4 Causes
5 Clinical Manifestations
6 Prevention
7 Complications
8 Assessment and Diagnostic Findings
9 Medical Management
10 Nursing Management
10.1 Nursing Assessment
10.2 Diagnosis
10.3 Planning & Goals
10.4 Nursing Interventions
10.5 Evaluation
10.6 Discharge and Home Care Guidelines
10.7 Documentation Guidelines
11 Practice Quiz: Anemia
12 See Also
13 Further Reading and Recommended Resources
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Description
Anemia is a condition that is slowly rising in cases across all countries. Every age and every stage
can be affected by anemia, and though others may consider this as a simple condition, it could
blow out of proportion if left untreated.
Anemia is a condition in which the hemoglobin concentration is lower than normal.

Anemia reflects the presence of fever than the normal number of erythrocytes within the
circulation.
Anemia is not a specific disease state but an underlying disorder and the most common
hematologic condition.
Classi cation
A physiologic approach classifies anemia according to whether the deficiency in erythrocytes is

caused by a defect in their production, by their destruction, or by their loss.
Hypoproliferative anemias. In hypoproliferative anemias, the marrow cannot produce

adequate numbers of erythrocytes.
Hemolytic anemias. There is premature destruction of erythrocytes that results in the
liberation of hemoglobin from the erythrocytes into the plasma; the released hemoglobin is
then converted into bilirubin, therefore bilirubin concentration rises.
Bleeding anemias. Bleeding anemias are caused by the loss of erythrocytes in the body.
Pathophysiology
The pathophysiology of anemias is drawn according to the cause of the disease.
Hypoproliferative Anemia
Decreased erythrocyte production. There is decreased erythrocyte production, reflected by

an inappropriately normal or low reticulocyte count.
Marrow damage. As a result of marrow damage, inadequate production of erythrocyte
occurs due to the medications or chemicals or from a lack of factors.
Hemolytic Anemia
Premature destruction. Premature destruction of erythrocytes results in the liberation of

hemoglobin from the erythrocytes into the plasma.
Conversion. The released hemoglobin is converted in large part to bilirubin, resulting in high
concentration of bilirubin.
Erythropoietin production. The increased erythrocyte destruction leads to tissue hypoxia
which stimulates erythropoietin production.
Increased reticulocytes. This increased production is reflected in an increased reticulocyte
count as the bone marrow responds to the loss of erythrocytes.
Hemolysis. Hemolysis is the end result, which can result from an abnormality within the
erythrocyte itself or within the plasma, or from direct injury to the erythrocyte within the
circulation.
Causes
It is usually possible to determine whether the presence of anemia is caused by destruction or

inadequate production of erythrocytes on the basis of the following factors.
Response. The marrow’s response to decreased erythrocytes as evidenced by an increased

reticulocyte count in the circulation blood.
Proliferation. The degree to which young erythrocytes proliferate in the bone marrow and the
manner in which they mature as observed in the bone marrow biopsy.
Destruction. The presence or absence of end products of erythrocyte destruction within the
circulation.
Clinical Manifestations
In general, the more rapidly the anemia develops, the more aggressive is its symptoms.
Decreased hemoglobin. A patient with anemia has hemoglobin levels between 9 to 11 g/dL.
Fatigue. Fatigue occurs because there is inadequate oxygen levels in the tissues that should
have been carried by hemoglobin.
Tachycardia. The heart compensates for the decrease in oxygen by pumping out more blood
so it can reach peripheral tissues in the body.
Dyspnea. Difficulty of breathing occurs because of the decreased concentrations of oxygen in
the blood.
With decreased hemoglobin that serves as the pigment in the red blood cells, the patient may
become pale because of the lack or decrease in the pigment that is hemoglobin.
Prevention
To prevent anemia, lifestyle modifications must be made.
Diet rich in iron. Ingestion of iron-rich foods could help prevent anemia because it adds to
the hemoglobin in the body.
Iron supplements. Iron supplements can also be taken to increase the hemoglobin levels in
the body.
Complications
Anemia has general complications and this includes:
Heart failure. As the heart compensates by pumping faster than the normal rate, the heart
muscles gradually weaken until the muscles wear out and the heart fails to function.
Paresthesias. Paresthesias develop when the muscles do not have enough oxygen delivered to
them.
Delirium. Insufficient oxygen in the brain results in delirium and is considered a fatal
complication of anemia.
Assessment and Diagnostic Findings
A number of hematologic studies are performed to determine the type and cause of anemia.
Blood studies. In an initial evaluation, the hemoglobin, hematocrit, reticulocyte count, and
RBC indices, particularly the mean corpuscular volume and red cell distribution width are taken
to assess for the presence of anemia.
Iron studies. Serum iron level, total iron binding capacity, percent saturation, and ferritin, as
well as serum vitamin B12 and folate levels, are all useful in diagnosing anemia.
CBC values. The remaining CBC values are useful in determining whether the anemia is an
isolated problem or part of another hematologic condition.
Medical Management
Management of anemia is directed towards correcting or controlling the cause of anemia.
Nutritional supplements. Use of nutritional supplements should be appropriately taught to

the patient and the family because too much intake cannot improve anemia.
Blood transfusion. Patients with acute blood loss or severe hemolysis may have decreased
tissue perfusion from decreased blood volume or reduced circulating erythrocytes, so
transfusion of blood would be necessary.
Intravenous fluids. Intravenous fluids replace the lost volumes of blood or electrolytes to
restore them to normal levels.
Nursing Management
The management of anemia by nurses should be accurate and appropriate so that objectives and
goals would be achieved.
Nursing Assessment
The assessment of anemia involves:
Health history and physical exam. Both provide important data about the type of anemia
involved, the extent and type of symptoms it produces, and the impact of those symptoms on
the patient’s life.
Medication history. Some medications can depress bone marrow activity, induce hemolysis,
or interfere with folate metabolism.
History of alcohol intake. An accurate history of alcohol intake including the amount and
duration should be obtained.
Family history. Assessment of family history is important because certain anemias are
inherited.
Athletic endeavors. Assess if the patient has any athletic endeavor because extreme exercise
can decrease erythropoiesis and erythrocyte survival.
Nutritional assessment. Assessing the nutritional status and habits is important because it
may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folic acid.
Diagnosis
Based on the assessment data, major nursing diagnosis for patients with anemia include:
Fatigue related to decreased hemoglobin and diminished oxygen-carrying capacity of the

blood.
Altered nutrition, less than body requirements, related to inadequate intake of essential
nutrients.
Altered tissue perfusion related to insufficient hemoglobin and hematocrit.
Planning & Goals
The major goals for a patient with anemia include:
Decreased fatigue
Attainment or maintenance of adequate nutrition.
Maintenance of adequate tissue perfusion.
Compliance with prescribed therapy.
Absence of complications.
Nursing Interventions
Nursing interventions are based on the data assessed by the nurse and on the symptoms that the
patient manifests.
To manage fatigue:
Prioritize activities. Assist the patient in prioritizing activities and establishing balance
between activity and rest that would be acceptable to the patient.
Exercise and physical activity. Patients with chronic anemia need to maintain some physical
activity and exercise to prevent the deconditioning that results from inactivity.
To maintain adequate nutrition:
Diet. The nurse should encourage a healthy diet that is packed with essential nutrients.
Alcohol intake. The nurse should inform the patient that alcohol interferes with the utilization
of essential nutrients and should advise the patient to avoid or limit his or her intake of
alcoholic beverages.
Dietary teaching. Sessions should be individualized and involve the family members and
include cultural aspects related to food preference and preparation.
To maintain adequate perfusion:
Blood transfusion monitoring. The nurse should monitor the patient’s vital signs and pulse
oximeter readings closely.
To promote compliance with prescribed therapy:
Enhance compliance. The nurse should assist the patient to develop ways to incorporate the
therapeutic plan into everyday activities.
Medication intake. Patients receiving high-dose corticosteroids may need assistance to obtain
needed insurance coverage or to explore alternative ways to obtain these medications.
Evaluation
Included in the expected patient outcomes are the following:
Reports less fatigue.

Attains and maintains adequate nutrition.
Maintains adequate perfusion.
Absence of complications.
Discharge and Home Care Guidelines
Health education is the main focus during discharge and for the home care.
Instruct the patient to consume iron-rich foods to help build-up hemoglobin stores.
Iron supplements. Enforce strict compliance in taking iron supplements as prescribed by the
physician.
Follow-up. Stress the need for regular medical and laboratory follow-up to evaluate disease
progression and response to therapies.
Documentation Guidelines
The data to be documented consists the following:
Baseline and subsequent assessment findings to include signs and symptoms.

Individual cultural or religious restrictions and personal preferences.
Plan of care and persons involved.
Teaching plan.
Client’s responses to teachings, interventions, and actions performed.
Attainment or progress toward desired outcome.
Long-term needs, and who is responsible for actions to be taken.
Practice Quiz: Anemia
Let’s reinforce what you’ve learned with this 5-item NCLEX practice quiz about Anemia.
 Exam Mode
In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only
be given after you’ve finished the quiz.
Start
 Practice Mode
Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single
page and correct answers, rationales or explanations (if any) are immediately shown after you
have selected an answer. No time limit for this exam.
Start
 Text Mode
Text Mode: All questions and answers are given on a single page for reading and answering at
your own pace. Be sure to grab a pen and paper to write down your answers.
1. The nurse begins to design a nutritional packet of information for a patient diagnosed
with iron-deficiency anemia. The nurse would recommend an increased intake of:
A. Fresh citrus fruits.

B. Milk and cheese.
C. Organ meats.
D. Whole grain bread.
2. A nurse should know that a diagnosis of hemolytic anemia is associated with all of
the following except:
A. Abnormality in the circulation of plasma.

B. Decrease in the reticulocyte count.
C. Defect in the erythrocyte count.
D. Elevated indirect bilirubin.
3. The most frequent symptom and complication of anemia is:
A. Bleeding gums.
B. Ecchymosis.
C. Fatigue.
D. Jaundice.
4. What is the hemoglobin level of a patient with anemia?
A. 21 to 25 g/dL.
B. 14 to 16 g/dL.
C. 9 to 11 g/dL.
D. 35 to 40 g/dL.
5. The following are symptoms of anemia except:
A. Fatigue.
B. Dyspnea.
C. Decreased hemoglobin.
D. Hypertension.
Answers and Rationale
1. Answer: C. Organ meats
Organ meats are rich in iron, which is needed for patients with iron-deficiency anemia.
Option A: Fresh citrus fruits are rich in vitamin C that can boost the immune system.
Option B: Milk and cheese are rich in protein that can strengthen the muscles.
Option D: Whole grain bread are rich in carbohydrates that supply energy.
2. Answer: B. Decrease in the reticulocyte count.
Increased reticulocyte count is associated with hemolytic anemia.
Option A: Abnormality in the circulation of plasma occurs because of the premature destruction
of hemoglobin.
Option C: Erythrocytes are being destroyed thus resulting in defect of erythrocyte count.
Option D: Indirect bilirubin is elevated because the released hemoglobin is converted in large
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bilirubin.
3. Answer: B. Ecchymosis
Ecchymosis is most common in anemia because blood vessels that are weak ruptures and results
into ecchymosis.
Option A: Bleeding gums is a symptom of idiopathic thrombocytopenia purpura.

Option C: Fatigue is a sign of anemia but it is not a complication.
Option D: Bilirubin concentration may be increased but not all results in jaundice.
4. Answer: C. 9 to 11 g/dL
A patient with anemia has decreased hemoglobin levels of 9 to 11 g/dL.
5. Answer: D. Hypertension
Hypotension occurs in anemia because of hypoperfusion.
Option A: Fatigue is a symptom of anemia as a result of decreased oxygenation.

Option B: Dyspnea occurs in anemia because the body is starving for oxygen that should have
been carried by hemoglobin in the red blood cells towards the body tissues.
Option C: Decreased hemoglobin is one of the signs that form the diagnosis of anemia.
See Also
Posts related to Anemia:
6 Sickle Cell Anemia Nursing Care Plans

Sickle Cell Anemia
4 Aplastic Anemia Nursing Care Plans
Further Reading and Recommended Resources
Recommended books and reading materials:
1. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care

2. Medical-Surgical Nursing: Assessment and Management of Clinical Problems
3. Medical-Surgical Nursing: Patient-Centered Collaborative Care
4. Saunders Comprehensive Review for the NCLEX-RN Examination
5. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing

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7/15/2018 Anemia Nursing Care Management: A Study Guide

Anemia is a condition in which the hemoglobin concentration is lower than normal.

A physiologic approach classifies anemia according to whether the deficiency in erythrocytes is

Hypoproliferative anemias. In hypoproliferative anemias, the marrow cannot produce

The pathophysiology of anemias is drawn according to the cause of the disease.

Decreased erythrocyte production. There is decreased erythrocyte production, reflected by

Premature destruction. Premature destruction of erythrocytes results in the liberation of

It is usually possible to determine whether the presence of anemia is caused by destruction or

Response. The marrow’s response to decreased erythrocytes as evidenced by an increased

To prevent anemia, lifestyle modifications must be made.

Anemia has general complications and this includes:

Assessment and Diagnostic Findings

Management of anemia is directed towards correcting or controlling the cause of anemia.

Nutritional supplements. Use of nutritional supplements should be appropriately taught to

The assessment of anemia involves:

Fatigue related to decreased hemoglobin and diminished oxygen-carrying capacity of the

Planning & Goals

The major goals for a patient with anemia include:

To maintain adequate nutrition:

To maintain adequate perfusion:

To promote compliance with prescribed therapy:

Included in the expected patient outcomes are the following:

Reports less fatigue.

Discharge and Home Care Guidelines

The data to be documented consists the following:

Baseline and subsequent assessment findings to include signs and symptoms.

Practice Quiz: Anemia

Practice Quiz: Anemia

Practice Quiz: Anemia

A. Fresh citrus fruits.

A. Abnormality in the circulation of plasma.

3. The most frequent symptom and complication of anemia is:

4. What is the hemoglobin level of a patient with anemia?

5. The following are symptoms of anemia except:

Answers and Rationale

1. Answer: C. Organ meats

2. Answer: B. Decrease in the reticulocyte count.

Increased reticulocyte count is associated with hemolytic anemia.

Option A: Bleeding gums is a symptom of idiopathic thrombocytopenia purpura.

A patient with anemia has decreased hemoglobin levels of 9 to 11 g/dL.

Hypotension occurs in anemia because of hypoperfusion.

Option A: Fatigue is a symptom of anemia as a result of decreased oxygenation.

Posts related to Anemia:

6 Sickle Cell Anemia Nursing Care Plans

Further Reading and Recommended Resources

Recommended books and reading materials:

1. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care

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