221 bleeding and anemia

What is anemia?

Decrease in:

• Red blood cells (RBCs)

• Hemoglobin (Hgb) quality

RBCs are produced in the bone marrow.

What nutrients are required to produce red blood cells?

• Iron

• Folic acid (Vitamin B9)

Vitamin B12

Why is kidney function important in RBC production?

Kidneys produce erythropoietin (EPO) which stimulates the bone marrow to make RBCs.

What lab test is commonly used to evaluate anemia?

CBC without differential

What does MCV (Mean Corpuscular Volume) measure?

Low MCV indicates decreased hemoglobin.

What does MCH (Mean Corpuscular Hemoglobin) measure?

Amount of hemoglobin per RBC.

What does MCHC (Mean Corpuscular Hemoglobin Concentration) measure?

Average concentration of hemoglobin in RBCs

How are MCV and MCH related?

They usually parallel each other.

What does RDW (Red Cell Distribution Width) measure?

Variation in RBC size.

What symptoms should be assessed when evaluating fatigue from anemia?

• Lethargy

• Response to activity

• Vital signs

• Dyspnea

• Pallor

What nursing interventions help manage fatigue in anemia?

• Cluster care

• Schedule rest periods

• Encourage energy-saving activities

• Assist with ADLs

What should nurses teach patients about fatigue management?

• Recognize fatigue signs

• Use energy conservation

• Maintain proper diet

• Consume Vitamin A

• Encourage strength training

• Perform important tasks first

What nursing interventions treat ineffective perfusion?

• Administer oxygen

• Position patient properly

• Provide IV fluids

• Administer RBC transfusion

What education should be provided for ineffective perfusion?

• Disease process

• Fall risk

• Dizziness precautions

• Medications and supplements

• Nutrition

Why are infants at risk for iron deficiency anemia?

Maternal iron stores become depleted at 6–9 months.

Why are adolescents at risk for iron deficiency anemia?

• Rapid growth

• Poor diet

• Menstruation

What can cause chronic iron deficiency anemia?

Slow occult bleeding

What lab test measures iron storage?

Ferritin

What are symptoms of iron deficiency anemia?

• Tachycardia

• Pallor

• Brittle spoon-shaped nails

• Fatigue

• Irritability

• Muscle weakness

• Systolic heart murmur

What dietary factors increase iron deficiency risk in infants?

• Excessive cow’s milk

• Lack of iron-fortified formula or cereal

What is the recommended milk/formula limit for older infants?

No more than 32 oz per day

What foods are good sources of iron for children?

• Red meat

• Tuna

• Salmon

• Eggs

• Tofu

• Grains

• Dried beans

• Peas

• Fruits

• Nuts

• Leafy greens

How should oral iron supplements be taken?

• Empty stomach

• 1 hour before meals

What medications should not be taken near iron supplements?

Avoid antacids and antibiotics within 2 hours.

What are important teaching points for liquid iron?

 

• Can stain teeth

• Use a straw

• Brush teeth afterward

What stool change is expected with iron therapy?

Green or dark stool

What are possible side effects of iron supplements?

• GI upset

• Constipation

• Nausea

What technique is used for IM iron injections?

Z-track method

Why should iron supplements be limited to one month supply?

To prevent iron overdose in children.

What are symptoms of iron overdose?

• Nausea

• Severe stomach pain

• Vomiting coffee-ground material

• Bloody diarrhea

• Coughing blood

• Shallow breathing

• Weak rapid pulse

• Pale skin

• Blue lips

• Convulsions

What vitamin improves iron absorption?

Vitamin C

What foods contain Vitamin C?

• Oranges

• Lemons

• Tomatoes

• Broccoli

• Peppers

• Melons

• Berries

What foods contain Vitamin B9 (folic acid)?

·       Cereal

·       Leafy greens

·       Egg yolk

·       Watermelon

·       Bananas

What is the function of Vitamin B12?

Important for DNA synthesis

What foods contain Vitamin B12?

• Beef

• Eggs

• Cheese

• Cereal

• Soybeans

When is chelation therapy recommended for lead poisoning?

Lead level greater than 44.

What are common sources of lead exposure?

• Homes built before 1978

• Pottery

• Painted toys

• Old furniture

What complication occurs with chronic lead exposure?

Neurologic problems

What labs are checked with lead poisoning?

H/H

What must be assessed before chelation therapy?

Kidney function (BUN and creatinine).

What happens to RBCs in sickle cell disease?

RBCs become crescent or sickle-shaped.

What triggers sickle cell crisis?

• Extreme hot/cold temperatures

• Dehydration

• Stress

• Infection

• High altitude

• Increased metabolic demand

What complications can occur during sickle cell crisis?

• Acute chest syndrome

• Pneumonia

• Pulmonary embolism

• Gallstones

• Stroke

How is sickle cell crisis treated?

• Oxygen

• Pain medication

• IV fluids

• Monitor intake/output

• Treat infection

• Rest

Elevate extremities

What should patients with sickle cell disease do for self-management?

• Avoid triggers

• Prevent infections

• Stay hydrated

• Get immunizations

• Take medications/vitamins

• Wear medical ID

• Use community resources

What is thalassemia?

Inherited blood disorder causing abnormal hemoglobin chains and fragile RBCs.

What lab findings occur in thalassemia?

• Decreased hematocrit

• Decreased hemoglobin

• Decreased folic acid

Decreased Vitamin B

What symptoms appear in infants with thalassemia?

• Pallor

• Fatigue

• Severe anemia

• Hepatosplenomegaly

What bone changes occur due to increased erythroid activity?

• Bone marrow expansion

• Thinning of bony cortex

• Growth retardation

• Osteoporosis

• Skeletal deformities

What complications result from excess iron in thalassemia?

• Bronze skin pigmentation

• Cardiomyopathy

• Pulmonary hypertension

• Liver disease

• Gallstones

• Endocrine disorders

• Delayed growth

• Small stature

• Hypogonadism

• Leg ulcers

• Intellectual disability

How is thalassemia managed?

• RBC transfusions

• Chelation therapy

• Splenectomy

• Bone marrow transplant (cure)

What medication removes excess iron in thalassemia?

Deferoxamine

What foods should be restricted in thalassemia?

• Red meat

• Liver

• Iron-fortified cereals

• Vitamin C supplements

What foods should be encouraged in thalassemia?

• Calcium-rich foods

• Dairy

• Leafy greens

• Fortified foods

• Adequate hydration

What causes hemophilia?

X-linked inherited disorder

• Hemophilia A = Factor VIII deficiency

• Hemophilia B = Factor IX deficiency

What is the most common bleeding site in hemophilia?

Bleeding into joints (hemarthrosis)

What is the most dangerous complication of hemophilia?

Intracranial bleeding

What complication can occur with muscle bleeding?

Compartment syndrome

What internal bleeding signs may occur in hemophilia?

• Hematuria

• GI bleeding

What lab finding occurs in hemophilia?

Prolonged PTT or aPTT

What symptoms indicate hemophilia?

·       Easy bruising

·       Nosebleeds

·       Heavy menstrual bleeding

·       Joint bleeding

·       Prolonged bleeding

·       Bleeding gums

·       Blood in urine/stool

How is hemophilia treated?

Clotting factor replacement therapy

What medication can stimulate clotting factor release?

Desmopressin (DDAVP)

What medication helps stabilize blood clots?

Aminocaproic Acid

What complication can occur with repeated clotting factor therapy?

Antibody development

What treatments may be required if antibodies develop?

• Steroids

• IVIG

What medications should be avoided in hemophilia?

ASA

What medication is safe for pain in hemophilia?

Acetaminophen (Tylenol)

What symptoms may indicate internal bleeding?

• Skin discoloration

• Back pain

• Stomach pain

What injection route should be avoided in hemophilia?

Intramuscular injections

How should clotting factor be stored at home?

In the refrigerator.

How long can clotting factor be used after reconstitution?

Within 3 hours.

What oral care is recommended for hemophilia?

Use a soft toothbrush.

What method is used to treat joint injuries in hemophilia?

RICE