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College of Nursing
A CASE STUDY IN
SEVERE ANEMIA
Submitted to:
Jameson Wils D. Ong I
Clinical Instructor
Submitted by:
Roy Baconga
Adel Lyde Bernales
Michelle Flores
Wella Orbigoso
Prettylyn Vallescas
BSN – III
Group 1
TABLE OF CONTENTS
PAGE
Acknowledgement-------------------------------------------------------------------
Introduction----------------------------------------------------------------------------
Objective of the Study--------------------------------------------------------------
Patient’s Profile-----------------------------------------------------------------------
Family Background------------------------------------------------------------------
Genogram ------------------------------------------------------------------------------
Physical Assessment---------------------------------------------------------------
Anatomy and Physiology----------------------------------------------------------
Pathophysiology----------------------------------------------------------------------
Laboratory Results-------------------------------------------------------------------
Symptomatology----------------------------------------------------------------------
Definition of Terms-------------------------------------------------------------------
Nursing Care Plan--------------------------------------------------------------------
Drug Study------------------------------------------------------------------------------
Health Teaching------------------------------------------------------------------------
Evaluation--------------------------------------------------------------------------------
ACKNOWLEDGEMENT
We will not be able to finish this case presentation without the help of those
people who sincerely gave their support to us. We would like to thank all the people
who generously gave their time, ideas and resources for the success of this
presentation.
To the family of our chosen patient, for their time, and full participation.
To all our clinical instructors who gave us freedom and the challenge to discover
on our own what life would need in this kind of profession.
To Mr. Jameson Wils D. Ong, I for supervising us in our duty in Medical Mission
Group Hospital in Tagum City.
To the staff of Medical Mission Group Hospital who supported us and make us
feel warmth.
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, inspiration, and support.
And finally, to GOD Almighty the GREAT PHYSICIAN and the AUTHOR OF LIFE
from whom wisdom comes. We thank HIM for the guidance and strength.
INTRODUCTION
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.
Anemia is a common blood disorder. Women and people Anemia is a common blood
disorder. Women and people with chronic diseases are at increased risk of the with chronic
diseases are at increased risk of the condition. Some people learn that their hemoglobin is
condition. Some people learn that their hemoglobin is low, which indicates anemia, when they
go to donate low, which indicates anemia, when they go to donate blood. Low hemoglobin
may be a temporary problem blood. Low hemoglobin may be a temporary problem remedied
by eating more iron-rich foods or taking a remedied by eating more iron-rich foods or taking a
multivitamin containing iron. However, it may also be a multivitamin containing iron. However,
it may also be a warning sign of blood loss in your body that may be warning sign of blood
loss in your body that may be causing you to be deficient in iron. If you're told that you
causing you to be deficient in iron. If you're told that you can't donate blood because of low
hemoglobin, ask your can't donate blood because of low hemoglobin, ask your doctor if you
should be concerned. If you suspect you doctor if you should be concerned. If you suspect
you have anemia, see your doctor. Anemia can be a sign of have anemia, see your doctor.
Anemia can be a sign of serious illnesses. Treatments for anemia range from serious
illnesses. Treatments for anemia range from taking supplements to undergoing medical
procedures taking supplements to undergoing medical procedures and even just eating
healthy varied diet.
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.
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.
OBJECTIVE OF THE STUDY
General Objectives:
Specific Objectives:
Sex: Male
Nationality: Filipino
MEDICAL DATA:
Patient's health history is the first part and one of the most sinificant aspects in case
studies. It is a systematic collection of subjective and objective data, ordering and a step by
step process inculcating detailed information in determining client's history, health status,
functional status and copping pattern. These vital information provide a conceptual baseline
data utilized in developing nursing diagnosis, subsequent plans for individualized care and for
the nursing process application as a whole.
Month PTA, admitted at a local hospital due to pallor and was discharged improving.
Week PTA, positive pallor accompanied with on and off dizziness persistence to admission.
According to him it was the 1st time to be hospitalized of his disease, He also has no
known allergy of kind. He never had a serious illness like this before to be brought to the
hospital. He said that he experience cough, colds, fever, stomachache and headache also
diarrhea on the past. He used to smoking and drinking when he was 15 years old but he quit
at the age of 60.
As claimed by patient during the interview, there is a family history of asthma on father
side. It includes his grandfather and his 1 sister and 1 brother. His grandfather died because
of aging. While his grandmother died of malaria.
a. Educational Background
- He is a high school graduate.
b. Occupation
- farmer, and they have farm
c. Religious Practices
- He is a solid Roman Catholic who hears mass every Sunday and on special days like
fiesta, Christmas and his birthday.
d. Economic Status
-His not able to estimate his earnings.
PHYSICAL ASSESSMENT
I. GENERAL SURVEY
III. SKIN:
Upon assessment, the patient’s skin is pale with poor skin turgor, no presence of
lesions and edema. Afebrile, with temperature of 36.6°C.
With dentures, pink gum, moist and firm texture; tongue in central position, pink in color
with no lesions noted and dry lips.
VI. SPEECH:
Neck moves freely without any discomfort, no visible distended veins and no lesions
noted.
X. CIRCULATORY SYSTEM:
Normal blood pressure at 100/80mmHg with regular rhythm at 72bpm with full
pulsation.
XI. ELIMINATION:
Eliminates regularly; defecated at least one times with no difficulty in bowel movement;
with soft formed stool and brownish in color.
Conscious able to cooperate with the task given; oriented with time, place, and person;
able to answer upon questioning.
ANATOMY AND PHYSIOLOGY
OF
BLOOD
BLOOD
− is a specialized body fluid that delivers necessary substances to the body cells
− such as nutrients and oxygen and transport waste products away from those
same cells.
REDBLOOD CELLS
− are the most abundant of the blood cells and they contain the oxygen- carrying
protein, hemoglobin that function in the transport of oxygen.
− Also called as erythrocytes.
WHITE BLOOD CELLS
− Constitute only 1 % of the total blood volume, they serve various roles in
immunity and inflammation. They include the granulocytes, the lymphocytes and
the monocytes.
− Also called as leukocytes.
PLATELETS
− Are small cell fragments that are involved in the blood clotting.
− Also called as thrombocytes.
LABORATORY RESULTS
Result: 1.9%
Normal: Adult 1-2
Infant 4-8
Normal Values
HEMATOLOGY RESULT
Kidneys:
There is no significant disparity in the sizes, shapes and locations of both kidneys. No evident
mass calculus, or any abnormality in the scans obtained.
The urinary bladder is distended. Attached to the lower left lateral wall and floor is an
irregularly – shaped complex structure, measuring 6.8x5.1x5.6 cm (LWT)
IMPRESSION:
is a reduced amount of
oxyhemoglobin in skin or
mucous membrane, a pale
color which can be caused is not usually clinically
by illness, emotional shock significant unless it is
Pallor √
or stress, avoiding accompanied by a general
excessive exposure to pallor (pale lips, tongue,
sunlight, anemia or palms, mouth and other
genetics. regions with mucous
membranes).
a range of afflictions,
varying from a general
state of lethargy to a is considered a symptom
Fatigue √
specific work-induced because it is reported by the
burning sensation within patient instead of being
one's muscles. observed by others.
Is a symptom of a number
of different conditions of
the head. Headache is
Headache x caused by a disturbance
of the pain-sensitive
structures in the head.
Lymphocytes - is a type of white blood cell in the vertebrate immune system. Functionally
distinct subsets of lymphocytes correlate with their appearance. Most, but not all large
granular lymphocytes are more commonly known as the natural killer cells (NK cells). The
small lymphocytes are the T cells and B cells. Lymphocytes play an integral role in the body's
defenses.
Monocytes - is a type of white blood cell, part of the human body's immune system.
Monocytes have two main functions in the immune system: (1) replenish resident
macrophages and dendritic cells under normal states, and (2) in response to inflammation
signals, monocytes can move quickly (approx. 8-12 hours) to sites of infection in the tissues
and divide/differentiate into macrophages and dendritic cells to elicit an immune response.
Reticulocytes - are immature red blood cells, typically composing about 1% of the red
cells in the human body. Reticulocytes develop and mature in the red bone marrow and
then circulate for about a day in the blood stream before developing into mature red
blood cells.
3.) Instruct in
daily mouth 5.)To avoid
care. bladder
distention/
4.)Monitor/ urinary stasis.
assist with
use of 6.) To promote
adjuncts. wellness.
5.)Maintain
adequate 7.) Premature
hydration, discontinuation
stand/ sit to of treatment
void, and when client
catheterize, if begins to feel
necessary well may result in
return of infection
6.) Review and potential
individual drug resistant
nutritional strains.
needs,
appropriate 8.) Inappropriate
exercise use can lead to
program and development of
need for rest. drug-resistant
strains/
7.) Emphasize secondary
necessity of infections.
taking
antivirals/antib 9.) To increase
iotics, as awareness of
directed. and prevention
of communicable
8.) Discuss diseases.
importance of
not taking 10.) To reduce
antibiotic/ incidence/
using “leftover transmission of
drugs” unless global infections.
specifically
instructed by
healthcare
provider.
9.) Provide
information/
involve in
appropriate
community
and national
education
programs.
10.) Discuss
precautions
with client
engaged in
international
travel and
refer for
immunizations
.
Nursing Diagnosis: Impaired physical mobility related to decrease muscle strength
9.) Encourage
adequate
intake of
fluids,
nutritious
foods.
10.)
Encourage
participation in
self care,
occupational
diversional/
recreational
activities.
DRUG STUDY
Mechanism of Action: A potent loop diuretic that inhibits sodium and chloride reabsorption at
the proximal and distal tubules and the ascending loop of Henle.
Adverse Reaction:
CNS: Vertigo, headache, dizziness, paresthesia, weakness, restlessness, fever
CV: orthostatic hypotension, thrombophlebitis with I.V administration
EENT: transient deafness, blurred or yellowed vision
GI: abdominal discomfort and pain, diarrhea, anorexia, nausea, vomiting, constipation,
pancreatitis
GU: nocturia, polyuria, frequent urination, oliguria
Hematologic: agranulocytes, leucopenia, anemia
Hepatic: hepatic dysfunction
Musculoskeletal: muscle spasm
Skin: dermatitis, purpura
Nursing Considerations
• Monitor weight, blood pressure, and pulse rate routinely with long term use and during
rapid diuresis. Use can lead to profound water and electrolyte depletion.
• Monitor uric acid level, especially in patients with a history of gout.
• Don’t confuse furosemide with torsemide or Lasix with Lonox.
Patient Teaching
• Advise patient to take drug with food to prevent GI upset, and to take drug in morning
to prevent need to urinate at night.
• Inform patient of possible need for potassium or magnesium supplements.
• Tell patient to check with prescriber or pharmacist before taking OTC drugs.
• Teach patient to avoid direct sunlight and to use protective clothing and a sunblock
because of risk of photosensitivity reactions.
Generic Name: Mebendazole
Brand Name: Vermox
Classification: Anthelmmintic
Adverse Reaction:
GI: Transient abdominal pain, diarrhea
Other: Fever
Patient Teaching
• Chew or swallow whole or crushed and mixed with food.
• Pinworms are easily transmitted; all family members should be treated for complete
eradication.
• Use strict handwashing and hygiene measures. Launder undergarments, bed linens,
and nightclothes daily. Disinfect toilet facilities daily and bathroom floors periodically.
• You may experience these side effects: Nausea, abdominal pain, diarrhea (eat
frequent small meals)
• Report fever, return of symptoms, severe diarrhea.
Evaluation
- Gather patient family health history that is fundamental for the onset of her illness.
- Discuss the diagnostic test undergone by the pt. and its implication.
- Classify prescribed drugs given by the pt. as the basis of his recovery.
- Formulate the nursing care plan to identify the present and possible problem of the
patient.
.
Exercise and Activity:
Emphasize the need to maintain regular exercise and activities; to maintain muscle
strength and motility, to help activities; 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 system. Passive exercise like breathing can also help
the patient to feel calm and comfortable.
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.
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.