REPORT ON THE INTRODUCTION ANEMIA

By:

M Ridho Hidayatullah

International Class D3 of Nursing

University of Muhammadiyah Banjarmasin

2016/2017
A. Definition
Anemia is a condition in which decreased levels of hemoglobin (Hb) or
red blood cells (erythrocytes), causing a decrease in capacity of the red blood
cells to carry oxygen ( POM, 2011).
Anemia is a disease of anemia, which is characterized by levels of
hemoglobin (Hb) and red blood cells (erythrocytes) was lower than normal. If the
hemoglobin level is less than 14 g / dl and erythrocyte less than 41% in men, the
man is said to be anemic. Similarly, in women, women who had a hemoglobin
level less than 12 g / dl and erythrocyte less than 37%, then the woman is said to
be anemic. Anemia is not a disease, but a reflection of the state of a disease or
disorder as a result of the body's functions. Physiologically anemia occurs when
there is a shortage of hemoglobin to carry oxygen to the tissues.
Anemia was defined as a decrease in red cell volume or hemoglobin
concentration to below the range of values that apply to healthy people. Anemia is
a symptom of an underlying condition, such as loss of blood components,
elements inadequate or lack of nutrients needed for the formation of blood cells,
resulting in decreased capacity of oxygen-carrying blood and there are many
types of anemia with different causes (Marilyn E, Doenges, Jakarta, in 2002 ).
Anemia is a condition in which the number of red blood cells or
hemoglobin concentration falls below normal (Wong, 2003).
B. Etiology
According to POM (2011), the cause of anemia are:
1. Less consume foods that contain iron, vitamin B12, folic acid, vitamin C,
and the elements necessary for the formation of red blood cells.
2. Heavy menstrual flow. Women who are menstruating prone to iron-
deficiency anemia due to blood when menstruating much and he does not
have enough iron stores.
3. Pregnancy. Pregnant women prone to anemia because the fetus is
absorbing iron and vitamins for growth.
 4. Certain diseases. Diseases that cause persistent bleeding in the
gastrointestinal tract such as gastritis and appendicitis can lead to anemia.
5. Certain drugs. Several types of medications can cause stomach bleeding
(aspirin, anti-inflamasi, etc.). Other drugs can cause problems in the
absorption of iron and vitamin (antacids, birth control pills, antiarthritis,
etc.).
6. The retrieval operation of part or all of the stomach (gastrectomy). This
can lead to anemia because the body absorbs less iron and vitamin B12.
7. Chronic inflammatory diseases such as lupus, rheumatoid arthritis, kidney
disease, thyroid problems, some types of cancer and other diseases can
cause anemia because they affect the process of formation of red blood
cells.
8. In children, anemia can occur due to hookworm infection, malaria or
dysentery that causes severe blood shortage.
C. Anemia CLASSIFICATION
classification There are different types of anemia, the anemia
classification according to morphology, micro and macro indicates the size of red
blood cells while chromic show color. The morphology, classification of anemia
comprising:
1. Anemia normocyticnormokrom
anemia PathophysiologyThis happens because blood loss or destruction of
excess blood causing bone marrow has to work harder in erythropoiesis. So
many young erythrocytes (reticulocytes) are visible on the picture of
peripheral blood. In this class, the size and shape of red blood cells contain
hemoglobin in normal and normal amounts but individuals suffering from
anemia. Anemia can occur due to hemolytic, post acute bleeding, aplastic
anemia, myelodysplasia syndrome, alcoholism, and anemia in chronic liver
disease.
2. normokrom macrocytic anemia
 Macrocyticmeans the size of red blood cells are larger than normal but
normokrom for normal hemoglobin concentration. This is caused by an
interruption or cessation of DNA synthesis of nucleic acids such as those
found on B12 deficiency or folic acid. It can also occur in cancer
chemotherapy, because disruption of cell
3. metabolism,hypochromic microcytic anemia
Microcytic means small, hypochromic means that it contains hemoglobin in
an amount that is less than normal. This generally describes the synthesis
insufficiency haem (iron), such as iron deficiency anemia, sideroblastic
circumstances and chronic blood loss, or globin synthesis disorders, such as
thalassemia (congenital abnormal hemoglobin disease).

Shortage of essential vitamins such as vitamin B12, folic acid, vitamin C

and iron can result in the formation of red blood cells, causing anemia ineffective.
To make a diagnosis of anemia should be combined consideration of
morphological and etiology. Here is the classification of anemia according to
etiology:
1. Aplastic Anemia
Aplastic anemia is a disorder in stem cells in the bone marrow that
can lead to death, at this point the number of blood cells produced
inadequate. Patients experiencing pancytopenia as lack of red blood cells,
white blood cells and platelets. Morphologically red blood cells seen
normositik and normokrom, reticulocyte count is low or missing and bone
marrow biopsy showed a condition called "dry puncture" with hypoplasia of
the real and a change in the fat tissue. Measures of treatment consists of
identifying and eliminating the causative agent. However, in some
circumstances could not be found etiological agent and the condition is
 called idiopathic. Some of these circumstances is thought to be
immunological state.
2. Iron deficiency anemia is
iron deficiency anemia are morphologically classified as microcytic,
hypochromic anemia with decreased hemoglobin quantitative synthetic. Iron
deficiency anemia is a major cause in the world. Particularly in women of
childbearing age, secondary to blood loss during menstruation and increased
iron requirements during pregnancy.
D. Clinical manifestation
1. Weak, tired, lethargic and tired
2. often complained of dizziness and eyedizzy-up
3. symptoms of eyelids, lips, tongue, skin and palms turned pale. Pale because
of shortage of blood volume and hemoglobin, vasoconstriction
4. tachycardia and heart murmurs (an increase in blood flow velocity) Angina
(chest pain)
5. Dyspnea, shortness of breath, quickly tired when activity (delivery of O2
decreases)
6. headache, weakness, tinnitus (ringing in the ears) describe SSP reduced
oxygenation in
7. severe anemia and CHF GI disorders (anorexia, nausea, constipation or
diarrhea)
E. Pathophysiology
existence of an anemia represented a marrow failure or loss of red blood
cells or both. Marrow failure (such as reduced erythropoiesis) can occur due to a
lack of nutrients, toxic exposure, tumor invasion or other unknown causes. Red
blood cells can be lost through bleeding or hemolysis (destruction).
Red blood cell lysis (dissolution) occurs primarily in phagocytic cells or
in the reticuloendothelial system, mainly in the liver and spleen. Byproducts of
this process is bilirubin which will enter the bloodstream. Any increase in red
blood cell destruction (hemolysis) immediately reflected by an increase in plasma
bilirubin (normal concentration of ≤ 1 mg / dl, levels above 1.5 mg / dl lead to
jaundice in the sclera).
If the destruction of red blood cells in the circulation experience, (the
hemplitik abnormality) then it will appear in the plasma hemoglobin
(hemoglobinemia). If the plasma concentration exceeds the capacity of plasma
haptoglobin (hemoglobin-binding proteins for free) to tie everything, hemoglobin
diffuses into the renal glomerulus and into the urine (hemoglobinuria).
Conclusion as to whether a patient's anemia caused by destruction of red
blood cells or red blood cell production is insufficient usually be obtained on the
basis of: 1. reticulocyte count in the blood circulation; 2. The degree of
proliferation of young red blood cells in the bone marrow and the way maturation,
as seen in the biopsy; and the presence or absence of hyperbilirubinemia and
hemoglobinemia.
F. PATHWAY
G. Investigations
a. Hb, hematocrit, red blood cell indices, the study of white blood cells, the
levels of Fe, iron binding capacity measurement, folate, vitamin B12, platelet
count, bleeding time, prothrombin time, and partial thromboplastin time.
b. Bone marrow aspiration and biopsy. Unsaturated iron-binding capacity of
serum
c. diagnostic examination to determine the presence of acute and chronic
diseases as well as a source of chronic blood loss.
H. Management
MANAGEMENT anemia aimed at finding the cause and replace lost blood:
1. Aplastic anemia:
o Bone marrow transplantation
o Providing immunosuppressive therapy with globolin antitimosit (ATG)
2. Anemia in kidney disease
o At paien dialysis should be treated by administration of iron and folic
acid
o availability of erythropoietin recombinant
3. anemia of chronic disease
most patients have no symptoms and do not require treatment for
aneminya, the successful handling of the underlying pathology, bone
marrow iron is used to make blood, so that Hb increases.
4. Iron deficiency anemia is the
o cause of iron deficiency Wanted
 o Using oral iron preparations: ferrous sulphate, ferrous gluconate and
ferrous fumarate.
5. megaloblastic anemia
Vitamin B12 deficiencytreated with vitamin B12, when the deficiency is
caused by defekabsorbsi or unavailability of intrinsic factor can be given
vitamin B12 by injection IM. To prevent recurrence of vitamin B12 anemia
therapy should be continued for life in patients suffering from pernicious
anemia or malabsorption that can not be corrected. Folic acid deficiency
anemia treatment with diet and the addition of folic acid 1 mg / day, IM in
patients with impaired absorption.
I. NURSING
1. Perform physical assessment
2. Get medical history, including the history of diet
3. Observe for manifestations of anemia
a. manifestations general
o muscle weakness
o Easily tired pale skin
b. manifestations of central nervous system
o Headache
o Dizziness
o Fireflies
o Peka stimulative
o thinking process is slow
o decline in the visual field
o Apathy
o Depression
c. Shock (anemia blood loss)
o peripheral perfusion labor
o Skin clammy
 o low blood pressure and blood pressure Setral
o Heart Increased frequency
nursing Diagnosis and intervention
nursing diagnoses that may arise and intervention:
DIANGOSA nURSING
nO aND PURPOSE aND CRITERIA OF
COLLABORATION
1 perfusion of tissue is not After ......... hour nursing action
effective b / d decrease in for adequate tissue perfusion
Hb concentration and clients with the following criteria:
blood, reduced oxygen - red mucous membranes
supply - conjunctiva was not anemic
- warm Akral
- vital signs within normal
ranges
2 nutrition less than body After nursing actions during
requirements b / d intake .......... the nutritional status of
is less, anorexia clients adequate criteria
- An increase in body weight in
accordance with the purpose of
- - weight ideally suited to the
height
- Can to identification nutritional
needs
- no signs of malnutrition
- shows improvement in the
functioning taste of swallowing
iNTERVENTION
peripheral sensation
Management
- Monitor their area certain that
only sensitive to hot / cold /
sharp / blunt
- Monitor their paretese
- Instruct family to observe the
skin if there are lesions or
lacerations
- Use Sarun hand for protection
- Limit movement of the head,
neck and back
- Monitor capability CHAPTER
- Collaboration analgetik
- Monitor their thrombophlebitis
- Discuss about cause changes
in sensation
Nutrition Management
- Assess for food allergies
- Collaboration with nutritionist
to determine the amount of
calories and nutrients the
patient.
- Instruct the patient to increase
the intake of Food
- instruct the patient to increase
the protein and vitamin C
- Provide sugar substance
- Assure containing edible diet
- No weight loss, which means
- importation of adequate
- signs malnutri the
- membrane of the conjunctiva
and mukosa no pale
- Value Lab .:
Protein total: 6-8 g%
Albumin:3.5-5,3g%
Globulin1.8 to 3.6g%
HB not less than 10 g%
high in fiber to prevent
constipation
- Provide food selected (already
consulted with a nutritionist)
- Teach patients how to make
daily food records.
- Monitor the amount of
nutrients and calories
- Provide information about the
nutritional needs
- Assess the patient's ability to
obtain the required nutrients
Nutrition Monitoring
- BB patients within normal
limits
- monitor their weight loss
- monitor the type and amount
of regular activity
- monitor interaction between
children or parents during
meals
- monitor the environment
during meal
- Schedule treatment and acts
during mealtimes
- Monitor dry skin and
pigmentation changes
- Monitor skin turgor
- Monitor dryness, dull hair, and
brittle
- Monitor nausea and vomiting
- Monitor levels of albumin,
total protein, hemoglobin, and
levels of hematocrit
- Monitor favorite foods
- Monitor the growth and
development of the
- Monitor pale, redness and
dryness of the conjunctiva
tissue
- nuntrition Monitor calorie
intake
- Note the edema, hiperemik,

3 self-care deficit b / d of
physical weakness
4 Risk of infection
After nursing actions during
.......... hour standalone client
needs are met with acriteria
- clientfree of body odor
- Declared comfort in the ability
to perform ADLs
- to perform ADLs with the help
of
After nursing actions during
.......... hours of the immune status
of the clients increased by criteria
- clients are free of signs and
symptoms of infection
- Demonstrated ability to prevent
infection
- WBC count within normal
limits
- Shows healthy behavior
hypertonic papillae of the
tongue and oral cavity.
- Note if the tongue magenta,
scarlet
Self Care assistane: ADLs
- Monitor capability client for
an independent self-care.
- Monitor the client's needs for
assistive devices for personal
hygiene, dressing, ornate,
toileting and eating.
- Provide assistance to clients as
a whole is able to perform
self-care.
- Encourage the client to
perform daily activities that
normally corresponding
capabilities.
- Push to perform
independently, but give help
when the client is unable to do
so.
- Teach clients / families to
promote independence, to
provide assistance only if the
patient is unable to do so.
- Provide daily routine activities
according to ability.
- Consider the age of the client
if it encourages the
implementation of daily
activities.
control infection
- Clean environment after use of
other patients
- Maintain isolation techniques
- Limit visitors if necessary
- Instruct visitors to wash their
hands during a visit and after
visiting leaving the patient
- Use soap antimicrobial hand
washing
- wash hands each before and
after the action of nursing
- Use clothes, gloves as
protective equipment
- Keep the environment aseptic
during installation tool
- Change layout IV peripheral
and the line of central and
dressing in accordance with
the general directions
- Use catheters intermittent
bladder infection to reduce
- nutrient intake Tingktkan
- Give antibiotic therapy when
necessary

- protection against infection

- Monitor for signs and
symptoms of systemic
infection and local
- Monitor granulocyte count,
WBC
- Monitor susceptibility to
infektion
- Limit visitors
- Filter visitors to infectious
diseases
- keep technique aspesis in
patients who are at risk
- Maintain isolation techniques
k/p
- Give care skin the area
epidemis
- Inspection of the skin and
mucous membranes of the
redness, heat, drainage
- Ispektion the condition of the
wound / surgical incision
- Push enter adequate nutrition
- Push fluid intake
- Encourage break
- Instruct patients to take
antibiotics as prescribed
- Teach the patient and family
 signs and symptoms of
infection
- Teach you how to avoid of
infection
- the suspicion Report infections
- Report culture-positive

5 activity intolerance bd After nursing actions for the Tolerance The activation
imbalance between supply client to move ...... .. criteria - Determining the cause of
and demand of oxygen - Participating in physical intolerance activity and
activity with BP, HR, RR determine whether the cause
corresponding of the physical, psychological /
- worsening of symptoms stating motivational
the effect of immediate onset - Observation client restrictions
OR and declared in activity.
- normal skin color, warm and - Assess the suitability of client
dry activity and daily rest
- Memverbalissikanthe - ↑ activity gradually, let
importance of activity clients participate can change
gradually
position, moving and self
- Expressing important sense Her
care
balance of exercise and rest
- Increased exercise tolerance - Make sure the client is
gradually changing positions.
Monitor symptoms of activity
intolerance
- When helping clients stand,
observation intolerance
symptoms such as nausea,
paleness, dizziness, impaired
consciousness and vital signs
- Perform ROM exercises if the
client can not tolerate the
activity
- Help clients choose activities
that are able to do
6 Disruption of gas Once the action ...... .. nursing oxygen Therapy
exchange bd ventilation- during respiration status: - Clean the mouth, nose and
perfusion improved gas exchange with the trachea secret
following criteria: - Maintain patent airway
- Demonstrate increased - oxygenation equipment Adjust
ventilation adequate the
oxygenation - oxygen flowMonitor
- cleanliness Maintain lungs, and - Hold patients
 free of any signs of respiratory
distress
- Demonstrate effective cough
and breath sounds were clean,
no cyanosis and dyspnea
(capable of removing sputum,
able to breathe easily, no
pursed lips)
- signs vital signs within normal
ranges
7 Ineffective breathing After nursing actions during .......
pattern bd ... clients respiratory status
improved with the criteria
- Demonstrate effective cough
and breath sounds were clean,
no cyanosis and dyspnea
(capable of removing sputum,
able to breathe easily, no
pursed lips)
- for signs mark Observation
hipoventi Outcome
- Monitor the patient's anxiety
towards oxygenation
Vital Sign Monitoring
- Monitor BP, pulse,
temperature, and RR
- Note the presence of blood
pressure fluctuations
- Monitor VS while the patient
is lying down, sitting or
standing
- Auscultation TD on both arms
and compare
- Monitor BP, pulse, RR,
before, during, and after
activity
- monitor the quality of the
pulse
- monitor the frequency and
rhythm of breathing
- Monitor voice lung
- Monitor breathing pattern
abnormal
- Monitor temperature, color
and moisture
- Monitor peripheral cyanosis
- Monitor their Cushing's triad
(pulse pressure widens,
bradycardia, increased
systolic)
- identification of the causes of
changes in vital signs
Airway Management
- Open the airway, use
engineering chin lift or jaw
thrust if necessary
- Position the patient to
maximize ventilation
- identification of patients the
need for installation of
equipment artificial airway
 - Indicates that a patent airway
(the client does not feel ter
choking, breathing rhythm,
respiratory frequency in the
normal range, no breath sounds
abnormal)
- Signs Vital signs within normal
range (blood pressure, pulse,
respiration)
8 Fatigue bd anemia After nursing actions during ......
.. .keletihan client is resolved with
the following criteria:
- Ability activityis adequate
- Maintaining adequate nutrition
- balance of activity and rest
- Using energy-conservation
techniques
- Maintaining social interaction
- Identifying factors that cause
physical and psychological
fatigue
- Maintaining the ability to
concentration
- Replace mayo if necessary
- Perform chest physiotherapy if
necessary
- Remove secretions by
coughing or suctioning
- Auscultation of breath sounds,
noting the additional sound
- Perform suction on mayo
- Give bronchodilators if
necessary
- Give humidifiers Kassa wet
NaCl damp
- Set intake to optimize fluid
balance.
Energy management
- Monitor client's response to
the activity of tachycardia,
dysrhythmias, dyspnoea, pale,
and the amount of respiration
- monitor and record the amount
of sleep clients
- Monitor discomfort atauu pain
during movement and activity
- monitor nutritional intake
- instruct the client to take down
the signs and symptoms of
fatigue
- Jelakan to the client
relationshipfatigue with the
disease process
- Note theactivities can increase
fatigue
- Encourage clients do increase
the relaxation of
- restrictions on bedrest and
activity increase
 REFERENCES

Brunner & Suddarth. 2002. Textbook of nursing medical-surgical, 8th edition vol
3.Jakarta: EGC
Carpenito, LJ 2000. Nursing Diagnosis, Applications in Clinical Practice, 6th
edition.Jakarta: EGC
Johnson, M., et al. 2000. Nursing Outcomes Classification (NOC)
SecondEdition.New Jersey: Upper Saddle River
Marlyn E. Doenges, 2002. Nursing care plan,Jakarta, EGC
McCloskey, CJ, etal.1996 Nursing Interventions Classification (NIC)
SecondEdition.New Jersey: Upper Saddle River
Patrick Davay, 2002 At A Glance Medicine, Jakarta, EMS
Santosa Budi. 2007. NANDA Nursing Diagnosis Guide 2005-2006.Jakarta: Prima
Medika
Smeltzer & Bare. 2002. Medical Surgical Nursing II.Jakarta: EGC
Wilkinson, Judith M. 2006. Nursing Diagnosis Handbook, 7th edition.EGC: Jakarta.