♦

Iron deficiency anemia -

hypochronic microcytic anemia
leading to hypoxemoc tissue
injury.

Incidence rate
A. Developed Countries
B. Tropical Areas
C. Women 15 - 35
D. Common among the poor

Predisposing Factor
A. Chronic Blood loss
– Trauma

– Menstruation

– Git bleeding

Upper GI bleeding: Melena

Lower GI bleeding:Hematochezia

*(Amibabiasis - DOC
metronidazole)

B. Inadequate intake of iron rich

food
C. Inadequate absorption of iron
due to
– chronic diarrhea

– Rt increased cereal intake

with with decreasesd animal

chon ingestion
– Malabsorption syndrome

". Sign and symptoms

A. Usually asymptomatic
B. Headache
C. Dyspnea
D. Dizziness
E. Palpitations
F. Cold Sensitivity
G. Generalized body malaise
H. Pallor
I. Brittleness of hair
J. Spoon shaped nails
(Koilonychia)
K. Atrophic glossitis, stomatitis,
dysphagia, -(Plumer Visons
Syndrome)
L. Pica - (eating of non edible
food)

*Nail - 35 - 45ʼ degrees

*Glossities - inflamation of the
tongue

X. Diagnostic procedure
All are decreased
– Rbc

– Hgb

– Hct

– Reticulocytes

– Iron

– Ferin

Y. Nursing management
A. Monitor for. Signs of bleeding
of all hematest including urine,
stool and GIT
B. Enfore CBR
C. Encourage increased iron diet

[] Food high on iron

Ex. 1. Organ liver meal
b. [Brown rice]
". [Egg yolk]
X. Dried fruits [(raisins)]
Y. Apricot
c. All the [nuts]
d. Fish ( Salmon, tuna,
haddock)
e. Legumes
f. Tofu
gh. Green leafy vegies

D. Avoid tannates in tea and

coffee
E. Administer medicationas
oredered
● Oral iron preparations

(300mg OD)
– FeSO4

– Fe Flumerate

– Fe Gluconate

Nursing guide
– best given on empty

stomach: to facilitate
absorption
– Best givenly with vit. C: for

faster absorption
 – When diluting it in liquid iron
preparation administer with
straw: to prevent staining of
the teeth

E.1 Monitor and inform client of

SE:
– Anorexia

– Nausea and vomiting

– Abdominal pain

– Diarrhea/constipation

– Melena

E. Administer medication as
ordered
● non compliance patient need

parenteral iron preparation

– iron dextran IM or IV

– Sorbitex IM

Nursing guide
– administer using z - track

method or deep IM: to

prevent staining and leakage
– Avoid massaging the injection

sites
– Instead encourage the client

to ambulate to promote
absorption

E.2 Monitor and inform client of

SE:
– pain at injection site
 – Localized abscess
– Lymphadenopathy
– Fever and chills
– Pruitus and urticaria
– Hypotension: indicative to
Anaphylaxis (epinephrine) -
broncodilating Effect.

Pernicious Anemia (Megalo

blastic anemia)
Resulting from a deficiency of
intrinsic factor leading to
HYPOCHLORHYDRIA ( decreased
in HCL acid secretions)

Incidence rate
– Elderly because of

degeneration of stomach

Predisposing factors
g. Subtotal gastrectomy
b. Hereditary factors
". Inflammatory disorder of the
ileum
X. Autoimmune
Y. Strictly vegetarian diet

● Stomach parietal cells

It produces It produces
intrinsic factors HCL acid
Promote It aids in
reabsorption of absorption
vit b12
(Cyanocobala
min). -
Maintains
integrity of
myelin sheath
Promotes
maturation of
RBC

Sign and symptoms

A. Anemia late symptoms
g. Headache
b. Dizziness
". Dyspnea
X. Palpitation
Y. Pallor
c. Body malaise
d. Brittleness of hair
B. Git symptoms
g. Stomatitis
b. Red beefy tongue
". Dyspepsia/ indigestion
X. Weight loss
Y. Jaundice
C. CNS changes
g. Parenthesis
b. Ataxia
". Numbness
X. Psychosis

Diagnostic Procedure
● schillings test - reveals

inadequate absorption of
vitamin b12
Nursing management
A. Enforce complete bed rest
B. Administer vitamin b12
injections at monthly intervals for
lifetime as ordered

Two common site of injection

– Dorso gluteal

– Ventro gluteal

Common SE of Vit. B12

– Free of toxicity

C. Increased caloric intake CHON,

CHO, FE and vit. C
D. Encourage client to use soft
bristled toothbrush and avoid
irritating mouthwashes
E. Avoid heat application

Aplastic Anemia - A stem cell

disorder characterized by bone
marrow depression leading to
PANCYTOPENIA (all blood cells
are decreased)

A. Anemia
B. Leukopenia
C. Thrombocytopenia

Predisposing factors
A. Chemicals - benzene and
derivatives
B. Exposure to radiation
C. Immunologic injury
D. Drugs -
•broad spectrum antibiotics
– Chloramphenicol

– Sulfonamides (Bactria)

•Chemotherapeutic Agents
– Nitrogen mustard (anti

metabolite)
– Vincristine

– Methotrexate -

– Phenylbutazones

Drugs
Drugs Antidote
Lead Ca. Editate
EDTA
Acetaminophe Acetylcestine
n
Cholinergic Atropine
Atropine Antilirium
Anti Phentolamine
depressant
Benzodiazepin Flumazenil
e
Iron Deferoxamine
(desferal)
Heparin Protamine So4
Digoxin Digibind
(Immune Fab)
Coumadin Vit. K
 (Aquamephyto
n
Methotrexate Leucovorin Ca.
Cyanide Na. Thiosulfate
Narcotic Naloxone
Analgesic (Narcan)
Thrombolytic Aminocaproic
Agents Acid (Amicar)

Sign and symptoms

A. Headache
B. Dizziness
C. Dyspnea
D. Palpitations
E. Pallor
F. Cold sensitivity
G. Generalized Body Malaise
H. Leukopenia
I. Thrombocytopenia
– petechia

– Ecchymoses

– Oozing of blood from

venipuncture sites

Diagnostic procedure
● CBC

● Bone Marrow Biopsy or

Aspiration- reveals fatty

streaks in the bone marrow
– site of bone marrow biopsy -

posterior iliac crest

Nursing management
A. Removal of underlying cause
B. BT as ordered
C. Enforce complete BR
D. Administer 02 inhalation
E. Reverse Isolation
F. Monitor for signs of infection
G Avoid IM, SQ or any
venipuncture site
H. Encourage client to use
electric razor when shaving
I. Medication as ordered
● immunosuppressant

● Ex. Anti lymphocyte globulin

– Imuran

– SE: crystalluria

– Force fluid

g. Epogen (Epocrit) -
stimulation erythrocytes
(RBC)
b. Filgrastin (Neupogen) -
stimulate neutrophils (WBC)

Disseminated intravascular
coagulation- An acute hemolytic
disorder characterized by
deficiency of prothrombin and
fibrinogen leading to wide spread
and systemic bleeding.

Predisposing factors
A. Rapid BT
B. Massive trauma
C. Massive burns
D. Neoplasia
E. Anaphylaxis
F. Hemolytic Reactions
G. Pregnancy

Sign and symptoms

A. Petechiae
B. Ecchymoses
C. Oozing of blood
D. Hemoptysis
E. Hemorrhages
F. Oliguria

Diagnostic procedures
● CBC - reveals

thrombocytopenia
● Stool for occult blood - +

● Ophthalmoscopic exam -

reveals sub retinal

hemorrhage
● ABG analysis - reveals

metabolic acidosis
– chronic

– DIC

– Dm

– illeustomy

Nursing management
A. Monitor for signs of bleeding of
all hems test
B. Administer IV fluid replacement
as ordered
C. Administer oxygen inhalation
as ordered
D. Administer medication as
ordered
– vit K

– Pitressin (Vasopressin)

E. Provide heparin lock

F. Institute NGT decompression
– iced saline solution

– Cold saline solution

G. Prevent complication
– hemorrhage

– Hypovolemic shock

– Acute respiratory

syndrome

blood transfusion
– For replace your circulating

blood volume
– To increase oxygen carrying

capacity of the blood

– Combat infection of

decreased WBC
– Prevent bleeding if decreased

PLT

Nursing Management
– proper refrigeration

– Blood typing and cross

matching
● Type O

● Type AB
● 85% of general population is
Rh (+)

– Aseptically assemble all

materials needed for BT
● Filter set (BT set)
● PNSS
● 18 - 19 gauge large bore
needle

– Instruct another RN to re
check the following:
● name of the patient
● BT and Crossmatching
● Expiration date
● Serial number

– Check the blood products for

presence of bubbles,
cloudiness, sediments and
dark color ( do not dispose
the blood!) (send it back to
the blood bank)
– NEVER WARM BLOOD
PRODUCTS: To prevent
contamination and bacterial
growth
– Transfusion should be
completed in 4 hours
– Avoid mixing or administering
drug at BT line
– Regulate at KVO (10-12gtts/
min) at 100cc/hr
 – Monitor VS before,
During, & After especially
every 15 minutes for the
first hour.

*3 - 5 gtts for first minute

*1st 15 mins is the most crucial:

Signs of BT reaction
– Hemolytic Reaction

– Allergic Reaction

– Pyrogenic Reaction

– Circulatory Overload

– Air Embolism

– Thrombocytopenia

– Citrate intoxication (+) tetany/

hypocalcemia
– Hyperkalemia (+) indicates

that the blood that was

transfuse is already EXPIRED

S/sx of hemolytic Anemia

– dizziness/headache

– Dyspnea

– Hypotension

– Flush skin

– Lumbar Flank pain, sterna

pain
– Port wine urine (red urine)

S/sx of Allergic Reaction

– fever and chills

– Dyspnea
 – Laryngospasm
– Bronchial wheezing
– Urticaria, pruritus - if positive
to hypotension indicative of
anaphylactic reaction: give
epinephrine

S/sx of pyrogenic Reaction

– fever and chills

– Headache

– Dyspnea

– Tachycardia/palpitations

– Diaphoresis

S/sx of circulatory overload

– dyspnea

– Rales/Crackles - excertional

discomfort
– Orthopnea

S/sx of Air Embolism

– dyspnea

– Chest pain

– Tachycardia/palpitation

S/sx of thrombocytopenia
– bleeding tendencies

A. Hematuria
B. Hemoptysis
– dyspnea

S/sx citrate of intoxication

– tetany
Nursing management: for all
type of reaction
– Stop the blood transfusions

– Notify the physician

– Flush with plain NSS or .9 Na

Chloride
– Never dispose the blood unit

send it to the blood bank for

re examination
– Obtain urine and blood

samples and send it to the

laboratory for re examination
– Administer medication as

oredered
A. Anti pyretics
B. Anti histamine
C. Diuretics
D. Ca. Gluconate
– Monitor VS , IO and neuro VS

polycythemia Vera
● Increased rbc volume

● Stem cell grow uncontrollably

● And bone marrow becomes

hyper cellular
● Spleen enlarges

● Blood becomes thick and

vicious
● Ruddy skin
 ● Headache
● Dizziness
● Blurred vision
● Angina and dyspnea
● Thrombophlebitis

Major cause
– hereditary

Treatment
– Phlebotomy

– Chemotherapy