Anemia is a common hematologic condition characterized by a reduction in red blood cell (RBC) count or hemoglobin levels, leading to decreased oxygen transport to body tissues.
For nurses, early identification and management of anemia are essential to prevent complications such as fatigue, tissue hypoxia, and impaired organ function.
Understanding the nursing process for anemia—including accurate assessment, diagnosis, intervention, and evaluation—helps ensure optimal patient outcomes and prepares nursing students for NCLEX-style clinical reasoning questions.
Pathophysiology Overview
Anemia results from one or more of the following mechanisms: blood loss, decreased RBC production, or increased RBC destruction.
- Blood loss anemia can occur from trauma, surgery, or gastrointestinal bleeding.
- Decreased RBC production is often related to iron, folate, or vitamin B12 deficiency or chronic kidney disease.
- Increased RBC destruction occurs in conditions such as hemolytic anemia or sickle cell disease.
Reduced hemoglobin concentration leads to diminished oxygen delivery. To compensate, the heart increases cardiac output, and the respiratory system increases rate and depth of breathing. Prolonged hypoxia can cause fatigue, pallor, dizziness, and shortness of breath—key symptoms that guide nursing assessment and interventions.
Focused Nursing Assessment and Diagnostics
Subjective Data:
- Reports of weakness, fatigue, dizziness, and shortness of breath on exertion
- Headaches or lightheadedness
- Difficulty concentrating
Objective Data:
- Pallor of skin, nail beds, and mucous membranes
- Tachycardia, hypotension, and dyspnea
- Brittle nails, spoon-shaped nails, or glossitis
- Cold extremities and delayed capillary refill
Diagnostic Tests:
- Complete Blood Count (CBC): Low hemoglobin, hematocrit, and RBC count
- Iron studies: Low serum iron, ferritin, and transferrin saturation
- Reticulocyte count: Evaluates bone marrow response
- Stool guaiac test: Detects occult blood loss
- Peripheral smear: Assesses RBC morphology
Nursing Care Plan #1: Fatigue Related to Decreased Oxygen-Carrying Capacity
Nursing Diagnosis:
Fatigue related to decreased oxygen-carrying capacity of the blood secondary to low hemoglobin levels, as evidenced by verbal reports of tiredness, inability to perform usual activities, and pallor.
Related Factors/Causes:
- Low hemoglobin concentration
- Reduced oxygen transport to tissues
- Decreased RBC production
Nursing Interventions and Rationales
- Encourage rest periods between activities.
Rationale: Conserving energy helps prevent overexertion and allows oxygen to be directed toward essential functions.* - Assist with activities of daily living (ADLs) as needed.
Rationale: Supporting mobility prevents fatigue while maintaining independence.* - Administer oxygen therapy as ordered.
Rationale: Supplemental oxygen increases tissue oxygenation in hypoxic patients.* - Monitor hemoglobin and hematocrit levels.
Rationale: Laboratory monitoring evaluates the severity of anemia and guides treatment.* - Encourage iron-rich foods and adequate hydration.
Rationale: Iron supports erythropoiesis, while fluids enhance circulation and oxygen transport.*
Desired Outcomes:
The patient verbalizes increased energy, performs daily activities with less fatigue, and demonstrates improved hemoglobin levels.
Nursing Care Plan #2: Activity Intolerance Related to Imbalance Between Oxygen Supply and Demand
Nursing Diagnosis:
Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by dyspnea, tachycardia, and weakness during exertion.
Related Factors/Causes:
- Low hemoglobin level
- Generalized weakness and reduced oxygen transport
Nursing Interventions and Rationales
- Plan care to include frequent rest periods between activities.
Rationale: Alternating rest and activity conserves oxygen and prevents exhaustion.* - Gradually increase activity levels as tolerated.
Rationale: Progressive activity improves endurance and cardiovascular adaptation.* - Monitor oxygen saturation and vital signs during activity.
Rationale: Detects early signs of hypoxia or cardiac stress.* - Provide emotional support and encouragement.
Rationale: Anxiety can increase oxygen demand; reassurance promotes calmness and compliance.* - Collaborate with physical therapy for energy-conservation techniques.
Rationale: Interdisciplinary care optimizes functional recovery.*
Desired Outcomes:
The patient performs ADLs with less dyspnea, maintains stable vital signs during activity, and reports improved tolerance for exertion.
Nursing Care Plan #3: Ineffective Tissue Perfusion Related to Decreased Hemoglobin Levels
Nursing Diagnosis:
Ineffective Tissue Perfusion related to decreased hemoglobin levels as evidenced by pallor, fatigue, delayed capillary refill, and dizziness.
Related Factors/Causes:
- Inadequate oxygen delivery due to anemia
- Altered blood flow and tissue hypoxia
Nursing Interventions and Rationales
- Assess skin color, temperature, and capillary refill regularly.
Rationale: Evaluating perfusion helps detect early signs of hypoxia or poor circulation.* - Administer prescribed iron supplements, folic acid, or erythropoietin as indicated.
Rationale: These promote RBC production and improve oxygen delivery.* - Maintain adequate fluid balance.
Rationale: Proper hydration supports blood volume and perfusion.* - Elevate lower extremities periodically.
Rationale: Promotes venous return and enhances peripheral circulation.* - Monitor for signs of hypoxia such as confusion, restlessness, or cyanosis.
Rationale: Early recognition of hypoxia allows prompt intervention.*
Desired Outcomes:
The patient demonstrates improved color, capillary refill under 2 seconds, stable vital signs, and alert mental status.
Nursing Care Plan #4: Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis:
Imbalanced Nutrition: Less Than Body Requirements related to inadequate intake of essential nutrients as evidenced by low hemoglobin levels, poor appetite, and weight loss.
Related Factors/Causes:
- Insufficient dietary iron, folate, or vitamin B12 intake
- Loss of appetite or gastrointestinal upset
Nursing Interventions and Rationales
- Assess current dietary habits and appetite.
Rationale: Establishes a baseline for nutritional planning.* - Provide small, frequent meals rich in iron and protein.
Rationale: Improves nutritional intake without causing fatigue or nausea.* - Encourage foods high in iron such as lean meats, beans, and leafy greens.
Rationale: Dietary iron supports red blood cell production.* - Recommend vitamin C-rich foods to enhance iron absorption.
Rationale: Vitamin C increases bioavailability of dietary iron.* - Collaborate with a dietitian for individualized nutritional support.
Rationale: Ensures comprehensive planning tailored to patient needs.*
Desired Outcomes:
The patient demonstrates improved appetite, maintains stable weight, and shows increased hemoglobin levels.
Nursing Care Plan #5: Risk for Injury Related to Dizziness and Weakness
Nursing Diagnosis:
Risk for Injury related to decreased oxygen supply to tissues and weakness secondary to anemia.
Related Factors/Causes:
- Orthostatic hypotension and fatigue
- Dizziness during ambulation
Nursing Interventions and Rationales
- Encourage the patient to rise slowly from lying or sitting positions.
Rationale: Prevents orthostatic hypotension and dizziness.* - Keep frequently used items within easy reach.
Rationale: Reduces unnecessary movement and fall risk.* - Maintain a clutter-free environment and ensure adequate lighting.
Rationale: Minimizes risk of accidents due to fatigue or disorientation.* - Provide assistive devices or supervision during ambulation if needed.
Rationale: Ensures safety and promotes confidence during mobility.* - Educate family members about safety precautions.
Rationale: Reinforces consistent safety measures in all settings.*
Desired Outcomes:
The patient remains free from falls or injuries and demonstrates understanding of safety strategies.
Patient Education and Safety
- Medication adherence: Stress the importance of taking prescribed iron or vitamin supplements as directed.
- Dietary guidance: Encourage consumption of iron-rich and folate-rich foods.
- Hydration: Promote adequate fluid intake to support circulation.
- Safety: Advise patients to change positions slowly and avoid strenuous activity until energy improves.
- Follow-up: Reinforce the need for periodic blood tests to monitor progress.
Frequently Asked Questions
1. What is the priority nursing diagnosis for anemia?
Fatigue or Activity Intolerance are often top priorities due to reduced oxygen delivery.
2. Which signs and symptoms should nurses monitor?
Pallor, fatigue, tachycardia, shortness of breath, dizziness, and delayed capillary refill.
3. What are the key nursing interventions for anemia?
Encourage rest, promote nutrition, administer iron therapy, and monitor for hypoxia.
4. How can nurses educate patients with anemia?
Teach medication adherence, dietary modification, and safety precautions.
5. What are expected outcomes in anemia care?
Improved energy levels, stable vital signs, and increased hemoglobin concentration.
Peer-Reviewed References
- Lewis, S. L., et al. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 11th ed. Elsevier.
- Gulanick, M., & Myers, J. L. Nursing Care Plans: Diagnoses, Interventions, and Outcomes. 10th ed. Elsevier.
- Ignatavicius, D. D., et al. Concepts for Interprofessional Collaborative Care. 9th ed. Elsevier.
- NANDA International. Nursing Diagnoses: Definitions and Classification, 2024–2026.
- Smeltzer, S. C., et al. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 15th ed. Lippincott.
