Anemia is a medical condition wherein a person lacks sufficient RBC count, hemoglobin, and hematocrit values resulting in a reduced oxygen-carrying and transport capacity of the blood to the body’s vital tissues.
There are numerous forms and representations of anemia, each with its own variability and cause. Anemia can be short or long-term and can range from mild to severe cases. If anemia is suspected, consult the doctor immediately, for it could be a warning sign of an underlying serious illness or disease.
Treatments for anemia could be achieved by practicing a varied healthy diet, taking certain drugs and supplements, and performing urgent medical procedures, which could improve a person’s response towards this serious illness. In this article we will discuss nursing care and anemia nursing care plans.
Iron Deficiency Anemia
Iron deficiency anemia is a common type of anemia that is caused by a lack of iron in the body. Iron is necessary for the production of hemoglobin, which carries oxygen in the blood. Iron deficiency anemia can occur due to a variety of factors, including poor diet, chronic blood loss, and pregnancy.
Symptoms of iron deficiency anemia can include fatigue, weakness, shortness of breath, pale skin, and dizziness. Treatment for iron deficiency anemia may include iron supplements or changes in diet to increase iron intake. In severe cases, blood transfusions may be necessary.
Other Types of Anemia
Hypoproliferative Anemia – this type of anemia is determined by diminished or ineffective erythropoiesis, as evidenced by a reduced reticulocyte count. Second, the use of medications and chemical agents results in bone marrow destruction, leading to a lack of erythrocyte production.
Examples of hypoproliferative anemia are the following:
- Vitamin Deficiencies anemia (e.g., Iron deficiency anemia, Vitamin B12 or folate deficiency, Anemia of chronic disease, aplastic anemia, etc.)
Hemolytic Anemia – this anemia is due to hemolysis of the red blood cells, causing hemoglobin to be released into the plasma. It can also be due to trauma or injury inflicted to the RBC membrane that causes liberation of its contents.
When there is increased erythrocyte destruction, anticipate the development of tissue hypoxia and the production of erythropoietin as a compensatory response of the body. EPO stimulates RBC production, and the effect is an increase in reticulocyte count.
Reticulocytes are immature red blood cells, and due to their lack of biconcave shape, their stability cannot be guaranteed in the sheer stress it would be subjected to in the blood circulation.
Examples of hemolytic anemia are the following:
- Sickle cell anemia or Sickle cell disease
- Anemia due to intrinsic causes (e.g., hereditary spherocytosis, G6PD deficiency, Sickle cell anemia, HbC disease, etc.)
- Anemia due to extrinsic causes (e.g., lead poisoning, hypersplenism, spur cell hemolytic anemia, autoimmune diseases, etc.)
Signs and Symptoms of Anemia
- Dyspnea or shortness of breath
- Abdominal Pain
- Visible signs of weakness/lethargy
- Tissue hypoxia
Causes of Anemia
Based on the following indicators, it is usually feasible to determine whether anemia is caused by the destruction or decreased production of erythrocytes.
- Manner of proliferation – If there is an increase in infiltration and production of immature red blood cells in the bone marrow, it could indicate certain kinds of anemia. And the process by which they develop can be seen in the bone marrow biopsy.
- Bone Marrow response – the BM compensates for the decrease in erythrocyte level, hence the increase in the production and release of reticulocytes in the blood circulation.
- Erythrocyte destruction – intravascular hemolysis resulting from RBC destruction can indicate anemia of certain origins (intrinsic or extrinsic), and this is made possible by the presence of end products within the blood circulation.
Risk Factors of Anemia
- Nutrient-deficient status
- Chronic ailments
- Gastrointestinal Bleeding
- Intestinal disorders (e.g., Celiac disease, Crohn’s disease)
- Exposure to chemicals
Diagnosis of Anemia
For initial investigation, laboratory tests for blood may be employed for such as measurements of:
- Hematocrit, Hemoglobin, Reticulocyte count, as well as the RBC indicators (e.g., mean corpuscular volume, red cell distribution width) to evaluate and confirm suspected cases of anemia
- Complete blood count – This blood test measures a wide range of blood components. And the remaining CBC parameters are useful to determine whether anemia is associated with another hematologic condition. Abnormal findings may indicate an infection or condition not entirely linked to anemia; hence, it is important to assess the patient’s blood profile.
- Iron studies – This is a common anemia screening test and is useful in determining its possible cause (e.g., iron overload, iron deficiency, response, etc.). Iron studies include total-iron binding capacity, ferritin, percent saturation, serum iron level, folate, and serum vitamin B12 determination.
Treatment for Anemia
Treatment of anemia usually depends on the type of anemia and its cause. However, the universal treatment scheme is through careful medical management and supportive therapy.
- Blood transfusions. As a result of a decrease in circulating red blood cells or blood volume, or blood loss. Patients with severe hemolysis may require a blood transfusion.
- Use of nutritional supplements. The proper use of nutritional supplements should be explained to the patient and his/her family, as excessive intake will not help to improve anemic symptoms.
- Administration of intravenous fluids
- Medications such as anti-anemic drugs
Prevention of Anemia
The following are measures to prevent anemia, especially in highly vulnerable patient groups:
- Take vitamins that contain iron.
- Practice good dietary intake.
- Eat plenty of vitamin C-rich foods. such as citrus fruits and fresh raw vegetables such as dark green leafy vegetables.
Anemia Nursing Care Plans & Nursing Diagnosis
Nursing Care Plans
Anemia Nursing Care Plan 1
Nursing Diagnosis: Fatigue related to lack of decreased oxygen-carrying capacity of blood due to decreased hemoglobin levels, secondary to anemia, as evidenced by frequent rest periods, dyspnea or pain during exercise, and verbalized exhaustion.
Desired Outcome: The patient will express comprehension of energy conservation.
Nursing Interventions for Fatigue
Determine the level and cause of fatigue. Fatigue can be brought on by a variety of medical disorders including anemia that results in the patient’s inability to tolerate physical activities and exercise, but in particular, tissue hypoxia caused by normocytic anemia is a known cause of fatigue.
Monitor the patient’s blood indices such as hematocrit, hemoglobin, RBC counts, and special tests such as reticulocyte counts. A full blood count is performed to establish the patient’s blood profile and identify deviations from the norm from which appropriate corrections can be made. In order to detect changes in the patient’s condition before they become life-threatening, it is necessary to compare serial laboratory values to track the patient’s disease progression.
Evaluate the patient’s ability to carry out ADLs and the capacity to do his/her usual routine tasks. Fatigue brought on by anemia manifests itself in various ways, affecting cognitive capacity and social and emotional well-being. However, the most typical manifestation is activity intolerance. Usually, fatigue hinders the patient’s capacity to participate and fulfill their societal and familial responsibilities (e.g., working away from home), which makes it difficult to perform certain tasks.
Educate and develop a regimen of activity and rest with the patient. Insist on the need to take frequent breaks from each task. It is possible to deplete the body’s energy reserves if the patient ignores its needs and demands. A schedule that alternates periods of activity and rest is recommended to help the patient achieve his/her planned activities without becoming fatigued.
Prepare for the possibility of a packed RBC transfusion. To improve the blood’s ability to carry oxygen (i.e., oxygen-carrying capacity).
Anemia Nursing Care Plan 2
Nursing Diagnosis: Risk for Bleeding related to loss of red blood cells, secondary to anemia
Desired Outcome: The patient will have normal platelet levels with the absence of bleeding, bruising and petechiae.
Nursing Interventions for Risk of Bleeding
Examine the patient’s skin for any bruising, petechiae, or any pronounced bleeding from the nose, mouth, vaginal area, gastrointestinal or urinary tract. Prompt therapy is made possible by an early diagnosis. Bleeding typically occurs if platelet counts fall below 20,000 per mm3. The presence of bruises and petechiae may suggest the presence of bleeding.
Substantiate blood tests and consolidate. Anemia might develop as a result of routine blood testing due to blood loss. Consolidation and maximizing blood samples (either by increasing the amount of blood drawn) reduces the number of venipunctures required.
Prepare for the possibility of a platelet transfusion when the patient’s platelets reach critical levels. To prevent hemorrhages in patients.
Educate the patient on bleeding control measures such as:
● Use of soft bristle toothbrush.
● Use of water-based lubricant
● Making the switch from tampons to pads.
● Use of electric shaver rather than a razor.
● Abstaining from rectal procedures if possible (e.g., suppositories or enemas, rectal temperature checks, and use of enemas)
Rationale: Bleeding precautions should be put in place as soon as a patient’s platelet count dips below 50,000mm3. Precautionary steps that decrease the risk of skin breaking would also reduce the likelihood of bleeding.
Anemia Nursing Care Plan 3
Nursing Diagnosis: Activity Intolerance related to a mismatch in the supply and demand of oxygen, secondary to anemia, as evidenced by a sedentary lifestyle, a general lack of strength, lethargy, a decrease of physical and physiologic adaptation.
Desired Outcome: The patient will have the ability to carry out daily routines.
Nursing Interventions for Activity Intolerance
Check for activity intolerance symptoms. On a scale of 0 to 10, ask the patient to rate his/her perceived level of exertion. Suppose the patient identifies and has signs of exertion (e.g., dyspnea, dizziness, palpitations, etc.). In that case, the patient should stop or reduce their activity until these signs are completely reduced or diminished.
Instruct the patient to practice deep breathing exercises. When taking deep breaths, the exchange of oxygen with the outgoing carbon dioxide increases more effectively.
Ensure that the patient’s physical function improves over time and that activities be gradually raised to the point of tolerance. To enhance the patient’s endurance and strength.
Intervention: Steadily increase the patient’s activity through progressively advancing the following (note: increase workout repetition and frequency than intensity):
a) In-bed activities to improve range of motion (ROM)
b) Take three or more deep breaths a day.
c) Sit properly, ensuring that the spine is aligned or straight for 30 minutes three times every day.
d) Walk for a minute or two in a room daily.
e) Walk through the length of the house, adding steps until the patient reaches the outdoors, conserving energy when returning.
Rationale: As the patient progressed and had successfully finished the given activities, it is best to insert a few more tasks to practice the patient’s tolerance and to maintain their improvements.
Anemia Nursing Care Plan 4
Nursing Diagnosis: Risk for Infection related to reduced internal defenses, secondary to anemia as evidenced by compromised status, presence of fever, and abnormal laboratory findings.
● The patient will practice preventative actions such as hand washing to lower the risk of infection
● The patient will demonstrate improved wellness as indicated by the absence of fever and within the normal WBC count.
Nursing Interventions for Risk for Infection
Intervention: Examine the patient for any indicators of infection and monitor his/her white blood cell count.
Rationale: Anemic patients (most importantly immunocompromised patients) are prone to having infections due to opportunistic pathogens. Assessing the patient’s signs and symptoms and carefully monitoring their WBC level would aid in assessing the risk for infection. And usually, WBC counts are typically between 4,000 and 11,000 per microliter in healthy adults.
During the planning stages, consider the use of antibiotics, antifungal drugs, and antiviral medications in advance. To eradicate the infection.
Instruct the patient and their visitors on proper handwashing techniques. To prevent the spread of infectious diseases. In addition to preventing transmission, hand hygiene can also help prevent the transmission of antibiotic-resistant bacteria.
Maintain sanitation and educate the patient on the practice of good hygiene such as oral hygiene and perineal care to avoid deterioration of the skin integrity. Prevention of infections is made easier with the use of these precautions.
Provide WBC growth factors for patients if prescribed. To promote WBC production.
Anemia Nursing Care Plan 5
Nursing Diagnosis: Deficient Knowledge related to inadequate resources and information with the condition secondary to anemia, as evidenced by verbalizations on the lack of understanding of the disease, inability to follow directions, constant inquiries, and conveyed incorrect information.
Desired Outcome: The patient will be able to explain his/her own illness and treatment options verbally.
Nursing Interventions for Deficient Knowledge
Examine the patient’s current knowledge of the illness, its progress, causative variables, diagnosis, and treatment. And determine if the patient or their family members are able to comprehend the new medical terminology. It is easier to design a personalized care plan when the patient’s current knowledge and perceptions have been established. The patient may have a basic concept of iron deficiency anemia, but other types of anemia may be unknown. Since most people aren’t exposed to the medical jargon used by health practitioners, it’s critical to make an effort to make sure that the patient is informed of their disease anemia. Educating the patient and their family and helping them better comprehend their illness and course of treatment is critical if we want to raise their level of awareness and comprehension of what they’re dealing with.
Explain the functions of blood constituents such as red blood cells, white blood cells, and platelets. Most patients have a rudimentary understanding of the hematological system and terminology.
Emphasize the importance of diagnostic tests (e.g., bone marrow aspiration and CBCs) and propose a hematologist referral. A comparison of the RBC indices and bone marrow aspiration findings will be made to determine whether the type(s) of anemia has manifested itself in the patient. And seeing a hematologist for suspected or existent blood issues is the best way to get an accurate diagnosis.
If aplastic anemia is the underlying cause, instruct patients to refrain from receiving blood transfusions from potential marrow donors and advise undergoing HLA typing. For the purpose of ensuring tissue compatibility for organ transplantation, HLA typing should be performed. The more genetic compatibility there is between the donor and recipient, the more tolerant their immune systems will be to the transplant.
Best Nursing Books and Resources
These are the nursing books and resources that we recommend.
The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care
This is a great reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnosis, it also helps guide the nurse to matching the nursing diagnosis to the patient assessment and diagnosis.
This handbook has been updated with NANDA-I approved Nursing Diagnoses that incorporates NOC and NIC taxonomies and evidenced based nursing interventions and much more.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.
Nursing Care Plans: Nursing Diagnosis and Intervention
Contains more than 200 care plans that adhere to the newest evidence-based recommendations.
Additionally, it distinguishes between nursing and collaborative approaches and highlights QSEN competencies.
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Muntner P, Hardy ST, Fine LJ, et al. Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018. JAMA. Published September 22, 2020. doi:10.1001/jama.2020.14545
Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018). Hypertension. Nature reviews. Disease primers, 4, 18014. https://doi.org/10.1038/nrdp.2018.14
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
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