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Transcript: Patient history/family history. Referral to nutritionist/dietician to ensure nutritional needs are met. Suggest small frequent meals with snacks throughout day to increase dietary intake. Encourage use of food diary. Monitor and record intake of protein, iron and vitamin C. Vitamin C helps the body to absorb iron. Continual assessments of client's nutritional intake and drug therapies. Dietary and drug therapy are emphasized 2-3 months for hemoglobin levels to return to normal. Drug therapies are cobalamin (B12). Clients with lifelong iron supplementation should be monitored for potential liver problems related to iron storage. Acute Interventions: blood/blood product transfusions, drug therapy, volume replacement and O2 therapy to stabilize condition. By: Nicole, Leila, Rio, Jorge and Zoe 3) Encourage patient to participate in activities that are within their tolerance level. Altered nutrition is a nursing diagnosis for someone who has Anemia, and therefore, collaboration with a dietitian may occur. The role of the dietitian is to determine what type of nutrients and how many calories are needed to meet the client’s nutritional requirements. A dietitian may also need to teach the client how to use a food diary to help record and evaluate their nutritional intake, as well as monitor and record intake of vitamin C, protein, and iron to provide the nutrients that are necessary to prevent hematopoiesis. 2) It is possible that iron supplements or monthly B12 injections may be needed to increase blood levels. Educate patient on these treatments, including their possible benefits and side effects. Diagnostic Study Nursing Management Hematologist Psychological/Emotional Implementation: Although Anemia can have many physical effects on the body, it is mainly the symptoms that affect the other holistic dimensions in individuals' lives. Correcting the cause of Anemia is the ultimate goal. difficulty concentrating feeling drained depression loneliness due to decreased activity participation mood swings affects families emotionally; feelings of helplessness, stress and concern 1) Review nutritional intake. Plan for 5-6 small meals daily including red meats (vegetarians can focus on tofu and lentils, although red meats are more easily absorbed by the body), eggs, green vegetables, and dried fruits (raisins). Including Vitamin C will assist with better absorption of Iron, while coffee and tea inhibit absorption. Educate on the importance of proper nutrition. Pernicious Anemia is a decrease in red blood cells that occurs when one's intestines can not properly absorb Vitamin B12. Iron Deficiency Anemia is a condition in which the body does not have enough healthy red blood cells, meaning that iron is lacking. Iron is a building block for red blood cells. This is the most common type of Anemia. Folic Acid Deficiency Anemia occurs when one's body does not have enough Folic Acid. Folic Acid is one of the Vitamin B's, which helps the body to make new cells, including new red blood cells. Bone Marrow Biopsy: The removal of soft tissue (marrow) from the inside of bone. It is usually taken from the hip bone. The nurse's responsibility is to take a health history, possible allergies, and educate client on procedure. Interprofessional Collaboration -gastric polyps which can develop into gastric cancer and gastric carcinoid tumors -residual neurological symptoms (ex. loss of position and vibration sense, memory loss, ataxia, anorexia, spasticity) -parasthesias of feet and fingers -enlarged liver that can lead to right sided heart failure -difficulty walking The hematologist will review and analyze blood samples, such as a CBC, for the progress or stage of an anemic patient. Severe Cases of Pernicious: fatigue, weakness, lightheaded, pallor complexion, heart palpitations, dizziness, fainting, include vital signs Folic Acid Signs and Symptoms Severe Cases of Folic Acid: Physical: fatigue, decreased activity tolerance, increased cancer risk, weakness, increased susceptibility to infections, supplements leading to constipation fatigue or lack of energy dizziness or light-headedness (especially when standing or with activity) headaches problems concentrating shortness of breath tingling sensations in extremities pale skin rapid heart rates, heart murmor constipation chest pain Iron (ferrous fumarate, glucomate, sulfate) Decreased activity tolerance due to weakness and fatigue. Abnormal hemoglobin levels due to lack of nutrients required for red blood cell production. Knowledge deficit of nutrient rich foods. Dietician Hindu, 7th Day Adventist and Buddhist religious beliefs may hinder iron intake (red meat) decreased spirituality enthusiasm Naturopath Were the goals met. If not, re-evaluate the methods used to see if changes need to be made to the care plan. Long Term Effects Assessment: In an anemic patient, the Naturopath will provide alternative means of treatment through herbals, diet changes, and cleaning and detoxing the body. Some


Transcript: Anemia What is it? Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Causes Possible causes of anemia include: •Certain medications •Chronic diseases such as cancer, ulcerative colitis, or rheumatoid arthritis •Genetis: Some forms of anemia, such as thalassemia, can be inherited •Kidney failure •Blood loss (for example, from heavy menstrual periods or stomach ulcers) •Poor diet •Pregnancy •Problems with bone marrow such as lymphoma, leukemia, or multiple myeloma •Problems with the immune system that cause the destruction of blood cells (hemolytic anemia) •Surgery to the stomach or intestines that reduces the absorption of iron, vitamin B12, or folic acid •Too little thyroid hormone (underactive thyroid, or hypothyroidism) •Testosterone deficiency Symptoms Possible symptoms include: •Chest pain •Dizziness or light-headedness (especially when standing up or with activity) •Fatigue or lack of energy •Headaches •Problems concentrating •Shortness of breath (especially during exercise) Tests The doctor will perform a physical examination, and may find: •Pale skin •Rapid heart rate •Heart murmur Blood tests used to diagnose some common types of anemia may include: •Blood levels of vitamin B12, folic acid, and other vitamins and minerals •Red blood count and hemoglobin level •Reticulocyte count •Ferritin level •Iron level Treatment Treatment should be directed at the cause of the anemia, and may include: •Blood transfusions •Corticosteroids or other medicines that suppress the immune system •Erythropoietin, a medicine that helps your bone marrow make more blood cells •Supplements of iron, vitamin B12, folic acid, or other vitamins and minerals Prognosis The outlook depends on the cause. Complications Severe anemia can cause low oxygen levels in vital organs such as the heart, and can lead to a heart attack. Questions What is anemia? What are some symptoms? How is the prognosis determined? National Heart, Lung, and Blood Institute- PubMed Health- Resources:


Transcript: Decreased or faulty RBC production: Sickle cell (shape) Pernicious (absorption) Iron deficiency (dietary) Megaloblastic (DNA malfunction) Thalassemia (protein) Spherocytosis (shape) G6PD deficiency (enzyme) cancers (catabolism) chronic diseases (catabolism) aplastic Due to Iron Deficiency * Hunger for strange substances (pica) * Koilonychias or upward curvature of nails * Mouth sore Due to Chronic Red Blood Cell Destruction * Yellow skin and eyes * Leg ulcers * Symptoms of gallstones Groupings by cause Schilling Test (B12 absorption) Pernicious (B12) Diagnosis/Tests Koilonychias or upward curvature of nails Mouth sores Tickly sensation in hands and feet Numbness Difficulty in walking Difficulty in moving Mental deterioration Hallucinations Paranoia (delusions) Schizophrenia (distortions of reality) Blood loss dietary insufficiency poor absorption autoimmune atrophic gastritis chronic gastritis gastric removal Cause/ Onset blood transfusion pain meds plenty of fluids Sickle cell (shape of RBCs) mostly African (lowland) faster break down than normal cells leads to RBC shortages Spherocytosis wrong shape causing spleen to filter them out of circulation G6PD deficiency mostly men (African/African-Amer) missing enzyme in wall of RBC making them more fragile pregnancy alcohol abuse infants, elderly Basics (cc) photo by Metro Centric on Flickr microcytic/hemolytic Anemia is often asymptomatic unless hematocrit falls below 30% General symptomology: fatigue tachycardia, palpitations pale skin SOB chest pain dizziness cold hands/feet headaches Low: HGB (hemoglobin) HCT (hematocrit) MCV (mean corpuscular volume) MCH (mean corpuscular hemoglobin) MCHC (mean...concentration) Dx Normal: MCHC Low: HGB HCT folic acid B12 High: MCV Anemia is a condition that develops when your blood lacks enough healthy red blood cells. These cells are the main transporters of oxygen to organs. If red blood cells are also deficient in hemoglobin (iron-rich protein that gives blood its redcolor), then your body isn't getting enough oxygen. RBCs are produced in the bone marrow and require sufficient B12, iron, and folate levels in the body. Hematocrit= Ratio of RBC to total blood volume Anemia=<41% (M); <37% (F) Aplastic (bone marrow not producing enough new stem cells to replenish RBCs) WBCs attacking bone marrow exposure to toxins, radiation parvo Budapest Blood Tests San Francisco Pain swollen hands/feet delayed growth vision problems frequent infections B12 supplement (injections/orally) hereditary Sx appear 4 mos+ Types/ Anemia of chronic diseases: HIV,rheumatoid athritis, cancer, Crohn's...can interfere with RBC production Anemia associated with bone marrow diseases such as leukemia affects blood production Stockholm Hereditary Sx Anemia (cc) photo by jimmyharris on Flickr (cc) photo by Franco Folini on Flickr Double click to crop it if necessary Sickle Cell Normal: MCHC High: MCV homocysteine and methlymalonic acid Vitamin Deficiency Anemias: Pernicious (Vitamin B12) intestine not absorbing enough B12 sometimes autoimmune Megaloblastic (B12 and Folate) defect in RBC DNA synthesis macrocytic, many large immature/dysfunctional RBCs in bone marrow Folic Acid macrocytic infants (Low birth weight/premature) jaundice...bilirubin is a breakdown product of hemoglobin Anemia is the most common blood condition in the U.S. It affects about 3.5 million Americans. RBC destruction (Hemolytic Anemia): Sickle cell Thalassemia Toxins from advanced LR/KD disease infections, drugs, snake/spider venom Vascular grafts, prosthetic heart valves, tumors, severe burns, chemical exposure, severe hypertension, and clotting disorders Enlarged spleen (splenomegaly) autoimmune hemolytic paroxysmal nocturnal hemogloninuria (autoimmune) There are more than 400 types of anemias, which are divided into three groups: Anemia caused by blood loss Anemia caused by decreased or faulty RBC production Anemia caused by destruction of RBCs dietary intake supplement Mean Corpuscular Volume (Ave size of RBC) Mean Corpuscular Hemoglobin Concentration (Ration of HGB to RBC) Sx Blood Loss (chronic or acute): gastritis, ulcers, cancer, hemorrhoids NSAIDS (ibu/asp) menstruation and childbirth hemoglobinuria (malaria/UR tumors General Sx Women and people with chronic diseases are at increased risk of anemia. Other Risk Factors: Iron, Folate, B12 poor diet Breastfeeding/Pregnancy Menstruation Digestive/Intestinal Disorders Due to Vitamin B12 Deficiency * Tickly sensation in hands and feet * Numbness * Difficulty in walking * Difficulty in moving * Mental deterioration * Hallucinations * Paranoia (delusions) * Schizophrenia (distortions of reality) Physical Exam blood/fluid transfusions dietary intake macrocytic/megaloblastic Tx Iron Deficiency Causes Low: HCT HGB folic acid Place your own picture behind this frame! (cc) photo by Metro Centric on Flickr Thalassemia (defect in a gene that helps control production of one of the proteins that make up hemoglobin) Alpha- gene or genes related


Transcript: altMD. (2012). Nutrition for Anemia. Retrieved from AnemiaCure. (2012). Anemia Natural Cure. [Photograph Fig. 7] March 13, 2012 from natural-cure/ Baldwin, M. Iron Deficiency Anemia. Causes of Iron Deficiency Anemia. [Photograph Fig. 3] March 13, 2012 from http://ww Beck, C. (2002). A Brief History of the Discovery of Sickle cell Anemia. Sickle Cell Anemia and Current Research. Retrieved from oject/History.html Benoist, B., McLean, E., Egli, I., Cogswell, M., Worldwide prevalence of anaemia 1993-2005. [Photograph Fig. 2,3] March 14, 2012 from CBR. (2011). COMIC BOOK LEGENDS REVEALED #322. [Photograph Fig.8] March 13, 2012 from http://goodcomics.comic (2007). Iron Supplements. [Photograph Fig. 6] March 14, 2012 from http://canadianvitam Cella, D. (2002). The Effects of Anemia and Anemia Treatment on the Quality of Life of People With Cancer. Cancernetwork. Retrieved from cle/10165 /101293 (2012). Anemia medications. Retrieved from hlml (2011). Running in the Heat: Tips for Staying Healthy, Keeping the High. [Photograph Fig. 5] March 14, 2012 from Running in the Heat: Tips for Staying Healthy, Keeping the High Johansen, K. (2009). Anemia. Durstine, L.J., Moore, G.E., Painter, P. L., Roberts, S.O.(Ed). Exercise Management for Persons With Chronic Diseases and Disabilities. (3rd ed.) (pp. 246-249). Windsor, ON. Human Kinetics Kollias, H., (2009). Research Review: Nutrition and Exercise Recovery – Part 1. [Photograph Fig. 1]. March 14, 2012 from Krimm, J.R., Chinnock, B.F., Talavera, F., Rebbecchi, T. (2012). Sickle Cell Crisis Overview. Emedicinehealth. Retrieved from .htm#Sickle Cell Crisis Overview University of Maryland Medical Center (UMMC). (2011). Anemia. Retrieved from www.umm. edu/altmed/articles/anemia- 00000.9.htm WebMD. (2012). Anemia. Retrieved from Exercise Considerations Scope: Prevalence of Anemia in Canada and the U.S. Overview of the Pathophysiology of Anemia Benefits of Exercise Exercise Considerations Behavior Modifications Management and Medication Appropriate Nutrition Strategies Pathophysiology Frequency Aerobic: 3-7 day/week Resistance: 2-3 days a week Flexibility: 5-7 days a week Intensity Aerobics: Moderate 40-70% Peak HRR, RPE 11-14/20 Resistance: 40-60% 1RM Time 30-60 min/session Flexibility: 15-30 sec Type Aerobic: Large Muscle Groups Endurance – Treadmill, Cycling, Circuit training, free weights, machine weights Flexibility: PNF, Static Dynamic (Johansen 2009, p.247) Anemia was once thought of as the “strange disease” by Dr. B Herrick when you noticed symptoms of one with asthma, decreased work capacity (exercise) and blood flow issues (Beck 2002) Known risk factors that can cause anemia are: Inadequate diet consisting of low iron, essential vitamins and minerals Intestines unable to absorb nutrient to sustain normal levels Pregnancy – body has to support the host and growing fetus Chronic condition – kidney disease, diabetes, cancers Being female – blood loss during monthly menstruation Family history (Johansen 2009, p.246) Examples of specific mechanisms and their caused towards anemia are: Production of Red Blood Cells (RBCs Deficiencies from iron, folate, or B12 “Hemolysis (autoimmune defects, hemoglobinopathies such as sickle cell disease” (Johansen 2009, p.246) Blood loss from menstruation, gastrointestinal bleeding and more (Johansen 2009, p.246) Fig. 5 2011 (cc) image by nuonsolarteam on Flickr Guiding someone through their exercises explaining the reason for the program designed will give the anemic individual a better understanding and outlook on how they can enjoy exercise on their own. As fatigue is prevalent in anemic people, individuals need to understand why and how exercise can assist in managing a healthy lifestyle and overall wellness. (Cella, 2002). Should be closely supervised and progressed slowly though their fitness training as to not be subjected to vigorous physical activity. (Johansen 2009, p.249) Fig. 2 Benoist, B., McLean, E., Egli, I., Cogswell, M., 1993-2005 Anemia as a public health problem by country: Preschool-aged childern Anemia is most common blood disorders in North America (Johansen 2009, p.246) “Defined as the condition in which the number of red blood cells per cubic millimeter, the amount of hemoglobin in 100 ml of blood, and/or the volume of packed red blood cells

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