Anemia is a symptom of an underlying condition, such as loss of blood components, inadequate elements, or lack of required nutrients for the formation of blood cells, that results in decreased oxygen-carrying capacity of the blood. There are numerous types of anemias with various causes. The following types of anemia are discussed here: iron deficiency (ID), the result of inadequate absorption or excessive loss of iron; pernicious (PA), the result of a lack of the intrinsic factor essential for the absorption of vitamin B12; aplastic, due to failure of bone marrow; and hemolytic, due to red blood cell (RBC) destruction. Nursing care for the anemic patient has a common theme even though the medical treatments vary widely.
1. Enhance tissue perfusion.
2. Provide nutritional/fluid needs.
3. Prevent complications.
4. Provide information about disease process, prognosis, and treatment regimen.
1. ADLs met by self or with assistance of others.
2. Complications prevented/minimized.
3. Disease process/prognosis and therapeutic regimen understood.
4. Plan in place to meet needs after discharge.
Nursing diagnosis for Anemia: Imbalanced Nutrition, Less than Body Requirements may be related to Failure to ingest or inability to digest food/absorb nutrients necessary for formation of normal RBCs possibly evidenced by Weight loss/weight below normal for age, height, and build; Decreased triceps skin-fold measurement; Changes in gums, oral mucous membranes; and Decreased tolerance for activity, weakness, and loss of muscle tone.
1. Demonstrate progressive weight gain or stable weight, with normalization of laboratory values.
2. Experience no signs of malnutrition.
3. Demonstrate behaviors, lifestyle changes to regain and/or maintain appropriate weight.
Nursing intervention with rationale:
1. Review nutritional history, including food preferences.
Rationale: Identifies deficiencies, suggests possible interventions.
2. Observe and record patient’s food intake.
Rationale: Monitors caloric intake or insufficient quality of food consumption.
3. Weigh periodically as appropriate (e.g., weekly).
Rationale: Monitors weight loss and effectiveness of nutritional interventions.
4. Recommend small, frequent meals and/or between-meal nourishment.
Rationale: May reduce fatigue and thus enhance intake while preventing gastric distension. Use of Ensure/Isomil or similar product provides additional protein and calories.
5. Suggest bland diet, low in roughage, avoiding hot, spicy, or very acidic foods as indicated.
Rationale: When oral lesions are present, pain may restrict type of foods patient can tolerate.
6. Have patient record and report occurrence of nausea/ vomiting, flatus, and other related symptoms such as irritability or impaired memory.
Rationale: May reflect effects of anemias (hypoxia, vitamin B12 deficiency) on organs.
7. Encourage/assist with good oral hygiene; before and after meals, use soft-bristled toothbrush for gentle brushing. Provide dilute, alcohol-free mouthwash if oral mucosa is ulcerated.
Rationale: Enhances appetite and oral intake. Diminishes bacterial growth, minimizing possibility of infection. Special mouth-care techniques may be needed if tissue is fragile/ulcerated/bleeding and pain is severe.
8. Consult with dietitian.
Rationale: Aids in establishing dietary plan to meet individual needs.
9. Monitor laboratory studies, e.g., Hb/Hct, blood urea nitrogen (BUN), prealbumin/albumin, protein, transferrin, serum iron, vitamin B12, folic acid, TIBC, serum electrolytes.
Rationale: Evaluates effectiveness of treatment regimen, including dietary sources of needed nutrients.
10. Administer medications as indicated, e.g.: Vitamin and mineral supplements, e.g., cyanocobalamin (vitamin B12), folic acid (Folvite), ascorbic acid (vitamin C).
Rationale: Replacements needed depend on type of anemia and/or presence of poor oral intake and identified deficiencies.