Nursing care plan anemias iron deficiency anemia of chronic disease pernicious aplastic hemolytic

I. Pathophysiology: decreased number of circulating red
blood cells (RBCs), reduction in the amount of hemoglobin
(Hgb) in the RBCs, or a combination of both, resulting in
diminished oxygen-carrying capacity of the blood
a. Iron deficiency anemia (ID): inadequate iron stores, which
results in insufficient Hgb (key molecule in RBCs), causing
cells to appear abnormal, unusually small (microcytic), and
pale (hypochromic)
b. Anemia of chronic disease (ACD): accompanies chronic
inflammatory, infectious, or neoplastic disorders
c. Pernicious anemia (PA): lack of intrinsic factor in the stomach
results in inability to absorb vitamin B12 causing abnormal
RBC formation
d. Aplastic anemia: failure of bone marrow to produce cells,
including RBCs and white blood cells (WBCs) and platelets
e. Hemolytic anemia: premature destruction of RBCs

II. Etiology
a. Adult anemia is usually defined as a Hgb level lower than
11 g/dL, with severe anemia defined as Hgb lower than
8 g/dL.
b. Associated with many physiological complications, including
dyspnea, fatigue, dizziness, decreased cognition,
impaired sleep, sexual dysfunction, and significant
debilitation
c. ID
i. Lack of iron in the body due to a variety of causes
1. Blood loss due to disease, such as gastric or duodenal
ulcers, diverticula, hemorrhoids, ulcerative colitis;
injury or trauma; or certain medications, including
aspirin or nonsteroidal anti-inflammatory drugs
(NSAIDs)
2. Inadequate nutrition, such as not eating enough foods
that contain iron
3. Malabsorption syndromes, such as not utilizing iron
from food that is eaten
4. Lead exposure
ii. Most frequently occurring form of anemia
d. ACD
i. Primarily due to slowed production of RBCs as a result
of low reticulocyte production
ii. Develops slowly and is only evident after time
iii. Symptoms are usually associated with the disease
causing the anemia rather than the anemia itself.
iv. Second most prevalent form of anemia (Hebbar &
Gibson, 2006; Krantz, 1994)
e. PA—an autoimmune disorder
i. Characterized by the production of autoantibodies to
gastric parietal cells and their secretory product—intrinsic
factor—which is needed for vitamin B12 absorption
ii. Conditions that interfere with the body’s absorption
and use of B12 include Crohn’s and Whipple’s diseases,
gastrectomy or gastric bypass, and the use of
chemotherapeutic medications.
f. Aplastic anemia—bone marrow failure
i. May be associated with conditions that affect
erythropoietin production and secretion, such as certain
cancers and cancer treatments and renal, hepatic, or
endocrine disorders
ii. Other known causes include exposure to chemicals, such
as benzene, insecticides, solvents; certain drugs, such as
chemotherapy, gold, seizure medications, some antibiotics;
viruses, such as HIV, Epstein-Barr; immune conditions,
such as systemic lupus erythematosus, rheumatoid arthritis;
radiation; and certain inherited disorders, such as Fanconi’s
anemia.
g. Hemolytic anemia—marked by an accelerated destruction
of RBCs
i. Several types of hemolytic anemias, including sickle cell
anemia (see Sickle Cell Crisis)
ii. Causes include hereditary factors, such as sickle cell
trait or disease; blood transfusion reactions; acute viral
or infectious agents; certain drugs, such as quinidine,
penicillin, and methyldopa; and toxins, such as
chemicals and venoms.

III. Statistics
a. Morbidity: Approximately 3.5 million Americans have anemia
(National Heart, Lung and Blood Institute [NHLBI],
2007); in 1996, an estimated 2.1 million individuals
younger than age 45 had anemia (Montoya et al, 2002); in
1999, 174,600 nursing home residents had anemia in the
United States (CureResearch, 2003).
b. Morbidity: 4,627 people die from anemia annually in the
United States (CureResearch, 2003).
c. Cost: $6.4 billion is spent annually (CureResearch, 2003).

Nursing Priorities
1. Enhance tissue perfusion.
2. Provide nutritional and fluid needs.
3. Prevent complications.
4. Provide information about disease process, prognosis,
and treatment regimen.

Care Setting
Clients are treated at the community level except in the presence
of severe cardiovascular or immune compromise.
Although the medical treatments vary widely due to the
many variations in anemia presentation, nursing care for the
anemic client has a common theme: managing physical
symptoms and maximizing quality-of-life issues.

Related Concerns
Acquired immunodeficiency syndrome (AIDS),
Burns: thermal, chemical, and electrical—acute and convalescent
phases,
Cancer,
Cirrhosis of the liver,
Heart failure: chronic,
Psychosocial aspects of care,
Renal failure: acute,
Renal failure: chronic,
Rheumatoid arthritis (RA),
Pulmonary tuberculosis (TB),
Upper gastrointestinal/esophageal bleeding,

Discharge Goals
1. ADLs met by self or with assistance of others.
2. Complications prevented or minimized.
3. Disease process, prognosis, and therapeutic regimen
understood.
4. Plan in place to meet needs after discharge.

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