ANEMIA

Iron deficiency Anemia – chronic normocytic, hypocromic (pale), microcytic anemia due to inadequate absorption of iron leading to hypoxemic injury.

Incidence rate:

1. Common – developed country – due to high cereal intake

Due to accidents – common on adults

2. Common – tropical countries – blood sucking parasites

3. Women – 15 – 35yo – reproductive yrs

4. Common among the poor – poor nutritional intake

Suicide - common in teenager

Poisoning – common in children (aspirin)

Aspiration – common in infant

Accidents – common in adults

Choking – common in toddler

SIDS – common in infant in US

1. Common in tropical zone – Phil due blood sucks

Predisposing factor:

1. Chronic blood loss

a. Trauma

b. Mens

c. GIT bleeding:

i. Hematemesis-

ii. Melena – upper GIT – duodenal cancer

iii. Hematochezia – lower GIT – large intestine – fresh blood from rectum

2. Inadequate intake of food rich in iron

3. Inadequate absorption of iron – due to :

a. Chronic diarrhea

b. Malabsorption syndrome –celiac disease-gluten free diet. Food for celiac pts- sardines

c. High cereal intake with low animal CHON ingestion

d. Subtotal gastrectomy

4. Improper cooking of food

S/Sx:

1. Asymptomatic
2. Headache, dizziness, dyspnea, palpitations, cold sensitivity, gen body malaise, pallor
3. Brittle hair, spoon shaped nails (KOILONYCHIA)=Dec O2=hypoxia=atrophy of epidermal cells
4. Atropic glossitis, dysphagia, stomatitis
5. Pica – abnormal craving for non edible food (caused by hypoxia=dec tissue perfusion=psychotic behavior)

Brittle hair, spoon shaped nail – atrophy of epidermal cells

N = capillary refill time 2 secs

N = shape nails – biconcave shape, 180°

Atrophy of cells “Plummer Vinsons Syndrome” due to cerebral hypoxia

1. Atropic glossiti – inflammation of tongue due to atrophy of pharyngeal and tongue cells

2. Stomatitis – mouth sores

3. Dysphagia

Dx Proc:

1. RBC
2. Hgb
3. Reticulocyte
4. Hct
5. Iron
6. Ferritin

Nsg Mgt

1. Monitor signs of bleeding of all hema test including urine & stool
2. Complete bed rest – don’t overtire pt =weakness and fatigue=activity intolerance
3. Encourage – iron rich food

2. Raisins, legumes, egg yolk

4. Instruct the pt to avoid taking tea - impairs iron absorption
5. Administer meds

a.) Oral iron preparation

Ferrous SO4

Fe gluconate

Fe Fumarate

Nsg Mgt oral iron meds:

1. Administer with meals – to lessen GIT irritation

2. If diluting in iron liquid prep –adm with straw

3. Give Orange juice – for iron absorption

4. Monitor & inform pts S/E

a. Anorexia

b. n/v

c. Abdominal pain

d. Diarrhea or constipation

e. Melena

If pt can’t tolerate oral iron prep – administer parenteral iron prep example:

1. Iron dextran (IV, IM)

2. Sorbitex (IM)

Nsg Mgt parenteral iron prep

1. Administer of use Z tract method to prevent discomfort, discoloration leakage to tissues.
2. Don’t massage injection site. Ambulate to facilitate absorption.
3. Monitor S/E:

a.) Pain at injury site

b.) Localized abscess (“nana”)

c.) Lymphadenopathy

d.) Fever/ chills

e.) Urticaria – itchiness

f.) Hypotension – anaphylactic shock

Anaphylactic shock – give epinephrine