Practice Teaching On Anemia: Presented By: Mr. Hari Singh Nagar M. SC Nursing 1 Year

Practice teaching
on
Anemia
Presented by:
Mr. Hari singh nagar
M. Sc Nursing 1st year
Anemia
Objectives
After completion of the class students will be able to
• Introduce the anemia.
• Define anemia
• Enlist the Causes of Anemia
• Enlist the classification of anemia
• Enlist the types of anemia
• Enlist the Pathophysiology of Anemia
• Explain the clinical manifestation of Anemia
• Enlist the diagnostic evaluation of anemia
Objectives
• Explain the management of anemia.
• Enlist the complication of anemia.
• Explain the nursing management of the anemia.
Introduction
It is a major killer disease in India.

Statistics reveal that every second Indian
women is anemic. One in every five
menstrual deaths is directly due to anemia.
It affects both the adults and children of
both sexes, although pregnancy women and
adolescent girls are most susceptible and
most affected by the disease.
Definition
• It is a condition in which the hemoglobin
concentration is lower then the normal. As
a results, the amount of oxygen delivered
to body tissue is diminished.
Normal value of Hb
men
13.5-16.5gm/100ml
female
12-15gm/100ml
Causes of anemia
Causes of Anemia
Increase Increase
requirements loss
Decrease Decrease
intake absorption
Risk Factor for Anemia
Low socio
Teenage
economic
pregnancy
status
Menstrual
Multiparty
problem
Classification of Anemia
1. On the basis of cause
• Bleeding (blood loss)
• Hypoproliferative anemia (inadequate
production of normal blood cells)
• Hemolytic (destruction of blood cells)
Classification of Anemia
2. On the basis of morphology
• Microcytic – If the cells are smaller than normal,
e.g. iron deficiency anemia, anemia of chronic
disease, thalassemia.
• Normocytic – if cells are in normal size, e.g.-

acute blood loss, anemia of chronic disease,
hemolytic anemia, Aplastic anemia.
• Macrocytic - if they are larger than normal,

e.g.-Megaloblastic anemia
Types of Anemia
1. Iron deficiency anemia – it is caused by a lack of
iron. It develop when body store of iron drops too
low to support normal RBCs production.
women are at risk, for menstrual blood flow and
growing fetus.
2. Anemia of chronic disease – it is a chronic disease
of inflammation, infection and malignancy cause this
type of anemia.
3. Thalassemia – it is a genetic disorder that is
characterized by abnormal formation of hemoglobin
it results in inadequate oxygen transport and
destruction of RBCs which leads to anemia.
Types of Anemia
4. Aplastic anemia – it is a rare disease in which

the bone marrow and hematopoietic stem cells
that are damaged leads to pancytopenia
(deficiency of all three cellular components of
the blood such as red cells, white cells, and
platelets).
5. Megaloblastic or folic acid deficiency anemia -
in this condition the bone marrow usually
produce large, abnormal and immature RBCs. It
results from inhibition of DNA synthesis during
RBCs production so it leads to continuing cell
growth without division.
Types of Anemia
6. Pernicious anemia - it occurs when the intestine

can’t properly absorb vitamin B12.
7. Sickle cell anemia – it is characterized by RBC
that assume the abnormal, rigid, sickle shape.
It results from the presence of mutated form
of a Hb.
Thalasemia
P/P of pernicious anemia
Normal gastric mucosa secrete a substance

called intrinsic factor necessary for
absorption of vit.B12 in ilieum.
If defect exists in mucosa intrinsic factor may
not be secreted
Orally ingested vitamin B12 is not absorbed.
Vitamin B12 is necessary for the normal DNA
synthesis in maturing RBCs.
Pernicious anemia
Clinical manifestations
• Easy fatigue and loss of energy
• Hypotension, rapid heart rate when exercise
• Shortness of breath and headache in
exercise.
• Difficulty in concentration.
• Dizziness, insomnia, leg cramps
• Pale skin, changes in stool color.
• Spleenomegaly
Diagnostic evaluation of anemia
• History
• Physical examination
• Complete blood count
• Others –
 Stool Hb test
Diagnostic evaluation of anemia
 Iron,, Folate, Vitamin b12, bilirubin.

 Hb electrophoresis
 Reticulocyte count
 Bone marrow biopsy
Management Of anemia
1. Blood transfusion – specially RBCs transfusion.
2. Iron supplements – oral ferrous sulphate,
parenteral iron therapy.
3. Nutritional therapy and dietary consideration
– vitamin b12 rich diet, iron rich diet, and
folic acid rich diet to be provided to the
patient.
4. Spleenectomy – removal of spleen.
5. Bone marrow and stem cell transplantation –
to enhance the production of RBCs, WBC,
platelets.
Management Of anemia
6. Activity restriction – minimizes the

activity, curtailing the exercise ( running
on the grass rather then the concrete).
Running on the hard surface develop the
hemoglobinuria.
Management Of iron deficiency
anemia
• Correction of chronic blood loss

• Oral or parenteral iron therapy
 Oral ferrous sulfate
 Iron dextran or iron sorbitex parenteral
therapy
Management Of pernicious
anemia
• Parenteral replacement with

hydroxycobalamine or cyanocobalamine is
necessary by IM injection every month.
Management Of folic acid
deficiency anemia
The goal is to identify and treat the cause
of the folate deficiency.
• You may receive folic acid supplements by
mouth or through a vein. If you have low
folate levels because of a problem with
your intestines, you may need treatment
for the rest of your life.
• Diet changes can help boost your folate
level. Eat more green, leafy vegetables
and citrus fruits.
Management Of aplastic
anemia
• Bone marrow transplantation

• Immunosuppressive treatment
• Androgens to stimulate bone marrow
regeneration
• Platelet and RBCS transfusion
Management Of thalasemia
• Blood transfusion
• iron chelation therapy
• Folic acid supplements
• BMT
• Spleenectomy
Management Of sickle cell
anemia
• Promote adequate oxygenation

• Blood transfusion
• Spleenectomy
• Butyrate and hydroxyurea
Complication of Anemia
• Hypoxia
• Severe fatigue
• Physical & mental growth retardation
• Neurologic damage
• Heart problem – irregular heart rate, heart
enlargement, heart failure
• Pregnancy complication – premature birth
• Death
Nursing
Management
1. Nursing diagnosis - Imbalanced nutrition less then
body requirement related to inadequate intake of
essential nutrients as evidenced by skin integrity,
color and body weight.
• Goals: Improve nutrition level
• Intervention:
• A healthy diet should be encouraged.
• Avoid alcoholic beverages.
• Dietary teaching session should be individualized
including culture aspect related to food
preference and food preparation.
2. Nursing diagnosis – activity intolerance related
to low level of Hb in body as evidenced by the
weakness, fatigue and malaise.
• Goal: Improve the activity intolerance

• Intervention:
• assist the patient to prioritize the Activities and
a establish balance between the activity and rest
that is realistic and feasible from the patient
perspectives.
• Patient with chronic anemia need to maintain some
physical activity and exercise to prevent the
deconditioning that results from the inactivity.
3. Nursing diagnosis – ineffective tissue perfusion
related to less blood volume as evidenced by skin
color (pallor).
• Goal: Improve tissue perfusion.
• Intervention:
• The nurse monitor the vital sign closely.
• lost volume replaced with blood transfusion or IV
fluids.
• Supplemental oxygen may be necessary but it is
rarely needed on a long term basis.
• Other medication such as antihypertensive agent
may be needed to be adjusted.
3. Nursing diagnosis – ineffective tissue perfusion
related to less blood volume as evidenced by skin
color (pallor).
• Goal: Improve tissue perfusion.
• Intervention:
• The nurse monitor the vital sign closely.
• lost volume replaced with blood transfusion or IV
fluids.
• Supplemental oxygen may be necessary but it is
rarely needed on a long term basis.
• Other medication such as antihypertensive agent
may be needed to be adjusted.
Research related to Anemia
Sanjeev M Chaudhary conducted a cross sectional
study of anemia among adolescent Females in the
Urban Area of Nagpur. Sample consisted of 296
adolescent females (10–19 years old). Major finding of
the study reveals that the prevalence of anemia was
found to be 35.1%. This study concluded that a high
prevalence of anemia among adolescent females was
found, which was higher in the lower socio-economic
strata and among those whose parents were less
educated. Mean height and weight of subjects with
anemia was significantly less than subjects without
anemia.
Summary
References
• “Joyce M. Black Jane Hokanson” medical
surgical nursing,7th edition, Elsevier
publication, volume 1,page no. 619-651
• “Suddarth’s & burnner” text book of medical
surgical nursing, twelfths edition, Wolters
publication, Page no. 910-927
• “Saunders” comprehensive review for the
NCLEX RN examination, fifth edition,
elsevier publication, page no. 520-522

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Practice teaching

It is a major killer disease in India.

• Normocytic – if cells are in normal size, e.g.-

• Macrocytic - if they are larger than normal,

4. Aplastic anemia – it is a rare disease in which

6. Pernicious anemia - it occurs when the intestine

Normal gastric mucosa secrete a substance

 Iron,, Folate, Vitamin b12, bilirubin.

6. Activity restriction – minimizes the

• Correction of chronic blood loss

• Parenteral replacement with

• Bone marrow transplantation

• Promote adequate oxygenation

• Goal: Improve the activity intolerance

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