Manuscript for Anemia

Abrina, Mary
Lim, Maverick
Malquesto, Aliana
Maravilla, Dessa
Roleda, Jonel
Subejano, Raymart

NON-MODIFIABLE FACTOR
Age
Chronic kidney disease
MODIFIABLE FACTOR
Decrease erythropoietin
production Micro nutrient deficiency

Decreased RBC production

LAB TEST

RBC: 3.02 million cells/mcL

Hgb: 8.1 g/dL

HCT: 25.2%
Decreased erythrocytes
MCH: 26.5 Hgb/cell

MCHC: 32%

RDW-CV: 15.8%

Blood urea nitrogen (BUN): 34

Decreased oxygen carrying mg/dLCreatinine: 1.4 mg/dL
LAB TEST
ability of blood GFR: 38 mL/minute/1.73 m

X-ray

Colonoscopy Tissue Hypoxia

S/X
Absorptiometry scan
Shortness of breath

Hearing loss

ANEMIA Dyspnea

Palpitations of the heart

Orthopnea

Fatigue

Arthritic pain
ANEMIA NURSING CARE PLAN

ASSESSMENT DIAGNOS PLANNING IMPLEMENTATIO RATIONALE EVALUATION

IS N
Independent: Independent: Short term:
a) It allows
Subjective: Impaired Short term: a. Position patient
increased
The client gas with head of thoracic After 30 minutes of
verbalized exchange After 30 minutes of bed elevated, in capacity and nursing intervention
promote lung
feeling of tired related to nursing intervention a semi-Fowler’s
expansion.
the patient was:
and Shortness altered the patient will: position (head  Participate in
of breath oxygen-  Participate in of bed at 45 b) Anxiety procedures to
increases
carrying procedures to degrees when dyspnea, optimize
Objective: capacity of optimize supine) as respiratory oxygenation
blood as oxygenation tolerated. rate, and work and in
of breathing
Physical ex.: evidenced and in b. Provide management
 Mildly by management reassurance and c) To prevent regimen
injury related
SOB at shortness regimen reduce anxiety. to her age and
within level of
rest of breath within level of c. Provide safety to maximize capability/con
 Dyspnea capability/con as necessary comfort. dition.
 Orthopne dition. d. Educate patient d) To promote  Relieve SOB
a  Relieve SOB about safe and
 Mild medication effective
medication
cognitive information administration Long term: After 1
impairme week of nursing
nt Long term: After 1 Dependent: intervention the
Dependent:
 Evaluatio week of nursing patient was:
n of the intervention the a. Administer a. Supplemental  Maintain
and maintain oxygen may
lungs patient will: optimal gas
oxygen be required to
indicates  Maintain administration maintain PaO2 exchange as
Diminishe optimal gas device as at an evidenced by
acceptable
d breath exchange as ordered, level.
usual mental
sounds in evidenced by attempting to b. This status,
the bases usual mental maintain medication oximetry
used to treat
with no status oxygen anemia in
results within
adventitio  Increased saturation at people with normal range
 us sounds oxygen 90% or CKD and baseline
 Oxygen saturation greater. HR for
saturation level in the b. Administer patient.
of 94% blood and medications
as prescribed
on 2 baseline HR GOAL MET
 Darbapoetin
L/min. for patient. alfa
Lab Results:
 RBC- 3.02
cells/mcl
 Hgb- 8.1
g/dL
 HCT- 25.2
%

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATIO RATIONALE EVALUATION

N
Subjective: Fatigue related Short term: Independent: a) It is critical to Short term:
compare serial
to decreased After 2 hours of a) Monitor After 2 hours of
laboratory values
Subjective: hemoglobin and nursing hemoglobin, to evaluate nursing
The client diminished intervention, hematocrit, progression or
intervention,
RBC counts, deterioration in
verbalized oxygen-carrying client will the client and to client has
and
complaint of capacity of the verbalize use of reticulocyte
identify changes verbalized use of
feeling tired blood evidenced energy counts. before they energy
become
by report of conservation b) Assist the conservation
potentially life-
feeling tired. principles. client in threatening. principles.
Objective: planning and b) A plan that
prioritizing balances periods
BP: 132/84 of activity with
activities of
Oxygen Sat: Long term: daily living
periods of rest Long term: After
can help the
94% After 1 week of (ADL). client complete
1 week of
-RBC: 3.2 nursing c) Educate desired activities nursing
-Hgb: 8.1 g/dl intervention, energy- without adding intervention, the
levels to fatigue.
-Hct: 25.2% Client will conservation c) Organization and client verbalized
verbalize techniques. time reduction of
Dyspnea reduction of d) Anticipate the management can fatigue, as
need for the help the client
weakness fatigue, as conserve energy evidenced by
evidenced by transfusion of and reduce reports of
packed RBCs. fatigue.
reports of increased
e) Instruct the d) Packed RBCs
increased client about increase oxygen- energy.
energy  medications
carrying capacity
of the blood.
that may e) Recombinant
GOAL MET:
stimulate RBC human
production in erythropoietin, a
hematological
the bone growth factor,
marrow. increases
Collaborative: hemoglobin and
Refer the client and decreases the
need for RBC
family to an transfusions.
occupational The occupational
therapist. therapist can
teach the client
about using
assistive devices.

Anemia Drug Study

DRUG Mechanism of Rationale Common Side Nursing
Action Effects Considerations while
taking the drug
Generic name: Induces Darbepoetin alfa Headache, The majority of
Darbepoetin alfa erythropoiesis. injection is used to body aches, patients with
Function as a treat anemia (a stomach pain, chronic kidney
Brand name: growth factor, lower than normal cough, disease will require
-Aranesp enhancing RBC number of red blood skin rash or supplemental iron
production. cells) in people with redness, during the course of
Classification: chronic kidney diarrhea, and. therapy.
Therapeutic failure (condition in injection site
class: Colony which the kidneys reactions (pain, The patient should
stimulating slowly and bruising, be monitored for the
factors permanently stop swelling, development of
Pharmacologic working over a warmth, constipation and the
class: period of time). redness, need for stool
Recombinant oozing, or softeners.
human bleeding).
erythropoietin Hgb and HCT should
be measured on the
Dosage: day patient is to
40mcg receive the injection,
and the drug should
Frequency: be held if the Hgb is
Every week greater than 11.5
g/dL. If a current
Route of Hgb level is
administration: unavailable, the
Subcutaneous drug should not be
given.
 Blood pressure
should be measured
twice daily after
treatment with
darbepoetin alfa is
initiated.
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
Generic name: Iron combines with Ferrous sulfate is Constipation. Monitor Hgb and
Ferrous sulfate porphyrin and used to treat iron Contact reticulocyte values
globin chains to deficiency anemia (a irritation. during therapy.
Brand name: form hemoglobin, lack of red blood Diarrhea. Investigate the
-Iron sulfate, which is critical for cells caused by Dark stools. absence of
FeroSul oxygen delivery having too little iron satisfactory
from the lungs to in the body). response after 3
other tissues. Iron weeks of drug
Classification: deficiency causes a treatment. Continue
Pharmacologic microcytic anemia iron therapy for 2–3
class: oral iron due to the months after the
supplement formation of small hemoglobin level
erythrocytes with has returned to
Dosage: insufficient normal (roughly
325mg hemoglobin. twice the period
required to
Frequency: normalize
BID hemoglobin
concentration).
Route of
administration:
PO
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
AMLODIPINE Amlodipine inhibits To treat Nausea Monitor blood
BESYLATE the influx of hypertension and to Diarrhea pressure before and
Generic name: extracellular maintain acceptable Flushing after administration
Amlodipine calcium ions into Blood pressure of Dizziness of the medication
heart muscle the patient Edema
Brand name: (myocardial smooth Palpitation Should be given and
Norvasc muscle cells) and taken at the same
peripheral vascular time for the next
smooth muscle dose.
Classification: cells, thereby
Pharmacologic preventing blood Monitor cardiac
class: Anti- vessels and heart rhythm regularly
hypertensive muscle contraction. during stabilization
Calcium channel This results in a of dosage and
blocker dilatation of the periodically during
Dosage: main coronary and long-term therapy
5mg systemic arteries,
decreased Administer without
Frequency: myocardial regards to food.
OD contractility, However, if stomach
increased blood upset occur this
Route of flow and oxygen medication can be
administration: delivery to the taken with meal.
PO myocardial tissue,
and decreased total You may experience
peripheral these side effects:
resistance. Nausea, vomiting
(eat frequent small
 meals); headache
(adjust lighting,
noise, and
temperature;
medication may be
ordered).

Report irregular
heartbeat, shortness
of breath, swelling
of the hands or feet,
pronounced
dizziness,
constipation.
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
CALCIUM As dietary To prevent or treat Nausea Taken with food
CARBONATE supplements to low blood calcium Vomiting
with vitamin D prevent or treat levels due to the Headache Assess allergic
Generic name: negative calcium client’s diet. reaction to the
Calcium balance (eg, medication
carbonate+vit D osteoporosis), the
calcium in calcium Assess and monitor
Brand name: salts moderates vitamin D and
Oscal nerve and muscle calcium level before
performance and and after
Classification: allows normal administration
Pharmacologic cardiac function;
class: Calcium also used to treat Caution the patient
supplement hyperphosphatemi about serious and
Dosage: a in patients with unusual side effects
Not indicated advanced renal size as palpitation,
but the usual insufficiency by loss of appetite,
dose is 1200 combining with mental disturbances
mg/day for dietary phosphate etc. which are to be
adults to form insoluble noted and reported
calcium phosphate, if experienced.
Frequency: which is excreted in
Twice daily feces; calcium salts
as antacids
Route of neutralize gastric
administration: acidity resulting in
PO increased gastric an
duodenal bulb pH;
they additionally
inhibit proteolytic
activity of peptic if
the pH is increased
>4 and increase
lower esophageal
sphincter tone.
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
POLYETHYLENE The mechanism of Given to treat Nausea, Assess any signs of
GLYCOL action is through occasional abdominal allergic reaction to
POWDER the osmotic effect constipation. bloating, know if the patient
Generic name: of polyethylene cramping and is allergic to the
Polyethylene glycol (the active flatulence may medication
glycol ingredient of occur
GoLytely). It causes Should be given
Brand name: water retention in orally and diluted as
Miralax the colon thereby directed.
producing a watery Provide health
stool. In just a few teaching of the
Classification: hours, GoLytely will effects of the
Pharmacologic take its effect in medication and
class: cleansing the when to report if
Osmotic bowel. unusual side effects
Laxative occur such as
Dosage: excessive watery
17 g in 8 oz stool, bleeding etc.
liquid
Monitor and assess
Frequency: stool frequency and
Daily consistency

Route of
administration:
PO
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
FUROSEMIDE The exact To treat edema Increased Monitor BP before
Generic name: mechanism of (peripheral edema volume and and after
Furosemide action is not fully as experienced by frequency of administration
understood, but the client) urination
Brand name: furosemide is Dizziness Record and monitor
Lasix believed to act at Feeling faint on weight
the luminal surface arising
Classification: of the ascending Drowsiness Administer with milk
Pharmacologic limb of the loop of or food to minimize
class: Loop Henle by inhibiting stomach upset
diuretic the active
Dosage: reabsorption of Give early in the day
40 mg chloride so that increased
Frequency: urination will not
OD disturb sleep.
Route of
administration: Caution the patient
PO about frequency of
urination as an
effect of the
medication

Monitor input and

output

Profound diuresis
with water and
electrolyte depletion
can occur; careful
medical supervision
is required.
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
ESCITALOPRAM The mechanism of To treat anxiety and Nausea Contraindicated with
Generic name: antidepressant depression of the Drowsiness MAOI
action of client Diarrhea
Brand name: escitalopram, the S- Nausea Monitor VS
Lexapro enantiomer of
racemic citalopram, Do not leave the
Classification: is presumed to be patient
Pharmacologic linked to
class: potentiation of Raise side rail to
Antidepressant serotonergic prevent fall
Dosage: activity in the
20 mg central nervous Caution patient or
Frequency: system (CNS) SO about the
OD resulting from its medication as it may
Route of inhibition of CNS cause suicidal
administration: neuronal reuptake thoughts, insomnia,
PO of serotonin (5-HT). drowsiness,
diarrhea, nausea,
serotonin syndrome
may cause QT
prolongation with
certain medications

Assess for sexual

dysfunction
may take 4-6 weeks
for full affect to take
place

Monitor for
serotonin syndrome
(mental changes,
NV, tachycardia,
hyperthermia)
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
PREDNISONE Prednisone itself is Given to treat Weight gain Assess and monitor
Generic name: inactive, and must autoimmune Headache vital signs for future
Prednisone first be converted disorder and Nausea comparison
Brand name: to prednisolone by peripheral Vomiting
Rayos, sterapred hepatic 11-β inflammation Restlessness Weigh the patient
hydroxysteroid before and after
Classification: dehydrogenase 1 administration
Pharmacologic before it can bind Weight gain of 5lbs
class: to glucocorticoid several days after
corticosteroid receptors. administration
Dosage: should be reported
10 mg
Monitor level of
Frequency: potassium in the
OD blood and ascertain
Route of laboratory
administration: monitoring
PO
Monitor any signs of
potassium
disturbances

DRUG Mechanism of Rationale Common side Nursing

Action effects Considerations while
taking the drug
OMEPRAZOLE Prevents the To treat and prevent Stomach pain Should be taken 30-
Generic name: transport of H ions gastric acid Gas 60 minutes prior to
Omeprazole into the gastric excessive production Nausea, eating
lumen by binding to or GERD, ulcer which vomiting
Brand name: gastric parietal are known among Diarrhea Tell the patient that
Prilosec cells, ↓ gastric acid older adults headache. capsules should be
 production swallowed whole
Classification:
Pharmacologic Instruct patient to
class: proton report black tarry
pump inhibitors stools
Dosage:
20 mg Report any changes
Frequency: in urinary
OD elimination such as
Route of pain or discomfort
administration: associated with
PO urination, or blood
in urine.

Report severe
diarrhea; drug may
need to be
discontinued.
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
CINACALCET Directly lowers Given as a treatment Dizziness Give with food or
Generic name: parathyroid of secondary Nausea shortly after a meal.
Cinacalcet hormone (PTH) hyperparathyroidism Vomiting
hydrochloride levels by increasing in patients with Anorexia Tablets should be
Brand name: the sensitivity of chronic kidney swallowed whole
Sensipar calcium-sensing disease on dialysis and not divided,
receptors on the crushed, or chewed.
Classification: parathyroid gland
Pharmacologic to extracellular Monitor for S&S of
class: calcium. The hypocalcemia (e.g.,
HORMONES & reduction in PTH paresthesias,
SYNTHETIC causes decreased myalgias, cramping,
SUBSTITUTES; calcium and tetany, convulsions).
PARATHYROID phosphate
AGENT; adsorption from Withhold drug and
CALCIUM bone, and thus notify physician for
RECEPTOR decreased serum serum calcium <7.5
AGONIST calcium and mg/dL or symptoms
Dosage: phosphate levels. of hypocalcemia.
30 mg The drug is a
Frequency: calcium receptor Drug should not be
OD agonist, also known resumed until serum
as a calcimimetic calcium levels reach
Route of agent. 8.0 mg/dL, and/or
administration: symptoms of
PO hypocalcemia
resolve.
Lab tests: Serum
calcium and
phosphorus within 1
wk after and iPTH 1–
4 wk after initiation
of drug or dose
adjustment;
thereafter, monthly
serum calcium and
phosphorus (more
often with a history
of a seizure
disorder), and iPTH
every 1–3 mo.
 Closely monitor iPTH
and serum calcium
with concurrent
administration of a
strong CYP3A4 (e.g.,
ketoconazole,
erythromycin,
itraconazole).

report promptly any

of the following:
seizure or
convulsion; muscle
spasms or cramping
of the abdomen,
back, legs, face;
burning, numbness,
pricking, tickling, or
tingling of the face,
lips, tongue, hands,
or feet; changes in
mental status.
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
Generic name: Inhibits HMG-CoA It's used to lower Constipation Obtain LFT results
Simvastatin reductase, an early cholesterol if you've Contact before initiation of
(and rate-limiting) been diagnosed with irritation. treatment and
Brand name: step in cholesterol high blood Diarrhea. thereafter when
Zocor biosynthesis cholesterol. It's also Dark stools. clinically indicated.
 taken to prevent Obtain lipid
Classification: heart disease, determinations after
Pharmacologic including heart 4 weeks of therapy
class: HMG-CoA attacks and strokes. and periodically
reductase thereafter.
inhibitors
Dosage:
20 mg

Frequency:
At bedtime

Route of
administration:
PO
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
Generic name: Competitive, Tiotropium Dry mouth, Watch for evidence
Tiotropium reversible inhibition demonstrated to be sore throat, of hypersensitivity
bromide of muscarinic efficacious in cough,
receptors in improving lung sinus In patients with
Brand name: smooth muscle function, decreasing problems, renal impairment,
Spiriva leads to risk of exacerbation constipation, watch for
bronchodialtion and slowing the fast heart rate, anticholinergic
Classification: worsening of disease blurred vision adverse reactions.
Pharmacologic or vision
class: changes,
Bronchodilator pain with
urination.
Dosage:
1 cap per
inhalation
device

Frequency:
Daily

Route of
administration:
Oral inhalation
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
Generic name: Tissues absorb Vitamin B12 is a Mild diarrhea, Allergy or sensitivity
Vitamin B12 vitamin B12 by nutrient that helps Itching, to cobalt or
specific B12 binding keep the body's skin rash, cobalamin: Do not
Brand name: proteins, nerve and blood headache, use vitamin B12 if
transcobalamin I cells healthy and Dizziness, you have this
and II, to enter the helps make DNA, the Nausea, condition.
cells. Most of the genetic material in vomiting.
Classification: vitamin is stored in all cells. Vitamin B12
Pharmacologic the liver. Vitamin also helps prevent a
class: B12 is essential for type of anemia
Dosage: DNA synthesis and called megaloblastic
1000 mcg energy production, anemia that makes
particularly in people tired and
Frequency: erythroid weak. Two steps are
Twice daily progenitor cells. required for the
body to absorb
Route of vitamin B12 from
administration: food.
Oral
DRUG Mechanism of Rationale Common side Nursing
Action effects Considerations while
taking the drug
Generic name: Thought to produce Aspirin has been Rash, Monitor salicylate
Aspirin analgesia and exert shown to reduce the gastrointestinal level
its anti- risk of vascular ulcerations,
Brand name: inflammatory effect events and there is abdominal Monitor patient for
- by inhibiting increasing evidence pain, hypersensitivity
prostaglandin and of its potential to upset stomach, reactions
Classification: other substances reduce the rate of heartburn,
Pharmacologic that sensitize pain cognitive decline in drowsiness, Stop drug 5 to 7
class: Salicylates receptors. Drug the elderly. headache, days before elective
may relieve fever cramping surgery to allow
Dosage: through central time for production
81 g action in the and release of new
Frequency: hypothalamic heat- platelets.
Daily regulating center.
In low doses, drug
Route of also appears to
administration: interfere with
PO clotting by keeping
a platelet-
aggregating
substance from
forming.