Group 2

Aguila, Louise Anne L.

Arcallana, Ilya O.
Dava, Trisha Andrea D.
Galeno, Angeli Ofel M.
Lauron, Janella Marie V.
Punzalan, Joann D.
Realeza, Rafael Harvey Grant L.
Vismonte, Maria Vianney O.
 SHORT Activity
The group will be asking for 5 volunteers to answer 6
multiple choice question. The moderator will read the
question once and will shout “Go!” then the players
who wants to answer will have to raise their hand. The
answer should be said in this format “Surname +
Answer”. If the player called fails to follow instructions,
other players can steal.
 01
Folic acid is part of vitamin b complex.
Particularly, what vitamin is this?
 A B C
Vitamin B12 Vitamin B9 Vitamin B6
 B
Vitamin B9
 02
What is the term used to refer to white blood cell
count of <10,000?
 A B C
Neutropenia Leukopenia Neutrophilia
 B
Leukopenia
 03

What is the main function of folate in our body?

 A B C
Aids in modeling the Produces red blood
Aids in DNA synthesis
size of RBCs cells
 A
Aids in DNA synthesis
 04
Red blood cells are formed in which system of the
body?
 A B C
Circulatory Skeletal Lymphatic
 B
Skeletal
 05
Who among the following population groups are
at risk with developing folate deficiency?
 A B C
Children Men Pregnant women
 C
Pregnant women
 06
What is the term used to refer to platelet count
of <400,000?
 A B C
Thrombosis Thrombocyte Thrombocytopenia
 C
Thrombocytopenia
Congratulations!
 Folate
deficiency
Lack of folic acid in the blood.
 Disease overview

Prevalence morbidity
>20% in nations with lower pay 95% of megaloblastic anemias
economies in pregnancy

<5% in nations with higher pay 33% pregnancies around the

economies world
Normal function of folate

METHIONINE SYNTHesis
Effect of low levels of serum folate

METHIONINE SYNTHesis
Normal red blood cells

Diameter: 6-8mm
Thickness of 2mm
Volume of 90 fl
Surface area 135 sqm
Abnormal red blood cells

Huge in size
Delayed maturation
Volume of >100 fl
Lesser in number
Shorter life span
Etiology
Modifiable factors comorbidities
● Alcoholism ● Malabsorption syndromes
● Inadequate nutrition ● Thiamine deficiency
● Drugs interfering with absorption
○ Methotrexate
○ Antiseizure drugs

non-Modifiable factors
● Chronic hemodialysis
● Increased requirement (pregnancy)
● Malabsorption syndromes
○ Celiac disease
○ Crohn’s disease
○ Small bowel resection
pathophysiology
Clinical manifestations
Weakness, listlessness, fatigue
Smooth, sore, red tongue
pallor
Mild diarrhea
Extremely pale
Confusion
Paresthesias
Difficulty maintaining balance
proprioception
 Laboratory findings

FOLATE DEFICIENCY LABORATORY FINDINGS

Hgb/H MCV Reticul Serum TIBC Transf Ferriti Bilirubi Serum Folate
ct ocytes Iron errin n n B12

↓ ↑ N or ↓ N or ↑ N Slight ↑ N or N ↓
<12-13 > 100 fl ≤ 1.5% ≥ 170 240-450 ↑ >330 slight 190-950 <2.7 to
g/dL mcg/dL mcg/dL >360 mcg/L pc/mL 17.0
↑
mg/dL ≥ 1.2 ng/mL
mg/dL
Diagnostic findings

Complete blood count

Schilling test
24 hr urine collection
Intrinsic factor antibody test
Replacement therapy
Physical examination
pallor
Physical examination
Aore, red, bereft and shiny tongue
Physical examination
anorexia
Physical examination
paresthesia
Physical examination
ataxia
Physical examination
Impaired thought process
Nursing dx
Actual diagnosis
● Acute/chronic pain
● Imbalanced nutrition: less than body
requirements
● Fatigue
● Impaired gas exchange
● Activity intolerance
● Impaired memory
● Ineffective tissue perfusion

Risk diagnosis
● Risk for falls
● Risk for ineffective tissue perfusion
● Risk for deficient fluid volume
Medical management
Pharmacology
● Drug replacement therapy: Folate
○ Dosage: 1mg per day via oral route
○ For those with malabsorption
syndromes: 5mg per day

Acute intervention
● Blood transfusions
● Drug therapy
● O2 therapy to stabilize patient
Nursing management
Dietary and lifestyle changes
● Educate client to eat foods high in folic
acid, such as:
○ Green leafy vegetables
○ Enriched grain products
○ Breakfast cereals
○ Orange juice
○ Peanuts
○ Avocado
● Encourage alternate rest and activity
periods
○ Avoid activity right after meals
● Aid with regular physical activities
 Aplastic
anemia
The body does not produce enough new
blood cells caused by decrease or damaged
bone marrow.
 Disease overview

Prevalence morbidity
Occurs in all ages 2 to 5 new cases per
million/year
 ANATOMY AND PHYSIOLOGY

NORMAL
Bone marrow produces stem
cells and other substances.
ABNORMALITY
70% of aplastic anemia are due
to the immune system
attacking the patient’s bone
marrow.
Etiology
● IDIOPATHIC

Modifiable factors
● Medication use
● Radiation
● Chemicals

non-Modifiable factors
● Hereditary
● Autoimmunity
pathophysiology
Clinical manifestations

Pallor
Fatigue
Shortness of breath
Palpitations
Headache
Cervical lymphadenopathy
petechiae/purpura
Nose bleeds
HISTORY

MEDICAL HISTORY
MEDICATION USE
FAMILY HISTORY
EXPOSURE TO RADIATION, CHEMICALS
AND TOXIC MATERIALS
 Laboratory findings
APLASTIC ANEMIA LABORATORY FINDINGS
Hgb/H MCV Reticul Serum TIBC Transf Ferrin Bilirubi Serum Folate
ct ocytes Iron errin n B12

↓ N or ↓ N or ↑ N or ↑ N N N N N
slight
↑

● Neutrophil <1500/mcL
● Hemoglobin <10g/dL
● Platelets <50,000/mcL
 Diagnostic findings

complete blood count

Bone marrow biopsy
Aspiration
Pathologic examination
Physical examination
pallor
Physical examination
Petechiae or purpura
Physical examination
Listlessness
Nursing dx
Actual diagnosis
● Fatigue
● Activity Intolerance
● Impaired gas exchange

Risk diagnosis
● Risk for infection
● Risk for bleeding
Medical management
Pharmacology
● Cyclosporin
● ATF
● Steroids
● Eltrombopag

Medical & surgical

● Blood transfusion
● HSCT
● Immunosuppressive therapy
Nursing management
● Signs of infection and bleeding
● Drug-drug interactions
● Supportive therapy
● WOF long term effects of therapy
● Patient Education
● Avoidance exposure to chemicals
 References
Aplastic anemia - Symptoms and causes. (2020, January 11). Mayo Clinic
.https://www.mayoclinic.org/diseases-conditions/aplastic-anemia/symptoms-causes/syc-20355015

Boundless. (n.d.). Boundless anatomy and physiology. Lumen. Retrieved November 6, 2021,

fromhttps://courses.lumenlearning.com/boundless-ap/chapter/red-blood-cells/#:~:text=A%20typical%20human%20RBC%20has,of%20about

%20136%20square%20micrometers.

Encyclopædia Britannica, inc. (n.d.). Folic acid deficiency anemia. Encyclopædia Britannica. Retrieved November 6, 2021, from

https://www.britannica.com/science/folic-acid-deficiency-anemia.

Folate-deficiency anemia. Johns Hopkins Medicine. (n.d.). Retrieved November 6, 2021, from

https://www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia.

Folate deficiency. Folate Deficiency - an overview | ScienceDirect Topics. (n.d.). Retrieved November 6, 2021, from

https://www.sciencedirect.com/topics/neuroscience/folate-deficiency
 References
Global folate status in women of reproductive age: A systematic review with emphasis on methodological issues. Annals of the New York Academy of
Sciences.

Retrieved November 6, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282622/.

Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Lewis's medical-surgical nursing: Assessment and
management of clinical problems. Elsevier.

Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's textbook of Medical-Surgical Nursing. Wolters Kluwer.

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-Surgical Nursing-E-Book: Assessment and Management

of Clinical Problems, Single Volume. Elsevier Health Sciences.

Megaloblastic anemia: Boston Children's Hospital. Boston Childrens Hospital. (n.d.). Retrieved November 6, 2021, from

https://www.childrenshospital.org/conditions-and-treatments/conditions/m/megaloblastic-anemia

Rogers, L. M., Cordero, A. M., Pfeiffer, C. M., Hausman, D. B., Tsang, B. L., De-Regil, L. M., Rosenthal, J., Razzaghi, H., Wong, E. C., Weakland, A. P., & Bailey, L.

B. (2018, November). Global folate status in women of reproductive age: A systematic review with emphasis on methodological issues. Annals of

the New York Academy of Sciences. Retrieved November 6, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282622/.