INTRODUCTION

As a part of my Advance Nursing Practice, I was posted in Emergency Ward of Life Care Hospital
Chiplun. I have selected Ms. Renuka for my Emergency care study, which was of 14yrs age

GENERAL INFORMATION:
NAME : Ms. Renuka

AGE/SEX : 14 years/ female

MARITAL STATUS : UnMarried

OCCUPATION : Student

RELIGION : Hindu

HOSP NO :

BEDNO :5

DATE OF ADDMISSION :

DATE OF SURGERY :

WARD : Emergency Ward

ADDRESS : At Chiplun

DIAGNOSIS : Anaemia

SOURCE OF INFORMATION : patient, record, relatives.

II] PRESENTING COMPLAINTS: Weakness, nausea, Loss of Balance Change

in the color of urine and stool.

III] SOCIO-ECONOMIC STATUS OF THE FAMILY:

Mr. Ganapathi is the bread winner of the family. He has a self business. His monthly income is
about 6000/-. All the facilities of electricity, water supply and drainage are available in his family. The
child is staying with his parents. They have good relationship among family members.

IV] HISTORY OF PRESENT ILLNESS ( MEDICAL & SURGICAL)

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 Present medical/surgical history:

Ms. Renuka got admitted in hospital with the complaints of Weakness, Loss
of Balance, Rash, Anorexia since 3 days. So she was brought to the hospital for
further management.

Past medical/surgical history:

There was no history of past medical illness .no past surgical history. No
history of allergies

Personal history:

Ms. Renuka looks thin in body build.. SHe looks anxious. SHe does not have
the habit of alcoholism, chewing betel leaves. His hobby is playing cricket. SHe use
to take from fast food contents with high spicy. Her bladder pattern is normal She is
not sleeping properly due to Tension She sleeps daily 3-4 hours / daily. She
believes allopathic treatment.

DEMOGRAPHIC CHARACTERISTICS:
SL Name Age Sex Relation Education Occupation Health status
NO
1 Mr. Ganapathi 40 yrs M Father 10th STD BUSINESS Healthy
th
2 Mrs. Yellawa 32 yrs F Mother 10 STD Housewife Healthy
Th
3 Ms. Renuka 14 yrs F Own 9 Student Unhealthy
rd
4 Master Akshay 8 yrs M Brother 3 STD Student Healthy

FAMILY TREE KEY

40 yrs Male
32 yrs Female
Patient

14 years 8 yrs

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PHYSICAL EXAMINATION.

a) Head to toe Examination

1. General Appearance.

Body Built: Moderately built body

Nutrition: Moderately Nourished.
Orientation: Oriented to time, place and person
Consciousness: Conscious.

2. Vital Signs.

T= 98°F
P=86b/min
R=18b/min
3. Head.
 Hairs brown in color
 Hair is well distributed.
 No lesions in scalp
4. Face.
 Symmetrical in shape.
5. Ear.
 No low set ears
 External auditory canal is normal.
 Hearing acquity is normal.
6. Eyes.
 Sclera is clear
 Conjunctiva- pale
 No sty
 Pupils are round and reacting to light and accommodation equally.
7. Nose
 No DNS
 Watery discharge from nose

8. Mouth
 No cleft lip and cleft palate
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  No angular stomatitis
 No glossitis
 No tonsillitis.
 Lip is pale in color.

9. Teeth
 Temporary teeth are present
 Dental caries are present.

10. Neck.
 No torticolis
 No thyroid enlargement
 No palpable lymph node

11. Respiratory System.

a) Inspection:
 Nasal flaring is absent.
 Respiratory rate: 30 br/min
 No scar marks
b) Palpation
 No abnormal masses felt
 Tactile fremitus is decreased
 No rosary ricketissae
 c) Percussion
 Normal resonance sound heard
d) Auscultation.
 Bilateral crackles heard over lower border of the lungs

13. Cardiovascular System.

a) Inspection:
 Cardiac heaves at 5th intercostal space.
 PMI at 5th intercostal space.
b) Palpation
 No fluid thrill

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c) Percussion
No abnormal percussion findings
d) Auscultation.
S1 S2 heard
14. Gastro-Intestinal System:
a) Inspection.
 No visible peristalsis
 No visible veins
 No abdominal distention
 No spider angioma
b) Auscultation.
 Bowel sounds heard
c) Percussion.
 No dull sound
d) Palpation.
 Tenderness present over the right hypochondriac region
 Muscle guarding is present
 Tenderness over the right hypochondriac region
 Liver is palpable 3cm below the right costal margin

15. Musculoskeletal System.

1. Upper Extremity
 Muscle strength: 5/5
 Right forearm is swollen and soft
2. Lower Extremity.
 Healed pyoderma scar over right ankle joint.
 No pitting edema
 Muscle strength: 5/5

16. Genito Urinary System.

Normal.
Labia majora covers the minora.
No abnormal discharge seen

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 17. Reproductive System.
No abnormality detected.

Developmental History.
a. Present status: Ms. Renuka is in adolescent stage.

ABOUT THE DISASES

INDRODUCTION

Blood is made up of various parts, including red blood cells, white blood cells, platelets, and plasma (the
fluid portion of blood). Red blood cells are disc-shaped and look like doughnuts without holes in the center.
They carry oxygen and remove carbon dioxide (a waste product) from your body. These cells are made in
the bone marrow—a sponge-like tissue inside the bones. White blood cells and platelets also are made in
the bone marrow. White blood cells help fight infection. Platelets stick together to seal small cuts or breaks
on the blood vessel walls and stop bleeding. With some types of anemia, you may have low numbers of all
three types of blood cells.

DEFINITION:

Anaemia is a condition in which blood has a lower than normal number of red blood cells

TYPES:

There are many types of anemia with specific causes and traits. Some of these include:

 Aplastic anaemia

 Blood loss anaemia

 Folate- or folic acid-deficiency anaemia

 Haemolytic anaemia

 Iron-deficiency anaemia

 Pernicious anaemia

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  Sickle cell anaemia

CAUSES OF ANAEMIA:

The three main causes of anemia are:

 Blood loss

 Lack of red blood cell production

 High rates of red blood cell destruction

Some people have anemia due to more than one of these factors.

SIGNS AND SYMPTOMS OF ANAEMIA:

The most common symptom of anemia is fatigue (feeling tired or weak). If you have anemia, it may
seem hard to find the energy to do normal activities.

Other signs and symptoms of anemia include:

BOOK PICTURE PATIENT’S PICTURE

Shortness of breath

Dizziness 

Headache 

Coldness in the hands and feet 

Pale skin 

Chest pain

These signs and symptoms can occur because your heart has to work harder to pump oxygen-rich blood
through your body.

ANEMIA DIAGNOSIS

1. Physical Examination:

Physical exam to find out how severe your anemia is and to check for possible causes. He or she may:
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 Listen to heart for a rapid or irregular heartbeat

 Listen to lungs for rapid or uneven breathing

 Feel the abdomen to check the size of your liver and spleen also may do a pelvic or rectal exam to
check for common sources of blood loss.

2. Diagnostic Tests and Procedures

You may have various blood tests and other tests or procedures to find out what type of anemia you
have and how severe it is.

3.Complete Blood Count

Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures
many parts of your blood.

The test checks the hemoglobin and hematocrit levels. Hemoglobin is the iron-rich protein in red
blood cells that carries oxygen to the body. Hematocrit is a measure of how much space red blood
cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia

4. Other Tests and Procedures.

If the CBC results show that you have anemia, you may need other tests, such as:

 Haemoglobin electrophoresis (e-lek-tro-FOR-e-sis). This test looks at the different types of

haemoglobin in blood. It can help diagnose the type of anaemia.

 A reticulocyte (re-TIK-u-lo-site) count. This test measures the number of young red blood
cells in blood. The test shows whether your bone marrow is making red blood cells at the correct rate.

 Tests for the level of iron in blood and body. These include serum iron and serum ferritin
tests. Transferrin level and total iron-binding capacity tests also measure iron levels.

TREATMENT:

Treatment for anemia depends on the type, cause, and severity of the condition. Treatments may
include dietary changes or supplements, medicines, or procedures.

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Goals of Treatment

The goal of treatment is to increase the amount of oxygen that your blood can carry. This is done by
raising the red blood cell count and/or hemoglobin level. (Hemoglobin is the iron-rich protein in red
blood cells that carries oxygen to the body.)

Another goal is to treat the underlying condition or cause of the anemia.

Dietary Changes and Supplements:

Low levels of vitamins or iron in the body can cause some types of anemia. These low levels may be
due to poor diet or certain diseases or conditions.

Common vitamin supplements are vitamin B12 and folic acid (Folate). Vitamin C sometimes is given
to help the body absorb iron.

Iron

Nonmeat foods that are good sources of iron include:

 Spinach and other dark green leafy vegetables

 Tofu

 Peas; lentils; white, red, and baked beans; soybeans; and chickpeas

 Dried fruits, such as prunes, raisins, and apricots

 Prune juice

 Iron-fortified cereals and breads

Iron also is available as a supplement. It's usually combined with multivitamins and other minerals
that help your body absorb iron.

Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes.

Vitamin B12

Low levels of vitamin B12 can lead to pernicious anemia. This type of anemia often is treated with
vitamin B12 supplements.

Good food sources of vitamin B12 include:

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  Breakfast cereals with added vitamin B12

 Meats such as beef, liver, poultry, and fish

 Eggs and dairy products (such as milk, yogurt, and cheese)

 Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers

Folic Acid

Folic acid (Folate) is a form of vitamin B that's found in foods. Your body needs folic acid to make
and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid
anemia and promotes healthy growth of the fetus.

Good sources of folic acid include:

 Bread, pasta, and rice with added folic acid

 Spinach and other dark green leafy vegetables

 Black-eyed peas and dried beans

 Beef liver

 Eggs

 Bananas, oranges, orange juice, and some other fruits and juices

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially
citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen
fruits, vegetables, and juices usually have more vitamin C than canned ones.

Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.

Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes,
and leafy green vegetables like turnip greens and spinach.

Vitamin B12

Low levels of vitamin B12 can lead to pernicious anemia. This type of anemia often is treated with
vitamin B12 supplements.

Good food sources of vitamin B12 include:

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 If your body is destroying red blood cells at a high rate, you may need to have your spleen removed.
The spleen is an organ that removes worn-out red blood cells from the body. An enlarged or diseased
spleen may remove more red blood cells than normal, causing anemia

You can't prevent some types of inherited anaemia, such as sickle cell anaemia. If you have an
inherited anaemia, talk with your doctor about treatment and ongoing care

Medicines

. Some of these medicines include:

 Antibiotics to treat infections.

 Hormones to treat heavy menstrual bleeding in teenaged and adult women.

 A man-made version of erythropoietin to stimulate your body to make more red blood
cells. This hormone has some risks. You and your doctor will decide whether the benefits
of this treatment outweigh the risks.

 Medicines to prevent the body's immune system from destroying its own red blood cells.

 Chelation therapy for lead poisoning. Chelation therapy is used mainly in children. This is
because children who have iron-deficiency anaemia are at increased risk of lead poisoning.

Procedures

If your anemia is severe, you may need a medical procedure to treat it. Procedures include blood
transfusions and blood and marrow stem cell transplants.

Surgery

If you have serious or life-threatening bleeding that's causing anemia, you may need surgery. For
example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer.

ANAEMIA PREVENTION:

 You may be able to prevent repeat episodes of some types of anemia, especially those caused by lack
of iron or vitamins. Dietary changes or supplements can prevent these types of anemia from occurring
again.
 Treating anemia's underlying cause may prevent the condition (or prevent repeat episodes). For
example, if medicine is causing your anemia, your doctor may prescribe another type of medicine.

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 To prevent your anemia from getting worse, tell your doctor about all of your signs and symptoms.
Talk with your doctor about the tests you may need and follow your treatment plan.You can't prevent
some types of inherited anaemia, such as sickle cell anaemia. If you have an inherited anaemia, talk
with your doctor about treatment and ongoing care

NURSING DIAGNOSIS :

1. Imbalanced nutritional status less than body requirement related to vomiting as evidenced by
refusal to breastfeeding, decrease in weight.

2. Activity intolerance related to body weakness as evidenced by lethargy.

3. Knowledge deficit related to therapeutic regimen.

4. Risk for infection related low immune system

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ASSESSMENT DIAGNOSIS OBJECTIVES PLANNING IMPLEMENTATION EVALUATION
Subjective data: Imbalanced Assess the nutritional status. Ms Renuka takes
Patient will have -Nutritional status is
nutritional status food according to
Ms. Renuka says improved assessed.
less than body her body
“I don’t feel like nutritional status -Nutritional intake
requirement -Asses for nutritional intake. requirement, which
eating food.” as evidenced by assessed.
related to is evidenced by
increase appetite
Objective data: vomiting as -Weight is monitored increase in food
and weight gain. -Monitor body weight every day and
evidenced by every day. intake.
She looks thin, compare it with the previous weight
decrease in
weak. record chart.
weight, weakness.
- -Provide food in small amount at -Food is provided in
frequent time interval. small amount and at
frequent time interval

-Iron and protein rich

-Advice to take iron and protein rich
diet like spinach,
diet.
grapes,guava is
provided.

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2. Subjective Activity Patient will be -Assess the activity performance - Activity performance -Ms. Renuka is
data: intolerance able to perform capacity of the child. capacity is assessed. trying to perfrom
related to body maximum level of small activities of
Ms. Renuka -Encourage to perform small activities - encouraged todo light
weakness as activities. daily living.
complaints, “I of daily living. work.
evidenced by
usually get tired -Alternative rest and
lethargy. -Provide alternative rest and work
and don;t feel like work period is
period.
doing anything “ provided.

Objective Data: -Iron and protein rich

-Encourage to take iron and calorie rich
diet like spinach,
Weakness,lethargy diet.
grapes,guava is
present
provided.

-Provide rest to the chid to conserve the - provided rest to

energy. conserve enough
energy.

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SUBJECTIVE Patient will get -Assess the knowledge level of the -The knowledge level of The parents and Ms
DATA: adequate parents regarding the specific problems the parents regarding Renuka have gained
Knowledge
knowledge the specific problems. some knowledge
The parents ask deficit related to
regarding regarding Anaemia.
“What can be the therapeutic - Explain regarding
therapeutic -Explain regarding anaemia and its
outcome of the regimen. anaemia and its
regimen as prognosis to avoid anxiety of the
disease condition” prognosis to avoid
evidenced by parents.
anxiety of the parents is
OBJECTIVE verbalization
given
DATA:
-Explain about the importance of The parents are explain
Frequent
therapeutic regimen to make her about the importance of
questioning.
understand about the importance of drug therapeutic regimen .
regimen.

-Show pictures of other child suffering Pictures of other child

same problems. suffering same
\
problems are shown.

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Objective data: Risk for infection Ms. Renuka will -Assess for the sign and symptoms of Ms. Renuka is free
related low be free from infection. from infection.
Pallor conjunctiva Ms. Renuka is assessed,
immune system infection
-Advice for iron and calorie rich diet. no signs and symptoms
of infection is seen

-Iron and calorie rich

diet like spinach
-Advice to maintain personal hygiene.
,guava,grapes are
provided.

-Encourage to keep the surrounding -Adviced maintain

clean. personal hygiene.

- Adviced to keep the

surrounding clean
-Review the laboratory investigations of
haemoglobin and WBC. Adviced for routine
blood investigation.

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COMPLICATIONS OF ANEMIA

 Some people who have anemia may have arrhythmias . An arrhythmia is a problem with
the rate or rhythm of the heartbeat. Over time, arrhythmias can damage your heart and
possibly lead to heart failure.
 Anemia also can damage other organs in your body because your blood can't get enough
oxygen to them.
 Anemia can weaken people who have cancer or HIV/AIDS. This can make their
treatments not work as well.
 Anemia also can cause many other health problems. People who have kidney disease and
anemia are more likely to have heart problems. In some types of anemia, too little fluid
intake or too much loss of fluid in the blood and body can occur. Severe loss of fluid can
be life threatening
 Treating anemia's underlying cause may prevent the condition (or prevent repeat
episodes). For example, if medicine is causing your anemia, your doctor may prescribe
another type of medicine.
 To prevent your anemia from getting worse, tell your doctor about all of your signs and
symptoms. Talk with your doctor about the tests you may need and follow your treatment
plan.

 Anemia also can cause many other health problems. People who have kidney disease and
anemia are more likely to have heart problems. In some types of anemia, too little fluid
intake or too much loss of fluid in the blood and body can occur. Severe loss of fluid can
be life threatening

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HEALTH EDUCATION

DIET

 Adviced to eat iron rich and protein rich diets like spinach, guava, dals,etc.
 Adviced to take Vitamin rich foods.
HYGIENE
 Explained the importance of maintaining good personal hygiene.
 Adviced to wear clean clothes.
 Adviced to wear footwear.
 Adviced to wash hands after defaecation.
 Adviced to wash hands before and after eating foods.
DEWORMING
 Adviced to take antihelminths. E.g. Tab. Albendazole 400mg

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CONCLUSION

Anemia is not a single disease but a condition, like fever, with many possible causes and many
forms. Causes of anemia include nutritional deficiencies, inherited genetic defects, medication-
related side effects, and chronic disease. It can also occur because of blood loss from injury or
internal bleeding, the destruction of red blood cells, or insufficient red blood cell production. The
condition may be temporary or long-term, and can manifest in mild or severe forms.

BILIOGRAPHY:

1. Park K; “Textbook of Preventive and social medicine”;M/S Banarsidas Bhanot publication;19th

edition;2007;page no 493-495.

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