ANEMIA

Group 5 BSN 2C
OVERVIEW
Anemia is a condition in which there are insufficient
healthy red blood cells to transport oxygen to your
body's tissues. Anemia, also known as low hemoglobin,
can cause fatigue and weakness.
Types and Causes

Iron deficiency anemia. This most common type of anemia is caused by a shortage of iron in
your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your
body can't produce enough hemoglobin for red blood cells.

Vitamin deficiency anemia. Besides iron, your body needs folate and vitamin B-12 to produce
enough healthy red blood cells. A diet lacking in these and other key nutrients can cause
decreased red blood cell production. Some people who consume enough B-12 aren't able to
absorb the vitamin. This can lead to vitamin deficiency anemia, also known as pernicious
anemia.

Anemia of inflammation. Certain diseases — such as cancer, HIV/AIDS, rheumatoid arthritis,

kidney disease, Crohn's disease and other acute or chronic inflammatory diseases — can
interfere with the production of red blood cells.
Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn't
produce enough red blood cells. Causes of aplastic anemia include infections, certain
medicines, autoimmune diseases and exposure to toxic chemicals.

Hemolytic anemias. This group of anemias develops when red blood cells are destroyed
faster than bone marrow can replace them. Certain blood diseases increase red blood cell
destruction. You can inherit a hemolytic anemia, or you can develop it later in life.

Sickle cell anemia. This inherited and sometimes serious condition is a hemolytic
anemia. It's caused by a defective form of hemoglobin that forces red blood cells to
assume an abnormal crescent (sickle) shape. These irregular blood cells die prematurely,
resulting in a chronic shortage of red blood cells.
Risk Factors Prevention
• A diet lacking in certain vitamins and • Iron
minerals
• Folate
• Intestinal disorders
• Vitamin B-12
• Chronic conditions
• Vitamin C
• Family history
• Other factors
Treatment and management
• Age
• Blood Transfusion
• Anemia and healthy eating habits
Complications
• Extreme fatigue
• Heart problem
• Death
DEMOGRAPHIC DATA
Name: Patient M Marital Status: Single
Age: 35 years’ old Religion: Roman Catholic
Sex: Male Nationality: Filipino
Weight: 59 kg Primary Language: Tagalog
Height: 159 cm Educational Attainment: Vocational
Graduate
Date of Birth: April 12, 1988
Address: San Isidro Diffun Quirino
•
PATIENT’S HISTORY
Past History
According to the patient this is his 3rd time getting hospitalization.
The first hospitalization occurred in 1976 as a results of Dengue at
Santiago Isabela Medical Center. The second hospitalization
occurred in the year 2018, when he was diagnosed with
hypertension at Quirino Province Medical Center. The also
mentioned that he also had a vehicular accident but was not
hospitalized because he only suffered from scratches. He also said
that he takes panto med for his liver and Jagaplex for his Vitamin.
Present History
On May 14, 2023, 1 day prior to admission patient X has been
experiencing dizziness and according to the patient when he poops
at night his stool is color black. May 15,2023 the patient
experienced vomiting that leads to body weakness at 2 Am and has
been admitted at Quirino Province Medical Center at 5Am with an
admitting diagnosis of Severe Anemia Secondary to UGIB. During
his admission he received 1 bag for blood transfusion at 2pm (May
16, 2023) and another bag for blood transfusion at 5Am (May 17,
2023).
Family History
According to patient X, they are four siblings and all of them are
boys, then he is the youngest among them. His mother is a
housewife and his father is a farmer and had a hypertension. He
also added that his siblings are healthy. He was the only one who
got sick and has an allergy to shrimp among his siblings.

Social History
Patient X smokes 5 sticks per day and drinks an alcohol every day.
He works at a fishpond in their barangay to make a living and help
his family.
GENOGRAM
LABORATORY VALUES
CLINICAL CHEMISTRY - A
Date/Time: Monday, May 15, 2023/6: 35 am
TEST RESULT NORMAL VALUE INTERPRETATION

BLOOD UREA M: 3.2-7.1; F: 2.5-6.1 HIGH

NITROGEN UV 20.6 IMPLICATION:
A sign
that your kidneys aren’t
working well.
SGOT/AST HIGH
M: 17-59 U/L F: 14-36 U/L IMPLICATION:
A high AST level often
68
means there is some liver
damage, but it is not
necessarily caused by
hepatitis C.
HEMATOLOGY CBC- 5 PARTS
Date/Time: Monday, May 15, 2023/8:29 am
PARAMETERS RESULT UNIT UNIT REF. RANGE INTERPRETATON

WHITE BLOOD HIGH

CELLS 11.26 10^9/L 5.00-10.00 IMPLICATION:
It usually means you have infection or inflammation in
your body.
NEUTROPHILS HIGH
NUMBER 7.15 10^9/L 2.00-7.00 IMPLICATION:
High neutrophil count is a sign that your body has an
infection. Neutrophilia can point to a number of
underlying conditions and factors, including: infection,
most likely bacterial.

RBC
1.65 10^9/L 3.50-5.50 LOW
IMPLICATION:
A low RBC count, also known as anemia, can affect
the body’s ability to transport oxygen and nutrients
around the cardiovascular system. It can cause fatigue,
dizziness, and heart palpitations.
HEMOGLOBIN LOW
47 g/L 110-160 IMPLICATION: Sign that your body isn't
getting enough oxygen, making you feel very
tired and weak.

HEMATOCRIT LOW
14.4 % 37.0-54.0 IMPLICATION: A low hematocrit level
means there are too few red blood cells in the
body. In these cases, a person may
experience symptoms that signal anemia.

RDW-CV HIGH
22.2 % 11.0-16.0 IMPLICATION:
A high RDW- CV means
that there’s variation in the
size of your red blood cells
beyond what’s considered
normal.
COURSE IN THE WARD
DATE/TIME DOCTORS DOCTORS ORDER INTERPRETATION
PROGRESS NOTES
5/15/2023 Please admit to Medical To provide care,
5pm ICU evaluation of patient’s
condition and proper
medical management
Secure Consent For legality purposes. To
have ethical
considerations and to
protect patient to make
health care decision
VS q4 and record please To monitor closely any
changes or abnormality
in the vital signs
 IVF:PLRS 1L FD then Use for daily
regulate to 8hrs maintenance of body
fluids and for
rehydration
DAT except dark It is interpreted to
colored foods avoid confusing the
blood with the color of
the food
70/40 – 90/40 CBC, Crea, BUN, It is done to know any
SGPT, SGOT, CXR- underlying condition
PA, 12LECG, FOBT, that produces changes
VA in the body
-Omeprazole 40mg -It reduces the amount
TIV now then 30mins of acid in the stomach
in AM before -It increases
breakfast. hemoglobin and
-Tranexamic acid 1g ferritin levels
TIV now then 500mg
q8
Secure 6units PRBC To replace blood loss
then transfuse once
available properly
typed and cross
matched
Pre BT meds: - Use to treat pain and
-Paracetamol 300mg reduce high
-Diphenhydramine temperature
25mg - Use to relieve
• Give 30mins prior to symptoms of allergy
BT
Refer accordingly For further assessment
and treatment.
02 at 2-3LPM/NC To provide
supplemental oxygen.
IVF to follow: PNSS For rehydration
1L x 8hrs
 70/40 Nonepinephrine drip: 2 To maintain blood
ampules in D5W500ml pressure in certain types
to start at 10ugtts/min of shock
then titrate
Refer For further assessment
and treatment.
5/16/2023 e) Hypotension Secure 5 units PRBC To replace blood loss
12:50am e) properly timed and
e) cross matched.
e) Dyspnea Transfuse 1unit x 4hrs
e) Chest pain interval q4-6hrs on next
e) Abdominal pain BT
Titrate norepinephrine To maintain blood
for 5ugtts/min to reach pressure
systolic BP greater than
or equal to 110mmHg
MAP
For Fecalysis, for PBS A test done on a stool to
prior to BT check if there are
conditions affecting the
digestive tract.
HgB=47 # Hypovolemic shock Repeat CBC 6hrs post BT after It is done to know any
due to Severe Anemia 3units of PRBC underlying condition that
secondary to UGIB produces changes in the
probably BPUD blood components.
Give calcium gluconate 10percent. Used as a mineral
10ml calcium gluconate + 50cc supplement to treat low
D5W TRF 20mins post BT of 3 unit blood calcium
PRBC
Start Omeprazole drip 80mg per IV To reduce the amount of
Bolus then 80mg + 90cc PNSS to acid in the stomach
run for 10hrs x 72hrs
Tranexamic acid 1g now then To increase hemoglobin
500mg q8
Provide oxygen support via nasal To provide supplemental
cannula at 2-4 LPN oxygen.
Continue Monitoring Monitor for any untoward
signs and symptoms
Refer For further assessment and
treatment.
5/17/2023 Gabapentin 300mg 1cap HS OD Used to relieve nerve pain
12:45am
 PNSS 1L for 16hrs (10cycles) Use for daily maintenance
of body fluids and for
rehydration
5/17/2023 (-) Melena IVF: PNSS 1L x 80ml/hour Use for daily maintenance
7am (-) Chest pain of body fluids and for
(-) Dyspnea rehydration
(+) Pallor
Facilitate BT of another unit Patients hemoglobin level
PRBC properly typed and is still low
cross matched
For CBC 6hours post BT It is done to know any
underlying condition that
produces changes in the
blood components.
Continue Monitoring Monitor for any untoward
signs and symptoms
Refer For further assessment and
treatment.
5/18/2023 Continue present management
12:24am
Refer For further assessment and
treatment.
PHYSICAL ASSESSMENT
DATE: MAY 18, 2023
TIME: 9:30am
GENERAL SURVEY: Patient X is sitting in bed, conscious, coherent, and
responsive as soon as we entered in the ward. The 35 years old has an ectomorphic
body and he has a pale skin. Patient X is poorly groomed and his nails in hands is dirty
and also in his foot.

VITAL SIGNS
Temp: 36.5
Blood pressure: 120/80
Respiratory rate: 22
Pulse rate: 103
Oxygen saturation: 98%
SKIN Inspection ● His skin is Abnormal,
pale, no because of his
lesion pale skin
EYELIDS Inspection ● Eyelids skin does not
have any discoloration Abnormal, because of
upper lid covers upper the palpebral
portion of cornea when conjunctiva
the patient is looking
straight
● Has palpebral conjunctiva
EYES
● Eyes are symmetric in size and
position, brown in color. Sclera
appeared white, no abnormal secretion Abnormal, because of
● Pupils are equally round, reactive to the blurred vision in
light and accommodation the right eye
● Perform Snellen Chart to test the Eye
vision: left eye is in clear vision and
the right eye is in blurred vision;
TEETH Inspection Abnormal, because
● Yellowish, of tooth decay,
tooth decay in indicates poor oral
right and left hygiene of the
teeth. patient
TONGUE Inspection ● Central in position Abnormal, because of
with whitish the whitish coating on
coating and veins the tongue
prominent in the
floor of the mouth
NAILS Inspection ● Nails are long with Abnormal. because of
dirt on its ends poor hygiene as well
● He has as the dirt on the nails
koilonychias nails and koilonychias nails
(spoon shape of
nails)
Palpation ● When the nail is Abnormal, because of
pinched the the slowly capillary
capillary refill goes refill
to 5 seconds
GORDON’S 11 FUNCTIONAL
PATTERN
HEALTH NUTRITIONAL- ELIMINATION ACTIVITY-
PERCEPTION- METABOLIC PATTERN EXERCISE
HEALTH PATTERN PATTERN
MANAGEMENT
PATTERN

SLEEP- REST COGNITIVE SELF ROLE-

PATTERN PERCEPTUAL PERCEPTION- RELATIONSHIP
PATTERN SELF CONCEPT PATTERN
PATTERN

COPING STRESS SEXUALITY- VALUE- BELIEF

PATTERN REPRODUCTIVE PATTERN
PATTERN
ANATOMY AND PHYSIOLOGY
Red Blood Cell
The function of the red cell and its hemoglobin is to carry oxygen from the lungs or gills to all the body
tissues and to carry carbon dioxide, a waste product of metabolism, to the lungs, where it is excreted. In
invertebrates, oxygen-carrying pigment is carried free in the plasma; its concentration in red cells in
vertebrates, so that oxygen and carbon dioxide are exchanged as gases, is more efficient and represents an
important evolutionary development. The mammalian red cell is further adapted by lacking a nucleus—the
amount of oxygen required by the cell for its own metabolism is thus very low, and most oxygen carried can
be freed into the tissues. The biconcave shape of the cell allows oxygen exchange at a constant rate over the
largest possible area.
White Blood Cell
White blood cell, also called leukocyte or white corpuscle, a cellular component of
the blood that lacks hemoglobin, has a nucleus, is capable of motility, and defends the body
against infection and disease by ingesting foreign materials and cellular debris, by destroying
infectious agents and cancer cells, or by producing antibodies.
Platelet
Platelets function to stop bleeding. During an injury, your platelets will cluster together at the
site of the wound to act as a plug, sealing blood vessels in a process called clotting to prevent
excess blood from leaving your body
PATHOP
HYSIOL
OGY
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Deficit Nursing  Establish rapport  To gain the patient trust and have a After 1hour of
“Mababa yung knowledge intervention, good nurse-patient relationship nursing
platelet ko.” as related to the patient intervention the
verbalized by the misinterpretatio will be able to  Determine the patient ability, readiness  The individual may not be physically patient was able to
patient n of information know and and barriers to learning emotionally, or mentally capable at this know and
understand the time understand the
causes and causes and effects
Objective: effects of  Provide positive reinforcement  This could encourage continuation of of anemia by
anemia efforts participated in
learning.

 Identify information that needs to be  Enhances possibility that information

remembered will be heard and understood

 Conveying respect is especially

 Provide an atmosphere of respect, important when providing education to
openness, trust, and collaboration. patients with different values and
beliefs about health and illness

 An assessment provides an important

 Observe and note existing starting point in education. Knowledge
misconceptions regarding the topic to be serves to correct faulty ideas.
taught.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Self-care deficit in After the 3hours on  Establish rapport  To gain theAfter the 3hours on
“Tatlong araw na bathing/ hygiene nursing intervention patient trust and nursing intervention
kong di naliligo”’ as related to decrease in the patient would be have a good the patient was able to
verbalized by the motivation able to know the nurse-patient know the importance
patient importance of self- relationship of self-care and
care and verbalize  Assist with verbalized
Objective: understanding meeting clients’  To enhance understanding
> long and dirty nails personal hygiene needs motivation and personal hygiene
> unpleasant odor promote
> presence of tooth integration of
decay self-care
independence
 Provide privacy
during  The need for
bathing/dressing privacy is
as appropriate fundamental for
most patients
 Encourage use of
clothing one size  This ensures
easier dressing
and comfort
DRUG STUDY
 DISCHARGE PLAN
Method Rationale
MEDICATIONS:
Patient should take her medication with a right drug, time, Taking the medication with a right drug time, dose, and
dose, and frequency as prescribed by the doctor. frequency is the best way to make your prescription works
properly.

Explain to the patient the side effects of each medication.

This will help the patients determine whether a medication is
working appropriately.
Advise the client not to miss the intake of medications given
by her physician upon discharge.
Because missing a dose may make the medicine less
effective.
ENVIRONMENT:
Maintain a quiet, pleasant environment to promote relaxation. Relaxing can make the flow of blood increase around the
Provide a comfortable environment. body giving more energy.
EXERCISE:
Advise patient to have exercise such as walking and do some
hose chores that the patient is comfortable to do and doesn’t
feel strained.
Health teaching
Encouraged the patient to increase the amount of iron they
consume and avoid some foods can make it harder for your
body to absorb iron. These include coffee, tea, milk, egg
whites, fiber, and soy protein.
Instructed the patient to drink plenty of water
Encouraged the patient to exercise like walking, Sweep, do
some household chores.
Instructed the patient to sleep 7-9 hours every night.
Certain aerobic exercise like walking can produce more red
blood cells, which boost the amount of hemoglobin and iron
in the body.
Best diet for a person with anemia includes plenty of foods
rich in iron and other foods that help the body to absorb iron.
A person should also be aware of foods that can inhibit iron
absorption.
To prevent dehydration and support their overall health.
Exercise helps people lose weight and lower the risk of some
diseases
Sleep keeps us healthy and functioning well.
Health teaching
Encouraged the patient to increase the amount of iron
they consume and avoid some foods can make it
harder for your body to absorb iron. These include
coffee, tea, milk, egg whites, fiber, and soy protein.
Instructed the patient to drink plenty of water
Encouraged the patient to exercise like walking,
Sweep, do some household chores.
Instructed the patient to sleep 7-9 hours every night.
Outpatient Follow up
Instructed the patient to Visit the Doctor for Follow
up check-up and If necessary
Best diet for a person with anemia includes plenty of
foods rich in iron and other foods that help the body
to absorb iron. A person should also be aware of
foods that can inhibit iron absorption.
To prevent dehydration and support their overall
health.
Exercise helps people lose weight and lower the risk
of some diseases
Sleep keeps us healthy and functioning well.
Follow up check-up can help you to identify
misunderstandings and answer questions, or make
further assessments and adjust treatments and to
determine if the medication is effective.
DIET
Eat iron-rich foods such as meat, chicken, fish, Iron is a mineral that the body needs for growth
eggs, dried beans and fortified grains. and development.
Eat foods high in folic acid, such as dried beans, Help the body make healthy new red blood cell.
dark green leafy vegetables, wheat germ and
Vitamin C is an antioxidant that helps protect your
orange juice.
cells against the effects of free radicals
Eat foods high in vitamin C, such as citrus fruits
and fresh, raw vegetables.
Spiritual
Showed support for religious practices by being To show respect
present and assisting with patient prayer.
Encouraged the patient to prayed for healing,
Having Faith to God in every Decision you pray
guidance regarding treatment, and help getting
about that thing that you are worrying about, and
through day to day life.
release it in to God, Ask Him to show you if there
is anything you can do, and leave it to him
THANK YOU FOR LISTENING!
MAY GODBLESS US ALL 