The Nursing Care Plan

Anemia is caused by the destruction of the Red Blood Cells (RBC’s) and is defined as “a decrease in circulating hemoglobin and oxygen-carrying capacity in the blood due to decreased erythrocyte and hemoglobin production, excessive hemolysis, or the loss of blood”. Pernicious Anemia is a deficiency in producing RBC’s due to a lack of Vitamin B-12 and or Vitamin B-9. Our red blood cells consist of hemoglobin, a protein full of iron, which give our blood its color (red).

Hemoglobin is what allows the red blood cells to carry oxygen to every part of our bodies from our lungs. It also carries carbon dioxide from the body to the lungs in order to be exhaled. Our red blood cells, along with other blood cells, are routinely made in our bone marrow.

The body must have iron, folate, Vitamin B-12, along with other nutrients ingested from food that we eat to produce hemoglobin and RBC’s.  Some expected findings for Pernicious Anemia are an enlarged, sore, and shiny tongue, digestive discomfort, a reduction in gastric acid which causes digestive discomfort, nausea, and diarrhea, and neurologic effects such as tingling or burning sensations in the extremities or the loss of muscle control and or coordination (ataxia). A decrease in appetite and weight loss are other signs and symptoms, along with irritability and an increased heart rate. Risk factors for pernicious anemia are having a family history of anemia, HIV, Chron’s disease, Type I diabetes as well as other autoimmune diseases.

Older adults, pregnant women, female menstruation, and excessive blood loss are some risk factors for pernicious anemia, and also vegetarians, people with poor diet habits, and those who have had their intestines and or part or all of their stomach removed. Laboratory tests can be performed to screen and diagnose anemia. These laboratory tests include a CBC count, B-12 deficiency testing, Reticulocyte count, Bone Marrow tests, and serum folate, iron and iron binding tests. Performing tests will help determine hemoglobin and hematocrit levels, determine the number of red and white blood cells and platelets in the blood, and measure the average size of RBC’s. 

Health promotion and prevention of this disorder are eating foods that are high in Vitamin B-12, Vitamin C, iron, and folate. It is important to try to avoid drinking alcohol, teas, coffee, and consuming plant-based foods that contain tannins. Tannins is also known as tannic acid and “is water-soluble polyphenols that are present in many plant-based foods”. Tannins have been said to be the cause for the decrease in feed intake and efficiency, low protein digestion in experimental animals, and a decrease in net metabolizable energy. Foods that have high tannin levels are deemed to have very little nutritional value benefits. The major effect of tannin is having a lower efficiency to convert absorbed nutrients into new body substances.

Iron, Vitamin B, Vitamin C, or Multivitamins can be taken to help maintain anemia. Blood transfusions, injection of erythropoietin which is a glycoprotein cytokine produced by our kidneys, chemotherapy, Vitamin B-12 injections, Immunotherapy, and Bone Marrow transplants are some therapeutic procedures than can be performed for more severe anemia cases.  Pernicious Anemia can eventually lead to oxygen deficiency when left untreated or diagnosed at a later stage. Iron plays a crucial part in aerobic capacity and performance due to irons important role of transporting oxygen to the muscles in the body. When there is not a sufficient amount of iron, the amount of oxygen transported to the muscles declines resulting in the ultimate oxygen consumption deterioration.

Our body needs oxygen and depend on constant oxygen supply that matches the changing metabolic requirements. If our oxygen supply decreases, tissue hypoxemia may occur and result in lactate production and anaerobic metabolism. Aerobic metabolism depends on oxygen, as well as cell integrity. Having pernicious anemia can cause complications if left untreated or not properly treated such as premature births, low birth weights, depression, cardiac problems, increased risk for infection, bone marrow malfunction, and delayed motor and or cognitive development with children. Death is also another complication known to occur with pernicious anemia if left untreated.  Primary prevention of anemia would be to make sure that you are obtaining a sufficient amount of iron in your diet. Secondary prevention for anemia is getting screened for hypoxemia and anemia and being diagnosed with anemia at an early stage and being treated for iron deficiency in order to maintain symptoms.

Tertiary care for anemia is focusing on helping to manage complicated, long term health issues that are caused by anemia to prevent further physical deterioration and to maximize the quality of life. Nursing care plans for anemia are to assess labs and diagnostic tests, assess each patients knowledge and understanding of their disorder, educate patients on general health and policy issues pertaining to respiratory health, promote, educate and encourage healthy lifestyles, follow up appointments and vaccinations, give oxygen therapy, and also maintain adequate oxygenation and monitor oxygenation. Other Interprofessional healthcare professionals that aid in the care and treatment of patients with anemia besides the Nurse are Hematologists, Gastroenterologists, Hepatologists, LPN’s, Oncologists, Nurse Practitioners, and Dieticians. 

References 

1. Anemia. (2019, August 16). Retrieved from https://www.mayoclinic.org/diseases-conditions/anemia/diagnosis-treatment/drc-20351366
2. Health Care Team Players: Meet the Nurse. (n.d.). Retrieved from https://www.aamds.org/health-care-team-players-meet-nurse
3. Hubert, R. J., & Meter, K. V. (2018). Goulds pathophysiology for the health professions. St. Louis, MO: Elsevier.
4. Sacirovi?, S., Asotic, J., Maksimovic, R., Radevic, B., Muric, B., Mekic, H., & Biocanin, R. (2013). Monitoring and prevention of anemia relying on nutrition and environmental conditions in sports. Retrieved January 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769080/

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