Lippincott Certification Review Medical-Surgical Nursing

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Chapter 8

Box 8-1: Types of Anemia (continued)

Description and Etiology

Signs and Symptoms

Medical Management

Nursing Interventions

Congenital hemolytic anemia: sickle cell anemia Anemia characterized by production of misshapen (sickle shaped) RBCs that do not bend or move easily through the vascular system. These cells may cause blockages or the damaged cells are destroyed. • Inherited (found primarily in persons of African descent due to heredity) Congenital hemolytic anemia: thalassemia Anemia characterized by missing amino acid chains that make up hemoglobin causing a deficiency in hemoglobin. • Inherited (primarily affects people of African, Asian, and Mediterranean descent) Iron deficiency anemia Anemia caused by iron supplies within the body • Chronic blood loss without iron replacement • Poor nutrition • Decreased iron absorption from the intestines • Increased need for iron, such as during childhood or pregnancy

• Abnormally shaped blood cells found on blood smear • Painful vaso-occlusive events in the extremities, lungs, or other affected organs (sickle cell crisis) • Other symptoms similar to other chronic anemias

• Hydroxyurea (Droxia or Hydrea) is a

• If the patient has sickle cell anemia, provide genetic counseling and options regarding gene replacement therapy. • Teach the patient to avoid factors that may precipitate sickle cell crisis, such as cold exposure, dehydration, excessive exercise, high altitudes, and smoking. • Monitor the patient closely during sickle cell crisis, especially regarding pain management and oxygenation.

chemotherapeutic drug that is used to reduce frequency of sickle cell crisis. • Supportive interventions are used to prevent infection, relieve pain, and provide fluid and oxygen during a sickle cell crisis, which can cause massive organ damage. • Stem cell transplant offers the chance for disease cure. • Genetic therapy is being investigated to facilitate prevention and cure. • Blood product transfusions are the primary treatment. • Chelating agents are used to remove excess iron from the blood after multiple transfusions have been administered. • Splenectomy may be required for severe thalassemia. • Stem cell transplant also is an option. • The cause of blood loss or nutritional deficits should be identified and corrected. • Oral iron supplementation may be prescribed. If the patient is unable to tolerate it, a parenteral iron formulation may be administered IM method or IV. • In extreme cases, blood transfusions may be administered.

• Cardiac problems, such as cardiomegaly, heart failure, and murmurs • Enlarged spleen • Excessive hematopoiesis and iron overload • Jaundice may also occur • Other symptoms similar to other chronic anemias • Fatigue due to RBC lack of ability to carry oxygen • Shortness of breath, pallor, dizziness, and headache • Cold sensitivity related to iron’s role in regulating body temperature • Brittle, spoon-shaped nails with longitudinal ridges • Cheilosis (painful mouth cracks or sores) and red, shiny tongue • Hypochromic, microcytic anemia (on blood smears); low serum iron level; and elevated serum iron-binding capacities

• Provide genetic counseling. • Monitor for activity intolerance due to impaired oxygenation.

• Help determine the cause of bleeding by testing stool, urine, vomitus, and sputum for blood. • Teach the patient how to take oral iron. Advise the patient to take iron pills with meals to reduce GI irritation and to continue therapy until the underlying problem is corrected. • Teach the patient about adverse reactions to oral iron therapy, such as black stools, constipation or diarrhea, and GI disturbances. • Educate the patient about nutrition, including the need for iron-rich foods and adequate vitamin C to enhance iron absorption.

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