anemia nursing diagnosis

Anemia is a widespread disease affecting up to one-third of the global population. The prevalence increases with age and is more common in women of reproductive age, pregnant women, and the elderly. Apart from age and sex, the race is also an important determinant of anemia, with the prevalence increasing in the African-American population (Xiao, 2022).

Definition

Anemia is strictly defined as a decrease in red blood cell (RBC) mass. Anemia is not a diagnosis, but a presentation of an underlying condition. Most clients experience some symptoms related to anemia when hemoglobin drops below 7.0 g/dL (Xiao, 2022).

Pathophysiology

The pathophysiology of anemia varies greatly depending on the primary cause. In acute hemorrhagic anemia, it is the restoration of blood volume with intracellular and extracellular fluid that dilutes the remaining RBCs, which results in anemia. A proportionate reduction in both plasma and red cells results in falsely normal hemoglobin and hematocrit. RBCs are produced in the bone marrow and released into circulation. Approximately 1% of RBCs are removed from circulation per day. An imbalance in the production, removal, or destruction of RBC leads to anemia (Xiao, 2022).

Etiology

The etiology of anemia depends on whether the anemia is hypoproliferative or hyperproliferative.

  • Hypoproliferative microcytic anemia has a mean corpuscular volume (MCV) of less than 80 fL, which includes conditions such as iron deficiency anemia, anemia of chronic disease, sideroblastic anemia, thalassemia, and lead poisoning.
  • Hypoproliferative normocytic anemia has an MCV of 80 to 100 fL and occurs in renal failure, aplastic anemia, pure red cell aplasia, and multiple myeloma.
  • Hypoproliferative macrocytic anemia has an MCV of >100 fL and is caused by alcohol, liver disease, hypothyroidism, folate, vitamin B12 deficiency, and medications.
  • Hemolytic anemia with extravascular hemolysis occurs when red cells are prematurely removed from the circulation by the liver and spleen, while intravascular hemolysis occurs when red cells lyse within the circulation and is less common.

Epidemiology

The prevalence of anemia is more than 20% of individuals who are older than 85 years. Approximately one-third of clients in the nursing home population have a nutritional deficiency as the cause of anemia, such as folate and vitamin B12 deficiency. Mild iron deficiency anemia is seen in women of childbearing age, usually due to poor dietary intake of iron and monthly loss of menstrual cycles (Xiao, 2022). Race is a factor in nutritional anemias and anemia associated with untreated chronic illnesses to the extent that socioeconomic advantages are distributed along racial lines in a given area. Overall, anemia is twice as prevalent in females as in males. This difference is significantly greater during the childbearing years due to pregnancies and menses (Maakaron & Besa, 2021).

Presentation

Too often, healthcare professionals rush into the physical examination without looking at the client for an unusual habitus or appearance of underdevelopment, malnutrition, or chronic illness. These findings can be important clues to the underlying etiology of the disease and provide information related to the duration of the illness. Symptoms may include:

  • Weakness
  • Tiredness
  • Lethargy
  • Restless legs
  • Shortness of breath, especially upon exertion
  • Chest pain
  • Reduced exercise tolerance
  • Pica
  • Hypotension
  • Tachycardia
  • Pallor of the palms, conjunctivae, or mucous membranes
  • Hepatomegaly
  • Splenomegaly
  • Lymphadenopathy

Interventions

The purpose of establishing the etiology of anemia is to permit selection of a specific and effective therapy.

Nursing Diagnosis for Anemia

Nursing Diagnosis

Risk for Infection


 

Assessment

Abdominal pain / headaches / bone or joint pain / muscle cramping / dyspnea / tachypnea / history or recurrent infections / swollen gums / fever / leukemic infiltrates in the dermis

Problem

Alterations in mature WBCs

Immunosuppression

Bone marrow suppression

Chronic disease

Malnutrition

 

Nursing Diagnosis

Risk for Deficient Fluid Volume


 

Assessment

Spontaneous, uncontrollable bleeding / changes in menstrual flow / fever / decreased skin turgor / dry oral mucous membranes / tachycardia / hypotension / shortness of breath / muscle cramping

Problem

Dehydration

Anorexia

Hypermetabolic state

Kidney stone formation

Tumor lysis syndrome

 

Nursing Diagnosis

Acute Pain


 

Assessment

Reports of bone or nerve pain / guarding behaviors / facial grimacing / alteration in muscle tone / tachycardia / increased blood pressure / shortness of breath / decreased ROM / narrowed self-focus

Problem

Enlarged organs and lymph nodes

Fear and anxiety

Tension and restlessness

Increased intolerance to pain

Depression

 

Nursing Diagnosis

Activity Intolerance


 

Assessment

Verbal report of fatigue / weakness / exertional discomfort / dyspnea / abnormal heart rate / decreased BP

Problem

Immobility

Generalized weakness

Hypoxia

Isolation due to bed rest

Imbalance in oxygen supply and demand

Nursing Diagnosis

Deficient Knowledge


 

Assessment

Verbalization of problem / request for information / statement of misconception / need for further information / lack of recall / questions

Problem

Development of preventable complications

Lack of exposure to resources

Information misinterpretation

Inaccurate follow-through of instructions

 

Nursing Diagnosis

Impaired Gas Exchange


 

Assessment

Dyspnea / use of accessory muscles / restlessness / confusion / tachycardia / cyanosis / hypoxia

Problem

Decreased oxygen-carrying capacity of the blood

Decreased blood flow to the peripheries

Inadequate cell nutrition

Abnormal RBC structure

Intolerance of strenuous physical activities

Increased blood viscosity

Bacterial pneumonia

 

Nursing Diagnosis

Ineffective Tissue Perfusion


 

Assessment

Diminished peripheral pulses / tachycardia / dyspnea / hypotension / decreased mentation / restlessness / decreased capillary refill / general pallor / angina / tingling in extremities / bone pain / visual disturbances / delayed wound healing

Problem

Vaso-occlusive sickling

Inflammatory responses

Myocardial damage

Small infarcts

 

Nursing Diagnosis

Impaired Physical Mobility


 

Assessment

Reports of pain / limited joint ROM / reluctance to move / inability to perform ADLs / guarding of joints / gait disturbances / generalized weakness

Problem

Recurrent bone infections

Pain and discomfort

Kyphosis of the upper back

Lordosis of the lower back

Osteoporosis

Compression deformities

Bacterial infections

 

Nursing Diagnosis

Risk for Impaired Skin Integrity


 

Assessment

Decreased skin turgor / dry, scaly, or itchy skin / dry oral mucous membranes / erythema of pressure points

Problem

Decubitus ulcers

Delayed wound healing

Tissue destruction

Chronic disease process

Inadequate primary defenses

 

Nursing Diagnosis

Imbalanced Nutrition: Less than Body Requirements


 

Assessment

Weight loss / weight below normal for age, height, and body build / decreased triceps or skinfold measurement / changes in gums or oral mucosa / decreased tolerance to activities / weakness / loss of muscle tone

Problem

Muscle wasting

Malnutrition

Immobility

Impaired oral intake

Dehydration

Inability to absorb nutrients necessary for the formation of normal RBCs

References

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A. Davis Company.

Maakaron, J. E., & Besa, E. C. (2021, September 27). Anemia: Practice Essentials, Pathophysiology, Etiology. Medscape Reference. Retrieved November 25, 2022, from https://emedicine.medscape.com/article/198475-overview#a1

Xiao, R. (2022, August 8). Anemia – StatPearls. NCBI. Retrieved November 25, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK499994/

 

 

 

 

 

 

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