Monday, May 5, 2014

Pathophysiology and Clinical Manifestation of Anemia

The basic physiologic defect caused by anemia is a decrease in the oxygen-carrying capacity of blood and consequently a reduction in the amount of oxygen available to the tissues. Most of the clinical manifestations are directly attributable to tissue hypoxia. Muscle weakness and easy fatigability are common, although children seem to have a remarkable ability to function quite well despite low levels of hemoglobin.
The skin is usually pale to a waxy pallor in severe anemia. Cyanosis is typically not evident; because it is the result of the quantity of deoxygenated hemoglobin and/or red blood cells, not inadequate oxygen saturation of existing hemoglobin. The doctor should also keep in mind that skin pigmentation can alter one's assessment of kin pallor.
Central nervous system manifestations inclined headache, dizziness, light- headedness, irritability, slowed thought processes, decreased attention span, apathy, and depression. Growth retardation resulting from decreased cellular metabolism and coexisting anorexia is a common finding in chronic severe anemia. It is frequently accompanied by delayed sexual maturation in the older child.
The effects of anemia on the circulatory system can be profound. A reduction is hemoglobin concentration that results in decreased oxygen-carrying capacity of the blood is associated with a compensatory increase in heart rate and cardiac output. Initially this greater cardiac output compensate for the lower oxygen-carrying capacity of the blood, since blood replenished with oxygen returns to the tissues at a faster than normal rate.
Diagnostic evaluation
Several tests can be used to the levels of RBC and hemoglobin. These are routine hematological laboratory procedures. Other tests used to diagnose the underlying cause of anemia are included elsewhere in the discussion of the particular disorder.
Therapeutic management
The objective of medical management is to reverse the anemia by treating the underlying cause. For example, in nutritional anemia the specific deficiency is replaced. In blood loss caused by hemorrhage, packed red blood cells or whole blood is given. In cases of severe anemia supportive medical care may include oxygen therapy restoration of adequate blood volume, intravenous fluids and bad rest.
Nursing considerations
Since anemia is not a disorder but a symptom of some underlying problem, nursing care is related to determining the cause, fostering appropriate supportive and therapeutic treatments, and decreasing tissue oxygen requirements.
Assist in establishing a diagnosis. Although, the physical examination yields valuable evidence regarding the severity of the anemia and some indication of its possible etiology, diagnosis primarily rests on hematological blood studies and a careful history.
Prepare child for laboratory tests. Explain to older children the need for repeated veni-punctures or finger-sticks for blood analysis. Particularly why a sequence of tests is required. Allow children to play with laboratory equipment and/or participate with test. Older children may enjoy looking at blood smears under a microscope or at pictures of blood cells.
Observe for signs of shock and hypoxia from repeated blood samples. Explain to parents reason for replacing withdrawn blood and necessity of performing tests.
Minimize physical exertion. Assess child's level of physical tolerance. Anticipate and assist child in those activities of daily living that may be beyond his tolerance. Provided diversional play activities that promote rest and quiet but prevent boredom and withdrawal choose an appropriate roommate of similar age and interests and one who requires restricted activity.
Minimize emotional stress. Anticipate child's irritability, short attention span, and fretfulness by offering to assist him in activities rather than waiting for him to ask. Assess parents' awareness of child's need for dependency to conserve strength. Explain to older children and parents reason for behavioral changes caused by anemia. Encourage parents to remain with child.
Place child in room with noninfectious children; restrict visitors with active illnesses. Advice visitors (and hospital personnel) to practices good hand washing. Report any temperature elevation to physician. Observe for leukocytosis. Maintain adequate nutrition.
Alert ancillary hospital personnel regarding child's physical tolerance and need for assistance during activity. Keep side rails raised and use safety restraints when applicable.
Be alert to signs of heart failure from excessive cardiac demands of from cardiac over load during blood transfusion. Practice all precautions. Check blood with another nurse and physician to ensure correct blood group/ type with that of child. Run blood slowly and remain with child for infusion of initial 50ml. Stop blood immediately if any untoward reaction occurs. Attach blood to piggy back setup with normal saline or other intravenous solutions to maintain open venous line. Observe for signs and symptoms of reaction.
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