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ANEMIA
Anemia ppt
Introduction
Anemia is one of the most underdiagnosed conditions
and, if left untreated, can have many serious
implications such as cardiovascular disease and
compromised immune functions
Introduction
According to WHO estimates, India is one of the
countries in the world that has highest prevalence of
anemia.
The bliss of motherhood thrives under the looming
presence of anemia in India.
Definition
Anaemia ( from Greek word anaimia, meaning lack
of blood)
is a decrease in number of red blood cells (RBCs) or
less than the normal quantity of hemoglobin in the
blood.
Anemia ppt
Definition
Men
•Hb < 13.5 gm/100ml
Women
•Hb < 12.0 gm/100ml
Anemia cases in India on rise: NFHS 3
report
Adolescence in India goes hand in hand with iron-deficiency
anemia, medically known as IDA
While 56 % of adolescent girls are anemic, boys too are falling
prey to the disease. Around 30 % of adolescent boys are
suffering from anemia.
The Hb count in most of the adolescent girls in India is less
than the standard 12 g/decilitre, the standard accepted
worldwide.
the disease troubles 59 % cases of pregnancy while 63 %of
lactating women are anemic. States like Bihar and Rajasthan
register 60 % of pregnant women to be anemic.
Anemia ppt
Red blood cell
cytoplasm is rich in Hb
mature red blood cells are flexible biconcave disks
that lack a cell nucleus
2.4 million new erythrocytes are produced per
second.
develop in the bone marrow and circulate for about
100–120 days in the body before their components
are recycled by macrophages.
RBC
women have about 4 to 5 million erythrocytes per
microliter (cubic millimeter) of blood and
men about 5 to 6 million;
people living at high altitudes with low oxygen
tension will have more
Each RBC contains approx. 270 million of Hb
biomolecules, each carrying 4 heme groups.
RBCs of an average adult human male store
collectively about 2.5 grams of iron, representing
about 65% of the total iron contained in the body
RBC
RBC
Just for GK……..
Do u
know????
The only known vertebrates
without RBC are the crocodile
icefishes .
They live in very oxygen rich cold
water and transport oxygen freely
dissolved in their blood.
RBC production
Anemia ppt
Immature RBC
about 1% of the red cells
develop and mature in the red bone marrow
then circulate for about a day in the blood stream
before developing into mature red blood cells.
do not have a cell nucleus.
Reticulocytes
MCV
measure of the average RBC size
allows classification
10 x HCT (%)
───────────────
RBC count
(millions/mm3)..
MCV
MCV
The normal range for MCV
80-99 fL.
Mean corpuscular hemoglobin concentration
(MCHC)
measure of the concentration of Hb in a given
volume of packed RBCs.
32 to 36 g/dl
MCHC
Hb
────
HCT
Mean corpuscular hemoglobin
MCH
mean cell Hb
average mass of hemoglobin per red blood cell
MCH = Hb / RBC
27 to 31 picograms/cell
Anemia is actually a sign of
a disease process rather
than a disease itself
The burden of anemia among women in India
M E Bentleyand P L Griffiths
Objective: to investigate the prevalence and determinants of
anemia among women in Andhra Pradesh.
Subjects:A total of 4032 ever-married women aged 15–49 from
3872 households.
Results:In all 32.4% of women had mild ,14.19% had moderate ,
and 2.2% had severe anemia . Protective factors include Muslim
religion, reported consumption of alcohol or pulses, and high
socioeconomic status, particularly in urban areas. Poor urban
women had the highest rates and odds of being anemic. Fifty-two
percent of thin, 50% of normal BMI, and 41% of overweight
women were anemic.
Conclusion:New program strategies are needed, particularly those
that improve the overall nutrition status of women of reproductive
ages. This will require tailored programs across socio-economic
groups and within both rural and urban areas, but particularly
among the urban and rural poor.
Causes
Causes
• Iron deficiency
anemia
• Anemia of chronic
disease
• Anemia from active
bleeding
Anemia related to
pregnancy
Anemia related to
poor nutrition
Pernicious Anemia
Sickle cell anemia:
Thalassemia
Alcoholism
Bone marrow-related
anemia
Aplastic anemia
Hemolytic anemia
Anemia related to
medications
Classification
Acute Chronic
Classification
If the cells are smaller than normal (under 80 fl), the
anemia is said to be microcytic;
if they are normal size (80–100 fl), normocytic;
if they are larger than normal (over 100 fl), the
anemia is classified as macrocytic.
Microcytic anemia
Heme synthesis
defect
•IDA
•Chronic
diseases
Globin
synthesis defect
• alpha-, and beta-
thalassemia
• HbE syndrome
• HbC syndrome
• various other
unstable Hb
diseases
Sideroblastic
defect
•Hereditary
sideroblastic
•Acquired
sideroblastic
•Reversible
sideroblastic
Iron deficiency anemia
Iron is an essential part of Hb
low iron levels result in decreased incorporation of
hemoglobin into red blood cells
hypochromic (paler than usual) and microcytic
(smaller than usual)
Causes
 insufficient dietary intake
absorption of Iron
losses due to diseases.
bleeding lesions of the gastrointestinal tract
parasitic infestation
Anemia ppt
Anemia of chronic diseases
Any long-term medical condition .
The exact mechanism of this process in unknown,
chronic infection or a cancer
people with chronic (long-standing) kidney disease.
Anemia of chronic diseases
crohn’s
disease
SLE
rheumatoid
arthritis,
ulcerative
colitis
Cancer Long-term
infections,
Liver
cirrhosis
CKD
Thalassemia
Thalassemia
Major
Intermedia
Minor
Macrocytic anemia
Megaloblastic anemia, the most common cause of
macrocytic anemia
due to a deficiency of either vitamin B12, folic acid (or
both).
Causes
 gastric bypass surgery
 Hypothyroidism
 Alcoholism
 Drugs that affect DNA
 Leukemia
 The anticonvulsant drug dilantin
Normocytic anemia
overall hemoglobin levels are decreased,
but the red blood cell size(MCV) remains normal.
Causes
 Acute blood loss
 Anemia of chronic disease
 Hemolytic anemia
 Aplastic anemia
Aplastic anemia
decrease in or damage to marrow stem cells, damage to
the microenvironment within the marrow, and
replacement of the marrow with fat.
It results in bone marrow aplasia (markedly reduced
hematopoiesis)
CAUSES
congenital or acquired
Idiopathic
Infections and pregnancy
certain medications, chemicals,
or radiation damage
Substances Associated With Aplastic
Anemia
Analgesics
Antiseizure agents (mephenytoin, triethadione*)
Antihistamines
Antimicrobials*
Antineoplastic agents (alkylating agents, antitumor antibiotics,
antimetabolites)
Antithyroid medications
Benzene*
Chloramphenicol*
Gold compounds*
Heavy metals
Hypoglycemic agents
Insecticides
Organic arsenicals*
Phenylbutazone*
Phenothiazines
Sulfonamides*
Sedatives
Hyperanemia
severe form of anemia
hematocrit is below 10%
Refractory anemia
not respond to treatment.
often seen secondary to myelodysplastic syndromes.
Sickle cell anemia
autosomal recessive
RBC that assume an abnormal, rigid, sickle shape
Sickling decreases the cells' flexibility and results in a
risk of various complications.
The sickling occurs because of a mutation in the
hemoglobin gene
Sickle cell anemia
WHO Grading of anemia
Grade 1 (Mild Anemia): 10 g/dl
Grade 2 (Moderate Anemia): 7-10 g/dl
Grade 3 (Severe Anemia): below 7 g/dl
Anemia ppt
Koilonychia
Angular cheilitis
Splenomegaly
Pica
Pallor
Anemic eyes
ANEMIA SYMPTOMS
Anemic woman
the signs that may indicate anemia
Change in stool color
rapid heart rate
low blood pressure
rapid breathing
pale or cold skin
yellow skin called jaundice if anemia is due to red blood
cell breakdown
heart murmur
enlargement of the spleen with certain causes of anemia
Anemia Diagnosis
complete blood count.
thorough evaluation of the patient
Physical examination and medical history
Lab tests for anemia
1.CBC
2.Stool hemoglobin test
3.Peripheral blood smear
4.Iron level
5.Transferrin level
6.Ferritin
7.Folate
8.Vitamin B12
9.Bilirubin
10.Lead level
11.Hemoglobin
electrophoresis
12.Reticulocyte count
13.LFT
14.RFT
15.Bone marrow biopsy
cause and the severity
iron supplements
investigations
hospitalization and transfusion of red blood cells
Medications
Iron
Vitamin supplements
epoetin alfa (Procrit or Epogen) injection
Stopping a medication that may be the cause of
anemia
Anemia Prevention
eating a healthy diet and limiting alcohol use.
seeing a doctor regularly and when problems arise
routine blood work
Anemia Prognosis
cause of the anemia and how severe it is
age
makes almost any medical problem worse
NURSING PROCESS:
Assessment
NURSING DIAGNOSES
Activity intolerance related to weakness, fatigue, and
general malaise
Imbalanced nutrition, less than body requirements,
related to inadequate intake of essential nutrients
Ineffective tissue perfusion related to inadequate
blood volume or HCT
Noncompliance with prescribed therapy
Nursing Interventions
MANAGING FATIGUE
Assist the patient to prioritize activities and to
establish a balance between activity and rest that is
realistic and feasible from the patient’s perspective.
Patients with chronic anemia need to maintain some
physical activity and exercise to prevent the
deconditioning that results from inactivity.
Nursing Interventions
MAINTAINING ADEQUATE NUTRITION
A healthy diet should be encouraged.
Because alcohol interferes with the utilization of
essential nutrients, the nurse should advise the patient
to avoid alcoholic beverages or to limit their intake
and should provide the rationale for this
recommendation.
Dietary teaching sessions should be individualized,
including cultural aspects related to food preferences
and food preparation.
Nursing Interventions
MAINTAINING ADEQUATE PERFUSION
Lost volume is replaced with transfusions or intravenous
fluids, based on the symptoms and the laboratory
findings.
Supplemental oxygen may be necessary, but it is rarely
needed on a long-term basis unless there is underlying
severe cardiac or pulmonary disease as well.
The nurse monitors vital signs closely;
other medications, such as antihypertensive agents, may
need to be adjusted or withheld.
Nursing Interventions
PROMOTING COMPLIANCE WITH PRESCRIBED
THERAPY
Patients need to understand the purpose of the
medication, how to take the medication and over what
time period, and how to manage any side effects of
therapy.
To enhance compliance, the nurse can assist patients
in developing ways to incorporate the therapeutic
plan into their lives, rather than merely giving the
patient a list of instructions.
PATIENT EDUCATION
Taking Iron Supplements
Take iron on an empty stomach (1 hour before or 2 hours
after a meal).
Start with only one tablet per day for a few days, then
increase to two tablets per day, then three tablets per day
Increase the intake of vitamin C (citrus fruits and juices,
strawberries,tomatoes, broccoli), to enhance iron
absorption.
Eat foods high in fiber to minimize problems with
constipation.
Remember that stools will become dark in color.
Nursing Interventions
MONITORING AND MANAGING POTENTIAL
COMPLICATIONS
assessfor signs and symptoms of heart failure.
A serial record of body weights can be more useful than a
record of dietary intake and output, because the intake
and output measurements may not be accurate.
In the case of fluid retention resulting from congestive
heart failure, diuretics may be required.
In megaloblastic forms of anemia, the significant
potential complications are neurologic.
A neurologic assessment should be performed for patients
with known or suspected megaloblastic anemia.
Nursing Interventions
Measure temperature of bath water with thermometer
because anemia may cause poor circulation.
Provide blankets and warm clothing to increase
comfort and aid circulation.
Notify physician if excessive vomiting, coughing or
straining at stools occurs so that medication can be
prescribed to alleviate symptom.
Avoid aspirin-containing products to prevent
bleeding.
Avoid forceful blowing.
Nursing Interventions
Avoid contact on gingival when brushing and flossing
teeth.
Avoid situations in which trauma may occur, such as
shaving with straight-edge razor, ambulating after
taking medication that may cause orthostasis, or using
sharp utensils
Avoid purseful sexual intercourse and use adequate
lubrication.
Nursing Interventions
Use of stool softeners or laxative to avoid PRN to
avoid straining.
Ascorbic acid (Vitamin C) promotes iron absorption,
thus iron preparations should be taken with orange
juice.
Bowel movements will be black from excess iron
excretion.
Iron supplements usually given for at least 6 months
to restore body stores.
Nursing interventions
Keep skin clean and bedclothes dry.
Encourage diet high in protein, vitamins, and minerals.
Encourage cool, bland foods; flavored ices and ice cream
are well tolerated.
Monitor Hb/Hct and assess whether other factors (e.g.,
nutritional deficiencies, fluid and electrolyte disorders,
depression, etc.) are contributing to symptomatology.
Assess activity schedule and suggest daily activities that
allow for rest periods.
Transfuse whole blood and packed red blood cells as
ordered by physician.
Nursing interventions
Avoid rectal thermometers, suppositories, and
enemas.
Avoid heating pads or hot water bottles.
Iron salts are gastric irritants and should always be
taken following meals.
Iron preparation taken on empty stomach cause
dyspepsia, abdominal discomfort, and diarrhea
Liquid iron preparations should be well diluted and
taken through a straw (undiluted liquid iron stains
teeth).
Anemia ppt

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Anemia ppt

  • 3. Introduction Anemia is one of the most underdiagnosed conditions and, if left untreated, can have many serious implications such as cardiovascular disease and compromised immune functions
  • 4. Introduction According to WHO estimates, India is one of the countries in the world that has highest prevalence of anemia. The bliss of motherhood thrives under the looming presence of anemia in India.
  • 5. Definition Anaemia ( from Greek word anaimia, meaning lack of blood) is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood.
  • 7. Definition Men •Hb < 13.5 gm/100ml Women •Hb < 12.0 gm/100ml
  • 8. Anemia cases in India on rise: NFHS 3 report Adolescence in India goes hand in hand with iron-deficiency anemia, medically known as IDA While 56 % of adolescent girls are anemic, boys too are falling prey to the disease. Around 30 % of adolescent boys are suffering from anemia. The Hb count in most of the adolescent girls in India is less than the standard 12 g/decilitre, the standard accepted worldwide. the disease troubles 59 % cases of pregnancy while 63 %of lactating women are anemic. States like Bihar and Rajasthan register 60 % of pregnant women to be anemic.
  • 10. Red blood cell cytoplasm is rich in Hb mature red blood cells are flexible biconcave disks that lack a cell nucleus 2.4 million new erythrocytes are produced per second. develop in the bone marrow and circulate for about 100–120 days in the body before their components are recycled by macrophages.
  • 11. RBC women have about 4 to 5 million erythrocytes per microliter (cubic millimeter) of blood and men about 5 to 6 million; people living at high altitudes with low oxygen tension will have more Each RBC contains approx. 270 million of Hb biomolecules, each carrying 4 heme groups. RBCs of an average adult human male store collectively about 2.5 grams of iron, representing about 65% of the total iron contained in the body
  • 12. RBC
  • 13. RBC
  • 14. Just for GK…….. Do u know???? The only known vertebrates without RBC are the crocodile icefishes . They live in very oxygen rich cold water and transport oxygen freely dissolved in their blood.
  • 17. Immature RBC about 1% of the red cells develop and mature in the red bone marrow then circulate for about a day in the blood stream before developing into mature red blood cells. do not have a cell nucleus. Reticulocytes
  • 18. MCV measure of the average RBC size allows classification 10 x HCT (%) ─────────────── RBC count (millions/mm3).. MCV
  • 19. MCV The normal range for MCV 80-99 fL.
  • 20. Mean corpuscular hemoglobin concentration (MCHC) measure of the concentration of Hb in a given volume of packed RBCs. 32 to 36 g/dl MCHC Hb ──── HCT
  • 21. Mean corpuscular hemoglobin MCH mean cell Hb average mass of hemoglobin per red blood cell MCH = Hb / RBC 27 to 31 picograms/cell
  • 22. Anemia is actually a sign of a disease process rather than a disease itself
  • 23. The burden of anemia among women in India M E Bentleyand P L Griffiths Objective: to investigate the prevalence and determinants of anemia among women in Andhra Pradesh. Subjects:A total of 4032 ever-married women aged 15–49 from 3872 households. Results:In all 32.4% of women had mild ,14.19% had moderate , and 2.2% had severe anemia . Protective factors include Muslim religion, reported consumption of alcohol or pulses, and high socioeconomic status, particularly in urban areas. Poor urban women had the highest rates and odds of being anemic. Fifty-two percent of thin, 50% of normal BMI, and 41% of overweight women were anemic. Conclusion:New program strategies are needed, particularly those that improve the overall nutrition status of women of reproductive ages. This will require tailored programs across socio-economic groups and within both rural and urban areas, but particularly among the urban and rural poor.
  • 25. Causes • Iron deficiency anemia • Anemia of chronic disease • Anemia from active bleeding Anemia related to pregnancy Anemia related to poor nutrition Pernicious Anemia Sickle cell anemia: Thalassemia Alcoholism Bone marrow-related anemia Aplastic anemia Hemolytic anemia Anemia related to medications
  • 27. Classification If the cells are smaller than normal (under 80 fl), the anemia is said to be microcytic; if they are normal size (80–100 fl), normocytic; if they are larger than normal (over 100 fl), the anemia is classified as macrocytic.
  • 28. Microcytic anemia Heme synthesis defect •IDA •Chronic diseases Globin synthesis defect • alpha-, and beta- thalassemia • HbE syndrome • HbC syndrome • various other unstable Hb diseases Sideroblastic defect •Hereditary sideroblastic •Acquired sideroblastic •Reversible sideroblastic
  • 29. Iron deficiency anemia Iron is an essential part of Hb low iron levels result in decreased incorporation of hemoglobin into red blood cells hypochromic (paler than usual) and microcytic (smaller than usual) Causes  insufficient dietary intake absorption of Iron losses due to diseases. bleeding lesions of the gastrointestinal tract parasitic infestation
  • 31. Anemia of chronic diseases Any long-term medical condition . The exact mechanism of this process in unknown, chronic infection or a cancer people with chronic (long-standing) kidney disease.
  • 32. Anemia of chronic diseases crohn’s disease SLE rheumatoid arthritis, ulcerative colitis Cancer Long-term infections, Liver cirrhosis CKD
  • 35. Macrocytic anemia Megaloblastic anemia, the most common cause of macrocytic anemia due to a deficiency of either vitamin B12, folic acid (or both). Causes  gastric bypass surgery  Hypothyroidism  Alcoholism  Drugs that affect DNA  Leukemia  The anticonvulsant drug dilantin
  • 36. Normocytic anemia overall hemoglobin levels are decreased, but the red blood cell size(MCV) remains normal. Causes  Acute blood loss  Anemia of chronic disease  Hemolytic anemia  Aplastic anemia
  • 37. Aplastic anemia decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, and replacement of the marrow with fat. It results in bone marrow aplasia (markedly reduced hematopoiesis) CAUSES congenital or acquired Idiopathic Infections and pregnancy certain medications, chemicals, or radiation damage
  • 38. Substances Associated With Aplastic Anemia Analgesics Antiseizure agents (mephenytoin, triethadione*) Antihistamines Antimicrobials* Antineoplastic agents (alkylating agents, antitumor antibiotics, antimetabolites) Antithyroid medications Benzene* Chloramphenicol* Gold compounds* Heavy metals Hypoglycemic agents Insecticides Organic arsenicals* Phenylbutazone* Phenothiazines Sulfonamides* Sedatives
  • 39. Hyperanemia severe form of anemia hematocrit is below 10%
  • 40. Refractory anemia not respond to treatment. often seen secondary to myelodysplastic syndromes.
  • 41. Sickle cell anemia autosomal recessive RBC that assume an abnormal, rigid, sickle shape Sickling decreases the cells' flexibility and results in a risk of various complications. The sickling occurs because of a mutation in the hemoglobin gene
  • 43. WHO Grading of anemia Grade 1 (Mild Anemia): 10 g/dl Grade 2 (Moderate Anemia): 7-10 g/dl Grade 3 (Severe Anemia): below 7 g/dl
  • 48. Pica
  • 53. the signs that may indicate anemia Change in stool color rapid heart rate low blood pressure rapid breathing pale or cold skin yellow skin called jaundice if anemia is due to red blood cell breakdown heart murmur enlargement of the spleen with certain causes of anemia
  • 54. Anemia Diagnosis complete blood count. thorough evaluation of the patient Physical examination and medical history
  • 55. Lab tests for anemia 1.CBC 2.Stool hemoglobin test 3.Peripheral blood smear 4.Iron level 5.Transferrin level 6.Ferritin 7.Folate 8.Vitamin B12 9.Bilirubin 10.Lead level 11.Hemoglobin electrophoresis 12.Reticulocyte count 13.LFT 14.RFT 15.Bone marrow biopsy
  • 56. cause and the severity iron supplements investigations hospitalization and transfusion of red blood cells
  • 57. Medications Iron Vitamin supplements epoetin alfa (Procrit or Epogen) injection Stopping a medication that may be the cause of anemia
  • 58. Anemia Prevention eating a healthy diet and limiting alcohol use. seeing a doctor regularly and when problems arise routine blood work
  • 59. Anemia Prognosis cause of the anemia and how severe it is age makes almost any medical problem worse
  • 61. NURSING DIAGNOSES Activity intolerance related to weakness, fatigue, and general malaise Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients Ineffective tissue perfusion related to inadequate blood volume or HCT Noncompliance with prescribed therapy
  • 62. Nursing Interventions MANAGING FATIGUE Assist the patient to prioritize activities and to establish a balance between activity and rest that is realistic and feasible from the patient’s perspective. Patients with chronic anemia need to maintain some physical activity and exercise to prevent the deconditioning that results from inactivity.
  • 63. Nursing Interventions MAINTAINING ADEQUATE NUTRITION A healthy diet should be encouraged. Because alcohol interferes with the utilization of essential nutrients, the nurse should advise the patient to avoid alcoholic beverages or to limit their intake and should provide the rationale for this recommendation. Dietary teaching sessions should be individualized, including cultural aspects related to food preferences and food preparation.
  • 64. Nursing Interventions MAINTAINING ADEQUATE PERFUSION Lost volume is replaced with transfusions or intravenous fluids, based on the symptoms and the laboratory findings. Supplemental oxygen may be necessary, but it is rarely needed on a long-term basis unless there is underlying severe cardiac or pulmonary disease as well. The nurse monitors vital signs closely; other medications, such as antihypertensive agents, may need to be adjusted or withheld.
  • 65. Nursing Interventions PROMOTING COMPLIANCE WITH PRESCRIBED THERAPY Patients need to understand the purpose of the medication, how to take the medication and over what time period, and how to manage any side effects of therapy. To enhance compliance, the nurse can assist patients in developing ways to incorporate the therapeutic plan into their lives, rather than merely giving the patient a list of instructions.
  • 66. PATIENT EDUCATION Taking Iron Supplements Take iron on an empty stomach (1 hour before or 2 hours after a meal). Start with only one tablet per day for a few days, then increase to two tablets per day, then three tablets per day Increase the intake of vitamin C (citrus fruits and juices, strawberries,tomatoes, broccoli), to enhance iron absorption. Eat foods high in fiber to minimize problems with constipation. Remember that stools will become dark in color.
  • 67. Nursing Interventions MONITORING AND MANAGING POTENTIAL COMPLICATIONS assessfor signs and symptoms of heart failure. A serial record of body weights can be more useful than a record of dietary intake and output, because the intake and output measurements may not be accurate. In the case of fluid retention resulting from congestive heart failure, diuretics may be required. In megaloblastic forms of anemia, the significant potential complications are neurologic. A neurologic assessment should be performed for patients with known or suspected megaloblastic anemia.
  • 68. Nursing Interventions Measure temperature of bath water with thermometer because anemia may cause poor circulation. Provide blankets and warm clothing to increase comfort and aid circulation. Notify physician if excessive vomiting, coughing or straining at stools occurs so that medication can be prescribed to alleviate symptom. Avoid aspirin-containing products to prevent bleeding. Avoid forceful blowing.
  • 69. Nursing Interventions Avoid contact on gingival when brushing and flossing teeth. Avoid situations in which trauma may occur, such as shaving with straight-edge razor, ambulating after taking medication that may cause orthostasis, or using sharp utensils Avoid purseful sexual intercourse and use adequate lubrication.
  • 70. Nursing Interventions Use of stool softeners or laxative to avoid PRN to avoid straining. Ascorbic acid (Vitamin C) promotes iron absorption, thus iron preparations should be taken with orange juice. Bowel movements will be black from excess iron excretion. Iron supplements usually given for at least 6 months to restore body stores.
  • 71. Nursing interventions Keep skin clean and bedclothes dry. Encourage diet high in protein, vitamins, and minerals. Encourage cool, bland foods; flavored ices and ice cream are well tolerated. Monitor Hb/Hct and assess whether other factors (e.g., nutritional deficiencies, fluid and electrolyte disorders, depression, etc.) are contributing to symptomatology. Assess activity schedule and suggest daily activities that allow for rest periods. Transfuse whole blood and packed red blood cells as ordered by physician.
  • 72. Nursing interventions Avoid rectal thermometers, suppositories, and enemas. Avoid heating pads or hot water bottles. Iron salts are gastric irritants and should always be taken following meals. Iron preparation taken on empty stomach cause dyspepsia, abdominal discomfort, and diarrhea Liquid iron preparations should be well diluted and taken through a straw (undiluted liquid iron stains teeth).