Kamis, 19 Mei 2011
THEORY REVIEW
Definition
Anemia is a term that indicates a low red blood cell count and hemoglobin and hematocrit levels below normal. Anemia is not a disease, but is a reflection of state of a disease or disorder caused bodily functions. Physiologically anemia occurs when there is a shortage of hemoglobin to carry oxygen to the tissues.
Pathophysiology
Incidence of anemia reflect the loss of marrow failure or excessive red blood cells or both. marrow failure can occur due to nutritional deficiencies, toxic exposure, tumor invasion or mostly due to unknown causes. Red blood cells can be lost through bleeding or hemplisis (destruction), this could be due to defect of red blood cells that are not in accordance with the resistance of red blood cells that causes destruction of red blood cells.
Red blood cell lysis (dissolution) occurs mainly in phagocytic cells or the reticuloendothelial system, mainly in the liver and spleen. byproduct of this process is bilirubin will enter the bloodstream. Any increase in red blood cell destruction (hemolysis) immediately reflected by increased plasma bilirubin (normal concentration ≤ 1 mg / dl, levels above 1.5 mg / dl result in jaundice in the sclera).
If the destruction of red blood cells experience in circulation, (the abnormalities hemplitik) then appear in plasma hemoglobin (hemoglobinemia). If the plasma concentration exceeds the capacity of plasma haptoglobin (hemoglobin-binding proteins for free) to tie it all, will diffuse hemoglobin in kidney glomerulus and into the urine (hemoglobinuria).
Conclusions about whether an anemia in patients caused by the destruction of red blood cells or red blood cell production is usually inadequate to diperleh basis: 1. reticulocyte count in the blood circulation; 2. the degree of proliferation of young red blood cells in bone marrow and how pematangannya, as seen in the biopsy, and presence or absence of hyperbilirubinemia and hemoglobinemia.
Anemia
↓
decreased blood viscosity
↓
peripheral blood flow resistance
↓
decrease in O2 transport to tissue
↓
hypoxia, pale, weak
↓
increased cardiac load
↓
increased heart work
↓
bad heart
Etiology:
1. Hemolysis (erythrocytes easily broken)
2. Bleeding
3. Emphasis bone marrow (for example, by cancer)
4. Deficiency of nutrients (nutritional anemia), including iron deficiency, folic acid, pyridoxine, vitamin C and copper
Classification of anemia:
Classification based on physiological approach:
1. Anemia hipoproliferatif, namely deficiency anemia red blood cell count caused by a defect of red blood cell production, including:
1. Aplastic Anemia
Cause:
· neoplastic agent / sitoplastik
· radiation therapy
· certain antibiotics
· drug konvulsan enthusiasm, thyroid, gold compounds, fenilbutason
· benzene
· viral infections (particularly hepatitis)
↓
Decrease in number of cell eritropoitin (stem cells) in bone marrow
Stem cell disorders (disorders division, replication, differentiation)
Barriers humoral / cellular
↓
Impaired stem cell in bone marrow
↓
The number of red blood cells produced inadequate
↓
Pancytopenia
↓
Aplastic Anemia
Symptoms:
· general symptoms of anemia (pale, weak, etc.)
· Deficiency platelets: ekimosis, petekia, epitaksis, gastrointestinal bleeding, urinary tract bleeding, CNS bleeding.
Morphological: anemia normositik normokromik
2. Anemia in kidney disease
Symptoms:
· blood urea nitrogen (BUN) greater than 10 mg / dl
· down 20-30% hematocrit
· red blood cells appear normal on peripheral blood smears
The reason is the decrease in survival of red blood cells and deficiency eritopoitin
3. Anemia of chronic disease
Various chronic inflammatory diseases associated with anemia type normositik normokromik (red blood cells with normal size and color). These disorders include rheumatoid artristis, lung abscess, osteomilitis, tuberculosis and various malignancies
4. Iron deficiency anemia
Cause:
a) inadequate iron intake, increased requirement during pregnancy, menstruation
b) Impaired absorption of (post-gastrectomy)
c) persistent blood loss (neoplasms, polyps, gastritis, varices of esophagus, hemorrhoids, etc..)
↓
eritropoesis disorders
↓
Iron absorption from the intestine less
↓
little red blood cells (the amount is less)
poor red blood cell hemoglobin
↓
Iron deficiency anemia
The symptoms:
a) The atrophy of tongue papillae
b) The tongue was pale, red, inflamed
c) Stomatitis angularis, pain in corner of mouth
d) Morphology: microcytic anemia hipokromik
5. Anemia megaloblastic
Cause:
· Deficiency of vitamin B12 deficiency and folic acid deficiency
· Malnutrition, malabsorption, decreased intrinsic factor (aneia rnis st gastrectomy), parasitic infections, intestinal diseases and malignancies, chemotherapeutic agents, tapeworm infection, eating fresh fish is infected, alcoholics.
↓
Impaired DNA synthesis
↓
Impaired maturation of red blood cell nucleus
↓
Megaloblas (eritroblas large)
↓
Erythrocyte immatur and hipofungsi
6. Anemia hemolitika, namely deficiency anemia red blood cell count caused by destruction of red blood cells:
· Effect of certain drugs
· Disease Hookin, limfosarkoma, multiple myeloma, chronic lymphocytic leukemia
· deficiency glucose 6 phosphate dihidrigenase
· autoimmune process
· transfusion reaction
· Malaria
↓
Erythrocyte cell mutations / changes in erythrocyte
↓
Antigesn on erythrocyte changes
↓
Considered a foreign object by the body
↓
red blood cells destroyed by the lymphocytes
↓
Hemolytic anemia
Signs and Symptoms
o Weak, tired, listless and tired
o Often berkunang complained of dizziness and eye- glow
o Symptoms of advanced form of the eyelids, lips, tongue, skin and palms become pale.
Possible Complications arise
General complications due to anemia are:
o Heart failure,
o Par estisia and
o Seizures.
Special Inspection and Support
o Levels of hemoglobin, hematocrit, red blood cell indices, white blood cell study, levels of Fe, the measurement of iron binding capacity, folate, vitamin B12, platelet count, bleeding time, prothrombin time and partial thromboplastin time.
o bone marrow aspiration and biopsy. Unsaturated iron-binding capacity of serum
o diagnostic examination to determine the presence of acute and chronic diseases as well as the source of chronic blood loss.
Performed by Therapy
Management of anemia is aimed to find the cause and replace lost blood:
1. Aplastic Anemia:
o Bone marrow transplant
o Provision of immunosuppressive therapy with globolin antitimosit (ATG)
2. Anemia in kidney disease
o In paien dialysis should be treated denganpemberian iron and folic acid
o The availability of recombinant eritropoetin
3. Anemia of chronic disease
Most patients have no symptoms and do not require treatment for aneminya, with the successful handling of the underlying abnormality, bone marrow iron used to make blood, so that Hb increases.
4. Anemia in iron deficiency
o Wanted causes of iron deficiency
o Use of oral iron preparations: feros sulfate, gluconate and fumarate ferosus ferosus.
5. Anemia megaloblastic
o vitamin B12 deficiency is treated with vitamin B12, if the deficiency is caused by the unavailability defekabsorbsi or intrinsic factor vitamin B12 can be given by IM injection.
o To prevent recurrence of anemia of vitamin B12 therapy should be continued during the life of patients suffering from pernicious anemia or malabsorption that can not be corrected.
o The handling of folic acid deficiency anemia with diet and addition of folic acid 1 mg / day, IM in patients with impaired absorption.
NURSING
I. Nursing Assessment
a. Age of children: Fe ↓ usually at age 6-24 months
b. Pallor
ü post-bleeding
ü on iron deficiency
ü anemia hemolistik
ü aplastic anemia
c. Easy tired
Lack of oxygen levels in the body
d. Dizziness head
Supply or blood flow is reduced keotak
e. Short Breath
Low levels of Hb
f. quick Nadi
Compensation of cardiovascular reflex
g. Elimination urnie and sometimes a decline in urine production
Decrease in blood flow keginjal so active renin-angiotensin hormaon to hold salt and water as a compensation for the repair perpusi with manefestasi decreased urine production
h. Disturbances in the nervous systems of
B 12 deficiency anemia
i. GI Disorders
In severe anemia often arise pain abdominal pain, nausea, vomiting and decreased appetite
j. Pika
A state that is reduced because children eat substances that tidakbergizi, child anything to eat something that is not food supposed to be (PIKA)
A state that is reduced because children eat substances that tidakbergizi, child anything to eat something that is not food supposed to be (PIKA)
k. Iritabel (whiny, cranky or easily offended)
l. The body temperature increases
Because dikeluarkanya leokosit of ischemic tissue
m. Diet
n. Investigations
- Hb
- Erythrocytes
- hematocrit
o. Program terafi, perinsipnya:
- Depending on the severity of anemia
- Not always in the form of blood transfusion
- Eliminate the cause and relieve symptoms
Normal values of blood cells
Types of blood cells
1. Erythrocytes (million / micro l) age of 5.9 bbl (4.1 to 7.5), 1 Year 4.6 (4.1 to 5.1), 5 Year 4.7 (4.2 -5 , 2), 8-12 Year 5 (4.5 -5.4).
2. Hb (g / dl) Newborns 19 (14-24), 1 of 12 (11-15), 5 Year 13.5 (12.5 - 15), 8-12 years 14 (13-15, 5).
3. Leokosit (per micro liter) 17 000 newborn infants (8-38), 1 Year 10,000 (5-15), 5 of 8000 (5-13), 8-12 Year 8000 (5-12).
Platelets (per micro liter) Newborns 200,000, 1 Year 260 000, 5 260 000 Years, 8-12 Years 260 000
4. Hemotokrit (% 0) Newborns 54, 1 / 36, 5 / 38, 8-12 Year 40.
II. Nursing Diagnosis
1. Intolerance activity b / d of oxygen transport system disorders secondary to anemia
2. Lack of nutrients from the need b / d of non adekuatan secondary input due to: lack of emotional stimulation / sensory or less knowledge about the provision of care
3. Anxiety / anxious b / d of the environment or people
III. PLAN
1) Activity intolerance b / d of oxygen transport system disorders secondary to anemia
Action Plan:
1. Monitor Vital signs such as tachycardia, palpitations, takipnue, dispneu, dizziness, skin discoloration, and other
2. Bantu activity within the limits of tolerance
3. Provide play activities, the transfer to prevent boredom and increase the breaks
4. Maintain the position of Fowler and provide supplemental oxygen
5. Monitor vital signs during rest
2) Lack of nutrients from the need b / d of non adekuatan secondary input due to: lack of emotional stimulation / sensory or less knowledge about the provision of care
Action Plan:
Action Plan:
1. Give nutrient-rich iron (Fe), such as meats, nuts, wheat,
dry cereal iron fortified
dry cereal iron fortified
2. Give milk after eating solid supplements
3. Give peroral iron preparations such as ferrous sulfate, ferrous fumarate, ferrous succinate,
ferrous gluconate, and give it between meals to improve absorption provided with orange
ferrous gluconate, and give it between meals to improve absorption provided with orange
4. Teach them how to prevent tooth discoloration due to drink or eat iron by rinsing after taking drugs, drinking preparations with water or orange juice
5. Give multivitamins
6. Do not give milk preparations with Fe
7. Kaji fases because adequate provision will change into a dark green fases
8. Monitor Hb or sign klinks
9. Encourage food and water to reduce constipation
10. Increase the additional intake of meat and whole grains and green vegetables in your diet
3) Anxiety / anxious b / d of the environment or people
Action Plan:
1. Involve parents with children in preparation for diagnostic procedures
2. Explain the purpose of the blood components
3. Anticipate sensitive excitatory kids, fussiness by helping the child activity
4. Encourage the child to express feelings
5. Give blood, blood cells or platelets in accordance with the provisions, with
hope the child would receive
REFERENCES
Nursalam, Rekawati, Sri Utami, Infant and Child Nursing, Jakarta, Medika, 2005
Robins, Fundamentals of Disease Pathology, EBC, 2005
Introduction of Nursing of the Child, Jakarta, Medika, 2006
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