NURSING ANEMIA

A. Understanding
Anemia is a symptom of an underlying condition, such as loss of blood components, the elements do not adequately or lack of nutrients needed for the formation of red blood cells, resulting in decreased oxygen-carrying capacity of blood (Doenges, 1999). Anemia is a term that indicates low blood cell count red and hemoglobin and hematocrit levels below normal (Smeltzer, 2002: 935). Anemia is reduced to below the normal value of red blood cells, hemoglobin and quality Bloods volume of packed red cells (hematocrit) per 100 ml of blood (Price, 2006: 256 .) Thus, anemia is not a diagnosis or a disease, but rather a reflection of the state of a disease or impaired function of the body and changes the fundamental patotisiologis anemnesis described through a thorough, physical examination and laboratory information.

B. Etiology
The most common cause of anemia is a lack of nutrients necessary for the synthesis of erythrocytes, including iron, vitamin B12 and folic acid. The rest is the result of a variety of conditions such as hemorrhage, genetic abnormalities, chronic disease, drug toxicity, and so forth. general causes of anemia: severe bleeding, acute (sudden), Accident, Surgery, Maternity, Broken blood vessels, Chronic Disease (chronic), nose bleeding, hemorrhoids (hemorrhoids), peptic ulcer, cancer or polyps in the gastrointestinal tract, kidney or bladder tumors, menstrual bleeding, reduction in red blood cell formation, deficiency of iron, vitamin B12 deficiency, folic acid deficiency, vitamin deficiency C, chronic diseases, increased red blood cell destruction, enlargement of the spleen, mechanical damage to red blood cells, the autoimmune reaction against red blood cells, paroxysmal nocturnal Hemoglobinuria, hereditary spherocytosis, hereditary Elliptositosis, G6PD deficiency, sickle cell disease, hemoglobin C disease, Disease hemoglobin SC, hemoglobin E disease, Thalassemia (Burton, 1990).

C. Pathophysiology

Anemia incidence reflects a failure of the bone marrow or excessive loss of red blood cells or both. Bone marrow failure caused by lack of nutrients DAPT, toxic exposure, inuasi tumor, or mostly due to unknown causes. Red blood cells can be lost through bleeding or hemolysis (destruction) in the latter case, the problem can be due to the effects of red blood cells that do not conform to the normal resistance of red blood cells or due to some factor outside the red blood cells that causes destruction of red blood cells. Lysis red blood cells (dissolution) occurs mainly in the phagocytic system or the reticuloendothelial system, especially in the liver and spleen. As a byproduct of this process is bilirubin is formed in phagocytes will enter the bloodstream.Any increase in red blood cell destruction (hemolysis) immediately direpleksikan with increasing plasma bilirubin (normal concentration of 1 mg / dl or less; levels of 1.5 mg / dl cause jaundice in the sclera. Anemia Anemia is a disease characterized low levels of hemoglobin (Hb) and red blood cells (erythrocytes). functions of blood is to carry food and oxygen to all organs of the body. If the supply is less, then the oxygen would be less. effect can inhibit the action vital organs, the brain One. brain consists of 2, 5 billion cell bioneuron. If the capacity is less, then the brain as a computer which weak memory, slow catch., and if it is damaged, it can not be repaired (Sjaifoellah, 1998).

D. Clinical Manifestations

Clinical symptoms appear to reflect dysfunction of various systems in the body such as decreased physical performance, neurological (nerve), which is manifested in behavioral changes, anorexia (emaciated body), pica, and abnormal cognitive development in children. Often, too, the growth abnormality, epithelial dysfunction, and reduced gastric acidity. An easy way to know anemia with 5L, which is weak, tired, listless, tired, spacey. 5 If these symptoms appear, we can be sure a person has anemia. Another symptom is the appearance of the sclera (the pale color on the lower eyelid). Anemia can cause fatigue, weakness, lack of energy and the head was floating. If anemia is more severe, it can cause a stroke or heart attack (Sjaifoellah, 1998).

B. Nursing Diagnosis

Nursing diagnosis is a unification of the problem of real or potential patients based on the data collected (Boedihartono, 1994). Diagnosis nursing appeared in patients with anemia (Doenges, 1999) include:

1.      Higher risk of infection related to an inadequate secondary defenses (decreased hemoglobin leucopenia, or a decrease in granulocytes (inflammatory response depressed)).

2.      Changes in nutrition less than body requirements related to the failure or inability to digest digest food / nutrient absorption necessary for the formation of red blood cells.

3.      Activity intolerance related to imbalance between oxygen supply (delivery) and needs.

4.      Changes in tissue perfusion associated with decreased cellular components necessary for the delivery of oxygen / nutrients to the cells.

5.      Higher risk to damage the integrity of the skin associated with changes in circulation and neurologist.

6.      Constipation or diarrhea associated with lower dietary input; digestive process changes; side effects of drug therapy.

7.      Lack of knowledge with respect with low exposure / recall; incorrect interpretation of information; does not know the source of information.

C. Interventions / Implementation of Nursing: 

1) High risk of infection related to an inadequate secondary defenses (decreased hemoglobin leucopenia, or a decrease in granulocytes (inflammatory response depressed)).

Objective: Infection does not occur. 

Criteria results:

- identify behaviors to prevent / reduce the risk of infection.

- improves wound healing, free of purulent drainage or erythema, and fever.

INTERVENTION & IMPLEMENTATION

Increase good hand washing; by the care givers and patients.

Rationale: prevent cross contamination / bacterial colonization.

Note: patients with severe anemia / aplastic can be risky due to the normal flora of the skin. Maintain strict aseptic technique on the procedure / treatment of wounds.

Rationale: reducing the risk of colonization / infection of bacteria.

Provide skin care, oral and perianal carefully.

Rationale: reducing the risk damage to the skin / tissue and infection.

Motivation change positions / ambulation often, coughing and deep breathing exercises.

Rational: improving pulmonary ventilation all segments and help mobilize secretions to prevent pneumonia.

Increase enter adequate fluids.

Rational: assist in the dilution of respiratory secret to facilitate spending and prevent stasis of body fluids such as respiratory and kidney.

Trends / limit visitors. Provide insulation where possible.

Rationale: limiting exposure to bacteria / infection. Protection of insulation required in aplastic anemia, when the immune response is very disturbed.

Monitor body temperature. Note the chills and tachycardia with or without fever.

Rationale: the process of inflammation / infection require evaluation / treatment.

Observe erythema / wound fluid.

Rationale: indicators of local infection.

Note: the formation of pus may not exist when granulocytes depressed. Take specimens for culture / sensitivity as indicated (collaboration).

Rationale: to distinguish the presence of infection, identify specific pathogens and influence the choice of treatment.

Provide topical antiseptic; systemic antibiotics (collaboration).

Rational: may be used as prophylactic to reduce colonization or for local treatment of the infection process.

2) Changes in nutrition less than body requirements related to the failure or inability to digest digest food / nutrient absorption necessary for the formation of red blood cells.

Objective: nutritional needs are met

Criteria results :

- Maintain your weight with normal laboratory values.

- No sign of mal nutrition experience.

- To show for behavioral, lifestyle changes to improve and or maintain an appropriate body weight.

INTERVENTION & IMPLEMENTATION

Assess nutritional history, including a favored meal.

Rational: identifying deficiencies, facilitate intervention.

Observation and record food enter the patient.

Rationale: overseeing enter or quality of calorie consumption of food shortages.

Measure your weight every day.

Rationale: overseeing the effectiveness of weight loss or nutrition intervention.

Provide eat a little with frequency frequent and or eating between meals.

Rationale: lowering weakness, increased intake and prevent gastric distention.

Observation and record the incidence of nausea / vomiting, flatus and and other related symptoms.

Rationale: GI symptoms may indicate the effect of anemia (hypoxia) in the organ.

Provide and good oral hygiene aids, before and after eating, use a soft toothbrush to brush the soft. Give dessert in dilute when oral mucosa injury.

Rationale: increased appetite and oral intake. Lowering the growth of bacteria, minimizes the chance of infection. Special oral care techniques may be needed when the network brittle / injuries / bleeding and severe pain.

3) Activity intolerance related to imbalance between oxygen supply (delivery) and needs.

Objective: to maintain / improve ambulation / activity.

Criteria results:

- Reported an increase in tolerance activities (including activities of daily living)

- Showed a physiological sign of intolerance, such as pulse, respiration, and blood pressure is still within normal range.

INTERVENTION & IMPLEMENTATION

Assess the patient's ADL ability.

Rationale: influencing choice of intervention / assistance.

Monitor loss or balance disorders , gait and muscle weakness.

Rationale: show changes neurology of vitamin B12 deficiency affects patient safety / risk of injury.

Observation vital signs before and after the activity.

Rationale: cardiopulmonary manifestations of heart and lung effort to bring an adequate amount of oxygen to the tissue.

Provide quiet environment, limit visitors, and reduce noise, maintain bed rest is indicated when.

Rationale: improving breaks to lower the body's need for oxygen and lowering strain the heart and lungs.

Use the energy-saving techniques, instruct the patient in case of fatigue breaks and weaknesses, instruct the patient did his best activity (without imposing themselves).

Rational: increase activity gradually to normal and improve muscle tone / stamina without drawbacks. Boost the self-esteem and sense of control.

4) Changes in tissue perfusion associated with decreased cellular components required for the delivery of oxygen / nutrients to the cells.

Objective: increase tissue perfusion.

Criteria results:

- indicates inadequate perfusion, such as vital signs stable.

INTERVENTION & IMPLEMENTATION

Supervise:

Vital signs assess capillary refill, color of skin / mucous membranes, nail beds.

Rational: provides information about the degree / adequacy of tissue perfusion and help determine the need for intervention.

Elevate head of bed as tolerated.

Rationale: increased lung expansion and maximizes oxygenation for cellular needs.

Note: if there are contraindications hypotension. supervising respiratory effort; auscultation of breath sounds adventisius note sounds.

Rational: dyspnea, the rush to show for impaired cardiac strain jajntung as long / compensation increase cardiac output.

Investigate complaints of chest pain / palpitations.

Rationale: cellular ischemia affects myocardial tissue / potential risk of infarction.

Avoid using a bottle warmer or hot water bottle. Measure the temperature of bath water with a thermometer.

Rationale: termoreseptor superficial dermal tissue due to interruption of oxygen. collaboration surveillance laboratory test results.

Give full of red blood cells / blood product packed as indicated.

Rationale: identify deficiencies and needs treatment / response to therapy.

Provide supplemental oxygen as indicated.

Rationale: maximizing oxygen transport to the tissues.

5) high risk for skin integrity related damage circulation and neurologic changes.

Objective: to maintain skin integrity.

Criteria results:

- identifying risk factors / behaviors of individuals to prevent dermal injury. INTERVENTION & IMPLEMENTATION

Assess skin integrity, record changes in turgor, impaired color, warm local, erythema, excoriation.

Rational: skin conditions affected by circulation, nutrition and immobilization.

Networks can become brittle and prone to infection and damage. repositioned periodically and massage the bone surface or if the patient does not move in bed.

Rationale: improving skin circulation everyone, limiting tissue ischemia / hypoxia affects cell.

Instruct the skin surface dry and clean. Limit the use of soap.

Rationale: humid areas, contaminated, providing a very good medium for the growth of pathogenic organisms. Soap can dry out the skin excessively.

Help for range of motion exercises.

Rationale: increased circulation network, preventing stasis.

Use protective equipment, such as sheepskin, baskets, mattresses air pressure / water. Protective heel / elbow and pillows as indicated. (Collaboration)

Rationale: avoid skin damage by preventing / decreasing the pressure on the skin surface.

6) Constipation or diarrhea associated with lower dietary input; digestive process changes; side effects of drug therapy.

Goal: create / return patterns of normal bowel function.

Expected outcomes :

- shows the change of behavior / lifestyle, which is needed as a cause, factor weights.

INTERVENTION & IMPLEMENTATION

Observation stool color, consistency, frequency and amount.

Rational: help identify the cause / factor ballast and appropriate intervention.

Auscultation bowel sounds. 

Rational : bowel sounds in general increased in diarrhea and constipation decreased.

Supervising the intake and output (food and fluids).

Rational: to identify dehydration, excessive loss or tool in identifying dietary deficiency.

Encourage fluids enter 2500-3000 ml / day in tolerance heart.

Rationale: helps to improve the consistency of the stool when constipated. Will help maintant hydration status on diarrhea.

Avoid gas forming foods.

Rationale: reducing gastric distress and abdominal distension Assess the perianal skin conditions with frequent, record changes in skin condition or begin to malfunction.

Perform maintenance defecation perianal every case of diarrhea.

Rationale: prevent skin excoriation and damage.

Collaboration siembang nutritionist for a diet with high fiber and bulk.

Rationale: fibers resist digestive enzymes and absorbing water in the stream along the intestinal tract and thus produce bulk, who works as a stimulus for defecation. Provide pelembek stool, mild stimulant, bulk-forming laxatives or enemas as indicated.

Monitor effectiveness. (Collaboration).

Rational: defecation easier if constipation occurs.

Provide antidiarrheal medications, such Defenoxilat hydrochloride with atropine (Lomotil) and drug absorbs water, such as Metamucil. (Collaboration).

Rational: decrease intestinal motility when diarrhea occurs.

7) Lack of knowledge with respect to the lack of exposure / recall; incorrect interpretation of information; does not know the source of information.

Objective: patients know and understand about the disease, diagnostic procedures and treatment plans.

Expected outcomes :

- The patient expressed understanding of the disease process and management of the disease.

- identify the factors causing.

- Doing tiindakan that needs / lifestyle changes.

INTERVENTION & IMPLEMENTATION

Provide specific information about anemia. Discuss the fact that the therapy depends on the type and severity of anemia.

Rationale: provides the knowledge base so that the patient can make the right choice. Lowers anxiety and can improve cooperation in treatment programs.

Review your goals and preparation for a diagnostic assay.

Rationale: anxiety / fear of ignorance increases stress, further increasing heart load. Knowledge lowers anxiety.

Assess the level of knowledge of the client and family about the disease.

Rationale: megetahui how much experience and knowledge of the client and family about the disease.

Provide a description of the client about his illness and his condition now.

Rational: by knowing the disease and its present state, the client and family will feel calm and reduce anxiety.

Instruct client and family to watch his diet.

Rational: diet and proper diet helps the healing process.

Prompt repeat clients and families about the material that has been given.

Rationale: knowing how far understanding of clients and their families and assess the success of the action taken.

REFERENCES

Boedihartono. 1994. Nursing Process in the Hospital. Jakarta.

Burton, JL 1990. Practical Aspects of Medicine. Binarupa Script: Jakarta

Carpenito, LJ 1999. Nursing care plans and documentation of nursing, Nursing Diagnosis and Collaborative Problems, ed. 2. EGC: Jakarta

Doenges, Marilynn E. 1999. Nursing care plan guidelines for planning and documenting patient. ed.3. EGC: Jakarta

Effendi, Nasrul. 1995. Introduction to Nursing Process. EGC: Jakarta.

Hassa. 1985. Child Health, vol 1. FKUI: Jakarta