INTRODUCTION

Everyone knows that we can't live without blood. Without blood, our organs couldn't get the oxygen and nutrients they need to survive, we couldn't keep warm or cool off, we couldn't fight infections, and we couldn't get rid of our own waste products. Without enough blood, we'd weaken and die.

There are diseases and conditions involving the blood. The most common is anemia. An anemia is a condition in which the number of red blood cells (RBC) or the amount of hemoglobin (the protein in red blood cells that carries oxygen throughout the body) is below normal. Megaloblastic Anemia (MGA), also known as Pernicious Anemia, is a rare blood disorder characterized by the presence of large, structurally and visually abnormal, immature red blood cells (megaloblasts). Decreased numbers and immaturity of white blood cells (leukocytes) and blood platelets (thrombocytes) may also occur. Megaloblastic Anemias are usually caused by a deficiency or defective absorption of either vitamin B12 (cobalamin) or folic acid. As a result, they are also known as the vitamin deficiency anemias. In most cases, the fundamental flaws leading to the several forms of MGA caused by vitamin deficiencies are present at the time of birth and exist as a result of a genetic defect. In addition, certain immunosuppressive drugs may also cause Megaloblastic Anemia.

As student nurses, we must be aware of the signs and symptoms of the disease so we could be more effective in doing our duties.

OBJECTIVES

GENERAL:

To improve our skills, knowledge and attitude necessary to care for our

patients with megaloblastic anemia.

SPECIFIC:

1. To understand the disease process, its etiology, signs and symptoms,

pathophysiology and diagnostic procedures,

2. To discuss and describe interventions for health promotion, prevention and

treatment of patients with megaloblastic anemia.

3. To develop a teaching program that will educate patients especially those

who are susceptible to anemia by reiterating the importance of good and

healthy nutrition.

4. To assist patients in overcoming the anxiety and depression brought about by

the condition.

5. To promote awareness to individuals by imparting knowledge so they could

learn and understand more about megaloblastic anemia.

Biographic data:

Name: Mr. XAddress: Caloocan CityAge: 40 years oldSex: MaleMarital Status: married Religion: Roman CatholicHealth Care financing: United HealthcareUsual Source of Medical Care: Health personnelChief Complaints: WeaknessMedical Diagnosis: Megaloblastic AnemiaDoctor: Dr. Romeo Rivera

History of present illness:

According to the patient, he was first diagnosed with Megaloblastic anemia last June of 2006 when he was hospitalized for 3 days at the Martinez Memorial Hospital. He was admitted with chief complain of body weakness. He received blood transfusion when hematology laboratory results revealed decreased blood count. From then on, he needed blood transfusion every time his blood count would fall below normal.

He was again hospitalized recently in the same institution. According to him, his appetite was decreased and had difficulty walking which is a common manifestation of anemia because of weak muscles. He was also pale and noticeably irritable. The laboratory results showed an alarming decrease in blood components. His hemoglobin count was 8.2 g/dl as compared to normal adult male range of 14 - 18 g/dl; hematocrit of 25% compared to normal adult male range 40 - 54% and RBC count of 2.5 mill/mcl, normal adult male range 4.2 - 5.6 mill/mcl.

Past history

According to Mr. X, he had measles when he was young, aside from the usual fever and cough. He doesn’t remember having immunizations although his mother has told him before that he completed his immunization vaccines when he was young,

He is not allergic to drugs, animals, insects, food or other agents.

Accidents and Injuries:

No accidents and injuries.

Family History Illness:

Hypertension and diabetes on his mother side.

Lifestyle and Personal Habits

Mr. X is a non-smoker but was a heavy drinker. When he was hospitalized two years ago, he stopped drinking under his physician’s advice. He doesn’t drink coffee or tea. He drinks soda once in awhile. He only takes drugs prescribed to him by his physician.

Social data:

Mr. X has a good relationship with regards to his family and relatives. He loves to travel. Before he was diagnosed with megaloblastic anemia, they would go to his hometown province and spend a few days there. Summer was his children’s favorite time of the year because they would often go out of town. But because of his condition, his lifestyle was changed. He tires easily aside from the fact that blood transfusion and hospital bills affect his family’s financial status.

Diet:

Mr. X eats 3-4 times a day. He prefers to eats fish and vegetables but would sometimes eat meat also.

Sleep/Rest Pattern:

According to him, he has ample time to rest although sometimes, because of stress brought about by his condition, he has difficulty falling asleep.

Ethnic affiliation:

Mr. X grew up in the province and is a believer of nuno sa punso, dwarfs and other superstitious beliefs He also believes in herb or quack doctors and faith healers.

Educational History:

Mr. X is a high school graduate from Mindoro.

Occupational History:

Mr. X has a small business painting cars. It is enough to make both ends meet for him, his wife and 3 children. He earns roughly about P30,000 - P40,000 every month. But since he was diagnosed with anemia, he works less and naturally earns less. His wife helps him by being a retail person for Avon and Saralee among others.

Economic Status:

Having a medical insurance helps him pay his medical bills. His family helps too in whatever way they can.

Psychological Data:

What troubles Mr. X most is his family’s financial concern. He doesn’t want to see his family suffer because of his condition. He wants to see his 3 children to grow up and be professionals some day.

GORDON’S FUNCTIONAL HEALTH PATTERNS

PATTERN OF HEALTH PERCEPTION AND HEALTH MANAGEMENT

Mr. X is very particular about his and his family’s health. He believes in the

saying that health is wealth. When he started feeling weak and had difficulty

breathing after doing some light activities, he went to see his doctor right away. No

one in his family was ever hospitalized so it is a bit difficult for him to accept the fact

that he, supposedly the head and pillar of the family is sick. At first, he had no clue

about what his condition is. But as time goes by, he learns a lot from his doctors and

his nurses.

NUTRITIONAL – METABOLIC PATTERN

Height : 5’7”

TIME FRAME WEIGHT BMI INTERPRETATIONBefore illness 136 lbs 20.64 NormalDuring illness 122 lbs 18.66 NormalWeight as of Feb. 1, 2007 122 lbs 18.66 Normal

Basis of Interpretation:

BMI of < 18.5 is classified as underweight BMI of 18.5 to 24.9 is classified as normal BMI of 25 to 29.9 is classified as overweight BMI of 30 to 39.9 is classified as obesity

*BODY MASS INDEX (BMI) = weight (kg) / height (m⅔)

Although Mr. X lost 14 lbs from the time prior to his illness up to the present, his body weight is still within the normal range based on his BMI.

DIETARY PATTERN

BEFORE ILLNESS PRESENTMEALS AMOUNT FOODS/DRINKS AMOUNT FOODS/DRINKS

Breakfast 2-3 cups3-5 pieces

2 glasses

RiceBoiled/scrambled eggswater

1 cup1 serving1 glass1 glass

RiceFish/vegetablesJuiceWater

Lunch 2-3 cups1 serving2 glasses

RicePork/fish/vegetableswater

1 cup1 serving2 glasses

RicePork/fish/vegetableswater

Snacks 1-2 pieces1-2 glasses

SandwichCola drinks

1 serving2 glasses

Pancit canton/ sopaswater

Dinner 2 cups1 serving2 glasses

RiceFish/vegetableswater

1 cup1 serving2 glasses

RiceFish/ vegetableswater

Favorite Foods : Dishes like pinakbet, sinigang na baboy or bangus, Vegetables like eggplant, ampalaya, and cabbage. Fruits like mango, apple and orange.

Vitamins : Folic Acid

VISIT TO FAST FOODRESTAURANTS : 2-3 x a week

(Jollibee, McDonalds, KFC)Allergies to Foods : None

PATTERN OF ELIMINATION

Bowel Elimination Before illness Present

Frequency Once a day Once a day

Character of stool Brownish, solid Brownish, solid

Problem Encountered None None

Urinary Elimination Before illness Present

Frequency 8 -10 x a day 8 -10 x a day

Character of urine Aromatic, pale yellow Aromatic, pale yellow

Problems Encountered None None

PATTERN OF ACTIVITY AND EXERCISE

Typical activity for the day prior to admission

Time Activity

6:00 – 7:00 AM > Wakes up

7:00 – 8:00 AM > prepare and eat breakfast

8:00 – 11:00 AM > Work

11:00-11:30 AM > Rest

11:30 – 12:00 NN > Eat lunch

12:00 – 1:30 AM > rest and sleep

1:30 – 5:00 PM > Work

5:00-6::00 PM > Socialize with neighbors and friends

6:00 – 7:00PM > Helps prepare dinner

7:00 - 8:00 PM > Eat dinner with family

8:00 – 11:00PM > Watch TV/Read

11:00 PM > Bed time

COGNITIVE – PERCEPTION PATTERN

We see no problem about the way he communicates. He could comprehend

easily and could recall past as well as recent events in his life. He talks with sense

and explains things logically.

PATTERN OF SELF PERCEPTION AND SELF CONCEPT

Mr. X has a positive outlook about life in general. He doesn’t take it against

himself or against anybody for what happened to him. He is very optimistic that he

would be better. In fact he is willing to undergo any medical interventions to alleviate

his sufferings and to prolong his life. He has his family’s support and that is what’s

giving him strength to battle towards recovery.

ROLE RELATIONSHIP PATTERN

Mr. X married his childhood sweetheart. He lives with wife and 3 children, 2

boys and 1 girl, all of them are going in a nearby public school. He is close with all of

his kids because he sees to it that he spends quality time with them even though he

tires easily. His wife is very supportive with what he is going through.

SEXUALITY PATTERN

According to Mr. X, although the quantity is lessened, he and his wife still

enjoy sex even after having 3 children and being married for almost 15 years. His

wife is “malambing” and thoughtful. She never misses to let him feel how much she

loves him and how much they need him. He admitted that his family is not a perfect

one but he and his wife made it a point to iron things out before it gets worse.

PATTERN OF COPING AND STRESS TOLERANCE

Mr. X views his problem more as a trial than an obstacle. Even though it

affected his work, it did not dampen his spirit and trust in the Lord. According to him,

it made him a better person. Now he realized the value of what he has. The only

thing that stresses him out is about his family’s finances. But as of now, they could

still manage. They still could eat 3-4 meals a day and he can still send his children to

school despite the hospital bills. Before his diagnosis, he copes stress by drinking

and playing basketball with his sons. Now, he feels relax when he watches the

television or listens to the radio. He plans on doing some gardening too because

according to one of his friends, gardening is one of the best way to relieve stress.

PATTERN OF VALUES AND BELIEFS

He believes in God and that God won’t give him problems he could not bear.

When he is not in the hospital, they go and hear mass as a family. He also has

strong ties with his mother and siblings. They don’t see each other as much as they

used to but because of the technology that we have now, the communication lines

remain open. In spite of his condition, he still provides for his family because that is

what his own father instilled in his mind when he was growing up. The man should

be the head and the pillar of the family. According to him, to be able to be called a

man, one has to provide, support and defend his family.

PHYSICAL ASSESMENT

I. GENERAL APPEARANCE

a. Body Build : Medium Frame

b. Height and weight : 5’7”; 122 lbs

c. Posture : erect and straight body posture

d. Hygiene and grooming : clean and neat

e. Body breath and odor : none

f. Appearance : appears weak

g. Mental status : clear and intact memory both recent

and remote, oriented to person, time

and place

h. Attitude : cooperative

i. Mood and affect : appropriate to situation

j. Organization of speech : understandable, moderate pace

k. Relevance and organization: has logical sequence and sense of

reality of thought

II. VITAL SIGNS

a. Temperature : 36.6’ C

b. Pulse Rate : 75 bpm

c. Respiration Rate : 18 bpm

d. Blood Pressure : 110/70 mmHg

III. INTEGUMENT

A. Skin

a. Color complexion : fair complexion

b. Skin moisture : dry, slightly wrinkled, dry lips

c. Skin temperature : normal

d. Skin turgor : slightly poor skin turgor

B. Nails

a. Fingernail plate shape : convex

b. Texture : smooth

c. Bed color : pink

d. Capillary refill : pink in color returns after 5 secs.

- Intact epidermis around the nail

IV. HEAD

A. Hair

a. Color : black

b. Distribution : evenly distributed

c. Texture and oiliness : silky, fine and oily

- Thin strands of hair

B. Scalp

- Absence of drandruff

- No lesions, masses, deformities, swelling and tenderness.

C. Skull

- Normocephalic

- Smooth, uniform consistency; absence of nodules or masses

D. Face - symmetrical facial features and movements

E. Eyes and Vision

a. Eyebrows : eyebrows are black, evenly distributed

and symmetrically aligned

b. Eyelashes : equally distributed, slightly curled

outward

c. Eyelids : skin is intact, lids close symmetrically

d. Bulbar conjunctiva : transparent, capillaries are not

evident, sclera appears yellowish

e. Palpebral conjunctiva: shiny, smooth, and slightly yellowish

f. Lacrimal gland : no edema, or tenderness over the

gland

g. Pupils : black in color, iris appears yellowish

h. Visual acuity : decreased visual acuity, difficulty in

reading prints in near vision (farsighted

65 degree)

i. Visual field : decreased peripheral vision

j. Consensual reaction to light and accommodation: normal

constriction of pupil upon the presence

of light ( PERRLA)

F. Ears and hearing

a. Auricles : symmetrical, skin color is same with

facial skin, aligned with outer canthus of

the eye; movable, firm and tender,

recoils back after it is folded

b. External ear canal : with scant amount of cerumen and few

cilia

c. Gross hearing acuity test: able to hear normal voice and

able to hear whisper voice within 6 inches (15. 24 cm)

V. NECK : No area of tenderness

-No masses found

-Range of motion is done actively within

normal limits and pain free

VI. CHEST

a. Anterior chest : intact skin with uniform color,

-no area of tenderness,

-no mass is found with visible bone

prominence

-Symmetrical chest expansion

b. Posterior Chest : fair complexion

- smooth skin

- no evidence of enlargement

- no area of tenderness

- no mass is found

VII. UPPER EXTREMITIES

a. Shoulder : range of motion on right shoulder is actively

done within normal limits and pain free.

- Left shoulder’s range of motion are done in

active assistive with restricted motions due to

IV line

b. Elbows : range of motion on left elbow is actively done

within normal limits and pain free.

-Right elbow’s range of motion is done actively

with normal limits and pain free.

c. Wrist and hands : range of motion of right wrist and fingers are

actively done within normal limit and pain free.

- Left wrist and fingers are not movable due to

inserted IV line.

d. Muscles : No tenderness found

VIII. ABDOMEN : soft abdomen, no masses and areas of

tenderness

-Uniform in color with no evidence of

enlargement of liver and spleen.

-Umbilicus is in the normal position between

the xiphoid process and symphysis pubis with Normal

Abdomen Bowel Sound (NABS)

IX. LOWER EXTREMITIES : fair complexion, smooth skin, symmetrical\

muscles, intact skin, warm to touch with good muscle

tone

-Range of motion on joints is done within normal limits

and pain free.

-Toe nails: with good capillary refill upon blanch tests

(<5 secs), convex, pinkish nail beds with intact skin

around the nails.

REVIEW OF SYSTEMS:

1. Hematopoietic system:

Normal Value Result Interpretationa. Hemoglobin 14 - 18 g/dl 8.2 Decreasedb. Hematocrit 40 - 54% 25 Decresed

c. RBC 4.2 - 5.6 mill/mcl 2.5 Decreasedd. WBC 3.8 - 10.8 thous/mcl 5.1 Normal

2. Genito-Urinary System

- Urinates 8-10 times per day, having a characteristic of aromatic pale yellow with no burning sensation.

3. Respiratory System:

Normal ResultRespiratory rate 12-20 bpm 18 bpm(normal)

4. Cardiovascular system:Normal Result

Pulse rate 60-100 bpm 75 bpm( normal )Blood pressure 120/180 mmHg 110/70( normal )

5. Integumentary System:

Normal ResultTemperature 37.5 36.6( normal)

6. Digestive System:- No constipation, no diarrhea and no allergies found.- Eliminates once a day (am), having a characteristic of brownish solid

and doesn’t experience any pain sensation.

7. Reproductive System:- No. of child: 3- Reproductive organs are well-functioning. No inflammations found.

However, having such condition lessened the number of times that they make love.

LABORATORIES

Date Taken: Feb. 1, 2008

Hospital: Martinez Memorial Hospital

Hematology Report

Normal Values Results InterpretationHemoglobin 14 - 18 g/dl 8.2 Decreased. In case of

megaloblastic anemia are abnormally large cells predominate, thicker as well as larger in diameter than normal RBC it appear supersaturated with hemoglobin. The RBC count is reduced more than proportionately as compared with hemoglobin

Hematocrit 40 - 54% 25 Decreased. Indicated by a reduced volume of packed red cells

followed by RBC counts and hemoglobin. Blood smear examination found evidences of macrocytes and nucleated red cells.

RBC 4.2 - 5.6 mill/mcl 2.5 Decreased. Disturbed red cell formation

WBC 3.8 - 10.8 thous/mcl 5.1 NormalPlatelet 150 - 450 245 NormalNeutrophil 0.500 – 0.700 0.692 NormalLymphocyte 0.200 – 0.500 0.328 NormalEosinophil 0 – 0.060 0.022 NormalMonocyte 0.020 – 0.090 0.021 NormalBasophil 0 – 0.20 0.002 Normal

Blood type : A

Rh : (+)

ANATOMY AND PHYSIOLOGY

The

The production of red blood cells is referred to as erythropoiesis.Mature red blood cells develop from haemocytoblasts. This development

takes about 7 days and involves three to four mitotic cell divisions, so that each stem cell gives rise to 8 or 16 cells.

The various cell types in erythrocyte development are characterised bythe gradual appearance of haemoglobin and disappearance of ribonucleic acid (RNA) in the cellthe progressive degeneration of the cell's nucleus which is eventually extruded from the cellthe gradual loss of cytoplasmic organelles, for example mitochondria

a gradual reduction in cell size

The young red cell is called a retlculocyte because of a network of ribonucleic acid (reticulum) present in its cytoplasm. As the red cell matures the reticulum disappears. Between 2 and 6% of a new-born baby's circulating red cells are reticulocytes, but this reduces to less than 2% in the healthy adult. However, the reticulocyte count increases considerably in conditions in which rapid erythropoiesis occurs, for example following haemorrhage or acute haemolysis of red cells. A reticulocyte normally takes about 4 days to mature into an erythrocyte.

In health, erythropoiesis is regulated so that the number of circulating erythrocytes is maintained within a narrow range. Normally, a little less than l% of the body's total red blood cells are produced per day and these replace an equivalent number that have reached the end of their life span. However that still represents a huge 200,000,000,000 cells

Erythropoiesis is stimulated by hypoxia (lack of oxygen). However, oxygen lack does not act directly on the haemopoietic tissues but instead stimulates the production of a hormone, erythropoietin. This hormone then stimulates haemopoietic tissues to produce red cells.

Erythropoietin is a glycoprotein. It is inactivated by the liver and excreted in the urine. It is now established that erythropoietin is formed within the kidney by the action of a renal erythropoietic factor erythrogenin on plasma protein, erythropoietinogen.

Erythrogenin is present in the juxtaglomerular cells of the kidneys and is released into the blood in response to hypoxia in the renal arterial blood supply.Various other factors can affect the rate of erythropoiesis by influencing erythropoietin production.

Thyroid hormones, thyroid-stimulating hormone, adrenal cortical steroids, adrenocorticotrophic hormone, and human growth hormone (HGH) all promote erythropoietin formation and so enhance red blood cell formation (erythropoiesis). In thyroid deficiency and anterior pituitary deficiency, anaemia may occur due to reduced erythropoiesis.

Polycythaemia (excess red blood cell production) is often a feature of Cushing's syndrome. However, very high doses of steroid hormones seem to inhibit erythropoiesis. Androgens (male hormones) stimulate and oestrogens (female hormones) depress the erythropoietic response. In addition to the effects of menstrual blood loss, this effect may explain why women tend to have a lower haemoglobin concentration and red cell count than men.Plasma levels of erythropoietin are raised in hypoxic conditions (low oxygen levels). This produces erythrocytosis (increase in the number of circulating erythrocytes) and the condition is known as secondary polycythaemia.

A physiological secondary polycythaemia is present in the foetus (and residually in the new-born) and in people living at high altitude because of the relatively low partial pressure of oxygen in their environment. Secondary polycythaemia occurs as a result of tissue hypoxia in diseases such as chronic bronchitis, emphysema and congestive cardiovascular abnormalities associated with right-to-left shunting of blood through the heart, for example Fallot's tetralogy. Erythropoietin is also produced by a variety of tumours of both renal and other tissues.The oxygen carrying capacity of the blood is increased in polycythaemia but so is the thickness (viscosity)of the blood. The increased viscosity produces circulatory problems such as raised blood pressure.Ther is a condition known as primary polycythaemia (polycythaemia rubra vera), where there are increases in the numbers of all the blood cells, and plasma erythropoietin levels are normal. The cause of this condition is unknown.The underlying cause of secondary polycythaemia is treated with the aim of eliminating hypoxia. Venesection (blood letting) is sometimes employed to reduce red cell volume to normal levels. Frequently blood is removed, centrifuged to remove cells and the plasma returned to the patient (plasmapheresis).In anaemia there is a reduction in blood haemoglobin concentration due to a decrease in the number of circulating erythrocytes and/or in the amount of haemoglobin they contain. Anaemia occurs when the erythropoietic tissues cannot supply enough normal erythrocytes to the circulation. In anaemias due to abnormal red cell production, increased destruction and when demand exceeds capacity, plasma erythropoietin levels are increased. However, anaemia can also be caused by defective production of erythropoietin as, for example, in renal disease.

GastritisGastritis

Faulty Dietary IntakeFaulty Dietary Intake

Dysfunctional Parietal Cell of the StomachDysfunctional Parietal Cell of the Stomach

Lack of Intrinsic Factor (GLYCOPROTEIN)Lack of Intrinsic Factor (GLYCOPROTEIN)

Malabsorption of Vitamin B12Malabsorption of Vitamin B12

Dysfunctional Binding of Transcobalamin IIDysfunctional Binding of Transcobalamin II

Vitamin B12 DeficiencyVitamin B12 Deficiency

Ineffective ErythropoiesisIneffective Erythropoiesis

Hypersegmented NeutrophilsHypersegmented NeutrophilsAbnormal ErythroblastAbnormal Erythroblast

MegaloblastMegaloblast

Megaloblastic AnemiaMegaloblastic Anemia

Decreased OxygenationDecreased OxygenationDecreased Nutrients to CellsDecreased Nutrients to Cells RBC Count 2.5 (decreased)RBC Count 2.5 (decreased)

Hemoglobin 8.2 (deceased)Hemoglobin 8.2 (deceased)Abnormal Cell MetabolismAbnormal Cell Metabolism Tissue HypoxiaTissue Hypoxia

Decreased production of energyDecreased production of energy Body WeaknessBody Weakness

Poor Skin TurgorPoor Skin Turgor Weight LossWeight Loss

PallorPallor

122 lbs122 lbs

DRUG STUDY

DRUG ACTION INDICATION CONTRAINDICATIO

N

SIDE EFFECTS

ADVERSE REACTION

DRUG INTERACTION

NURSING RESPONSIBILITIES

Generic Name: Antamin

Classification:Antihistamine/ antiallergic

Dosage:1 amp. IV prior to BT

Competes with histamine for Receptor sites on effector cells Drug prevents but doesn’t reverse histamine mediated response.

Allergy Prophylactic drug for possible BT reaction

Lower respiratory tract disease

Drowsiness, hypnosis, gastrointestinal

Depression, Irritability, hallucination, muscular weakness, incoordination, headache

No known drug-drug interaction.

Warn the patient to avoid alcohol and hazardous activities that require alertness until CNS effects of drug. Observe for the 10 R’s of the drug

DRUG STUDY

DRUG ACTION INDICATION CONTRAINDICATION SIDE EFFECTS

ADVERSE REACTION

DRUG INTERACTION

NURSING RESPONSIBILITIES

Generic Name: Aeknil

Classification:Non-oploid analgesic

Dosage:1 amp. IV PRN ANST(-)

Unknown, thought to produce analgesic by blocking pain impulses

fever Long term use in anemia

Skin rashes and other allergic reactions,GI disturbance

Hematologic anaphylaxis, tinnitis

No known drug-drug interaction

-Warn the patient that high doses of long term use can cause liver damage.

-Observe for the 10 R’s of the drug administration

DRUG STUDY

DRUG ACTION INDICATION CONTRAINDICATION

SIDE EFFECTS

ADVERSE REACTION

DRUG INTERACTION

NURSING RESPONSIBILITIES

Generic Name: Folic Acid

Classification:Vitamin B complex

Dosage:OD

-It is converted to tetrahydrofolic acid which is a cofactor in the biosynthesis of purines and thymidylates of nucleic acid.

-Synthetic folic acid is absorbed from the GI tract even if the client suffers from malabsorption syndrome.

Treatment of megalo-blastic anemia and nutritional deficiency

Use in aplastic, hormocytic or pernicious anemia.

Allergies, rashes, itching

Erythema, general malaise, abdominal distention, flatulence, bitter or bad taste

No known drug-drug interaction

-Take only as directed. Avoid alcohol.

-Drug may discolor urine into a deep yellow.

-Add dietary sources of folic acid which includes: green leafy vegetables, beans, milk, fortified breads and cereals

-Observe for the 10 R’s of the drug administration

DRUG STUDY

DRUG ACTION INDICATION

CONTRAINDICATION

SIDE EFFECT

ADVERSE REACTION

DRUG INTERACTION

NURSING CONSIDERATION

Brand Name:Pred 20

Generic Name: Prednisone

Classificatio:Anti inflammatory

Dosage:1 tab TID

-3 to 5 times as potent as cortisone or hydrocortisone

-May cause moderate fluid retention.

-Metabolized in the liver to prednisone, the active form

Erythroblastopenia

Contraindicated with infections, especially TB, fungal infections, varicella.

Weight gain, headache

Vertigo, insomia, depression, cataracts, peptic ulcer

No known drug-drug interaction

-Take only as directed. Avoid alcohol.

-Observe for the 10 R’s of drug administration

-Report for any adverse reaction.

NURSING CARE PLAN

ASSESSMENT NURSING DIAGNOSIS

RATIONALE PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective: “sa totoo lang di ko talaga alam kung ano ang leukemia” as verbalized by the patient.

Knowledge deficit related to lack of information resources as manifested by verbalization of situation reflecting ignorance.

Deficiency of cognitive information regarding the etiology as well as the signs and symptoms of the disease.

The patient will be able to attain right information and knowledge about the nature of illness within 2 hours.

- Determine client’s ability to learn.

- Provide information relevant to the situation.

- Use team and group teaching as appropriate

- To determine the cognitive ability of the patient.

- To add new information relevant to the condition of the patient.

- So that the patient will be easily gain some relevant information because they can share information

Goal is met: After 2 hrs of nursing intervention, the patient gained correct information and knowledge regarding his condition.

NURSING CARE PLAN

ASSESSMENT NURSING DIAGNOSIS

RATIONALE PLANNING IMPLEMENTATION RATIONALE EVALUATION

- 4 secs of nail blanch test

- pallor

- decreased count of hematocrit (25)

- decreased count of hemoglobin(8.2)

- decreased count of RBC(2.5)

Risk for ineffective tissue perfusion (peripheral) related to decreased Hgb concentration in the blood as manifested by decreased hemoglobin(8.2)

In case of megaloblastic anemia there is an abnormal production of enlarged but few RBC, the Hgb decreases thus lowering the oxygen-carrying capacity of the blood that is at risk for failure to nourish the tissues at capillary level

The patient will be able to increase his RBC and Hgb concentrations within 4 hours.

- Give blood transfusion as ordered by the physician.

- Instruct the patient to limit his physical activities.

- Encourage the patient to eat foods rich in Vit. B12, protein and Iron.

- Instruct the patient to take

- To replace the decreased count of RBC and Hgb.

- Extreme activities consume a greater concentration of O2.

- Vit.B12 is required for for healthy RBC; iron is important for the delivery of O2 to tissues and blood components; protein to build and repair tissues.

- After 4 hours of nursing intervention, the laboratory results showed an increase in the patient’s Hgb and RBC count.

folic acid and as prescribed by the doctor.

- Folate is required for the nucleoprotein synthesis and maintainance of normal erythropoiesis

NURSING CARE PLAN

ASSESSMENT NURSING DIAGNOSIS

RATIONALE PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective: “para akong nauupos na kandila.” As verbalized by the patient.

Objectives:- Weakness

-Dyspnea

-Pallor

-Decreased activity level

Activity intolerance related to insufficient oxygen delivery to the body parts secondary to production of abnormally large RBC as evidenced by body weakness.

Any anemia in which there is a predominant number of megaloblasts, erythroblasts and relatively few normoblasts among the hyper-plastic erythroid cells in the bone marrow characterized by numbness and tingling,weakness, a soar smooth tongue as well as

Within 2 days of my duty, the patient will be able to demonstrate increase in strength and ability to perform activities without difficulty in breathing.

-Teach the client the preventive measures and the possible cause of his illness.

-Encourage the client to take a rest and follow medical advice.

-Assist the client in his nutritional intake.

-Encourage the client to practice self-care.

-To educate and help the client to have awareness regarding his illness.

-For faster recovery.

-For the client to know what food to avoid.

-To promote wellness.

Goal met:The patient was able to demonstrate increase in strength and was showed no signs of difficulty in breathing.

dyspnea after slight exertion, faintness, pallor of the skin andmucuous membrane, anorexia, diarrhea, loss of weight .

-Assist in IV infusion. -To prevent

fluid and electrolyte imbalance

DISCHARGE PLAN

MEDICATION: Folic Acid and Prednisone

EXERCISE:

Perform passive ROM exercise like flexion, extention of the extremities.

Brisk walking every morning.

TREATMENT:

Blood transfusion if blood count falls below normal.

Folic acid injection if available.

HEALTH TEACHING:

Encourage participation in recreation and regular exercise program

Provide appropriate level of environmental stimulation (e.i; music, TV/ radio,

personal possessions and visitors)

Suggest use of sleep aid/ promote normal sleep/rest.

OPD: Return to OPD for further check-up when there are changes on physical strength.DIET:

High fiber diet like vegetables and fruits.

Protein rich diet

Folic and vitamin B12 rich foods such as : liver, dried beans, peas, wheat products,

spinach, dark leafy vegetables, meat, eggs, milk

SIGNS/SYMPTOMS:

Observe for signs and symptoms such as body weakness, poor skin turgor, pallor

and weight loss.

Prognosis

The prognosis of the patient is expected to be good and will respond well to

treatment usually within two months. Although anemia is considered incurable, regular Vit.

B12 shots will alleviate symptoms and reverse the complications. Some symptoms will

disappear as soon as treatment begins.

The client must be instructed about the medications he must take and reinforce all

the medical advice given by the attending physician. Diet would play a vital part in his

recovery, hence must be strictly implemented. Although he displayed willingness to get

better, continuous monitoring of his blood components must be strictly observed.