Anemia Nursing Diagnosis, Interventions & Care Plans

Anemia is a common condition that affects millions of people around the world. It can cause extreme fatigue, weakness, and other serious health complications if left untreated.

Traditional treatments for anemia often involve taking iron supplements or making dietary changes, but these methods are not always effective in managing symptoms.

Nursing interventions and care plans provide a comprehensive approach to treating anemia by addressing both the physical and emotional needs of patients. With nursing interventions, nurses can develop individualized treatment plans tailored to each patient’s unique needs and lifestyle.

What is Anemia?

Anemia is a condition caused by a decrease in red blood cells or hemoglobin levels. These two substances are responsible for carrying oxygen around the body and delivering it to organs and tissues. When anemia occurs, there is not enough oxygen available for the body’s needs, causing fatigue, weakness, pale skin, and other symptoms.

Anemia can be characterized by a decreased amount of hemoglobin (13.5 g/dL in men and 12.0 g/dL in women) or hematocrit (41.0% in men and 36.0% in women) or red blood cell count (RBC). Hemoglobin and hematocrit measurements are more routinely used than RBC counts in everyday clinical practices. The normal range of values depends on ethnicity, gender and age; therefore, lower limits may vary for each individual.

According to the National Cancer Institute, Anemia is graded as follows:

1. Mild: Hemoglobin 10.0 g/dL to lower limit of normal
2. Moderate: Hemoglobin 8.0 to 10.0 g/dL
3. Severe: Hemoglobin 6.5 to 7.9 g/dL
4. Life-threatening: Hemoglobin less than 6.5 g/dL

Pathophysiology

The pathophysiology of anemia is complex and can involve impaired red blood cell production, destruction of red blood cells, or increased loss through bleeding. Impaired red blood cell production can be caused by a lack of essential vitamins or minerals in the diet, such as iron or vitamin B12. It may also be due to chronic diseases like kidney failure, cancer, or severe infections.

Destruction of red blood cells can be caused by autoimmune diseases, such as hemolytic anemia, where the body’s immune system attacks its own red blood cells. Increased loss through bleeding is often seen in people with gastrointestinal disorders or heavy menstrual periods. The underlying cause of anemia should always be identified and treated in order to

Types of Anemia and Causes 

Iron deficiency anemia

• This is the most common type of anemia, which results from either loss or malabsorption of iron.
• Patients with this form of anemia may present with reduced size RBCs (microcytic).
• Iron is a crucial component for hemoglobin production, which is necessary for transporting oxygen in the body.
• This anemia is more common in women with heavy menstruation, people with gastrointestinal ulcers, and those who have a poor dietary intake.

Vitamin B-12 deficiency anemia

• Vitamin B-12, folate, and iron play a vital role in the production of red blood cells.
• A deficiency may be due to inadequate consumption of Vitamin B-12 or the inability to absorb it.
• If there is adequate intake but an impaired absorption, this form of anemia is known as pernicious anemia.

Folic acid deficiency anemia

• Similar to Vitamin B-12 deficiency anemia, folic acid deficiencies can be caused by either a poor diet or malabsorption.
• Aplastic anemia
• In this form of anemia, bone marrow fails to produce red blood cells.
• It may occur due to infections, certain medications, autoimmune diseases, and exposure to hazardous substances.

Sickle cell disease

• This is a genetic disorder that results in defective hemoglobin formation.
• It causes red blood cells to assume an abnormal, crescent shape, reducing their life span and resulting in chronic anemia.

Autoimmune hemolytic anemia

• This is caused by abnormal immune system function which leads to the destruction of red blood cells at a faster rate than new ones can be produced.
• It occurs due to an inability of the body to recognize its own cells as ‘self’.
• Therefore, the immune system mistakenly attacks and destroys red blood cells.
• This leads to anemia due to a low number of functional RBCs circulating in the body.

Nursing Interventions for Anemia

• Assess the severity of the anemia by measuring hemoglobin levels. This will help determine the best course of action to take in managing the condition.
• Educate patients on lifestyle changes they

Risk Factors

• Poor diet/ malnourishment: a diet low in iron, vitamin B-12, and folate prevents new red blood cell formation , leads to a deficiency in these vital nutrients and can cause anemia.
• Infections: chronic infections may lead to anemia through an impairment of red blood cell production.
• Gastrointestinal disorders: conditions such as Crohn’s disease or ulcerative colitis can disrupt the absorption of iron, folate, or vitamin B12 leading to malabsorption syndromes.
• Bleeding: heavy menstrual periods, gastrointestinal bleeding, or other sources of bleeding can lead to a loss of red blood cells and subsequently anemia.
• Chronic Diseases: conditions such as kidney failure, cancer, or sickle cell disease can all impair red blood cell production leading to anemia.
• Medications: certain medications, such as those used in the treatment of cancer or autoimmune disorders, can interfere with red blood cell production and lead to anemia.
• Age: young children and older adults are at greater risk for developing anemia due to their higher demand for oxygen and nutrients.

Signs and Symptoms

The symptoms of anemia depend on its severity and underlying cause. Common signs and symptoms include:

• Fatigue
• Weakness
• Shortness of breath
• Dizziness or lightheadedness
• Paleness
• Rapid heart rate
• Headaches or ringing in the ears (tinnitus)
• Cold hands and feet
• Lack of concentration

Treatment and Management

The treatment for anemia depends on its cause. In many cases, supplementation with iron, vitamin B-12, or folate may be necessary to replenish the body’s stores of these nutrients. In other cases, a change in diet may need to be made to ensure adequate nutrient intake. Treatment for anemia may also include medications or supplements that help increase red blood cell production. In some cases, an underlying condition causing the anemia needs to be treated.

The goals of treatment are to reduce symptoms and restore normal hemoglobin levels in the blood. Treatment should focus on identifying and treating the underlying cause of the anemia as well as managing the signs and symptoms. Patients should also be educated on lifestyle modifications that can help prevent anemia and reduce its severity. These include a balanced diet with adequate amounts of iron, vitamin B-12, and folate; reducing the risk for infection; avoiding excessive bleeding; avoiding medications that can interfere with red blood cell production; and managing any underlying diseases or conditions.

A combination of lifestyle modifications, medications, and supplements can help reduce the severity of anemia and improve overall health. It is important to follow-up with a doctor regularly and have regular blood work done in order to monitor hemoglobin levels. With proper management, anemia can be controlled and many people are able to lead healthy lives.

Diagnosis

Values may vary among different references and also differ between genders.

• CBC

Hemoglobin <10 g/ dL

Hematocrit <36%

RBCs <4 x 1012

• Positive bone marrow aspiration for anemia
• Colonoscopy to determine if there is any bleeding
• Fecal occult blood sample

Nursing Care Plan for Anemia

Nursing Assessment

Assess for the following subjective and objective data:

Subjective Data:

• Patient’s experience of fatigue, weakness, shortness of breath, dizziness or lightheadedness, paleness, rapid heart rate

• Patient’s dietary history (including iron and vitamin B-12 intake)

Objective Data:

• Measure hemoglobin levels

• Vital signs – assess for tachycardia and hypotension

• Skin paleness and nail beds (assess for pallor)

• Assess for edema or other signs of fluid overload.

Nursing Diagnosis For Anemia

Based on the assessment data, major anemia nursing diagnoses associated with anemia include

• Prioritize activities. Assist the patient in prioritizing activities and establishing balance between activity and rest that would be acceptable to the patient.
• Exercise and physical activity. Patients with chronic anemia need to maintain some physical activity and exercise to prevent the deconditioning that results from inactivity.

Nursing Interventions For Anemia

Nursing interventions are based on the data assessed by the nurse and on the symptoms that the patient manifests.

Manage Fatigue:

• Prioritize activities. Assist the patient in prioritizing activities and establishing balance between activity and rest that would be acceptable to the patient.
• Exercise and physical activity. Patients with chronic anemia need to maintain some physical activity and exercise to prevent the deconditioning that results from inactivity.

Maintain Adequate Nutrition:

• Monitor dietary intake. Assess the patient’s diet to ensure adequate intake of essential nutrients and follow-up with a  registered dietitian if necessary.
• Encourage iron rich foods.
• Encourage the patient to eat foods that are rich in iron, such as red meat, eggs, fortified cereals and grains, dark green leafy vegetables, dried fruit, and legumes.
• Vitamin B12 supplementation.
• Supplementing with vitamin B12 can help replace lost stores of this nutrient due to malabsorption syndromes or other conditions that interfere with absorption of essential nutrients.

Improve Tissue Perfusion:

• Monitor hemoglobin levels regularly. Regularly monitor hemoglobin levels to assess effectiveness of treatment and to adjust medications or supplements as needed.
• Monitor for signs of fluid overload. Monitor the patient’s vital signs and assess for edema or other signs of fluid overload that could result from treatment with erythropoiesis-stimulating agents (ESAs).
• Encourage lifestyle modifications. Encourage the patient to make lifestyle modifications that can reduce risk of anemia, such as reducing their risk for infection, avoiding excessive bleeding, and managing any underlying diseases or conditions.

Evaluation:

The goal of nursing interventions is to reduce symptoms and restore normal hemoglobin levels in the blood. The effectiveness of nursing care can be evaluated by monitoring hemoglobin levels over time and assessing the patient’s response to treatment. The patient’s compliance with lifestyle modifications is also important to evaluate. If goals are not met, the nursing interventions may need to be adjusted or revised.

Discharge and Home Care Guidelines:

• Monitor hemoglobin levels regularly and follow-up with the doctor.

• Follow a balanced diet to ensure adequate intake of essential nutrients, especially iron, vitamin B-12, and folate.

• Take medications or supplements as prescribed by your doctor.

• Avoid excessive bleeding or other activities that can increase risk for anemia.

• Make lifestyle modifications as necessary to prevent anemia or reduce its severity.

• Contact your healthcare provider if you have any questions about your condition or treatment plan.

Documentation Guidelines:

• Document patient’s subjective and objective data including symptoms, dietary history, hemoglobin levels, and responses to interventions.

• Note any lifestyle modifications suggested by the healthcare provider and the patient’s adherence to these guidelines.

• Record any medications or supplements taken as prescribed.

• Assess patient’s response to treatment over time and document changes in hemoglobin levels.

• Document any follow-up with a doctor or other healthcare provider as recommended.

​Final Words

Anemia nursing diagnosis, management, and interventions can help improve patients’ lives. With proper lifestyle modifications, medications, and supplements, anemia can be managed effectively. It is important for nurses to assess patient data and monitor hemoglobin levels regularly in order to provide the best care for a patient with anemia.

​References:

1. https://en.wikipedia.org/wiki/Anemia#:~:text=Anemia%20or%20anaemia%20(British%20English,in%20the%20amount%20of%20hemoglobin.
2. https://www.ncbi.nlm.nih.gov/books/NBK568790/