Anemia
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CONTENTS:
INTRODUCTION.
CLINICAL MANIFESTIATION.
DEGREE OF ANEMIA.
CAUSES OF ANEMIA.
ANEMIA DURING PREGNANCY.
TYPES OF ANEMIA AND PREGNANCY
NURSING CARE PLAN.
Complication of anemia
Objectives of anemia seminar
After mastering the content of this
seminar you should be able to:
Define anemia and identify the causes
of anemia in pregnancy
Discuss the clinical manifestation of
anemia and causes of it.
List the types of anemia and discuss
each types.
Take example of N.C.P
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Anemia
INTRODUCTION
• Is a reduction ability of the blood to carry
oxygen to the cells ¸ Also
• Is a deficiency in the no. of (RBC) ¸ the
quantity of Hb and/or the volume of (RBC)
hematocrit.
• In pregnancy the anemia one of the
major complication health problem during
pregnancy¸ because women more prone to
be have anemia.
Clinical manifestation
• Caused by the body's response to tissue.
- Depend on the severity of hypoxia anemia and
presence of coexisting disease (determine by the
level of Hb). And that depend on degrees of
anemia:
• mild anemia: (10-14) g/dl→ No
symptoms
• moderate anemia: (6-10)g/dl→ Dyspnea
at rest
CONT. degrees of anemia
•Sever anemia: <6g/dl→ include
palpation, dyspnea, diaphoresis,
integument change pallor, jaundice. Also
increase HR and stroke volume,
development of systolic murmurs and
bruits.
WHAT CAUSE ANEMIA IN
GENERAL
Caused by:
 Rapid blood loss
 Impaired production of (RBCs).
 Increase destruction of (RBCs).
How we can classify anemia?
 Morphology: lab results of (RBCs) size ¸
color¸ shape.
 Etiology: according to clinical condition
causing anemia
So what happened during
pregnancy?
• A fetus is depend in his developmental
and growing on his mother blood¸ and that
lead to consume more than normal of
nutrition or elements from blood of mother.
• So anemia in pregnancy defined as
the level of hemoglobin below than 10
g/dl and level of hematocrit below 30%.
ANEMIA DURING
PREGNANCY
There are many things we want to discus in this
case, and it:
•The definition of every types of anemia.
•Main causes of every type of anemia.
•The relationship between the type of anemia and
pregnant women.
•Clinical manifestation to every type.
•The diagnostic studies to every type.
•The main intervention and treatment to every type.
•Prevention of anemia.
Decrease (RBC) production.
Decrease hemoglobin synthesis:
Iron deficiency anemia.
Def. it the decrease the quantity of (RBCs) in
blood.
Iron is present in all RBCs as heme in Hb, so
we use a Hb. To measure the decrease in
RBCs.
This type of anemia develops as a result of
inadequate dietary intake or mal absorption,
blood loss or hemolytic.
Cont.
During pregnancy the fetus depend on
his mother in his production of RBCs
by the use the iron in his mother
blood and the expanding of plasma
volume.
The s&s include pallor, glossitis,
cheilitis, headache, paresthesias,
pallor, and sensitivity to cold,
weakness, fatigue, and tachycardia.
cont. Iron deficiency anemia.
•Diagnostic studies: include of Hb,HCT,
and serum iron→ low level
•Serum ferritin levels and transferring
saturation rates are the most reliable predictor
of iron deficiency anemia.
•The main intervention is to treat the
cause, direct iron replacing by increasing
intake from good sources, and iron
supplement or transfusion of (RBCs).
Forms of iron supplements
•Dietary sources of iron include meat, chicken ,fish and
green leafy vegetables
•Iron supplements (60mg/dl) of elemental iron or 300
mg ferrous sulfate by oral are commonly used.
•Vit.C used to enhance absorption of iron and
production Hb.
•Empty stomach is the best for absorption of iron.
•The effect of iron on GI system including nausea &
vomiting, epigastric discomfort, abd. Cramping, Black,
tarry stool & constipation.
Prevention of
Iron deficiency anemia.
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In pregnancy period increase the diet
that rich in iron, because 50% of
pregnant women prone to have iron
deficient
Take iron supplements.
Thalsemia
•Def. it Genetic disorder or inherited
disease of inadequate production of
normal Hb.
•Caused by decrease production rate
of globins protein, which results in
hemolytic and anemia.
•There is no relationship between this
type and pregnancy, but pregnancy
makes it more badly.
Cont. Thalsemia
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S&S splenomegaly, hepatomegaly,
jaundice, pallor, mental physical
retardation & chronic anemia.
Diagnosis by level of Hb & HCT in
blood.
The main intervention is blood
transfusion.
No way to prevent this type of
anemia, we can just decrease s&s.
Defective DNA synthesis
•Group of disorders caused by
impaired DNA synthesis and
characterizes by the presence of
large RBCs, but defective and easily
destroyed.
Vitamin B12 (coblamin) deficiency
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Def. lack of Vit. B12 in body, and Vit. B12 is
important production of blood cells and
function of daily nervous system.
Caused by decrease presence or absence of
intrinsic factor which is a protein secreted
by gastric mucosa, also the diet that low in
Vit. B12 or intestinal malabsorption.
During pregnancy malnutrition or elements
deficiency.
S&S tissue hypoxia, abdominal pain,
dyspnea, fatigue, weakness, numbness,
palness.
Diagnostic studies. Lab tests of Vit. B12
levels and HCT level
Cont. Vit . B12 Deficiency
•The main intervention: pt should be
instructed on adequate dietary and parenteral
administration.
•Is Vit. B12 supplements Vit. B12 pills with a
more balanced diet (lack of Vit. B12).
•In malabsorption is Vit. B12 injection.
•In pernicious anemia requires lifelong
therapy.
•Increase intake of meats, eggs and diary
products.
•Prevention of lack Vit. B12 be by the
balance diet also to prevent it after surgery the
Pt. take injection of Vit. B12.
Folic acid deficiency.
Def. F.A deficiency which is imp. for growth of RBCs and
formation.
Caused by poor nutrition, malabsorption syndrome,
alcohol abuse, hemodialysis pt., cytotoxic drugs and
pregnancy.
The need for F.A increase during pregnancy because
the poor nutrition and is combined usually with Vit. B12
deficiency.
Folic acid deficiency is associated with neural
tube defects.
All women of childbearing age take (0.4mg) of folic
acid daily.
Cont. Folic acid deficiency.
• S&S headache, weakness, sore mouth
and tongue, pallor.
• Diagnostic studies. CBC (size, shape,
quantity).
• The main intervention: F.A supplements
and well balances nutrition.
• Prevention of it by increase the intake of
food high in folic acid includes leafy dark
green vegetables, fruits and liver.
B. increase RBC
destruction
1. Sickle cell anemia.
•Def. Group of inherited disorders
characterized by presence of abnormal form
Hb in the blood.
•This abnormal Hb (HbS) causes the
sickling of RBCs.
•Caused by malnutrition, excessive physical
activity, emotional stress, dehydration, genetic
disorder and bone marrow disorder.
Cont. Sickle cell anemia.
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During pregnancy malnutrition or emotional
stress the main factors to cause S.C.
S&S pallor of mucus membrane, fatigue,
breathlessness, rapid HR,
fever, failure of
the spleen to fagocytize F.B, susceptibility to
infections, decrease exercise tolerance, Jaundice,
pain due to ischemia of tissue.
Diagnostic studies: CBC
SICKLE CELL TEST
DNA TESTING
The main intervention and
treatment: for s.c.a
• Transfusion to maintain the HCT of at least
30%
• avoid tissue deoxygenation.
• promote proper hydration.
• Bone marrow transplants.
• Genetic counseling.
•Prevention: consist of well balanced
nutrition, and appropriate physical activity.
C. Rapid blood loss
ACUTE BLOOD LOSS.
CHRONIC BLOOD LOSS
Complication of anemia:
1.Premature labor
2.Intrauterine growth retardation.
3.Increase the risk for infection after
birth.
Nursing care plan
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Risk for altered tissue perfusion
related to maternal anemia during
pregnancy.
Objective data:-exhaustion,
headache, lethargic.
Subjective data:- pale, decrease BP,
hypothetic, decrease PVC.
CONT. N.C.P
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Outcome identification:-client
will take adequate measures to
guard against anemia during
pregnancy and experience
adequate tissue perfusion during
pregnancy.
CONT. N.C.P
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Intervention
Instruct how to have adequate time for rest and
sleep
Instruct how to increase her nutritional intake.
Instruct how to avoid over load activities.
Teach her the proper way of preparing her
weal's.
Give her the prescribed iron or folic pills
Increase her fluid intake.
Review plans for lab testing and scheduling of
antepartum care visit.
CONT. N.C.P
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Outcome evaluation:
client takes prenatal supplement daily;
Hb is above 11 mg/dl; fetal heart rate is
120 to 1160
COMPLICATION Of THE
PREGNANT WOMEN
i.Premature labor
ii.Hypertension
iii.Low birth wt.
iv.Septicemia
v.Maternal anemia.
URINARY TRACT INFECTION
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Contents.
Definitions of UTI and type of it
Risk of UTI on women.
Signs and symptoms of UTI.
Diagnostic studies for UTI.
Risk of UTI during pregnancy.
Assessment of UTI.
Nursing care plan
prevention of UTI.
URINARY TRACT INFECTION
OBJECTIVES
Each one of you will be able to:
 Identify UTI
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Explain the diagnostic studies
Assess the patient who have UTI
the complication of UTI on
pregnancy
Urinary tract infection
• UTI: IS THE PRESENCE OF ANY PATHOGENIC
MO IN THE UT WITH OR WITHOUT S&S.
•Common pathogen found in UTI: Escherichia coli
and Entrobacteia.
• Major types of UTI: cysitits (infection of the
bladder), urithritis, prostatitis, and pyelonephritis.
• In women more prone to UTI because of the
short female urethras (4cm), and proximity to
Vagina, periuretheral gland, and rectum.
Cont. UTI
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Elderly women often have incomplete
emptying of the bladder and urinary
stasis; post menopausal women are
susceptible to colonization of bacteria due
to absence of estrogen.
* FEMALE 14 TIMES TO HAVE UTI
MORE THAN MALE.*
UTI affects 5%_ 20% of pregnant
women, and it the most common infection
of bacteria during pregnancy.
Clinical manifestations
Lower UTI: frequent pain and burning on
urination, spasm of the bladder, hematuria,
and back pain may be present.
Upper UTI: fever, chills, flank pain, painful
urination, tenderness as the costovertebral
angle, nausea, vomiting, pruritus, wt. loss,
edema, fatigue, and shortness of breath.
DIAGNOSTIC STUDIES.
Includes: Urinalysis, CBC,
electrolytes, createnin and
BUN,. Also
 Urine culture (C&S), KUB, IVP
or IVU and testing for STD.
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What happened during
pregnancy?
•The anatomic changes during
pregnancy in UT predispose women to
infection, the growing of uterus
compress both uterus which decrease
the flow to the bladder, and that increase
the mother and also the fetus to infection
by the causing of urinary stasis.
Cont.
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The incidence of glycosuria
increased, which favor bacterial
growth and development of UTI.
During pregnancy the plasma
volume increase and GFR and
urine output increase.
ASSESSMENT
•Hx. Of S&S of UTI.
•Knowledge about if pt. know to prevent
UTI and complication
•Identify the color, volume, odor
concentration, and frequently of urine.
Nursing care plan
Nursing diagnosis: risk for infection to
stasis of urine with pregnancy.
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subjective data:
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pain on urination
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Frequency of urination
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Hematuria
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Objective data:
bacterial count of more than 100,000
colonies per milliliter in a clean-catch
specimen
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Cont. N.C.P
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Outcome identification: client will
demonstrate no signs of infection
during pregnancy.
Intervention:
voiding frequency (at least per 2 hrs)
Wiping front to back after bowel
movements.
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Prevention
i.General hygiene
ii.Drink 8-12 glasses of liquid/day
iii.Urinate before and after intercourse.
REFERENCES
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Lewis, medical surgical nursing, 6th
edition, 2004,
Burroughs, Maternity nursing, 3rd edition,
1997
Matenal & child nursing care, 3rd edition
www.ask.com
www.who/complication during
pregnancy.com