NURSING CARE of INEFFECTIVE TISSUE
PERFUSION
in PATIENT WHO APLASTIC ANEMIA
presented by
Syaifurrahman Hidayat
DEFINITION
Aplastic anaemia (AA) is an immune
mediated disorder characterised by
peripheral blood pancytopenia with a
hypocellular bone marrow (Marsh JC,
Ball SE, Cavenagh J, et al, 2009). This
bone marrow failure mostly results from
T-cell mediated destruction of bone
marrow haematopoietic stem cells.
Allogeneic haematopoietic stem cell
transplantation (allo-HSCT) replaces
these stem cells
ANATOMY AND PHYSIOLOGY
APLASTIC ANAEMIA
• Blood is composed of 3
cell types that are
suspended in a proteinrich fluid called plasma
• Red blood cells
(erythrocytes)
• White blood cells
(leukocytes)
• Platelets (thrombocytes)
ETIOLOGY
Medicines
 Nonsteroidal anti-inflammatory drugs
(NSAIDs) -- medicines used to treat
pain and inflammation. Examples
include indomethacin (Indocin),
piroxicam Feldene), and diclofenac
(Voltaren)
 Amphetamines, including MDMA
(Ectasy)
 Antibiotics, including sulfonamides
(“sulfa drugs”) and forms of penicillin
ETIOLOGY (cont....)
Chemicals
 Benzene, which is found in gasoline,
automobile exhaust fumes, cigarette
smoke, emissions from coke ovens
and other industrial processes, and
waste water from certain industries, is
the most common offender.
 Industrial pesticides, like
organophosphates and carbamates
RISK FACTORS
 Hepatitis
 Viruses such as Epstein-Barr virus,
cytomegalovirus (CMV), parvovirus
B19, and HIV
 Pregnancy
 Auto-immune diseases like lupus
(systemic lupus erythematosus) and
rheumat oid arthritis
 Severe radiation poisoning (as seen
after an atomic bomb explosion)
PATHWAY APLASTIC ANEMIA
Aplasia system hematopoetic in bone
marrow
Granulopoetic
Trombopoetik
Content of Hb,
Hmt, Erit
Granulositopenia
& Leukopenia
Trombositopenia
Hypoksia
Defense of body
Eritropoetic
Heart
compensation
Fatigue
Risk
infection
bleeding
CLINICAL FEATURES
• Hemorrhage
• Fever
• Lifethreatening
infections
CASE STUDY
• Fulfillment of Basic Human Needs
Assessment Jean Watson Nursing
• Nursing Diagnosis
• Nursing Care Plan
DISCHARGE PLANNING
1. Give instruction to parents on how to protect
children from infection
a. Limit contact with infected agents
b. Identify the signs and symptoms of infection
2. Give instruction to parents for observe signs of
complications
3. Give instruction to parents on drug delivery
a. monitor therapeutic response of children
b. monitor the response is not favorable
4. Provide information about community support
systems for children and families for long-term
adaptation
a. go back to school
b. Parent group
c. financial advice
SUMMARY OF THE CASE
• In patients Miss "AI" with medical diagnosis of
aplastic anemia symtoms include pallor,
weakness, tiredness, lack of red blood cells
which is based on the results of laboratory tests
on 4 September 2013, HGB 11,4 g/dl, HCT
13%, WBC 2,10 x103/ul, PLT 32,9x103/ul
• AI is Thymoglobulin therapy with dosage 180
mg one time per day. But result laboratory on 9
September 2013 a significant decrease in
hemoglobulin result is 8,4 gr/dl, that is cause the
risk of infection is easy to attack people with
aplastic anemia
SUMMARY OF THE CASE (cont....)
• Deficit of blood cells in the bone marrow due to lack of
pluripotent stem cells to the bone marrow fails to form a
blood cell. Bone marrow failure is due to many factors.
start of induction drugs, viruses, and chemicals. This is
because due to lack of subject content of platelets and
leukocytes lack of content, the content of leukocytes and
platelets is due to a natural decrease in bone marrow
failure
• Some things need to be noticed by the patient Miss "AI" to
always keep a balance among body immunity to always
consume foods that contain lots of iron such as meat,
vegetables and fruits, avoid foods that inhibit iron
absorption such as tea and coffee, as well as always keep
away from the risk of infection against viruses and
bacteria.
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