4 Nursing Care Plans for Anemia Plus Diagnosis and Interventions with Examples

Introduction

Anemia is defined as a low number of red blood cells. Anemia is reported as low hemoglobin or hematocrit in a routine blood test. Hemoglobin is the main protein in your red blood cells. It carries oxygen and delivers it throughout your body. If you have anemia, your hemoglobin level will be low too. If it is low enough, your tissues or organs may not get enough oxygen. Symptoms of anemia — like fatigue or shortness of breath — happen because your organs aren’t getting what they need to work the way they should.

Women, young children, and people with long-term diseases are more likely to have anemia. Important things to remember are:

• Certain forms of anemia are passed down through your genes, and infants may have it from birth.
• Women are at risk of iron deficiency anemia because of blood loss from their periods and higher blood supply demands during pregnancy.
• Older adults have a greater risk of anemia because they are more likely to have kidney disease or other chronic medical conditions.

This blog post discusses nursing care plans for anemia together with the diagnosis, causes, symptoms and interventions with elaborate examples. As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Symptoms of Anemia

The signs of anemia can be so mild that you might not even notice them. As your blood cells decrease, symptoms often develop at a certain point. Depending on the cause of the anemia, symptoms may include:

1. Dizziness, lightheadedness, or feeling like you are about to pass out
2. Fast or unusual heartbeat
3. Headache
4. Pain, including in your bones, chest, belly, and joints
5. Problems with growth for children and teens
6. Shortness of breath
7. Skin that’s pale or yellow
8. Cold hands and feet
9. Tiredness or weakness

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Types of Anemia Based on Cause

There are more than 400 types of anemia, and they’re divided into three groups:

1. Anemia caused by blood loss
2. Anemia caused by decreased or faulty red blood cell production
3. Anemia caused by the destruction of red blood cells

Anemia Caused by Blood Loss

You can lose red blood cells through bleeding. This can happen slowly over a long period of time, and you might not notice. Causes can include:

1. Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis (inflammation of your stomach), and cancer
2. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, which can cause ulcers and gastritis
3. A woman’s period, especially if you have heavy menstruation (or heavy period). This can be associated with fibroids.
4. Post-trauma or post-surgery as well.

Anemia Caused by Decreased or Faulty Red Blood Cell Production

With this type of anemia, your body may not create enough blood cells, or they may not work the way they should. This can happen because there’s something wrong with your red blood cells or because you don’t have enough minerals and vitamins for your red blood cells to form normally. Conditions associated with these causes of anemia include:

1. Bone marrow and stem cell problems
2. Iron-deficiency anemia
3. Sickle cell anemia
4. Vitamin-deficiency anemia, specifically b12 or folate

Bone marrow and stem cell problems

Bone marrow and stem cell problems may keep your body from producing enough red blood cells. Some of the stem cells in the marrow that’s in the center of your bones will develop into red blood cells. If there aren’t enough stem cells, if they don’t work right, or if they’re replaced by other cells such as cancer cells, you might get anemia. Anemia caused by bone marrow or stem cell problems includes:

• Aplastic anemia happens when you don’t have enough stem cells or have none at all. You might get aplastic anemia because of your genes or because your bone marrow was injured by medications, radiation, chemotherapy, or infection. Other malignancies that commonly affect the bone marrow include multiple myeloma or leukemia. Sometimes, there’s no clear cause of aplastic anemia.
• Lead poisoning. Lead is toxic to your bone marrow, causing you to have fewer red blood cells. Lead poisoning can happen when adults come into contact with lead at work, for example, or if children eat lead paint chips. You can also get it if your food comes into contact with some types of pottery that aren’t glazed right.
• Thalassemia happens with a problem with hemoglobin formation (4 chains aren’t correctly formed). Patients with thalassemia make really small red blood cells though they can make enough of them to be asymptomatic, or it can be severe. It’s passed down in your genes and usually affects people of Mediterranean, African, Middle Eastern, and Southeast Asian descent. This condition can range from mild to life-threatening; the most severe form is called Cooley’s anemia.

Iron-deficiency anemia

Iron-deficiency anemia happens because you don’t have enough of the mineral iron in your body. Your bone marrow needs iron to make hemoglobin, the part of the red blood cell that takes oxygen to your organs. Iron-deficiency anemia can be caused by:

• A diet without enough iron, especially in infants, children, teens, vegans, and vegetarians
• Certain drugs, foods, and caffeinated drinks
• Digestive conditions such as Crohn’s disease, or if you’ve had part of your stomach or small intestine removed
• Donating blood often
• Endurance training
• Pregnancy and breastfeeding use up iron in your body
• Women period
• A common cause is chronic slow bleed, usually from a Gastrointestinal source.

Sickle Cell Anemia

Red blood cells, which are usually round, become crescent-shaped because of a gene problem. Anemia results when the red blood cells break down quickly, so oxygen doesn’t get to your organs. The crescent-shaped red blood cells can also get stuck in tiny blood vessels and cause pain.

Vitamin deficiency Anemia

Vitamin deficiency anemia can happen when you aren’t getting enough vitamin B12 and folate. You need these two vitamins to make red blood cells. This kind of anemia can be caused by:

• Dietary deficiency: If you eat little or no meat, you might not get enough vitamin B12. If you overcook vegetables or don’t eat enough of them, you might not get enough folate.
• Megaloblastic anemia: When you don’t get enough vitamin B12, folate, or both
• Pernicious anemia: When your body doesn’t absorb enough vitamin B12

Other causes of vitamin deficiency include medications, alcohol abuse, and intestinal diseases such as tropical sprue.

Anemia Caused by Destruction of Red Blood Cells

When red blood cells are fragile and can’t handle the stress of traveling through your body, they may burst, causing what’s called hemolytic anemia. You might have this condition at birth, or it could come later. Sometimes, the causes of hemolytic anemia are unclear, but they can include:

1. An attack by your immune system, as with lupus. This can happen to anyone, even a baby still in the womb or a newborn. That’s called hemolytic disease of the newborn.
2. Conditions that can be passed down through your genes, such as sickle cell anemia, thalassemia, and thrombotic thrombocytopenic purpura (TTP)
3. Enlarged spleen. This can, in rare cases, trap red blood cells and destroy them too early.
4. Something that puts strain on your body, such as infections, drugs, snake or spider venom, or certain foods
5. Toxins from advanced liver or kidney disease
6. Vascular grafts, prosthetic heart valves, tumors, severe burns, being around certain chemicals, severe hypertension, and clotting disorders

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Risk factors of Anemia

These factors place you at increased risk of anemia:

1. A diet lacking in certain vitamins and minerals. A diet consistently low in iron, vitamin B-12, folate, and copper increases your risk of anemia.
2. Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in the small intestine — such as Crohn’s disease and celiac disease — puts a person at risk of anemia.
3. Menstruation. In general, women who haven’t had menopause have a greater risk of iron deficiency anemia than do men and postmenopausal women. Menstruation causes the loss of red blood cells.
4. Pregnancy. Being pregnant and not taking a multivitamin with folic acid and iron increases your risk of anemia.
5. Chronic conditions. If you have cancer, kidney failure, or another chronic condition, you could be at risk of anemia of chronic disease. These conditions can lead to a shortage of red blood cells.
6. Slow, chronic blood loss from an ulcer or other source within your body can deplete your body’s store of iron, leading to iron deficiency anemia.
7. Family history. If your family has a history of inherited anemia, such as sickle cell anemia, you also might be at increased risk of the condition.
8. Other factors. A history of certain infections, blood diseases, and autoimmune disorders increases your risk of anemia. Alcoholism, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia.
9. Age. People over age 65 are at increased risk of anemia.

Diagnosis of Anemia

A complete blood count (CBC) test will measure the red blood cells, hemoglobin, and other parts of the blood. The doctor will ask about family history and medical history after the CBC. They’ll probably do some tests, including:

• Blood smear or differential to count your white blood cells, check the shape of your red blood cells and look for unusual cells
• Reticulocyte count to check for immature red blood cells

Complications of Anemia

Left untreated, anemia can cause many health problems, such as:

1. Extreme fatigue. Severe anemia can make you so tired that you can’t complete everyday tasks.
2. Pregnancy complications. Pregnant women with folate deficiency anemia can be more likely to have complications, such as premature birth.
3. Heart problems. Anemia can lead to a rapid or irregular heartbeat (arrhythmia). When you’re anemic, your heart pumps more blood to make up for the lack of oxygen in the blood. This can lead to an enlarged heart or heart failure.
4. Death. Some inherited anemias, such as sickle cell anemia, can lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal. Among older people, anemia is associated with an increased risk of death.

Prevention of Anemia

Many types of anemia can’t be prevented. But you can avoid iron deficiency anemia and vitamin deficiency anemias by eating a diet that includes a variety of vitamins and minerals, including:

Iron. Iron-rich foods include beef and other meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables, and dried fruit.

Folate. This nutrient, and its synthetic form folic acid, can be found in fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products, such as bread, cereal, pasta, and rice.

Vitamin B-12. Foods rich in vitamin B-12 include meat, dairy products, fortified cereal, and soy products.

Vitamin C. Foods rich in vitamin C include citrus fruits and juices, peppers, broccoli, tomatoes, melons, and strawberries. These also help increase iron absorption.

Treatment of Anemia

The treatment will depend on the type of anemia. There are a lot of causes, so there are also many treatments available.

• A patient with aplastic anemia might need medication, blood transfusions, or a bone marrow transplant.
• A patient with hemolytic anemia might need medication that will hold back the immune system.
• If it’s caused by blood loss, the patient might have surgery to find and fix the bleeding.
• If it is iron-deficiency anemia, the patient probably needs to take iron supplements and change diet.
• Sickle cell anemia treatment includes painkillers, folic acid supplements, intermittent antibiotics, or oxygen therapy. Hydroxyurea (Droxia, Hydrea, Siklos) is often prescribed to decrease sickle cell pain crises (a complicated mechanism). The voxelator (Oxbryta) medication can help the red blood cells keep their proper shape. Crizanlizumab-tmca (Adakveo) can keep the blood cells from sticking together and blocking vessels. L-glutamine oral powder (Endari) can cut down on your hospital trips for pain and guard against a condition called acute chest syndrome.
• A patient has vitamin B12 or folate deficiency will be prescribed supplements.
• Thalassemia doesn’t usually need treatment, but if it is a severe case, the patient might need blood transfusions, a bone marrow transplant, or surgery.

Nursing Care Plans for Anemia Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Fatigue

Fatigue: An overwhelming, sustained sense of exhaustion and decreased physical and mental work capacity at the usual level.

May be related to decreased hemoglobin and diminished oxygen-carrying capacity of the blood.

Possibly evidenced by:

1. Exertional discomfort or dyspnea.
2. Inability to maintain usual level of physical activity.
3. Increased rest requirements.
4. Report of fatigue and lack of energy.
5.  

Desired Outcomes

A patient will verbalize the use of energy conservation principles.

 A patient will verbalize reduction of fatigue, as evidenced by reports of increased energy and ability to perform desired activities.

Nursing Interventions	Rationale
Assess the specific cause of fatigue.	The specific cause of fatigue is due to tissue hypoxia from normocytic anemia; Other related medical problems can also compromise activity tolerance.
Assess the  A patient’s ability to perform activities of daily living (ADLs) and the demands of daily living,	Fatigue can limit the patient’s ability to participate in self-care and perform their role responsibilities in family and society, such as working outside the home.
Assist the patient in planning and prioritizing activities of daily living (ADL).	This will allow the patient to maximize their time for accomplishing important activities. Not all self-care and hygiene activities need to be completed in the morning. Likewise, not all housework needs to be completed in one day.
Assist the patient in developing a schedule for daily activity and rest. Stress the importance of frequent rest periods.	Energy reserves may be depleted unless the patient respects the body’s need for increased rest. A plan that balances periods of activity with rest periods can help the patient complete desired activities without adding fatigue levels.
Monitor hemoglobin, hematocrit, RBC counts, and reticulocyte counts.	Decreased RBC indexes are associated with the decreased oxygen-carrying capacity of the blood. It is critical to compare serial laboratory values to evaluate patient progression or deterioration and identify changes before they become life-threatening.
Educate energy-conservation techniques.	Patients and caregivers may need to learn skills for delegating tasks to others, setting priorities, and clustering care to use the available energy to complete desired activities. Organization and time management can help the patient conserve energy and reduce fatigue.
Instruct the patient about medications that may stimulate RBC production in the bone marrow.	Recombinant human erythropoietin, a hematological growth factor, increases hemoglobin and decreases the need for RBC transfusions.
Provide supplemental oxygen therapy as needed.	Oxygen saturation should be kept at 90% or greater.
Anticipate the need for the transfusion of packed RBCs.	Packed RBCs increase the oxygen-carrying capacity of the blood.
Refer the patient and family to an occupational therapist.	The occupational therapist can teach the patient about using assistive devices. The therapist also can help the patient and family evaluate the need for additional energy-conservation measures in the home setting.

Nursing Care Plan 2: Diagnosis -Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic.

May be related to:

• Complexity of treatment.
• Lack of recall.
• Lack of resources.
• New condition or treatment.
• Unfamiliarity with the disease condition.

Possibly evidenced by:

• Inaccurate follow-through of instructions.
• Questioning members of the health care team.
• Verbalized inaccurate information.

Desired Outcomes

A patient will verbalize understanding of own disease and treatment plan.

Nursing Interventions	Rationale
Assess current knowledge of the diagnosis, disease process, possible causative factors, and treatment.	Determining the patient’s current knowledge and perceptions will facilitate the planning of individualized teaching. Patients may have a general understanding of anemia related to iron deficiency but limited knowledge of other types of anemia.
Assess the patient’s and family’s understanding of the new medical vocabulary.	Usually, people have a limited understanding of medical vocabulary, hence are not exposed to the language being used by the health care professionals.
Explain the importance of the diagnostic procedures (such as complete blood count), bone marrow aspiration, and a possible referral to a hematologist.	Diagnosing a type of anemia will be based on the changes in the RBC indexes and the findings in the bone marrow aspiration.
Explain the hematological vocabulary and the functions of blood elements, such as white blood cells, red blood cells, and platelets.	Patients usually have a basic knowledge of the hematological system.
Instruct patient to avoid known risk factors.	Causative factors such as alcoholism, exposure to toxic chemicals, dietary deficiencies, and the use of some medications can affect red blood cell production and lead to anemia.
For aplastic anemia:
Explain that blood transfusions from prospective marrow donors should be avoided.	Histocompatibility antigens may lead to donor marrow rejection.
Explain the need for rapid human leukocyte antigen (HLA) typing.	The human leukocyte antigen (HLA) test, also known as HLA typing or tissue typing, identifies antigens on the white blood cells (WBCs) that determine tissue compatibility for organ transplantation.
Explain that immunosuppressive therapy is the treatment of choice in patients without HLA-matched donors and older than 40 years of age.	The treatment of choice in patients without HLA-matched donors is immunosuppression with granulocyte-macrophage-colony-stimulating factors, cyclophosphamide, anti-thymocyte globulin, and cyclosporine.
Explain that allogeneic hematopoietic stem cell transplantation is the standard treatment for patients younger than 40 years old who have HLA-identical related donors.	Hematopoietic stem cell transplantation (HCT) effectively treats many life-threatening diseases. Usually, a  patient’s own (autologous) cells or (allogeneic) cells from a donor with the same genetic makeup are used.
Explain the potential complications associated with immunosuppressive therapy.
Acute graft-versus-host disease (GVHD).	The earliest symptoms include a red maculopapular rash, dryness of the eye, abdominal pain, and jaundice.
Chronic GVHD.	Patients with Chronic GVHD may present with a variety of symptoms. Skin rash and mouth sores are among the common initial signs of the disease. The rash is often slightly raised and may be itchy.
Rejection of donor marrow.	Rejection happens when a sensitization to histocompatibility antigens is acquired during previous blood transfusions and carries a high mortality rate. Conditioning regimens using cyclophosphamide (Cytoxan) and total lymphoid irradiation show a decrease in the risk for graft failure.
For nutritional deficiency anemia:
Explain the importance of vitamin B12 replacement.	Vitamin B12 injections are used to treat this vitamin’s low levels (deficiency). They are given monthly for the remainder of the patient’s life. It elevates levels of vitamin B12, a deficiency caused by a lack of intrinsic factors that impair vitamin absorption.
Educate the patient and the family regarding food rich in iron, folic acid, and vitamin B12.	A balanced diet that includes a variety of foods from each food group usually contains essential nutrients needed to promote RBC formation. Patients need to have an adequate intake of dark-green leafy vegetables animal products, including fish, meat, poultry, eggs, milk, and fortified breakfast cereals.
Educate the patient and the family regarding replacement therapy with folic acid and iron.	The dosage and frequency of administration will depend on the severity of anemia. Iron supplements are given orally with meals to prevent a gastric upset. Intramuscular injections are also available given via the Z-track method to prevent leakage of the solution in the subcutaneous tissue along the needle tract. While folic acid is given orally with a full glass of water.
For blood loss anemia:
Instruct the patient about certain medications that may stimulate RBC production in the bone marrow.	Recombinant human erythropoietin, a hematological factor, elevates hemoglobin levels and decreases the need for a transfusion of packed RBC.
Explain that a transfusion of packed RBCs may be needed.	One unit of packed RBC raises the hemoglobin level by 1 g/dL.

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Nursing Care Plan 3: Diagnosis – Risk for Infection

Risk for Infection: At increased risk for being invaded by pathogenic organisms.

Risk Factors

• Bone marrow malfunction.
• Marrow replacement with fat in aplastic anemia.

Desired Outcomes

A patient will have a reduced risk of infection as evidenced by an absence of fever, normal white blood cell count, and implementation of preventive measures such as proper handwashing.

A patient will have vital signs within the normal limit.

Nursing Interventions	Rationale
Assess for local or systemic signs of infection, such as fever, chills, swelling, pain, and body malaise.	Opportunistic infections can easily develop, especially in immunocompromised patients.
Monitor WBC count.	A low white blood cell count (leukopenia) is a decrease in disease-fighting cells (leukocytes) in your blood. In general, for adults, a count lower than 4,000 white blood cells per microliter of blood is considered a low white blood cell count.
Instruct the patient to report signs and symptoms of infection immediately.	A simple fever is significant enough not to pay attention to. A need for antibiotic therapy may be indicated.
Anticipate the need for an antibiotic, antiviral, and antifungal therapy.	These agents are effective against killing an infection.
Instruct the patient to avoid contact with people with existing infections.	These can be a source of infection for the immunocompromised patient. Children 12 years of age or younger are at risk because they can be carriers of infection, especially upper respiratory infection.
If the patient is hospitalized, provide a private room for protective isolation.	Environmental changes may be important if the absolute neutrophil count is less than 500/mm3. Protective isolation precautions may include placing the patient in a private room, limiting visitors, and having all people who encounter the patient use mask, gowns, and gloves. These patients are at significant risk for infection.
Instruct the patient to avoid eating raw fruits and vegetables and uncooked meat.	These food items can harbor bacteria. A low-bacterial diet protects the patient from exposure to pathogens.
Stress the importance of daily hygiene, mouth care, and perineal care.	These preventive measures help avoid skin breakdown and lessen the risk of infection.
Teach the patient and visitors proper handwashing.	Practicing hand hygiene is an effective way to prevent infections. Washing hands can prevent the spread of germs, including those that are resistant to antibiotics.
Administer WBC growth factor to stimulate the production of neutrophils.	Colony-stimulating factors (CSFs), long-acting pegfilgrastim, filgrastim are medications used to stimulate the production of infection-fighting white blood cells.

Nursing Care Plan 4: Diagnosis – Risk for Bleeding

Risk for Bleeding: At risk for a decrease in blood volume that may compromise health.

Risk Factors

• Bone marrow malfunction.
• Marrow replacement with fat in aplastic anemia.

Desired Outcomes

A patient will have a reduced risk for bleeding, as evidenced by normal or adequate platelet levels and absence of bruises and petechiae.

Nursing Interventions	Rationale
Assess the skin for bruises and petechiae.	Bruises and petechiae are usually evident when the platelet count drops to 20,000 mm3.
Assess for any frank bleeding from the nose, gums, vagina, or urinary or gastrointestinal tract.	The early assessment facilitates immediate treatment. These sites are most common for spontaneous bleeding.
Monitor platelet count.	A low platelet count or thrombocytopenia is caused by a bone marrow malfunction resulting from nutritional deficiencies, drugs, certain viral causes, or aplastic anemia. The risk for bleeding is increased as platelet count is decreased.
Monitor stool (guaiac) and urine(Hemastix) for occult blood.	These tests help identify the site of bleeding.
Consolidate laboratory blood sampling test.	Repeated blood sampling over time can lead to anemia. Consolidation minimizes the number of venipunctures and optimizes blood volume.
Instruct the patient in dietary modifications to reduce constipation.	Eating a diet high in fiber and drinking a lot of fluids to avoid constipation or using a stool softener and other laxatives as prescribed if having difficulty passing stool.
Instruct the patient about bleeding precautions. Instruct the patient to use an electric shaver, not a razor. Use a soft toothbrush when brushing the teeth. Use pads instead of tampons. Avoid rectal procedures such as suppositories, enemas, and rectal temperature readings. Using a water-based lubricant during sexual intercourse to reduce friction (KY Jelly or Astroglide)	Once the patient’s platelet count drops to 50,000mm3, bleeding precaution should be instituted immediately to avoid the risk of spontaneous bleeding.
Anticipate the need for a platelet transfusion once the platelet count drops to a very low value.	Platelet replacement may be required to reduce the risk of bleeding. Premedication with antihistamine and antipyretics reduces transfusion reaction side effects.

References

• ncbi.gov
• scholar.google.com