DISC 5

Chapter_019.pptx

Chapter 19

Cardiovascular Function

Cardiovascular disease is the leading cause of death in the United States and is a major cause of disability.

Risk factors: high cholesterol levels, hypertension, diabetes mellitus, tobacco use, physical inactivity, obesity, alcohol use, age, and heredity

Older adults who stay physically fit have twice the work capacity and a lower amount of body fat than older adults who are sedentary.

Introduction

Heart rate decreases, left ventricular wall thickens, increased collagen and decreased elastin in heart muscle and vessel walls, size of left atrium increases, and aortic distensibility and vascular tone decrease.

Decrease in cardiac output and reserve

S4 heart sound and grade 1 or 2 systolic murmur are common.

Age-Related Changes in Structure and Function (1 of 2)

Conduction system

SA node, AV node, and the bundle of His become fibrotic with age; number of pacemaker cells decreases.

Vessels

Calcification of vessels occurs; elastin in vessel wall decreases; less sensitive to the baroreceptor regulation of blood pressure.

Age-Related Changes in Structure and Function (2 of 2)

Decreased cardiac output and cardiac reserve decrease older adult’s response to stress.

During stress or stimulation, heart rate increases more slowly; once elevated, takes longer to return to the resting rate

Response to Stress and Exercise

50% of hospitalizations attributed to coronary heart disease; conditions such as strokes, hypertension, heart failure, arrhythmias, valvular conditions, and peripheral vascular disease account for other cardiovascular diseases.

Common Cardiovascular Problems

Nonmodifiable:

Age, gender, family history

Modifiable:

Smoking, high blood pressure, high-fat diet, obesity, physical inactivity, stress

Risk Factors

Reducing fat content will reduce cholesterol.

Stop smoking

Walking is the best activity for older adults.

Maintain healthy body weight—BMI 18.5–25 kg/m2.

If diabetic monitor for symptoms of CAD

Effectively manage stress

Be aware menopause increases rate of heart disease for women

Lifestyle Changes to Reduce Risk Factors

More than 50% of the population older than age 65 has high blood pressure.

Normal blood pressure is a SBP less than 120 mmHg and/or DBP less than 80 mmHg.

Prevention and proper management is necessary to reduce the risk of cardiovascular, renal, and cerebrovascular diseases.

Primary—family history, age, race, diet, smoking, stress, alcohol and drug consumption, lack of physical activity, and hormonal intake

Secondary—caused by underlying disease

Hypertension (HTN)

Blood pressure should be lowered gradually, beginning with low doses of a single agent.

Goal of treatment is a blood pressure less than 120/80 mmHg.

Diuretics

Beta-blockers

Angiotensin-converting enzyme inhibitors

Calcium channel blockers

HTN: Pharmacologic Treatment

Unrecognized and untreated: significantly increases the risk of coronary disease, heart and renal failure, and stroke

Individual pharmacologic and nonpharmacologic treatment program based on assessment of total cardiovascular risk; the risk of cardiovascular-related death from stroke and heart attack can be reduced

HTN Prognosis

Symptoms early in disease: vague discomfort, fatigue, headache, epistaxis, and dizziness

Symptoms in severe disease: throbbing occipital headache, confusion, vision loss, focal deficits, and coma

Check for heart and kidney involvement

Objective data: blood pressure taken on three separate occasions, with patient both sitting and standing

Can you name four nursing diagnoses for HTN?

HTN: Assessment and Diagnosis

Potential for injury

Need for patient teaching, resulting from new diagnosis of hypertension, self-care management, and interventions

Poor coping mechanisms, resulting from perceived limitations of diagnosis

Inadequate nutrition resulting from high fat, caloric, and sodium intake, and altered taste

The patient will demonstrate the following:

Identify personal risk factors

Explain the disease process and its effects on health and well-being

Incorporate nonpharmacologic treatment measures into daily living

Verbalize purpose, dose, action, and significant and reportable side effects

Increase social interaction

Eat a low-fat, low-cholesterol, and reduced-calorie diet

HTN: Planning and Expected Outcomes

Teach disease process and therapeutic interventions.

Provide information about disease process, signs and symptoms of hypertension, treatment regimen, medications, and monitoring.

Explain importance of low-sodium, high-potassium, low-fat, reduced-calorie diet

Encourage alcohol restriction, smoking cessation exercise, and weight loss

HTN: Intervention

Determine the patient’s achievement of the expected outcomes.

Patient’s blood pressure should decrease and return to optimum levels.

Patient should be able to maintain treatment plan without side effects or complications.

Determine patient’s perception of any change in quality of life.

Accurate documentation of blood pressure, exercise, and dietary intake

HTN: Evaluation

The nurse caring for an older adult notices his blood pressure reading have been running high. Last check was 188/95. The nurse questions the patient, and he states he was on a water pill but didn't like having to go to the bathroom so much so he stopped taking it. The nurse realized that patient has a knowledge deficit and needs to begin a teaching session. Which areas are a priority to include in the nurse’s teaching at this time?

Quick Quiz!

Answers will vary but should include disease process, diet, exercise, and pharmacologic and nonpharmacologic treatments.

Answer to Quick Quiz

Atherosclerosis is usual cause; angina, myocardial infarction (MI), and sudden death may be final outcomes.

Normal process of aging; severity can be accelerated with smoking, physical inactivity, and obesity, elevated serum cholesterol levels, hypertension, and diabetes

Symptoms of angina or MI may be vague and atypical due to neuropathies and changes in pain recognition.

They may seek not medical attention as soon as they should

Unrecognized MI may cause cardiac damage and precipitate complications of heart failure and pulmonary edema.

Coronary Artery Disease (CAD)

12 lead electrocardiogram (ECG)

Cardiac biomarkers/enzymes

Complete blood count (CBC)

Comprehensive metabolic panel

Serum lactate dehydrogenase (LDH)

Chest radiography

Color-flow Doppler transthoracic echocardiography and coronary angiography

Exercise stress test

CAD: Diagnostic Tests and Procedures

Directed toward restoring balance between myocardial oxygen demand and oxygen supply

Nitrates

Beta-blockers

Calcium channel blockers

Fibrinolytics, anticoagulants, and antiplatelets

Lipid lowering drugs

CAD: Pharmacologic Treatment

Percutaneous transluminal coronary angioplasty (PTCA)

Coronary artery bypass graft (CABG) surgery

Age-related physiologic changes, longstanding unhealthy lifestyles, and chronic conditions in older adults may complicate the progress and treatment of CAD, but adopting healthy lifestyle can influence outcomes.

CAD: Nonpharmacologic Treatment and Prognosis

CAD is leading cause of death in women.

Smaller coronary arteries that occlude easier

They experience atypical symptoms: epigastric pain and shortness of breath

Do not receive the same standard of emergency coronary care as men

Have poorer outcomes

CAD in Women

Complete health history and physical examination

Complaints of dyspnea, fatigue, syncope, vertigo, and confusion warrant further investigation

Can you name five nursing diagnoses for CAD?

CAD: Assessment and Diagnosis

Chest discomfort, resulting from an imbalance between oxygen need and supply

Ineffective cardiac output, resulting from decreased pumping ability of the heart

Decreased activity level, resulting from decreased cardiac output

Potential for nonadherence

Anxiety, resulting from fear of death

The patient will demonstrate the following:

Verbalize pain relief

Maintain adequate circulation

Tolerate activity

Explain the disease process and therapeutic plan

Describe actions to take in the event of chest pain

Express fears and have reduced anxiety

CAD: Planning and Expected Outcomes

Focus on relieving pain, improving myocardial blood flow, decreasing myocardial workload, and educating the patient.

System assessments should be conducted on a regular basis to detect progress and prevent complications.

Encourage participation in cardiac rehabilitation programs.

Discuss resumption of sexual activity.

CAD: Intervention

Evaluation and documentation of progress of an older patient with CAD focus on the achievement of goals outlined in the planning process

CAD: Evaluation

Atrial fibrillation, sick sinus syndrome, and heart block occur more often in the older population.

Atrial fibrillation is the most common contributing factor for ischemic stroke.

Sick sinus syndrome is alternating episodes of bradycardia (<60 beats/min), normal sinus rhythm (60–100 beats/min), tachycardia (>100 beats/min), and periods of long sinus pauses.

Heart block is delayed or blocked impulses between the atria and ventricles and is classified as first-, second-, or third-degree heart block.

Arrhythmia

Diagnosed by ECG

Holter monitor

Patient-activated event recorder

Test to determine cause after arrhythmia is diagnosed

Arrhythmia: Diagnostic Tests and Procedures

Control the underlying cause, slow the heart rate and/or converting the rhythm to a normal sinus rhythm, and preventing stroke

Drugs for rate control: beta-blockers and calcium channel blockers

Oral anticoagulants are prescribed to reduce risk of thromboembolic events.

Elective cardioversion is appropriate for acute atrial fibrillation.

Atrial Fibrillation Treatment

Treatment of sick sinus syndrome is permanent Pacemaker.

Treatment for first-degree heart block includes correction of the causative factor (e.g., electrolyte imbalance or drug toxicity).

Permanent cardiac pacemaker for symptomatic second- and third-degree blocks

When corrected arrhythmias have an excellent prognosis

A-Fib has an increased risk for ischemic stroke.

Sick Sinus Syndrome and Heart Block Treatment and Arrhythmia Prognosis

History of CAD, heart failure, hypertension, cardiac valve disease, and current medications

Symptoms: confusion, palpitations, and dizziness, SOB, chest pain and syncope

Objective data: LOC, orientation, HR and rhythm, BP, peripheral pulses, and urine output

Laboratory values: electrolytes, hemoglobin, and hematocrit

Can you name four nursing diagnoses?

Arrhythmia: Assessment and Diagnosis

Reduced cardiac perfusion, resulting from altered heart rate and rhythm

Reduced physical stamina, resulting from altered heart rate and cardiac output

Potential for injury, resulting from potential thrombus and emboli formation

Potential for nonadherence, resulting from lack of information about disease process, drugs, and treatment plan

The patient will demonstrate the following:

Maintain an adequate cardiac output.

Tolerate activity.

Remain free from injury.

Verbalize knowledge about his or her diagnosis, treatment plan, and health maintenance behaviors.

Arrhythmia: Planning and Expected Outcomes

Monitor vital signs, heart rate, and rhythm.

Encourage patient to promptly report symptoms.

Assess cardiovascular, respiratory, and neurologic systems, as well as intake and output.

Assist patients to identify of factors that increase or decrease activity tolerance.

Prevent injury.

Consult home health agency.

Encourage patient to wear medical-alert bracelet.

Arrhythmia: Intervention

Patient should maintain a cardiac rhythm that supports adequate cardiac output.

Older adult’s readiness for independence is defined by their ability to resume ADLs, knowledge of the therapeutic plan, and achievement of expected outcomes.

Documentation: patient’s response to treatment plan and how well symptoms are controlled

Arrhythmia: Evaluation

A 78-year-old is admitted to the telemetry unit with congestive heart failure (CHF). Hx: HTN, chronic mitral valve regurgitation. Meds: Lasix 80 mg QID, Dioxin 0.125 mg daily, Cardizem 60 mg TID. Initial assessment: pulse rate rapid and very irregular, patient is restless, skin is pale and cool, she is dizzy when she stands up and is slightly SOB. Blood pressure (BP) 106/88, cardiac monitor shows atrial fibrillation rate ranging from 150 to 170 bpm; Pox is 90%.

1. What should you do first?

2. What other assessments would you perform?

3. What possible treatment will be ordered for this patient?

Quick Quiz!

1. What should you do first?

Oxygen, obtain VS call rapid response or HC provided give medications if due

2. What other assessments would you perform?

LOC, neurocheck, cardiovasc, resp, and I&O

3. What possible treatment will be ordered for this patient?

Beta-blockers, calcium channel blockers, elective cardioversion, and anticoagulant therapy

Answer to Quick Quiz

Later that evening, the patient calls the nurse and states that she feels something terrible is going to happen. The patient c/o SOB and has coughed up bloody sputum.

1. What do you suspect is happening?

2. What is the first action you need to take?

3. What other assessments should you perform at this time?

Quick Quiz!

1. What do you suspect is happening?

P.E.

2. What is the first action you need to take?

Call rapid response provide oxygen, obtain VS elevate HOB.

3. What other assessments should you perform at this time?

Neuro, respiratory

Answer to Quick Quiz

Major risk factor for syncope and falls

Dizziness with position changes, results from decreased sensitivity of baroreceptors

Defined: decrease of 20 mmHg or greater in systolic blood pressure, or a decrease of 10 mmHg or greater in diastolic blood pressure, on standing

Risk factors: autonomic dysfunction, low cardiac output, and hypovolemia; use of sedatives, antihypertensives, vasodilators, and antidepressants; increase in sedentary activity

Orthostatic Hypotension

Complete health history and physical examination

Investigate reports of syncope, falls, and near falls in relation to medications, meals, and environmental factors.

Evaluate hydration status along with a CBC and serum glucose level.

Check orthostatic blood pressure.

Review all prescribed and OTC medication for those known to cause hypotension.

Orthostatic Hypotension: Assessment

The patient will do the following:

Remain free of injury

Verbalize and correctly demonstrate measures to prevent symptoms of orthostatic hypotension

Verbalize fears and identify coping measures

Can you name three nursing diagnoses?

Orthostatic Hypotension: Diagnosis, Planning, and Expected Outcomes

Potential for reduced cardiac perfusion

Potential for injury

Need for health teaching, resulting from positional hemodynamic changes and risk for falls

Teach how to change positions slowly.

Exercise lower legs and ankles.

Work with patient and physician to eliminate unnecessary medications.

Encourage patient to limit alcohol intake, avoid large meals, and monitor and control diabetes.

Provide education on environmental safety.

Safe performance of ADLs and document trends in BP.

Orthostatic Hypotension: Intervention and Evaluation

Syncope is a transient loss of consciousness, usually related to decreased cerebral perfusion, with spontaneous recovery.

Most frequent cardiovascular causes of syncope—cardiac arrhythmias, sick sinus syndrome, atrioventricular block, aortic stenosis, cardiomyopathy, acute myocardial cell death, and orthostatic hypotension.

Syncope With Cardiac Causes

Complete history and physical examination

Obtain information from witnesses to syncopal episode.

12-lead ECG

Auscultate carotid arteries for bruits

CBC, complete chemistry panel, and glucose levels

Can you name three nursing diagnoses for syncope?

Syncope: Assessment and Diagnosis

Reduced cardiac output, resulting from inadequate left ventricular filling, arrhythmia, or orthostasis

Potential for injury

Anxiety, resulting from near or full loss of consciousness

The patient will demonstrate the following:

Regain a normal range of cardiac output as demonstrated by stable vital signs and alert and oriented sensorium.

Verbalize understanding of the cause of syncope and the therapeutic treatment plan.

Syncope: Planning and Expected Outcomes

Emergency measures to correct life-threatening arrhythmias when needed

Administer oxygen and monitor O2 saturation.

Assist in the identification of causes of syncope.

Implement measures to avoid constipation.

Instruct to lie down if dizzy or symptomatic.

Positive change in the clinical picture with identification of causes and prevention methods

Syncope: Intervention and Evaluation

Cardiac valves do not completely open or close.

Most common in mitral and aortic valves

Stenosis of mitral valve impedes blood flow from left atrium to ventricle during diastole.

Mitral regurgitation allows ejected blood to flow back into left atrium from ventricle during systole

Stenosis of aortic valve obstructs blood flow from left ventricle to aortic arch during systole.

Aortic regurgitation allows ejected blood to flow back into left ventricle from the aorta during diastole.

Valvular Disease

CXR and ECG

ECG with doppler and ultrasonography

Cardiac catheterization

Exercise tests

Valvular Disease Diagnostic Tests and Procedures

Manage presenting symptoms and correct the cause.

Treat heart failure and A-fib if present.

Prophylactic antibiotics before invasive procedures

Surgical repair or replacement may be necessary.

Mortality and morbidity rates higher for those requiring valve surgery but surgery has increased quality of life

Valvular Disease Treatment and Prognosis

History of prior infections, family history of cardiac disease, current medications

Symptoms

Cardiac and respiratory system

Auscultation

Can you name four nursing diagnoses for valvular disease?

Valvular Disease: Assessment and Diagnosis

Reduced cardiac output, secondary to altered blood flow through the heart

Reduced activity level, secondary to decreased cardiac output

Anxiety, secondary to new diagnosis, treatment plan, and uncertain outcome

Inadequate knowledge, secondary to lack of previous exposure to information about the disease process, drugs, and treatment plan

The patient will demonstrate the following:

Maintain adequate cardiac output

Tolerate a usual level of daily activity

Experience reduced anxiety

Correctly explain the disease process, therapeutic plan, and preventive precautions

Valvular Disease: Planning and Expected Outcomes

Cardiovascular and respiratory assessments

Monitor patients for therapeutic and adverse reactions to medications prescribed.

Monitor VS, heart and breath sounds, and cardiac rhythm.

Ensure patient maintains bed rest when ordered and performs range-of-motion exercises.

Elevate head of bed.

Administer oxygen as prescribed.

Valvular Disease: Intervention (1 of 3)

Assess a patient’s activity level and balance activity with rest periods.

Teach patient to rise slowly and stay in a sitting position for a few minutes before standing.

Encourage use of secure footwear and handrails for support.

Review disease process and treatment plan.

Review low-sodium diet and bleeding precautions.

Antibiotics for invasive procedures

Valvular Disease: Intervention (2 of 3)

If scheduled for valvular surgery, pre- and postoperative education provided to patient and family

After surgery, monitor closely for complications

Exercise and ADLs should be gradually resumed during the first 6 weeks of recovery.

Signs, symptoms, and complications of valvular disease should be reviewed with patient.

Valvular Disease: Intervention (3 of 3)

Should demonstrate adequate cardiac output, ability to perform ADLs within limitations, and control of symptoms

Documentation should accurately reflect care delivered in preoperative and postoperative periods.

Document of progress toward self-care and degree of functional ability

Valvular Disease: Evaluation

Leading cause of hospitalization in the older adult population

Classification: The ACCF/AHA stages of heart failure determine the presence of and severity of failure, the New York Heart Association (NYHA) functional classification focuses on symptomatology and exercise capability

Common risk factors include coronary heart disease, hypertension, diabetes mellitus, obesity, and smoking.

Heart Failure

12-lead ECG

B-type natriuretic peptide, CBC, urinalysis, serum electrolytes, kidney function, thyroid panel, and lipid panel

Chest x-ray

Echocardiogram

Heart Failure Diagnostic Tests and Procedures

Control of precipitating factors

Pharmacologic therapy

Low-sodium diet

Restriction of fluids

Appropriate rest and exercise

Pharmacological therapy

Nonpharmacological therapy

Heart Failure Treatment

Systolic heart failure:

Diuretics, ACEIs, beta-blockers, aldosterone antagonists, digoxin, anticoagulants, sympathomimetics

Diastolic heart failure:

Calcium channel blockers, ACEIs, ARBs, beta-blockers or dig for rate control, diuretics

Poor prognosis with higher mortality for systolic heart failure, 80 years and older: mortality at 5 years is roughly 50%

Heart Failure Specific Treatment and Prognosis

History of CAD, rheumatic heart disease, hypertension, cardiac valve disease, infection, and current medications

BP, pitting edema, jugular venous distension, heart and lung sounds

Orthopnea, fatigue at rest, paroxysmal nocturnal dyspnea, and nocturnal urination

Determine how symptoms have affected ADLs

Can you name eight nursing diagnoses for heart failure?

Heart Failure: Assessment and Diagnosis

Reduced cardiac output resulting from decreased cardiac contractility

Altered gas exchange resulting from pulmonary venous congestion

Increased fluid volume resulting from increased sodium and water reabsorption

Anxiety resulting from perceived threat to self

Reduced stamina resulting from decreased cardiac output

Decreased ability to cope resulting from knowledge deficit and fear of uncertain outcome

Altered sleep pattern resulting from nocturnal dyspnea and nocturnal urination

Need for health teaching resulting from lack of previous exposure to disease process, drugs, and treatment plan

The patient will demonstrate the following:

Maximize cardiac output

Improved gas exchange

Reduced dependent edema and abdominal girth

Experience less anxiety

Restoration of activity level

Adequate sleeping pattern

Adequate knowledge

Heart Failure: Planning and Expected Outcomes

Assess BP, apical pulse, heart rate, heart and lung sounds, and peripheral edema

Monitor intake and output, daily weights, and electrolytes

Increase the patient’s activity according to tolerance position

Instruct on diet, fluids, and diuretics

Instruct to report a weight gain of 3 lb in 48 hours

Referral to home health agency

Heart Failure: Intervention

Improved ventricular function

Increased activity levels without experiencing dyspnea and return to usual ADLs

Document trends

Heart Failure: Evaluation

The nurse is preparing an older adult for discharge after treatment for congestive heart failure. The nurse is sure to include which of the following instructions? (Select all that apply.)

Resume all usual activity as before admission.

Take diuretic with dinner every night.

Take blood pressure and heart rate daily.

Notify health care provider of a weight gain of 3 lbs in 48 hours.

Take digoxin in the morning with breakfast.

Maintain a low sodium diet.

Quick Quiz!

ANS: C, D, F

Answer to Quick Quiz

Associated with significant morbidity and mortality; if left untreated, can be life-threatening

Symptoms appear when the artery is unable to supply the tissues with adequate oxygenated blood flow.

Intermittent claudication (muscle ischemia) is one of the initial symptoms of atherosclerosis obliterans.

Foot appears pale when elevated and dusky red in dependent positions.

Can result in dry skin, thickened toenails, loss of pedal hair, cool skin, and painful arterial ulcers

Advanced stages of ischemia lead to necrosis, ulceration, and gangrene of the toes.

Peripheral Artery Disease (PAD)

Tests and procedures

Doppler ultrasound (Duplex), angiography

Treatment

Lifestyle modifications, pharmacotherapy, percutaneous transluminal angioplasty, thromboendarterectomy, revascularization, amputation

Lifestyle changes can prevent or halt the progression of PAD but if ineffective, pharmacological therapy or surgical intervention may be necessary.

PAD Diagnostic Procedures, Treatment, and Prognosis

Complete history and physical examination

Subjective and objective data

Can you name four nursing diagnoses for PAD?

PAD: Assessment and Diagnosis

Decreased peripheral tissue perfusion, resulting from decreased arterial blood flow

Decreased activities of daily living, resulting from an imbalance between tissue need and blood supply

Potential for skin integrity issues

Inadequate knowledge, resulting from lack of previous exposure to disease process, drug, and treatment plan

The patient will demonstrate the following:

Manifest reduced signs and symptoms of arterial insufficiency

Successfully participate in activities within limits imposed by the disease

Demonstrate protective behavior and self-care measures to prevent injury to the skin

Correctly describe the disease process and treatment plan

The patient will identify personal risk factors and methods to reduce these factors.

PAD: Planning and Expected Outcomes

Initiate a graduated, regular exercise program

Encourage patients to balance activities with rest

Educate patient to prevent injuries

Focuses on achievement of expected outcomes

PAD: Intervention and Evaluation

Common disorders: varicose veins, venous ulceration, and deep vein thrombosis

Primary varicose veins can lead to venous ulcers.

Secondary varicose veins result from deep vein thrombosis.

Chronic Venous Insufficiency (CVI)

Tests and procedures:

Doppler ultrasound, plethysmography, venous duplex ultrasonography, contrast venography

Laboratory work: platelet count, prothrombin time, PTTs, aPT, INR, D-dimer, and chemistry

Treatment:

Palliative measures to ease symptoms, pharmacologic therapy, surgical strategies

CVI: Diagnostic Tests and Treatment

Complete history and physical examination

Subjective data: pain in extremity, precipitating factors, relieving factors, modifiable risk factors, and personal and family history

Objective data: skin color, hair distribution, atrophy, edema, varicosities, petechiae, lesions, and ulcerations

Can you name three nursing diagnoses for CVI?

CVI: Assessment and Diagnosis

Potential for skin integrity issues resulting from venous stasis

Decreased peripheral tissue perfusion resulting from interruption of venous flow

Pain resulting from inflammatory processes

Skin integrity will be maintained or improved.

The patient will exhibit no ulceration or signs of the inflammatory process.

Tissue perfusion will be improved, as evidenced by decreased edema and fewer complaints of discomfort.

CVI: Planning and Expected Outcomes

Assessment of skin integrity

Doppler sensor if pulses seem absent

Elevate affected extremity

Demonstrate application and removal of elastic compression stockings

Prevent hazards of immobility

Instruction on foot care

Progress in maintaining skin integrity, improving venous circulation, and reducing pain and discomfort

CVI: Intervention and Evaluation

Over 20% of older adults over the age of 85 have anemia.

Usually insidious in nature and an incidental finding on hematological studies

Common causes: iron deficiency anemia, anemia of chronic disease, and anemia related to CKD

Anemia

History and physical

CBC with differential and peripheral smear

Reticulocyte count

Lactate dehydrogenase level

Serum ferritin

Serum iron

Total iron-binding capacity

Anemia Diagnostic Tests and Procedures (1 of 2)

Anemia Diagnostic Tests and Procedures (2 of 2)

Vitamin B12

Folate

TSH

Serum chemistry with eGFR

Iron deficiency anemia

Stool for occult blood

Treatment includes dietary sources of iron and supplemental intake of iron, if no response to oral replacement, IV iron should be tried.

Anemia of chronic disease

C-reactive protein, fibrinogen, erythrocyte sedimentation rate, IL6, and hepcidin levels

Treatment focuses on the underlying disease.

Administration of an erythropoiesis stimulating agent

Additional Diagnostic Tests, Procedures, and Treatment (1 of 2)

Folate deficiency

Homocysteine levels

Treatment: increased dietary intake (e.g., citrus fruits and dark green vegetables) of folic acid; older adults with alcoholism usually require exogenous folic acid

Pernicious anemia

Serum B12 level, methylmalonic acid level

Treatment: vitamin B12 given oral, nasal, or injection

Additional Diagnostic Tests, Procedures, and Treatment (2 of 2)

Depends on cause

With medications and dietary changes, prognosis usually good

Anemia Prognosis

Focuses on underlying cause and its effects on functional ability

Can you name three nursing diagnoses for anemia?

Anemia: Assessment and Diagnosis

Decreased activity resulting from an imbalance between oxygen supply and demand

Inadequate nutrition resulting from malabsorption or decreased intake of vitamins, minerals, and nutritious foods

Need for patient teaching resulting from lack of exposure to information about condition and treatment plan

The patient will demonstrate the following:

Experience increases in activity without dyspnea.

Consume a well-balanced diet with foods high in minerals and vitamins.

Verbalize an understanding of the cause of anemia and the treatment plan.

Anemia: Planning and Expected Outcomes

Instruct on diet and food selection.

Monitor for side effects of medications.

Assess income for food purchases.

Instruct on maintaining activity and rest balance.

Patient should have fewer complaints of dyspnea, fatigue, and dizziness, and weight should be within the established norm.

Normal values of hemoglobin, hematocrit, and RBC count indicate success of interventions.

Anemia: Intervention and Evaluation