Nursing care in patients with Anemia aplastic

Anemia aplastic

A. UNDERSTANDING
Aplastic anemia is a disorder in bone disumsum stem cells that can cause death if the amount of blood cells produced are not adequate.

B. ETIOLOGY

• Certain antibiotics such as chloramphenicol
• Viral infections such as hepatitis
• Benzene
• Radiation Therapy
• Antineoplastic agents or cytotoxic

C. Pathophysiology
The existence of an anemia reflect the existence of a marrow failure or excessive loss of red blood cells or both. Marrow failure (eg reduced eritropoesis) can occur due to nutritional deficiencies, toxic exposure, invasion of tumor or other cause not yet known. Red blood cells can be lost through bleeding or hemolysis (destruction).

Red blood cell lysis (dissolution) occurs mainly in phagocytic cells or the reticuloendothelial system primarily in the liver and spleen. As a result of this process is bilirubin that form in the phagocyte will enter the bloodstream. Any increase in red blood cell destruction (hemolysis) immediately reflected by increased plasma bilirubin. (Normal concentration of 1 mg / dl or less; levels above 1.5 mg / dl result in jaundice in the sclera).
If experiencing the destruction of red blood cells in circulation, the hemoglobin will appear in the plasma (hemoglobinemia). If the plasma concentration exceeds the capacity of plasma haptoglobin (hemoglobin-binding proteins for free) to bind it all (eg if there are more than about 100 mg / dl), hemoglobin will be diffused in the kidney glomerulus and into the urine (hemoglobinuria).
Conclusions about whether an anemia in certain patients is caused by destruction of red blood cells or red blood cell production is not sufficient in a way that is:

1. Calculate reticulocyte in blood circulation.
2. The degree of proliferation of young red blood cells in bone marrow and how pematangannya.
3. Presence or absence of hyperbilirubinemia and hemoglobinemia.

Aplastic anemia is caused by a decrease in precursor cells in bone marrow with fat that can occur in congenital or acquired and idiopathic (no cause is not clear). Various kinds of infections during pregnancy can be as originators, or can be caused by drugs, chemicals, or damage radiation. Substances that often cause bone marrow aplasia is benzene and benzene derivatives (eg, airplane glue); anti-tumor drugs such as nitrogen mustard,; antimetabolik, including metotrexate and 6-merkaptopurin; and berabagai other toxic substances such as arsenic.

Various materials which sometimes causes aplasia or hypoplasia include various antimicrobial, anti-convulsive, anti-thyroid drugs, oral hypoglycemic drugs, anti histamine, analgesic, sedativ, phenothiasine, insecticides, and heavy metals. In various circumstances, aplasia anemia occurs when the drugs or substances included in the amount of toxic chemicals. If exposure is stopped immediately (in this case at the first occurrence of retikulositopenia, anemia, granulositopenia, thrombocytopenia) can be expected soon and perfect healing. In a young man who experienced puberty during hepatitis have a high risk of experiencing severe aplasia anemia with mortality rates of 90% in the first year with a mean survival of six months; marrow transplantation is a treatment option.

D. CLINICAL MANIFESTATIONS

• Pale as a result of reduced blood volume and decreased hemoglobin.
• Dyspnea, shortness of breath and tired quickly when berktivitas.
• Loss of appetite, nausea and stomatitis.
• Tachycardia and cardiac noise as a picture of the workload and bulk Increased heart.
• Headache, dizziness and weakness as a result of reduced supply of oxygen carried by red blood cells into the central nervous system.

E. EXAMINATION SUPPORT
Laboratory (Hb, HCT, Platelets, Granulocytes)

F. MANAGEMENT
There are two methods of treatment are now often implemented are:

1. Transplantation of bone marrow Bone marrow transplantation was undertaken to provide a network inventory hematopoesti that still works. For transplantation is required ability to adapt behasil donor and recipient cells and to prevent complications during healing. With the use of the immunosuppressant cyclosporin, the incidence of rejection for grafts less than 10%.
2. Immunosuppressive therapy with antitimosit globin (ATG). Immunosuppressive therapy with ATG given to stop the immunological function that extends the bone marrow aplasia allowing experienced healing. ATG was given every day through a central venous catheter for 7-10 days. Patients who respond usually recovers within a few weeks to 3 months, but if it responds slowly to 6 months after treatment. Patients who experience severe anemia and treated early during the history of the disease have the best chance of responding to the ATG. Supportive therapy plays an important role in the management of aplastic anemia. Patients supported with transfusions of red blood cells and platelets are sufficient to overcome the symptoms.

G. NURSING DIAGNOSIS ARISING

• Imbalance nutrition less than the needs associated with nausea, vomiting, anorexia.
• Activity intolerance related to reduced oxygen supply to the central nervous system.
• PK: Thrombocytopenia
• PK: Bleeding
• Risk of infection associated with invasive measures: a reduction in immunological

H. LITERATURE

1. Arif Mansjoer, 2000, Capita Selekta Medicine, Publisher Media Aeusculapius FK-UI, Jakarta
2. Doenges M.E. at al., 1992, Nursing Care Plans, F.A. Davis Company, Philadelphia
3. Renowned, HY, et al, 2002, Textbook Medical-Surgical Nursing Brunner & Suddarth, EGC, Jakarta
4. Joane C. Mc. Closkey, Gloria M. Bulechek, 1996, Nursing Interventions Classification (NIC), Mosby-Year Book, St. Louis
5. Marion Johnson, et al, 2000, the Nursing Outcome Classifications (NOC), Mosby-Year Book, St. Louis
6. Marjory Gordon, et al, 2001, Nursing Diagnoses: Definition & Classification 2001-2002, NANDA
7. Soeparman. (1987). Medicine, Faculty of medicine Publishing Center, Jakarta.

I. NURSING DIAGNOSIS

Imbalance nutrition less than the needs associated with nausea, vomiting, anorexia.

Purpose:
Once the action has been nursing for 3x24 hours clients nutritional needs are met with the criteria results:

• Adequate nutrient intake.
• Nausea, vomiting, loss anoreksi
• Free from signs of malnutrition.
• There was no decline Weight Loss

Intervention:

• Monitor nutritional intake and output
• Monitor weight gain corporate clients Explain to klie about the importance of nutrition for the body and the diet prescribed and ask again what has been described
• Help clients and families identify and select foods that contain calories and protein in accordance with a programmed diet.
• Serve food in warm and attractive
• Collaboration with a dietitian to determine the proper diet as well as physicians in the provision of vitamins.

Activity intolerance related to reduced oxygen supply to the central nervous system.

Purpose:
Once the action has been nursing for 3x24 hours clients can increase activity tolerance criteria:

• Freedom from exhaustion after activity
• A balance needs activity and rest
• There is an increasing activity tolerance

Intervention:

• Monitor vital signs
• Review the causes of intolerance client activity
• Train ROM when circumstances allow clients
• Teach client techniques energy savings for activity
• Increase client activity according to ability

PK: Thrombocytopenia

Purpose:

• Nurses are expected to minimize complications from the presence of thrombocytopenia with the criteria:
• Trombosit in normal circumstances (350-450 rb / MMK).

Intervention:

• Observation of general condition Clients
• Monitor laboratory results (number of platelets)
• Observation of signs of bleeding
• Collaborative provision platelet transfusion

PK: Bleeding

Purpose:
Nurses are expected to minimize complications from the bleeding with criteria:

• Hb levels within limit Normal
• There are no signs hypovolemic shock

Intervention:

• Observation of general condition Clients
• Monitor laboratory results (figure hemoglobin)
• Observation of signs of bleeding

Resiko infeksi berhubungan dengan tindakan invasif; penurunan imunologis

Purpose:After nursing for a 3x24 hour action does not occur with infection criteria:

• There are no signs of infection.
• Vital signs within limit Normal
• Number of leucocytes and differential within normal limits.

Intervention:

• Monitor vital sign andsigns of infection
• Monitor laboratory results (number of leucocytes and differential)
• Perform aseptic techniques and Septic each perform action on the client.
• Observations on the region where the stabbing infusion,catheter
• Teach the client and families about how infection prevention and signs of infection
• Collaborative provision antibiotic