Anemia

ANEMIA

UNDERSTANDING
Anemia is a reduction in red blood cell count, hemoglobin quantity and volume of red blood cells (hematocrit per 100 ml of blood).
Anemia can be classified according to:

1. The morphology of red blood cells and index-index
2. Etiology

Classification of Anemia According to Micro and Macro morphology showed red blood cell size while kromik show warnanya.Ada three major classifications are:

• Anemia Normositik Normokrom is size and shape of red blood cells of normal and contained normal amounts of hemoglobin (MCV and MCHC normal or low.
• Anemia Makrositik normokrom is size of red blood cells are larger than normal but normal hemoglobin concentration (MCV increased, normal MCHC).
• Microcytic hypochromic anemia is the size of red blood cells contain hemoglobin small amounts of less than normal (MCV and MCHC less).

Included in the category of microcytic hypochromic anemia is deficiency anemia can occur due to iron deficiency, pirodoksin or copper.Iron Deficiency Anemia is a condition in which total body iron content falls below normal levels that occur due to lack of sufficient iron to synthesize hemoglobin.

Pathophysiology

Iron-deficiency anemia is anemia most often affects children. Babies born to builan enough nonanemik and well-nourished mothers, have adequate supplies of iron until the birth weight doubling time is generally 4-6 months old. After that iron must be available in the diet to meet the needs of children. If iron intake from food is insufficient iron deficiency anemia.
This most often occurs due to the introduction of solid foods too early (before age 4-6 months) discontinuation of infant formula containing iron or breast milk before age 1 year and excessive drinking cow's milk without the addition of solid foods rich in iron. Babies are not enough months, infants with perinatal excessive bleeding or infants of mothers who are malnourished and lack of iron also do not have adequate iron stores. These babies are at higher risk of iron deficiency anemia before the age of 6 months.
Iron-deficiency anemia can also occur due to chronic blood loss. At Baby this happens because of chronic intestinal bleeding caused by a protein in cow's milk is not heat resistant. At any age children as much as 1-7 ml of blood loss from the gastrointestinal tract every day can cause iron deficiency anemia. In young women iron deficiency anemia can also occur due to excessive menstrual.

CLINICAL Pathway

Lack of Iron Intake >>>>Insufficient iron reserves >>>>Anemia Def. Iron
>>>>Weak >>>>Pale >>>>Fever

SIGNS AND SYMPTOMS

* Conjunctiva was pale (hemoglobin (Hb) 6 sampai10 g / dl).
* Palms pale (Hb below 8 g / dl)
* Irritability and anorexia (Hb 5 g / dl or lower)
* Tachycardia, systolic murmur
* Pika
* Lethargy, increased sleep needs
* Losing interest in toys or play activities.

COMPLICATIONS

* Poor muscle development (long term
* Decreased concentration of power
* The test results decreased development
* The ability to process information decreases heard

SPECIAL INSPECTION AND SUPPORT

• Free erythrocyte porphyrin levels increased
• Decreased serum iron concentration
• Transferrin saturation decreased
• Serum ferritin concentration declined
• Hemoglobin decreased
• The ratio of erythrocyte hemoglobin porphyrin ---- more than 2.8 ug / g is diagnostic for iron deficiency
• Cospuscle Mean volume (MCV) and mean cospuscle hemoglobin concentration (MCHC) ---- decline causes hypochromic microcytic anemia or red blood cells that are small and pale.
• During treatment ---- reticulocyte count increased within 3 to 5 days sesuadh commencement of iron therapy indicates a positive therapeutic response.
• With treatment, hemoglobin ------- back to normal in 4 to 8 weeks indicate additional iron and adequate nutrition.
• Therapy Effort aimed at the prevention and treatment interventions. Prevention includes: Encourage moms to give milk, Eat iron-rich foods and taking prenatal vitamins that contain iron.

Therapies
to treat iron deficiency anemia treatment program consists of the following:

• Iron is given orally in doses of 2-3 mg / kg of iron element of all forms of iron is as effective (ferrous sulfate, ferrous fumarate, ferrous succinate, ferrous gluconate.
• Vitamin C should be given together with iron (Vitamin C increases iron absorption).

Iron therapy should be given at least 6 weeks after the anemia is corrected to replenish iron reserves. Injected iron is rarely used anymore unless there is malabsorption of small bowel disease.

NURSING PROBLEMS

1. Activity Intolerance related to oxygen transport damage secondary to the decrease of red blood cells
2. Changes in nutrition: less than body requirements
3. Fatigue
4. Risk of infection associated with a decrease in resistance secondary to tissue hypoxia and / or white blood cells are abnormal (neutropenia, leukopenia)
5. Risk of injury: The tendency of bleeding associated with thrombocytopenia and splenomegaly
6. High risk of changes in growth and development.

COLLABORATION ISSUES

* PK: Bleeding
* PK: Heart Failure
* PK: Excess iron (repeated transfusions).

PLANNING NURSING

* Goal
Main Objectives include tolerance of activity, achievement and maintenance of adequate nutrition and lack of complications.

* Criteria Results
1. Improve a child's skin color
2. Pattern tumbuih children improved (as shown on the map the growth)
3. Activity levels of children according to age
4. The old man showed his understanding of the rules of treatment at home (For example: The drug, iron-rich foods that fit).

* Intervention
a. Monitor therapheutik effects and unwanted effects of iron therapy in children:

• Side effects of oral therapy (eg, tooth discoloration)
• Teach about ways to prevent tooth discoloration:
• Drink iron preparations with water, preferably with orange juice
• Gargling after taking the drug.
• Encourage to increase fiber and water to reduce the effects of iron constipation
• To overcome the severe constipation due to iron try to lower doses of iron but prolong duration of treatment.

b. Teach the parents about the intake of adequate nutrition.

* Reduce the intake of milk in children
* ncrease your intake of meat and substitute the corresponding protein
* Add whole grains and green vegetables in your diet.

c. Get information about the history of diet and feeding behavior

• Assess the factors that cause nutritional deficiencies,-psychosocial, behavioral and nutritional
• Create a plan with their parents about the eating habits of approaches that can be accepted
• Refer to the nutrition expert for evaluation and intensive therapy.
• Encourage mother to breastfeed her baby because of iron from breast milk is easily absorbed.

Rational

• By monitoring therapheutik effects can be known advantages and disadvantages of granting therapheutik they will be making it easier for i for further action.
• By teaches parents about adequate nutrition intake for iron for children can be met in accordance with age beside their parents better understand the importance of the need for iron for children.
• By providing information about the history of dieting and eating behaviors can be known habits that benefit / harm to the health of the client.
• With Mother to breastfeed their infants suggest iron deficiency in infants and children can be prevented because the milk contains iron that is easily absorbed by the body.

REFERENCES

1. Cecily L. Betz, et al, 2002, Pocket Book of Pediatric Nursing, EGC Jakarta.
2. Suriadi, et al, 2001, Child Nursing, prints I, publisher CV Great Seto, Jakarta
3. Faculty of medicine, 1998, Child Health Sciences, Printing infomedika, Jakarta.
4. Richard, R., et al, 1992, Health Sciences Children Part II.
5. Sylvia A. Price, et al, 1995, Pathophysiology Clinical Concepts of disease processes, Issue 4, EGC, Jakarta.
6. Sell ​​Lynda Carpenito, 2001, Handbook of Nursing Diagnosis, Issue 8, EGC, Jakarta.