Categories
Medical Surgical

Anemia

Anemia is a condition of lower-than-normal red blood cell (RBC)  count and hemoglobin (Hgb) level. It is often not a specific disease state but a sign of an underlying disorder. Anemia results in a diminished amount of oxygen delivery to body tissues.  There are many different kinds of anemia, but all can be classified as being due to a decrease in the production of RBC’s (hypoproliferative), excessive destruction of RBC’s  (hemolytic), or a loss of RBC’s (eg. gastrointestinal bleeding). Other etiologic factors  include deficits in iron and nutrients, hereditary factors, and chronic diseases. Complications of severe anemia include heart failure, paresthesias, confusion, and other problems specific to type of anemia.

CLINICAL MANIFESTATIONS

Several factors influence symptom of development from anemia, including its severity, speed of development (the faster the onset, the more severe the symptoms), and duration (eg. its chronicity; long-term anemia may produce few or no symptoms); the patient’s metabolic requirements and concurrent disorders or disabilities (eg. cardiopulmonary disease); and special complications or features of the condition that produced the anemia. Pronounced symptoms of anemia include the following:

  • Dyspnea, chest pain, muscle pain or cramping, tachycardia
  • Weakness, fatigue, general malaise
  • Pallor of the skin and mucous membranes (sclera, oral mucosa)
  • Jaundice (megaloblastic or hemolytic anemia)
  • Smooth, red tongue (iron-deficiency anemia)
  • Beefy-red, sore tongue (megaloblastic anemia)
  • Angular cheilosis (ulceration of the corner of the mouth)
  • Brittle, ridged, concave nails and pica (unusual craving for starch, dirt, ice) in patients with iron-deficiency anemia

ASSESSMENT and DIAGNOSTIC METHODS

  • Complete hematologic studies (eg. Hgb, hematocrit, reticulocyte count, and RBC indices, particularly mean corpuscular volume)
  • Iron studies (serum iron level, total iron-binding capacity, percentage saturation, and ferritin)
  • Serum vitamin B12 and folate levels, haptoglobin and erythropoietin levels
  • Bone marrow aspiration and biopsy
  • Other studies as indicated to determine underlying illness

Gerontologic Considerations

Anemia is the most common hematologic condition affecting elderly people. In this population, bone marrow typically has a decreased ability to respond to the body’s need for blood cells. The inability to increase blood cell production  adequately in cases of increased need seriously affects cardiopulmonary function. Because elderly people with a concurrent cardiac or pulmonary problem may be unable to tolerate anemia, a prompt, through evaluation of the anemia is warranted.

MEDICAL MANAGEMENT

The goal is to correct or control the cause of the anemia and replace lost or destroyed RBC’s by transfusing packed RBC’s. In elderly patients it is important to identify and treat the cause of anemia rather than considering it a consequence of aging.

Reference:

Handbook for Brunner and Suddarth’s

Textbook of Medical-Surgical Nursing 11th edition

Joyce Young Johnson

Lippincott Williams & Wilkins pp.35-37

Categories
Medical Surgical

Angina Pectoris

Angina pectoris is a clinical syndrome characterized by paroxysms of pain or a feeling of pressure in the anterior chest. The cause is insufficient blood flow, resulting in an inadequate supply of oxygen to meet the myocardial demand.  angina is usually the result of atherosclerotic (a form of arteriosclerosis characterized by the deposition of atheromatous plaques containing cholesterol and lipids on the innermost layer of the walls of large and medium-sized arteries) heart disease and is associated with s significant obstruction of a major coronary artery. Factors affecting anginal pain are physical exertion, exposure to cold, eating a heavy meal, stress, or any emotion-provoking situation that increases myocardial workload. Atypical angina is not associated with the above and may at rest. Diabetic neuropathy can interfere with neuroreceptors, thus dulling the patient’s perception of pain.

CLINICAL MANIFESTATIONS

  • Pain varies from a feeling of indigestion to a choking or heavy sensation in the upper chest to agonizing pain. The patient with diabetes mellitus may not experience severe pain with angina.
  • Angina is a accompanied  by severe apprehension and a feeling of impending death.
  • The pain is usually retrosternal, deep in the chest behind the upper or middle third of the sternum.
  • Discomfort is poorly localized and may radiate to the neck, jaw, shoulders, and inner aspect of the upper arms ( usually the left arm).
  • patient feels a tightness, heavy choking, or strangling sensation with a viselike (tight), insistent quality. Shortness of breath, pallor, diaphoresis, dizziness, light-headedness, nausea, and vomiting may be noted ( called angina-like signs if noted alone; may represent myocardial infarction).
  • Angina is accompanied by a feeling of weakness or numbness in the arms, wrists, and hands.
  • An important characteristics of anginal pain is that it subsides when the precipitating cause is removed or with nitroglycerin ( it is used  in medicine to dilate blood vessels). Chemical formula: C3H5N3O9

ASSESSMENT and DIAGNOSTIC METHODS

  • Evaluation of clinical manifestations of pain and patient history
  • Electrocardiogram changes ( 12-lead ECG), stress testing, blood tests
  • Echocardiogram, nuclear scan, or invasive procedures such as cardiac catheterization and coronary artery angiography

Gerontologic Considerations

The elderly person who experiences angina may not exhibit the typical pain profile because of age-related changes in neuroceptors. In older patients, pain may be sensed in the jaw or fainting  may occur. Advise patient to recognize feelings of weakness as an indication for rest or taking prescribed medications. During exposure to cold temperature, elderly patients may experience anginal symptoms more quickly than younger people. Encourage these patients to wear warm clothing as appropriate.

MEDICAL MANAGEMENT

The goals of medical management are to decrease the oxygen demands of the myocardium and to increase the oxygen supply through pharmacologic therapy and risk factor control.

SURGICAL MANAGEMENT

Frequently, therapy includes a combination of medicine and surgery. Surgically, the goals of management include revascularization ( the process of restoring the functionality of an affected organ) of the blood supply to the myocardium.

  • Coronary artery bypass surgery or minimally invasive direct coronary artery bypass (MIDCAB)
  • Percutaneous transluminal coronary angioplasty (PTCA) or percutaneous transluminal myocardial revascularization (PTMR)
  • Application of intracoronary stents and atherectomy to enhance blood flow.
  • Lasers to vaporize plaques
  • Percutaneous coronary endarterectomy to extract obstruction

PHARMACOLOGIC THERAPY

  • Nitrates, the mainstay of therapy (nitroglycerin)
  • Beta-adrenergic blockers (metoprolol [Tropol]
  • Calcium ion antagonists and calcium-channel blockers (amlodipine [Norvase] and diltiazem [Cardizeml])
  • Antiplatelet and anti-coagulant medications (aspirin, clopidogrel [Plavix], ticlodipine [Ticlid], or heparin)
  • Oxygen therapy

Reference:

Handbook for Brunner and Suddarth’s

Textbook of Medical-Surgical Nursing 11th edition

Joyce Young Johnson

Lippincott Williams & Wilkins pp.63-65

Categories
Medical Surgical

How Dangerous is Placenta Previa?

content.revolutionhealth.com

My sister got pregnant  with her second baby and experienced bleeding during her 1st trimester.The doctor’s findings was placenta previa. She was advised to have bed rest and avoid heavy household chores. During her 2nd trimester, she had bleeding again. She was admitted to the hospital and put on under observation. The doctor told us that if the bleeding won’t stop, she will undergo emergency caesarian and there will be less chance of survival for the baby because she is too small and underweight. With God’s help, the bleeding stopped and she was advised to have a complete bed rest. She was not allowed to move even in going to the bathroom. She urinates and defecates in a bed pan and someone should assist her.  If she wants to take a bath, someone should bathe her. Her doctor encouraged her to eat foods rich in carbohydrates and protein for the baby to gain weight and eat plenty of fruits especially papaya to avoid constipation. The baby’s weight should reached at least 2 kls to survive and the pregnancy should at least reached 34 weeks for the baby to mature. Her operation was scheduled last June 2, 2010 but she had bleeding last May 16, 2010 and underwent emergency caesarian. She had blood transfusion due to blood loss during the bleeding. The baby’s weight was 2.4 kls. with no complications. She just needs to be incubated for 3 days for observation since she was a premature baby. After 3 days the baby was discharged with assurance from her pediatrician that she is okay and develop no complication at all.

Looking back on the days that I took care of my sister, I realized that her pregnancy was very dangerous and it could cause death of the baby if she will not be rushed to the hospital in less tan 15 minutes. Until now I’m still confused on what causes placenta previa. All I know is that women who had caesarian during their first pregnancy are at risk to have a placenta previa on their 2nd pregnancy.

Happy Reading……