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(IRON DEFICIENCY ANEMIA (:star: Most common chronic hematologic disorders.…

- - - - :red_flag:Diagnostic Tests
        When the loss is sudden, plasma volume has not had a chance to increase so the loss of the RBCs may not show up in blood work and may even appear high for the first 2 - 3 days.
        However, once the plasma volume is replaced, the RBC mass is less concentrated, and RBC, HGB and HCT levels are low and reflect the actual loss.
        :pen:Nursing care and Assessments
        Assess: expression of pain (Internal hemorrhage) or numbness
        Carefully monitor blood loss from drainage tubes and dressings
        Administer blood products as indicated.
        
        :black_flag:Collaborative care
        
        Replace blood volume to prevent shock
        
        indentify source of hemorrhage and stop blood loss
        I.V fluids used include: dextran, hetastarch, albumin and crystolloid electrolyte soultions. The amound caries depending on solutions used.
        Once the volume is replaced, attention is moved to correcting RBC loss: body needs 2 - 5 days to manufacture more RBCs, sometimes blood transfusions are needed if loss is significant.
        Possible iron supplement due to inadequate sources.
        
        :!?: The anemia should begin to correct itself once all of above is done and there should be no need for long term treatment of this type of anemia.
- - - - :crescent_moon: Vaso-occlusive crisis are severe and painful. blood flow is impaired causing vasospasms, severe hypoxia causes changes in membrane permeability, plasma loss, circulatory stagnation, leading to tissue ischemia infarction and necrosis. Shock may occur in severe oxygen depletion and decreased blood volume.
        this crisis can last from days to weeks and usually depends on the amount of Hgb S present.
      - Manifestations
        -usually asymptomatic until sickling episode occurs
        -pallor (examine mucous membranes)
        -grayish cast
        -jaundice
        -prone to gallstones
        -Pain with fever, swelling, tenderness, tachypnea, nausea, and vomiting
      - Complications
        -infection (pneumonia most common)
        -Acute chest syndrome
        -Priapism
      - Diagnostic Studies
        :crescent_moon: peripheral blood smear
        :crescent_moon: sickling test
        :crescent_moon: hemoglobin electrophoresis
        :crescent_moon: skeletal x-rays
        :crescent_moon: MRI
        :crescent_moon: Doppler studies
      - Management
        
        teach patient to avoid high altitudes, adequate fluid intake, treat infections fast
        -Pneumovax, Haemophilus influenzae, influenza, & Hepatitis immunizations are important.
        -treat ulcers with rest, antibiotics, warm saline soaks, debridement, and grafting
        -treat priapism with pain medications, fluids, and procardia
        -sickle cell crisis requires hospitalization. Administer oxygen, assess changes in respiratory status
        -institute rest and DVT prophylaxis
        -administer fluids and electrolytes
        -transfusion therapy
        -Pain control by PCA (morphine and hydromorphone)
        -Hematopoietic stem cell transplantation
        -Support group