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Anemias (Sickle Cell Disease :recycle: (Clinical Manifestations: Pain is…

- - - - Repeated ischemia episodes progress to organ damage from anoxia and infraction. :red_flag:
      - Conditions that causes sickling :warning:
        
        hypoxia
        
        dehydration
        
        infection
        
        venous stasis
        
        pregnancy
        
        alcohol consumption
        
        high altitudes
        
        low and high environmental /body temps
        
        acidosis
        
        strenuous exercise
        
        emotional stress
        
        anesthesia
  - - - The average normal RBC lifespan is about 120days, compared to the lifespan of an RBC with HbS lifespan of 10-20 days. The destruction of a large amount of sickled RBC's leads to hemolytic anemia. :red_flag:
  - - - Nursing interventions:
        
        Hospitalization if severe with opioid analgesics
        
        Morphine IV (can be used patient controlled infusion pump)
        
        Hydromorphone IV ( can be used patient controlled induction pump)
        
        NSAIDs' orally
        
        Hydroxyurea (Droxia) reduced the number of sickling and pain episodes by stimulating fetal HbF, but increases incidence of leukemia)
        
        Penicillin twice daily (if there is any existing infection)
        
        IV fluid hydration 250ml/hr. x 4hours
        
        low temp room
        
        repositioning
        
        aroma therapy
        
        therapeutic touch
        
        warm soak compresses
        
        Vitals ever 4 hour
        
        oxygen therapy with nebulizer (to prevent dehydration)
        
        teach patient to avoid events that cause hypoxia
        
        monitor the patient if they had a transfusion of RBC's which lead to increase in HbA and dilute HbS.
- - - - Serum folate is low (Normal is 3-25mg)
        
        Serum cobalamin is normal
        
        Replacement therapy (1mg per day by mouth)
        
        Encourage pts to eat foods with folic acid
      - Clinical Manifestations
        same as for cobalamin deficiency minus the neuro problems
      - Etiology
        Dietary deficiency (lacking green leafy veggies, liver, yeast, dry beans, nuts), malabsorption syndrome (Crohn's), drugs, increased requirement, alcohol abuse and anorexia, loss during hemodialysis
    - - Management
        
        inc intake of foods rich in vit B12
        
        Parental or intranasal administration of cobalamin (CaloMist) *pts will die in 1-3 yrs w/o treatment
      - Diagnostic Studies
        
        Macrolytic RBCs have abnormal shapes and fragile cell membranes
        
        Serum cobalamin levels are dec.
        
        Upper GI endoscopy with gastric mucosa biopsy
        
        Shilling test: measures B12 in urine after pt is given radioactive B12
      - Clinical Manifestations
        General: pallor, jaundice, glossitis, fatigue, weight loss, weakness, vomiting, abdominal pain
        Neuro: paresthesias (B12 is needed for nerve fx; neurotonic), impaired thought process, ataxia, muscle weakness
      - Etiology
        Poor intake of foods with Vit B12 (vegetarians/ diets lacking dairy), small bowel resection, alcoholism, chronic diarrhea, diverticula, tapeworm, overgrowth of intestinal bacteria, long term use of H2 histamine receptor blockers and PPIs, deficiency in intrinsic factor (pernicious anemia).
        *intrinsic factor is a protein secreted by the parietal cells of the gastric mucosa, required for b12 absorption in distal ileum.