Wednesday, January 10, 2018

NCP Nursing Care Plans For Aplastic Anemia

NCP Nursing Care Plans For Aplastic Anemia. Aplastic, or hypoplastic, anemia is a bone marrow failure that is characterized by a decrease in all formed elements of peripheral blood and its bone marrow. If all elements are suppressed resulting in loss of production of healthy erythrocytes, platelets, and granulocytes the condition is known as pancytopenia. Onset is often insidious and may become chronic; however, onset may be rapid and overwhelming when the cause is a myelotoxin. Aplastic and hypoplastic anemia are potentially fatal, commonly used interchangeably with other terms for bone marrow failure, aplastic anemia correctly refer to pancytopenia resulting from the decreased functional capacity of a hypoplastic, fatty bone marrow. These disorders usually produce fatal bleeding or infection, particularly when they're idiopathic.

Causes For Aplastic Anemia
Injury or damage to the stem cells that inhibit red blood cell (RBC) production.

Complications For Aplastic Anemia
Life-threatening hemorrhage from the mucous membranes is the most common complication of aplastic or hypoplastic anemias because affected patients develop alloimmunization, which can make platelet transfusions ineffective. Immunosuppression can lead to secondary opportunistic infections.

The patient's history may not help to establish disease onset because the symptoms usually develop insidiously. The patient may report signs and symptoms of anemia (progressive weakness and fatigue, shortness of breath, and headache) or signs of thrombocytopenia (easy bruising and bleeding, especially from the mucous membranes [nose, gums, rectum, vagina]).

Inspection may reveal pallor if the patient is anemic, and ecchymosis, petechiae, or retinal bleeding if thrombocytopenia is present. You may note alterations in the level of consciousness and weakness if bleeding into the central nervous system has occurred.

Auscultation may reveal bibasilar crackles, tachycardia, and a gallop murmur if severe anemia results in heart failure.

The patient may also have signs and symptoms of an opportunistic infection (most commonly, a bacterial infection). Fever, oral and rectal ulcers, and sore throat may indicate the presence of an infection but without characteristic inflammation due to leukopenia.

Diagnostic tests For Aplastic Anemia
  • Complete blood count
  • Serum iron; coagulation tests; bone marrow biopsy; hemoglobin electrophoresis;
  • transaminase; bilirubin; lactic dehydrogenase; blood urea nitrogen; creatinine;
  • hepatitis testing; peripheral smear.
Nursing diagnosis Nursing Care Plans For Aplastic Anemia
Nursing outcomes Nursing Care Plans For Aplastic Anemia
Nursing Key outcomes Nursing Care Plans For Aplastic Anemia, Patient will;
  • State the need to increase activity level gradually and the importance of rest periods.
  • Express feelings of comfort and decreased pain.
  • Identify measures to prevent or reduce fatigue.
  • Verbalize fears and concerns.
  • Oral mucous membranes will remain intact.
  • Maintain a normal body temperature.
  • Maintain adequate fluid balance.
  • Free from signs and symptoms of infection
Nursing interventions Nursing Care Plans For Aplastic Anemia
  • To identify causative/precipitating factors. Assist client to deal with contributing factors and manage activities within individual limits. Activity Therapy Prescription of and assistance with specific physical, cognitive, social and spiritual activities to increase the range, frequency, or duration of an individual’s or group are activity. Energy Management Regulating energy use to treat or prevent fatigue and optimize function
  • Pain Management Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the patient. Analgesic Administration Use of pharmacologic agents to reduce or eliminate pain. Environmental Management Manipulation of the patient’s surroundings for promotion of optimal comfort
  • Energy Management regulating energy use to treat or prevent fatigue and optimize function. Exercise Promotion Facilitation of regular physical exercise to maintain or advance to a higher level of fitness and health. Nutrition Management Assisting with or providing a balanced dietary intake of foods and fluids
  • Anxiety Reduction Minimizing apprehension, dread, foreboding, or uneasiness related to an unidentified source or anticipated danger. Security Enhancement Intensifying a patient’s sense of physical and psychological safety. Coping Enhancement Assisting a patient to adapt to perceived stressors, changes, or threats that interfere with meeting life demands and roles
  • Oral Health Restoration, Oral Health Maintenance, Promotion of healing for a patient who has an oral mucosa or dental lesion. Maintenance and promotion of oral hygiene and dental health for the patient at risk for developing oral or dental lesions. Promotion of oral hygiene and dental care for a patient with normal oral and dental health
  • Temperature Regulation: Attaining and/or maintaining body temperature within a normal range. Fever Treatment Management of a patient with hyperpyrexia caused by nonenvironmental factors
  • Fluid Monitoring Hemodynamic Regulation Bleeding Precautions Collection and analysis of patient data to regulate fluid balance Optimization of heart rate, preload, afterload, and contractility Reduction of stimuli that may indicate bleeding or hemorrhage in at risk patients
  • Infection Protection Infection Control and Surveillance Prevention and early detection of infection in a patient at risk, Minimizing the acquisition and transmission of infectious agents, Purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making
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