Saturday, August 21, 2010

Aplastic Anemia Nursing Care Plan

Aplastic anemia is a condition where bone marrow does not produce sufficient new cells to replenish blood cells. The condition, per its name, involves both aplasia and anemia. Typically, anemia refers to low red blood cell counts, but aplastic anemia patients have lower counts of all three blood cell types: red blood cells, white blood cells, and platelets, termed pancytopenia.
Signs and Symptoms:
  • Anemia with malaise, pallor and associated symptoms such as palpitations
  • Thrombocytopenia (low platelet counts), leading to increased risk of hemorrhage, bruising and petechiae
  • Leukopenia (low white blood cell count), leading to increased risk of infection
  • Reticulocytopenia (low reticulocyte counts)
In many cases, the etiology is considered to be idiopathic (cannot be determined), but one known cause is an autoimmune disorder in which white blood cells attack the bone marrow.

Risk for Infection

Aplastic anemia is characterized by the depression of hemato-poietic activity in bone marrow affecting all blood cells.  In effect, serum level of RBC, WBC and Platelets are depleted.  Apparently, WBCs or leukocytes are the ones responsible in acting against foreign microorganisms that invade the body. Such event of a depleted leukocytes can highly predisposes the individual to acquire various secondary infec-tions since the body is said to be immuno-compromised.  Thus, a nursing diagnosis of risk for infection was derived.
Assessment Nursing Dx Planning Nursing Inter­ventions Rationale Expected Outcome
S = O O = the client manifested the ff. s/sx:
  • weakness
  • easy fatigability
  • dryness of lips
  • bloodstained gums and teeth
  • with untrimmed and dirty fingernails
  • with limited range of motion
  • lab values suggest a decreased in WBC count, neutrophils, hematocrit, hemoglobin and
  • thrombocytes
= the client may further manifest:
-flushed skin
-various signs of different systemic infection such as:
Resp: Cough, colds, adventitious breath sounds
Skin: rashes, itchiness, wounds, untimely wound healing
GI: nausea, vomiting, abdominal discomfort
GU: dysuria, abnormal discharges and other associated symptoms
Risk for Infection r/t inadequate secondary defenses 2 Aplastic Anemia Short term: After 4 hours of NI, the client will identify interven-tions to reduce/ prevent risk for infection.
Long term:
After 3 days of NI, the client will display techniques and lifestyle changes conducive for her health promotion and disease prevention and she will be free from signs of potential infection.
1.       Maintain established rapport 2.       Monitor vital signs, especially temp.
3.       Stress proper hand washing techniques by all caregivers between therapies
4.       Monitor visitors/ caregivers of the client.  Instruct SO to limit visitors especially those with known contagious illnesses.
5.       Maintain aseptic/sterile techniques as much as possible
6.Advise the use of facial mask when going outside the client’s room
7.       Encouraged early ambulation, deep breathing and turning exercises as indicated.
8. Provide regular catheter/ perineal care as indicated
9.       Reinforce teachings about diet.  Avoid raw meats, fruits and vegetables.  Consume prescribed nutritionally adequate menus.
10.    Enforce strict bed rest.  Provide the client her favorite books as necessary.
11. Review to the client and SO about the nature of the disease and the interventions needed.
12.    Instruct the client to report significant changes that she may experience typical to a presence of infection.
13. Refer to other members of the health care team.
1. to gain trust & relieve anxiety 2.  to obtain baseline data; also, fever is usually the initial sign of infection
3.       hand washing is the primary measure against nosocomial infections/ cross contamination
4.       prevents unwanted exposure of the client to other communicable diseases
5.  to avoid cross contamination
6. reverse isolation is an important for clients who are immuno-suppressed
7. simple exercises helps tone body built and strengthen the body system.
8.  to prevent growth  of microorganisms
9.  to provide an optimum nutrition to meet daily needs of client; raw food can contain microorganisms that may precipitate infection
10.    client is in great need of staying on her room to avoid potential exposure to pathogenic elements
11.  helps alleviate anxiety; can also foster cooperation and compliance to prescribed therapeutics
12. to intervene with such events accordingly
13.    promotes inter-disciplinary care rendered to the client
Short term: The client shall have identified interventions to reduce/prevent risk for infection
Long term:
The client shall have displayed techniques and lifestyle changes conducive for her health promotion and disease prevention and have been free form signs of potential infection.