Nursing Interventions And Implementing Patient Care Plans For Anemia

Understanding anemia

It’s important to understand that anemia is not a disease in itself. Instead, it’s a symptom that can come from a variety of causes. Anemia happens when the amount of red blood cells in your blood is insufficient or when the red blood cells themselves are unhealthy, or both. This reduces the ability of your blood to transport oxygen from your lungs to the rest of your body, including your brain.

Many of us experience anemia at some point in our lives. Mild anemia can often be treated with lifestyle changes. Other forms of anemia, however, can be more severe and may require medical treatment.

Causes of anemia

Anemia can result from a wide variety of health issues. Here are some of the possible causes of anemia:

• Pregnancy. The body’s requirements for iron are increased during pregnancy, and many pregnant women don’t get enough iron to meet these needs, resulting in anemia. A small decrease in red blood cell count is normal during pregnancy, as there is an increase in the fluid volume of the blood, which dilutes the red blood cells. However, more severe anemia can cause problems for the mother and baby.

• Unusually heavy menstruation. This may result from conditions like hormonal imbalances or fibroids (benign growths inside the uterus).

• Insufficient consumption of iron. This is rarely the sole cause of anemia in the US, but it is more common in developing nations.

• Insufficient consumption of vitamin B12. Vegans and vegetarians are at higher risk because B12 is mainly found in animal foods, including meat, fish, eggs, and dairy. Taking supplements or eating foods fortified with B12 (such as nutritional yeast and many cereals) can address this issue.

• Insufficient absorption of nutrients like iron, vitamin B12, and folate. This may be the result of a digestive condition like celiac disease, or it can be caused by the surgical removal of a significant part of the intestine (such as bariatric surgery for weight loss).

• Bleeding in the digestive tract. This may occur because of conditions like ulcers, colon polyps, or cancer. Even a small amount of bleeding can eventually lead to anemia over time if the body is unable to make enough red blood cells to replace those that are lost.

• Chronic diseases. Chronic inflammation interferes with the body’s ability to use iron to make red blood cells. Several conditions can cause chronic inflammation that leads to anemia, including lupus, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and chronic infections.

• Kidney disease. The kidney makes a hormone called erythropoietin, which stimulates the production of red blood cells. Kidney disease can reduce the production of this hormone, leading to anemia.

• Excessive alcohol consumption. Alcohol can damage the bone marrow, resulting in lower red blood cell counts. It also leads to liver disease, and anemia is a common complication of liver disease.

• Pernicious anemia. This is caused by a genetic disorder that results in insufficient production of intrinsic factor (IF), which is required to absorb B12. People with pernicious anemia need to receive B12 supplementation through injection, as they are unable to efficiently absorb it from food or supplements.

• Aplastic anemia. Also called bone marrow failure, this is a rare but serious condition that occurs when your bone marrow cannot make enough of any type of blood cell. Along with anemia, this also causes a low white blood cell count, which increases the risk of infection.

• Thalassemia. This is another genetic condition that affects the production of hemoglobin, the protein in red blood cells that carries oxygen. There are several different types of thalassemia. Severe thalassemia is typically identified in childhood, but more mild cases may be diagnosed later in life.

• Sickle cell disease. This is another genetic condition that affects hemoglobin production and causes the red blood cells to be abnormally shaped. Along with anemia, this causes an increased risk of blood clots and infections.

• Bleeding disorders, such as Von Willebrand's disease or hemophilia. These conditions cause chronic blood loss, and if the body is not able to make enough red blood cells to replace those that are lost, anemia will result.

Who is at increased risk of developing anemia?

The following groups of people are at increased risk:

• People who menstruate, especially if they have heavier than normal periods. This also includes people with endometriosis, polycystic ovary syndrome, and other reproductive conditions that can cause heavy periods.

• People who are pregnant or nursing, due to sharing nutrients with the child. Acute blood loss during childbirth can also cause anemia.

• People with a strong family history of anemia, which may result from a genetic condition like thalassemia or sickle cell disease.

• People with conditions that cause GI bleeding, such as Crohn’s disease, ulcerative colitis, or ulcers.

• People who avoid the consumption of animal products. Vitamin B12 is naturally found in meat, dairy, and eggs, so avoiding these foods can result in insufficient consumption of B12. If you avoid animal foods, consider supplementation or eating fortified cereal or nutritional yeast.

• Older adults. The body’s production of intrinsic factor tends to decline with age, and older adults are at a greater risk for developing pernicious anemia. Nearly 2% of people over age 60 have this condition.¹

Although people in these groups are at a higher risk for anemia, anyone can potentially develop anemia.

When is nursing care necessary for anemia?

In many cases, anemia can be treated. If it’s caused by an underlying medical condition, treatment of this condition may help raise the red blood cell count. Some people may benefit from getting extra iron, vitamin B12, or folate, either through their diets or by taking supplements.

Nursing care generally becomes important when the anemia is chronic or is caused by a severe medical condition. In these cases, nurses can work with the patient to help them better manage symptoms and improve their quality of life. The majority of people with chronic anemia are outpatients. A very common scenario in which nursing care is helpful is a patient with pernicious anemia who needs periodic B12 infusions.

In cases where anemia is caused by an underlying medical condition, regular care by both doctors and nurses is often necessary. This could include patients with conditions of the digestive system or the female reproductive system. In many cases, you will work with both your primary care provider and a specialist physician, such as a gastroenterologist or gynecologist.

For the small number of patients with anemia who need to be hospitalized, inpatient nursing care is crucial.

What kind of care might nurses offer for anemia?

Nursing care for anemia focuses on managing symptoms of anemia and the underlying condition. For example, a nurse might:

• Help you develop a plan to manage fatigue, such as by spreading out physical activity and including enough rest in your day.

• Educate you about nutrition. People with vitamin-deficiency anemia may need to work with a nutritionist. But a nurse can help with some aspects of planning your dietary intake to include enough iron, vitamin B12, and folate. If you are being discharged from the hospital after experiencing anemia, a nurse will likely talk to you about planning a healthy and balanced diet.

• Help with medications. Some medications and supplements for anemia must be administered by injection or through an IV. A nurse often administers these during outpatient visits. If you’re hospitalized for anemia, a nurse will manage all your medications during your hospital stay.

• Educate you about your condition, what caused it, and how you can prevent it from happening again. They will help you understand your treatment plan and what is going to happen moving forward.

• Teach patients with pernicious anemia how to self-administer their B12 injections during the maintenance phase.

• Provide emotional support.

• Educate family members who are involved in the patient’s care. This is especially likely to be needed when the patient is a child or an older adult.

Nursing care is about supporting you, managing your symptoms, and improving your quality of life. One key aspect of nursing care is patient education. Nursing interventions can provide patients with the motivation, information, and skills to promote behavioral changes, such as dietary improvements, that can help to improve a patient’s condition. 

This type of intervention has been shown to be beneficial for patients with anemia. For example, in one study of patients with aplastic anemia, an educational intervention provided by nurses was shown to significantly improve patients’ quality of life.²

Managed care and sickle cell anemia

Sickle cell anemia is an inherited condition that predominantly affects Black people. Unfortunately, medical staff members’ conscious or unconscious bias against Black people may sometimes interfere with patients’ care.

Nursing care is particularly important for helping keep a person with sickle cell anemia out of the ER, helping them find alternatives for pain control (such as acupuncture), and supporting the function of the care team. Nurses often serve to educate the patient and family and may need to help address any underlying mistrust of the healthcare system.

When you’re a patient, it is always important to advocate for yourself within the healthcare system, including with nurses. Don’t be afraid to express your needs and to ask questions about your care.

The lowdown

If you have chronic anemia, you will likely receive nursing care. Trained nurses can help educate you on how to best manage your condition, deal with symptoms such as fatigue, improve self-care, and achieve a better quality of life. They may also help with administering medications and coordinating your overall care plan.