Advance Adult Care Nursing

Case Study

Student Name: Sima saeed ID: 439801409 Date: 4/12/2021-29/4/1443

Hospital: Al Namas Hospital Instructor Name: Dr Eman Elsayed

Date of Patient Admission: 15/11/2021 Time: 11:34 am

I. Demographic Data:

Patient Initials: Nasser seaad Mubarak Al-shahran Age: …78 Gender: Male

Occupation: r e t i r e d Marital Status: Married

Religion: Muslim Educational Level: U n i v e r s i t y

II. History:

Chief Complain:

Anemia

Past Medical History:

Diabetes Mellitus

(1)

Medical Diagnosis

Medical Diagnosis Definition Etiology, Signs, Symptoms

Anemia Etiology;

blood loss,
Anemia occurs when there are

not enough healthy red blood increased destruction of RBCs (hemolysis),

cells to carry oxygen to your decreased production of RBCs.

body's organs. As a result, it's

Iron deficiency anemia signs and symptoms

common to feel cold and may include:

symptoms of tiredness or Extreme fatigue.

weakness. There are many Weakness.

different types of anemia, but the Pale skin.

most common type is iron- Chest pain, fast heartbeat or shortness of

deficiency anemia breath.

Headache, dizziness or lightheadedness.

Cold hands and feet.

Inflammation or soreness of your tongue.

Brittle nails.

Symptoms

Fatigue.

Weakness.

Pale or yellowish skin.

Irregular heartbeats.

Shortness of breath.

Dizziness or lightheadedness.

Chest pain.

Cold hands and feet

(2)

Allergies:

1. Food: NO

2. Medications: NO
3. Others: NO

4. Smoking:

General Data:

1. Body Temperature: ( 36.5 C )

2. Respiration: ( 22 b \ m )

Pulse: (113 b \ m )

4. B/P: ( 104 \ 44 mmHg )

Height: ( 170 cm )

6. Weight (95 kg)

General Appearance:

Glasgow Coma Scale

• Eye response : Eye-opening spontaneously – (4 points )

• Verbal response : Orientated (time, place, and persons) – ( 5 points )

• Motor response : Obeys command – ( 6 points )

GCS : 15 \ 15

III. Physical Examination

A-Integument:

Abnormal

Skin and mucous membranes:

Pallor (pale skin, mucosal linings and nail beds)

▪ (noticeable pallor indicates that the anemia is probably severe)

Diaphoresis

Cheilosis.

B-Head & Neck:

Normal

C-Breast & Axillae:

Normal

D-Lung & Thorax:

Abnormal

tachypnea

(3)

E-Cardiovascular System:

Abnormal
hypotension

tachycardia

G-Abdomen:

Normal

H-Musculoskeletal System:

Abnormal

Severe pain

I-Neurological Examination:

Normal

J-Renal System: you can ask the patient about this system

Normal

K-Reproductive System: you can ask the patient about this system

Normal

Affected Part:

…Red Blood
Cell Because It is usually possible to determine whether the presence of anemia is caused by

destruction or inadequate production of erythrocytes on the basis of the following factors.

• Response. The marrow’s response to decreased erythrocytes as evidenced by an increased

reticulocyte count in the circulation blood.

• Proliferation. The degree to which young erythrocytes proliferate in the bone marrow and the

manner in which they mature as observed in the bone marrow biopsy.

• Destruction. The presence or absence of end products of erythrocyte destruction within the

circulation,failure to transport oxygen in the blood.

(4)

Self Care Ability

Activity Independent Assistive Dependent

Eating/Drinking /

Bathing /

Toileting /

Ambulating /

Patient Laboratory Data

Date Lab Test Normal Values Current Values Nursing Interpretations

WBC 4.5 - 11 x 103 15 .15 x 109 cells/L Leukocytosis

cells/mm3 (4.5- 11 is a condition that causes you to

x 109 cells/L) have too many white blood cells

(WBC). WBCs are part of your

immune system and help fight

infections and diseases.

causes or increases my risk for

leukocytosis Infections,

inflammation, or tissue damage,

Immune reactions, Bone marrow

problems, Physical or emotional

stress.

Hgb Male: 14-16.5 g/dL; 8 g/dL Decreased haemoglobin

Female: 12-15 g/dL A low hemoglobin level is referred

to as anemia or low red blood count.

A lower than a normal number of red

blood cells is referred to as anemia

and hemoglobin levels reflect this

number. There are many reasons

(causes) for anemia.

Hct Male: 42 – 52%; 27% Decreased Hematocrit

Female: 35 – 47% A lower than normal hematocrit can

indicate: An insufficient supply of

healthy red blood cells (anemia) A

large number of white blood cells

due to long-term illness, infection or

a white blood cell disorder such as

leukemia or lymphoma Vitamin or

mineral deficiencies.

Platelets 150,000 to 400,000 179 cells/mm³ Normal

cells/mm³

Glucose 70-110 mg/dL (3.9- 3,89 mmol/liter Normal

6.1 mmol/liter)

BUN 8 to 25 mg/dL 9,7 mg/dL Normal

High Creatinine
Creatinine Adult males: 21–26 296 mg/kg/24 hr

mg/kg/24 hr Adult Anemia is the common symptom of

females: 16–22 Chronic Kidney Disease patients

mg/kg/24 hr (CKD)with high creatinine level. With the

development of CKD, anemia gets more

and more serious, causing a series of

problems and influencing the life quality

seriously. Patients usually suffer from

tired or fatigued, shortness of breath,

dizziness, rapid heartbeat, pale skin and

gums and so on. So CKD patients with

high creatinine level are in a serious

period, they need a scientific anemia

management for the high quality life.

The most common causes of

longstanding (chronic) kidney disease in

adults are

high blood pressure and diabetes

.(History of the patient)

Na 135-145 mEq/L 135 mEq/L Normal

K 3.5 – 5.0 mEq/L 4 mEq/L Normal

Cl 95 – 105 mEq/L /

Co2 23 to 29 mEq/L /

RBC Male adult: 4.5 – 3,08 million/mm3 Anaemia

6.2 million/mm3 ; Anemia is defined as a low number

Female adult: 4.5 – of red blood cells. In a routine blood

5.0 million/mm3 test, anemia is reported as a low

hemoglobin or hematocrit.

Hemoglobin is the main protein in

your red blood cells. It carries

oxygen, and delivers it throughout

your body. If you have anemia, your

hemoglobin level will be low too.

MCV 78 – 100 μm3 88 μm3 Normal

(male) 78 – 102

μm3 (female)

(5)

Treatment (List all treatment: refer to chart, medication sheet, kardex)

Drugs & Dosage Indication for Expected Side Nursing

Classification & Patient Effects Implications

Route

Vancomycin Vancomycin is indicated in all common adverse side Monitor BP and heart

1gm age groups for the treatment effects IV administration rate continuously

of the following infections: - of vancomycin include: through period of drug

complicated skin and soft * Low blood pressure administration

tissue infections (cSSTI) - (hypotension) *Allergic

IV
bone and joint infections - reactions, such as Can cause ototoxicity,
OD

community acquired anaphylaxis or hives * nausea, vomiting,

pneumonia (CAP) - hospital Toxicity to the kidneys nephrotoxicity,

acquired pneumonia (HAP), (nephrotoxicity) * anaphylaxis, red-man

including Dizziness * Shortness syndrome

ventilator associated of breath or wheezing *

pneumonia (VAP) - infective Muscle pain or spasms

endocarditis in the chest and back

Assess for infection

Other adverse effects Dose dependent draw

that are less common serum trough levels

include: *Chills *Drug frequently

fever *An increase in

white blood cell count Administer over at least

(eosinophilia) 60 minutes to avoid

*Inflammation of a vein skin irritation

at the injection site

(phlebitis)

H.Albumin Albumin (Human) 25% is Common side effects Monitor BP, pulse and

50ml indicated in the emergency may include: *nausea, respiration, and IV

IV treatment of hypovolemia vomiting; *fever, chills; albumin flow rate.

TID with or without shock. Its *fast heart rate; *mild Adjust flow rate as

effectiveness in reversing rash; or *flushing needed to avoid too

hypovolemia depends largely (warmth, redness, or rapid a rise in BP.

upon its ability to draw tingly feeling).

Lab tests: Monitor
interstitial fluid into the

circulation. It is most effective dosage of albumin

in patients who are well using plasma albumin

hydrated. When blood (normal): 3.5–5 g/dL;

volume deficit is the result of total serum protein

hemorrhage, compatible red (normal): 6–8.4 g/dL;

blood cells or whole blood Hgb; Hct; and serum

should be administered as electrolytes.

quickly as possible. When Other adverse effects : Observe for bleeding

* a light-headed feeling, points that did not

hypovolemia is long standing

and hypoalbuminemia exists like you might pass out; bleed at lower

accompanied by adequate *weak or shallow

hydration or edema, 20% - breathing; *throbbing

headache, blurred
BP with injuries or
25% albumin solutions surgery and as BP rises.

should be used. vision, buzzing in your (6)

ears; *anxiety, Monitor I&O

confusion, sweating, ratio and pattern. Report

changes in urinary
pale skin; or *severe

shortness of breath,
output. Increase in
colloidal osmotic

wheezing, gasping for pressure usually causes

breath, cough with diuresis, which may

foamy mucus, chest persist 3–20 h.

pain, and fast or uneven

heart rate.

 Pathophysiology of the Disorder:

The pathophysiology of anemias is drawn according to the cause of the disease.

• Hypoproliferative Anemia
▪ Decreased erythrocyte production. There is decreased erythrocyte production, reflected by an
inappropriately normal or low reticulocyte count.
▪ Marrow damage. As a result of marrow damage, inadequate production of erythrocyte occurs due
to the medications or chemicals or from a lack of factors.
• Hemolytic Anemia
▪ Premature destruction. Premature destruction of erythrocytes results in the liberation of
hemoglobin from the erythrocytes into the plasma.
▪ Conversion. The released hemoglobin is converted in large part to bilirubin, resulting in high
concentration of bilirubin.
▪ Erythropoietin production. The increased erythrocyte destruction leads to tissue hypoxia which
stimulates erythropoietin production.
▪ Increased reticulocytes. This increased production is reflected in an increased reticulocyte count
as the bone marrow responds to the loss of erythrocytes.
▪ Hemolysis. Hemolysis is the end result, which can result from an abnormality within the
erythrocyte itself or within the plasma, or from direct injury to the erythrocyte within the circulation.

Clinical picture:

Clinical Picture: Rational for clinical Medical treatment Surgical Rational

Signs & picture treatment
symptoms
Hypotension symptoms causes of hypotension Medicines are only given if your Obstructive Hypotension
and signs: Blurred Vision (Anemia (A deficiency of low blood pressure is causing hypotension is may cause
Chest Pain Cold Skin some nutrients can hamper complications: 1. Beta or alpha most commonly decreased
Confusion Dizziness the production of red blood agonists Beta-agonists cause caused by massive blood flow to
Fainting Fatigue Increased cells and therefore affect the the heart to beat faster, pulmonary your brain and
Thirst Lightheadedness oxygen-carrying capacity of whereas alpha agonists induce thromboembolism. heart. This may
Nausea Pale Skin Rapid the blood.) , heart disorders constriction of the blood Treatment options lead to a stroke
Breathing Shock Vomiting (Certain heart problems can vessels. 2. Fludrocortisone This include or heart attack
Weakness affect the pumping efficacy of drug helps the kidneys to retain thrombolytic and can be
the heart, causing the blood water and salt, thereby therapy or surgical life threatening
pressure to drop.) increasing the volume of blood embolectomy. .
in the body and, therefore, the
blood pressure. 3. Midodrine
This drug is a vasoconstrictor
that helps narrow the blood
vessels, consequently
increasing the blood pressure.
It is commonly used for
orthostatic hypotension.

yellowish skin causes of yellowish skin Treatment depends on the surgery, usually Anemia, a
symptoms and signs: Anemia (The low level of cause of your paleness. only in severe lack of red
pale or yellowish skin hemoglobin cause pale or Options can include: *Eat a cases of acute blood cells,
especially the inside yellowish skin) balanced diet. *Take iron, blood loss or for can cause
lower of eyelids, nails. vitamin B 12, or folate treatment of fatigue, pale
Paleness can also supplements arterial blockage skin,
appear on some or weakness,
more body parts like dizziness,
face, hands, gums headache and
more.
 Hyperglycemia Early Past Medical History with Hyperglycemia treatment Metabolic Hyperglycemi
signs and symptoms Diabetes Mellitus Physical Fluid replacement. You'll surgery, a, or high
*Frequent urination stress (from Anemia) receive fluids — usually otherwise known blood glucose,
*Increased thirst through a vein as bariatric occurs when
*Blurred vision *Fatigue (intravenously) — until surgery, may be there is too
*Headache Later signs you're rehydrated. The fluids an option for the much sugar in
and symptoms Fruity- replace those you've lost treatment of the blood.
smelling breath Nausea through excessive urination, hyperglycemia in This happens
and vomiting Shortness as well as help dilute the patients with type when your
of breath Dry mouth excess sugar in your blood. 2 diabetes who body has too
Weakness Confusion Electrolyte replacement. are obese. little insulin
Coma Abdominal pain Electrolytes are minerals in (the hormone
your blood that are that transports
necessary for your tissues glucose into
to function properly. The the blood), or
absence of insulin can lower if your body
the level of several can't use
electrolytes in your blood. insulin
You'll receive electrolytes properly. The
through your veins to help condition is
keep your heart, muscles most often
and nerve cells functioning linked with
normally. Insulin therapy. diabetes.
Insulin reverses the
processes that cause
ketones to build up in your
blood. Along with fluids and
electrolytes, you'll receive
insulin therapy — usually
through a vein.

(7)
 Nursing Care Plan

Nursing Planning & Goals Implementation Rational Evaluation

Diagnosis
Actual Client will verbalize use Assist the client in Energy reserves may Client use the principles
problems of energy conservation developing a schedule be depleted unless the for energy conservation.
Fatigue principles. for daily activity and client respects the
rest. Stress the body’s need for
importance of frequent increased rest. A plan
related to
rest periods. that balances periods
of activity with periods
Decreased of rest can help the
hemoglobin client complete desired
and activities without
diminished adding levels to fatigue.
oxygen Client will verbalize Educate Organization and Reports less fatigue.
carrying reduction of fatigue, as energy conservation time management
capacity of the evidenced by reports techniques. can help the client
blood. of increased energy conserve energy and
and ability to perform reduce fatigue.
desired activities.
Instruct the client Recombinant human Goal was met.
about medications erythropoietin, a
that may stimulate hematological growth
RBC production in factor, increases
the bone marrow. hemoglobin and
decreases the need
for RBC transfusions.
Provide Oxygen saturation
supplemental oxygen should be kept at
therapy, as Dr.order 90% or greater.

Potentaial Patient will identify Encourage deep These methods boost Patient know factors
problems factors that aggravate breathing technique oxygen delivery to the that aggravate activity
activity intolerance. and administer oxygen tissues. intolerance.
Activity as Dr.order.
Intolerance Patient will report the Aid in gradual increase This develops Patient can perform
ability to perform of activities to tolerance endurance while required activities of
related to required activities of daily as the patient’s preventing problems daily living.
living. strength progress. caused by prolonged
Imbalance bedrest.
between Patient will identify Allow time for the Lessening any Decreased the patient
oxygen supply methods to reduce patient to have interruptions allows the activity intolerance .
and demand activity intolerance. undisturbed rest. patient to rest and
benefit from sleep until
anemia is resolved
Tell the patient that Improvements in Goal was met
symptoms commonly dietary intake and
are relieved and strength also may help
tolerance for activity reduce symptoms.
increased with the
treatment regimen. Close monitoring will
serve as a guide for
Document response to optimal progression of
activity activity

(8)
 Special interventions

Special Nursing Interventions for anemia include assessing how well the patient performs
regular tasks, recommending rest and quiet, providing assistance for activities as necessary,
elevating head of bed as much as the patient tolerates, planning activity progression and helping
patients to conserve energy. Nurses also perform laboratory tests the doctor orders, such as red
blood cell count, arterial blood gases, hemoglobin and hematocrit. Instruct the patient to consume
iron-rich foods to help build-up hemoglobin stores. Iron supplements.
Enforce strict compliance in taking iron supplements as
prescribed by the physician. Follow-up. Stress the need for regular medical and laboratory
follow up to evaluate disease progression and response to therapies.

Provide nutritional education

*Increase green leafy vegetables *Incorporate foods high in vitamin C
*Intake of red meat, lamb, poultry and venison as well as fish and shellfish
*Intake of seafood and shellfish
*Limit or avoid intake of foods high in calcium
*Leafy greens such as spinach, kale and chard are high in iron and folate.
Anemia is a condition where a patient has a below normal level of red blood cells. This can cause
symptoms like fatigue, dizziness, weakness and shortness of breath. Nursing interventions serve to
help the patient to return to optimal function and to help the doctor evaluate the patient's red blood
cell levels

(9)
Continuing Care of the Patient and Teaching:
…… Diet :The nurse should encourage a healthy diet that is packed with essential nutrients.
Dietary teaching: Sessions should be individualized and involve the family members and include
cultural aspects related to food preference and preparation.
Enhance compliance:The nurse should assist the patient to develop ways to incorporate the
therapeutic plan into everyday activities. Follow-up: Stress the need for regular medical and
laboratory
follow-up to evaluate disease progression and response to therapies.

References:
▪ Anemia - Wikipedia
▪ Anemia - Symptoms and causes - Mayo Clinic
▪ Normal Lab Values: Reference Guide for Nursing and NCLEX - Nurseslabs
▪ Anemia Nursing Care Management: A Study Guide (nurseslabs.com)
▪ Anemia Nursing Care Plans: 5 Nursing Diagnosis [2019 Guide] (nurseslabs.com)
▪ Nursing Care Plan for Anemia | NURSING.com Courses
Instructor Comments:
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