By: Jemal B.

NURSING MANAGEMENT OF
PATIENTS WITH CARDIOVASCULAR
DISORDERS

12/20/2024 Jemal B. (Msc)

 CORONARY ARTERY DISEASE (CAD)
2
I- CORONARY ATHEROSCLEROSIS
is an abnormal accumulation of lipid or fatty
substances and fibrous tissue in the vessel wall.
These substances create blockages or narrow the vessel
in a way that reduces blood flow to the myocardium.

By: Jemal B. 12/20/2024

 Risk Factors
3

Non modifiable Risk Factors Modifiable Risk Factors

Family history of coronary High blood cholesterol and
heart disease triglyceride level
Increasing age Cigarette smoking, tobacco
Gender (heart disease use
occurs three times more
often in men than in Hypertension
premenopausal women) Diabetes mellitus
Race (higher incidence of Lack of estrogen in women
heart disease in African
Physical inactivity
Americans than in
Caucasians) Obesity
By: Jemal B. 12/20/2024
 Pathophysiology
4

Begins as fatty streaks, lipids that are deposited in the intima of the
arterial wall.
An inflammatory response happens.
T lymphocytes and monocytes infiltrate the area to ingest the lipids as a
result endothelial damage
; this causes smooth muscle cells within the vessel to proliferate and form
a fibrous cap over the dead fatty core(Lipids(Cholesterol).

By: Jemal B. 12/20/2024

 ….Pathophysiology
5

These deposits, called atheromas or plaques, protrude

into the lumen of the vessel,

Resistance to blood flow

Myocardial ischemia chest pain

Atherosclerotic plaques may rapture and a fibrin

thrombus is formed myocardial infarction

By: Jemal B. 12/20/2024

 ….Pathophysiology
6

By: Jemal B. 12/20/2024

 ….Pathophysiology
7

By: Jemal B. 12/20/2024

 Clinical Manifestations
8

Angina pectoris (acute onset of chest pain due to

myocardial ischemia)

SOB

Nausea

Unusual fatigue

By: Jemal B. 12/20/2024

 Common types of Angina
9

a) Stable angina
Predictable and consistent pain of short duration,
easily relieved
Precipitated by effort or some activity (running,
walking, etc.)
Typical presentations are that of chest discomfort
b) Unstable angina "crescendo angina;“
symptoms occur more frequently and longer lasting
>10 min, more severe,
may not be relieved by rest/nitroglycerin
By: Jemal B. 12/20/2024
 …..Common types of Angina
10

c) Refractory angina
severe incapacitating pain;
Do not respond to conventional therapy including drugs
and pt may suffer severe chest pain
d) Variant angina
Pain at rest usually at night
e) Silent angina
objective evidence of ischemia (such as ECG changes),
but patient reports no symptoms
By: Jemal B. 12/20/2024
 Diagnosis
11

History
Physical Examination
Serum lipid levels
Exercise stress test
ECG
By: Jemal B. 12/20/2024
 Prevention
12

Can be by the control of the following four

modifiable risk factors of CAD
Increased Cholesterol
Cigarette Smoking
DM
Hypertension By: Jemal B. 12/20/2024
 …..Prevention
13

I. Controlling cholesterol level

Desired goal is to have low LDL and high HDL
values
The desired level of LDL depends on the patient:
< 160 mg/dL for patients with one risk factors
 < 130 mg/dL for patients with two or more risk factors

 < 100 mg/dL for patients with CAD

HDL > 40-60 mg /dL

By: Jemal B. 12/20/2024
 Non-Drug Management
14

Dietary measures

Weight reduction

Increased physical activity

Promoting cessation of tobacco use

Early detection and treatment of hypertension

Controlling DM By: Jemal B. 12/20/2024

 Drug Management
15

Medications that decrease LDL, triglycerides and that

increase HDL

Niacin : Decreased blood lipids

lower LDL and triglyceride levels, and increase HDL
levels.

By: Jemal B. 12/20/2024

 ……Drug Management
16

Fibric acids: primarily inhibits triglyceride synthesis.

Fenofibrate
Colofibrate
Bile acid sequestrates: lowers LDLs
Cholestryramine
Colesevelam
Colestipol HCL By: Jemal B. 12/20/2024
 MYOCARDIAL INFARCTION
17

Coronary occlusion, heart attack, and MI are terms

used synonymously, but the preferred term is MI

MI refers to the process by which areas of myocardial

cells in the heart are permanently destroyed.

By: Jemal B. 12/20/2024

 .....Myocardial Infarction
18

Causes:

Reduced blood flow in a coronary artery

Decreased oxygen supply and

Increased demand for oxygen

By: Jemal B. 12/20/2024

 .....Myocardial Infarction
19

Risk Factors
Hypercholesterolemia - high LDL, low HDL
Tobacco smoking, Alcohol, OCP
Air pollution: CO,
Advanced age
Gender (men)
Diabetes mellitus, Obesity (BMI >30 kg/m²)
High blood pressure, Lack of physical activity
Family history of ischemic heart disease or MI
By: Jemal B. 12/20/2024
 .....Myocardial Infarction
20

Pathophysiology
Atherosclerotic plaque in coronary artery
Plaques can become unstable, rupture, and
additionally promote a thrombus that occludes the
artery
As the cells are deprived of oxygen, ischemia
develops, cellular injury occurs, and over time, the lack
of oxygen results in Ischemic cascade: death of the
heart cells near the occlusion
Infarction or cell death By: Jemal B. 12/20/2024
 Ruptured
Myocardial
Infarction

21 By: Jemal B. 12/20/2024

 Clinical Manifestations
22

Chest Pain
Occurs suddenly & not relieved by rest or nitrate
Locations: retrosternal, radiating to the neck, jaw, and arms or
to the back
May occur while the patient is active or at rest, asleep or walk
Commonly occurs in the early morning
Usually lasts for 20 minutes
Palpitations.
Heart sounds may include S3, S4, and new onset of a
murmur.
Increased jugular venous distention
By: Jemal B. 12/20/2024
 …..Clinical Manifestations
23

❑ Shortness of breath

❑ Cool, pale, and moist skin.

❑ tachycardia and tachypnea.

❑ Dysrhythmias

❑ Anxiety, restlessness, light headedness

By: Jemal B. 12/20/2024

 Dx
24

❑ PATIENT HISTORY: the description of the presenting

symptom (eg, chest pain) and the history of previous
illnesses and family health history, particularly of
heart disease.

❑ ECG

❑ LABORATORY TESTS: increased Creatine, increased

Myoglobin, increased Troponin
By: Jemal B. 12/20/2024
 Non-drug treatment (General
25
measures)
Bed Rest
Bowel
→ Constipation
Stool softener & Laxatives
Diet
Low fat, low Sodium , high fiber diet.
Sedation
↓Anxiety & ensures adequate sleep
Diazepam 5mg 3-4x/day , Additional dose at bed time
By: Jemal B. 12/20/2024
 Medical Management
26

Goals:-

Minimizing myocardial damage

Preserving myocardial function

Preventing CC

By: Jemal B. 12/20/2024

 Medical Management
27

Drug treatment(DACA):
 Oxygen, 2-4 l/min, via facemask
PLUS
 Nitroglycerin, 0.5mg, sublingual, every 5 min up to 3 doses.
PLUS
 Acetylsalicylic acid, 160-325 mg. P.O. QID
PLUS
 Diazepam, 5mg P.O. 3-4 times daily.
PLUS
 Morphine, (for control of pain), 2-4 mg IV. every 5 min until the desired
level of analgesia is achieved or until unacceptable side effects occur.
PLUS
 Heparin: For all patients with myocardial infarction (MI), 7500 units
subcutaneously every 12 hours BID untilBy:the patient
Jemal is ambulatory
B. 12/20/2024
 Medical Management
28

Followed by:
 Warfarin, for at least 3 months
PLUS
 Enalapril, 5 - 40 mg P.O. once or divided into two to three
doses daily
PLUS
 Metoprolol, 5 mg I.V. every 2 to 5 min for a total of 3
doses By: Jemal B. 12/20/2024
 HEART FAILURE
29

❖ HF, often referred to as congestive heart failure

(CHF), is the inability of the heart to pump sufficient

blood

❖ to meet the needs of the tissues for oxygen and nutrients.

❑ The term HF indicates myocardial heart disease

By: Jemal B. 12/20/2024
 Classification of HF
30

❑ Systolic heart failure- an alteration in ventricular

contraction.
❑ Results when the ventricle is unable to contract forcefully during
systole to eject adequate amount of blood into the circulation

❑ Diastolic heart failure- an alteration in ventricular filling

❑ Occurs when the left ventricle is unable to relax adequately during
diastole resulting in decreased ventricular filling and inadequate CO

By: Jemal B. 12/20/2024

 …..Classification of HF
31

❑ Left sided HF: - results from left ventricle dysfunction,

❑ which causes blood to back up through the left atrium and into
the pulmonary veins increasing pulmonary pressure.
❑ cause pulmonary congestion & Edema

❑ Right sided HF:- results from a diseased right ventricle (RV)

that causes back ward flow of blood to the right atrium (RA)
and venous circulation
❑ causing peripheral edema, hepatomegally, spleenomegally,
congestion of the GI tract By: Jemal B. 12/20/2024
 ……Classification of HF
32

NYHA- Based on physical limitations

Class Description
Class I No limitation of physical activity; there are no symptoms
from ordinary activities
Class II Slight limitation of physical activity; the patient is
comfortable at rest or with mild exertion
Class III Marked limitation of physical activity; the patient is
comfortable only at rest
Class IV Total limitation, any physical activity brings discomfort
and symptoms occur at rest By: Jemal B. 12/20/2024
 ……Classification of HF
33
Stages of CHF- The American College of Cardiology
/American Heart Association
Stage A: patients who are at high risk for developing HF but without
structural heart disease or symptoms of HF E.g., patients with DM or Hth

Stage B: patients with structural heart disease but without symptoms of

HF

Stage C: Structural heart disease and symptoms of HF

Stage D: patients requiring special interventions (end-stage

heart failure) By: Jemal B. 12/20/2024
 ETIOLOGY
34

Main causes
CAD and/or Underlining factors
hypertension
Valvular heart disease
Hypoxia
Anemia (hematocrit < 25%)
Congenital heart disease
Compensatory mechanisms
By: Jemal B. 12/20/2024
 Clinical Manifestations
35

Left Sided Heart Failure

Decreased CO
Fatigue, Decreased activity tolerance
Altered digestion
Oliguria
Nocturia
Angina (chest pain)
Tachycardia, palpitation
Pallor, Cool, clammy skin
weak pulse
Confusion, restlessness, Dizziness, anxiety, lightheadedness
Left lateral displacement of apical impulse
By: Jemal B. 12/20/2024
 Clinical Manifestations….
36
Left Sided Heart Failure…
Pulmonary congestion
Cough - initially dry and nonproductive
Shortness of breath
Orthopnea
Adventitious breath sounds, (Crackles or wheezes)
Tachypnea
Decreased oxygen saturation
Murmurs
S3/S4 By: Jemal B. 12/20/2024
37 By: Jemal B. 12/20/2024
38
Right Sided Heart Failure
Because of systemic Nocturia &Oliguria
congestion:
Weakness
Jugular vein distension
Hepatomegally & Weight gain
spleenomegally
Ascites
Anorexia, nausea,
abdominal pain
Dependent edema -legs &
sacrum By: Jemal B. 12/20/2024
39

By: Jemal B. 12/20/2024

 Dx
40

History
Physical Examination
Chest X-ray
ECG
Echocardiogram
Pulse oximetry
Laboratory studies : serum electrolytes, blood
urea nitrogen (BUN), creatinine, complete blood
cell count (CBC) By: Jemal B. 12/20/2024
FRAMINGHAM CRITERIA FOR THE DIAGNOSIS OF
HEART FAILURE
41

MAJOR CRITERIA
PND or orthopnea

neck vein distention

cardiomegaly

S3/gallop

Acute pulmonary edema

By: Jemal B. 12/20/2024

 ….FRAMINGHAM CRITERIA ..
42

MINOR CRITERIA
Bilateral ankle edema
Night cough
Dyspnea on exertion
Hepatomegaly
Pleural effusion
Tachycardia(heart rate >120 beats/min)
The diagnosis of chronic heart failure requires the
simultaneous presence of at least 2 major criteria or 1
major criterion in conjunction with 2 minor criteria
By: Jemal B. 12/20/2024
 Management
43
General Measures
Activity
❑ Heavy physical labor is not recommended
❑ Routine modest exercise for class I–III HF
within limits of symptoms
Diet
 Low sodium diet (< 2g -3g /day)
 Avoid excessive fluid intake
By: Jemal B. 12/20/2024
 Main Goals Of Therapy
44

To eliminate or reduce etiologic or contributing

factors

To reduce the workload on the heart (preload ,

contractility & after load)

By: Jemal B. 12/20/2024

 Pharmacologic therapy
45

1. ACE - inhibitors (ACE-Is):

 Promotes vasodilatation & diuresis by decreasing
preload & after load
 Include: captopril, enalapril, lisinopril

2. Hydralazine– Decreased systemic vascular

resistance
3. Beta blockers: reduce the constant stimulation of
the sympathetic nervous system E.g. propranolol
4. Digitalis e.g. digoxin 0.125, 0.25, 0.5 mg
By: Jemal B. 12/20/2024
- slow conduction through the atrioventricular node
 ….Pharmacologic therapy
46

5. Diuretics: increase the rate of urine production and

the removal of excess extracellular fluid from the body
❑ Thiazides e.g. chlorothiazide, hydrochlorothiazide

❑ Loop diuretics e.g. furosemide (lasix)

❑ Potassium sparing e.g. spironolactone

❑ Combination agents e.g. spironolactone +

hydrochlorothiazide
By: Jemal B. 12/20/2024
 According to DACA of Ethiopia
47

First line
Digoxin 0.125-0.375 mg po daily
Plus
Furosemide , 40-240 mg, po divided in to 2-3 doses daily
Plus
Enalapril 5-40 mg po once or divided in to two dose daily
And/or
Spironolactone 25-100mg po once daily or divided into
two doses
By: Jemal B. 12/20/2024
 Nursing Intervention
48

1. Maintaining normal body fluid

 Evaluating degree of peripheral edema

 Daily measurement of abdominal girth

 Monitoring intake & out put and daily body weight

 Restriction of sodium diets & fluid

 Avoid diet high in fat/cholestrol

By: Jemal B. 12/20/2024
 …..Nursing Intervention
49

2. Improving activity tolerance

❑ Avoid prolonged bed rest
❑ Emotional & physical support to reduce oxygen consumption
❑ Moderate physical exercise for a total of 30 min with 3-5
times per week
❑ Monitoring patient’s response to activity

3. Maintaining skin integrity

❑ Monitor signs of edema
❑ Meticulous skin care
❑ Pad bony prominences
❑ Passive ROM to extremities every 4 hours to facilitate venous
return of the fluid
❑ Turning & repositioning the patient every 2 hours
By: Jemal B. 12/20/2024
50

By: Jemal B. 12/20/2024

 By: Jemal B. 51

HYPERTENSION

Blood pressure is the product of cardiac output multiplied by peripheral

12/20/2024 resistance. Cardiac output is the product of the heart rate multiplied by the
stroke volume.
 HYPERTENSION
52

is a systolic blood pressure greater than 140 mm Hg

and a diastolic pressure greater than 90 mm Hg over
a sustained period, based on the average of two or
more blood pressure measurements taken in two or
more contacts with the health care provider after an
initial screening.

By: Jemal B. 12/20/2024

 Classification Of Blood Pressure:
for Adults Age 18 and Older
53

Category Systolic BP (mmHg) Diastolic BP (mmHg)

Optimal <120 <80

Normal <130 <85

High normal 130-139 85-89

Stage 1 or Mild HTN 140-159 90-99

Stage 2 or Moderate HTN 160-179 100-109

Stage 3 Severe HTN > 180 > 110

By: Jemal B. 12/20/2024
 Types of hypertension
54
1. Primary (Essential) hypertension
❖ Accounts for about 90-95% of all cases
❖ Has no known causes
❖ Onset usually between the age of 30 & 50 years
❖ factors that may contribute for the development include:
Genetic predisposition: the exact mechanism has not been established
Environment:
Dietary salt intake and Salt sensitivity
Obesity
Occupation
Family size and crowding
Stress and increased serum lipid level
By: Jemal B. 12/20/2024
Pregnancy-induced hypertension: Toxemia of pregnancy
 2. Secondary hypertension
55

❖ In 5-10 % of patients with hypertension, the hypertension

is secondary to identifiable disorder
❖ Identifiable causes include:
 Renal vascular & renal parenchymal disease
 congenital abnormalities of aorta

 Cushing syndrome
 Brain tumors
 Encephalitis
 Medications
• Glucocorticoids
• Mineralocorticoids
• Sympathomimetic
By: Jemal B. 12/20/2024
 Pathophysiology
56

Hypertension may be caused by one or more of the

following:
❑ 1. Increased sympathetic nervous system activity
❑ 2. Increased activity of renin-angiotensin-aldosterone
system
❑ 3. Decreased vasodilation of the arterioles
❑ 4. Structural and functional changes in the heart and blood
vessels By: Jemal B. 12/20/2024
 Clinical manifestations
57

Hypertension is often called “silent killer” because it is

frequently asymptomatic especially if the hypertension
is mild or moderate.
 Headache: Is the most common symptom, Occurs in the
occipital region, Worsen on the morning on arising

 kidneys involvment:
Nocturia
By: Jemal B. 12/20/2024
Increased BUN & serum creatinine level
 ….Clinical manifestations
58

Cerebrovascular involvement
Speech & vision alteration
Dizziness
Stroke
Weakness
Faintness (sudden fall)
Sudden hemiplegia
Vascular complications
 Blurring of vision
 Epistaxis
Occasionally, retinal changes
 Hemorrhages
 Cotton wool spots (small infarction)
By: Jemal B. 12/20/2024
 Diagnosis
59

History
Physical Examination
Measuring blood pressure (at least 1week apart)
Ophthalmologic examination
Lab tests
 U/A – e.g. urine catecholamine
 Blood chemistries (level of Na+, K+, Cl-, LDL etc)

 Creatinine, BUN

 ECG, Echocardiography & chest X-ray

By: Jemal B. 12/20/2024
 Management
60

The managements of hypertension include:

Lifestyle modifications
Pharmacologic therapy

By: Jemal B. 12/20/2024

 ….Management
61

Lifestyle Modifications
Weight reduction
Moderation of alcohol in take
Regular physical activity
Reduction of salt intake
Smoking cessation
Life style modifications are indicated for the person
with either border line or sustained hypertension
➢ If the BP remains > 140/90mmHg after 3-6 months
By: Jemal B. 12/20/2024
of life style changes, drug therapy is indicated.
62
The DASH Diet
Grains and grain products 7–8gm/day

Vegetables 4–5gm/day

Fruits 4–5gm/day

Low fat or fat-free dairy foods 2–3gm/day

Meat, fish, poultry

Nuts, seeds, and dry beans 4–5gm/weekly

By: Jemal B. 12/20/2024
 Pharmacologic/drug therapy
63

Goal-

Preventing death and complications by achieving

and maintaining the BP at 140/90 mmHg or lower
and

lower than 130/80 mmHg for people with DM &

chronic kidney diseases.

By: Jemal B. 12/20/2024

 Pharmacologic/drug therapy
64

Vasodilating drugs
hydralazine
β-adrenergic blocking drugs
Atenolol
Metoprolol
Propranolol
Anti adrenergic drugs (centrally acting)
Methyldopa
Alpha (α)-adrenergic blocking drugs
doxazosin
Prazosin
By: Jemal B. 12/20/2024
 ….Pharmacologic
65

Calcium channel blockers: Nifidipine, Verapamil, Diltiazem

ACE I inhibitors: Captopril , Enalapril, Lisinopril

Angiotensin II receptor antagonists: Valsartan , Losartan,

Irbesartan

Diuretics: Furosemide (Lasix), Hydrochlorothiazide

By: Jemal B. 12/20/2024
 DACA of Ethiopia
66

drugs used as first step agents

Diuretics
Beta Blockers
Calcium antagonists
ACE-Is

By: Jemal B. 12/20/2024

 …..DACA of Ethiopia
67

First line drugs for non-emergency conditions

Hydrochlorothiazide, 12.5-50 mg/day PO And/or
Nifedipine 10-40 mg, PO TID And/or
Propranolol 40-160 mg PO divided in to 2-4 doses
Alternative
Enalapril, 2.5-40 mg PO, once or divided in to two doses
daily And/or
Methyldopa, 250-2000 mg PO in divided doses. OR
Hydralazine, 10-20 mg, slow IV can be given in severe
hypertension. OR
Atenolol, 50 – 100 mg p.o daily
By: Jemal B. 12/20/2024
 Hypertensive Crises
68

Blood pressure elevation to such degree can

cause vascular damage, encephalopathy, retinal
hemorrhage, renal damage and death.

1 –2% of the hypertensive population develop

this complication.

By: Jemal B. 12/20/2024

 HYPERTENSIVE EMERGENCY
69

❑ is hypertension with acute impairment of one or more

organ systems in which there is acute impairment of
target organ
❑ It generally occurs at the blood pressure is severely
elevated [180 or higher for systolic pressure or 120 or
higher for diastolic pressure], ,
❑ but can occur at even lower levels in patients whose blood
pressure had not been previously high
❖ In these conditions, the blood pressure should be
lowered aggressively over minutes
❑ Progressive end-organ dysfunction.
By: Jemal B. 12/20/2024
 HYPERTENSIVE EMERGENCY
70

❑ The nurse may think that taking vital signs every 5

minutes check vital signs at 15 or 30 minutes intervals if
the situation is more stable.

By: Jemal B. 12/20/2024

 HYPERTENSIVE URGENCY
71

❑ urgency is a situation where the blood pressure levels

exceeding 180 systolic OR 110 diastolic but there is no
associated organ damage.
❑ No progressive target-organ dysfunction
❑ Treatment of hypertensive urgency requires readjustment
and/or additional dosing of oral medications,
❑ but most often does not necessitate hospitalization for rapid
blood pressure reduction
By: Jemal B. 12/20/2024
 Clinical Manifestation
72

The eyes: may show retinal hemorrhage

The brain: headache, vomiting, and/or subarachnoid or
cerebral hemorrhage
shows manifestations of increased intracranial pressure
The kidneys: hematuria, proteinuria, and acute renal
failure
CVS: Patients will usually suffer from left ventricular
dysfunction
Other : Chest pain, Arrhythmias, Epistaxis, Dyspnea,
Faintness or vertigo, Severe anxiety
By: Jemal B. 12/20/2024
 Treatment of Hypertensive Emergency
73

❑ Hydralazine, 5 mg IV every 15-min should be given

until the mean arterial
❑ blood pressure is reduced by 25% (within minutes to 2
hours),

❑ furosemide, 40 mg IV can be used according to

blood pressure response

By: Jemal B. 12/20/2024

 Treatment of Hypertensive Urgency
74

❑ Nifedipine, 20-120 mg p.o in divided doses per day

could be used. OR

❑ Captopril, 25-50 mg p.o three times daily

By: Jemal B. 12/20/2024

 Nursing Interventions
75

❑ Improving activity tolerance

❑ Alleviating pain:
❑ encourage/maintain bedrest during acute phase.
provide/recommend nonpharmacological measures

❑ Patient education about lifestyle modifications

❑ Compliance to therapeutic regimens
❑ Nutritional advice
❑ Avoiding potential complication
By: Jemal B. 12/20/2024
76

RBC Disorders

By: Jemal B. 12/20/2024

 ANEMIA
77

Anemia is a qualitative or quantitative deficiency of

hemoglobin, in red blood cells that transports oxygen.

It is a lower-than-normal number of red blood cells, usually

measured by a decrease in the amount of hemoglobin.

Is the most common disorder of blood which leads to hypoxia

in organs.

Not specific disease but a sign of underlying disorder.

By: Jemal B. 12/20/2024
 Potential causes
78

1. Loss of RBCs—bleeding, (eg. GIT, uterus, nose, or wound)

2. Decreased production of RBCs (ineffective

erythropoiesis):.

3. Hemolysis: overactive spleen (e.g. hypersplenism) or

production of abnormal RBCs (eg, sickle cell anemia)

By: Jemal B. 12/20/2024

 Specific Types Of Anemia
79

1. Vitamin B12/ Cobalamin Deficiency Anemia

Also called Pernicious anemia

Vitamin B12 is essential for normal nervous system function

and blood cell production.

For vitamin B12 to be absorbed by the body, it must bind to

intrinsic factor, a protein secreted by cells in the stomach.

➢ Source: Dairy products, eggs, fish, meat, and poultry

By: Jemal B. 12/20/2024
 Causes
80

Diet low in vit B12 (e.g. strict vegetarian)

Chronic alcoholism

Abdominal or intestinal surgery

Intestinal malabsorption disorders

Tape worm

By: Jemal B. 12/20/2024

 2. Folate-deficiency Anemia
81

Referred to as megaloblastic anemia

Folate, also called folic acid, is necessary for RBC formation

and growth.

Folate is not stored in the body in large amounts,

Occurs in about 4 out of 100,000 people.

➢ Source: Green leafy vegetables andBy:liver.

Jemal B. 12/20/2024
 Cause/Risk factors
82

Poor dietary intake of folic acid

Eating overcooked food

Malabsorption diseases

Certain medications e.g. phenytoin

Third trimester of pregnancy

Alcoholism

By: Jemal B. 12/20/2024

 3. Iron Deficiency Anemia
83

it is the most common form of anemia

Decrease number of RBC in blood result too little

iron.

RBCs are not providing adequate oxygen to body

tissues.

Source: meat (liver), fish and poultry

By: Jemal B. 12/20/2024

 Causes
84

Too little iron in the diet

Poor absorption of iron by the body

Loss of blood (including from heavy menstrual bleeding)

Risky groups
♣ Women of child-bearing age
♣ Pregnant or lactating women
♣ Infants, children, and adolescents in rapid growth
♣ People with a poor dietary intake of iron

♣ Blood loss: peptic ulcer, long term ASA

By: Jemal B. use, colon ca
12/20/2024
 4. Hemolytic Anemia
85

Inadequate number of circulating RBCs caused by

hemolysis greater than erythropoiesis.

The bone marrow is unable to compensate for premature

destruction.

By: Jemal B. 12/20/2024

 Causes
86

➢ Abnormal hemoglobin: Sickle cell anemia, Thalassemia

➢ Enzyme deficiencies: Glucose-6-phosphate dehydrogenase

deficiency

➢ Transfusion reaction

➢ Autoimmune hemolytic anemia

By: Jemal B. 12/20/2024

➢ Infection: malaria
 Normal and Sickle shaped RBC

87

By: Jemal B. 12/20/2024

 5. Idiopathic/Aplastic Anemia
88

Also called pancytopenia

Is a failure of the bone marrow to properly form all

types of blood cells

Results from injury to the stem cell

Cause is unknown, but is thought to be an

autoimmune process.

By: Jemal B. 12/20/2024

 Common Clinical Manifestation Of Anemia
89

 Paleness ▪Susceptibility to infections

 Yellow eyes/skin ▪Ulcers on the lower legs

▪Jaundice
 Fatigue
▪Bone pain
 Breathlessness
▪Fever
 Rapid heart rate

 Delayed growth and puberty

By: Jemal B. 12/20/2024
 Assessment and Diagnostic Findings
90

Physical Exam & history

CBC

Hgb concentration, Hct,

ESR, folate level, serum vit B12

Iron tests (serum level, binding capacity, % saturation)

Bone marrow aspiration and biopsy

Elevated bilirubin

Erythropoietin levels
By: Jemal B. 12/20/2024
 Criteria Of Anemia In Adults
91

Factor Women Men

RBC x 106 cells/mcL < 4.0 < 4.5

Hgb (g/dl) < 12 < 14

HCT (%) < 37 < 40

By: Jemal B. 12/20/2024

 Treatments For Anemia
92

Treatment depends on severity and the cause.

Treatment goals:

➢ To get RBC counts or Hgb levels back to normal

➢ To treat the underlying cause of the anemia

By: Jemal B. 12/20/2024

 Iron deficiency anemia
93

Iron supplements- for several months or longer

If the underlying cause of iron deficiency is loss of blood,
the source of bleeding must be located and stopped.
Food rich in iron: Meat, poultry, fish, eggs, dairy products, or
iron-fortified foods.
Ferrous sulfate :300mg PO TID for 4-6 months

Prophylactic therapy: pregnancy, sever hemolytic anemia,

in patients with dialysis
By: Jemal B. 12/20/2024
 Management …
94

Vit B12 Deficiency: is treated with which is given parentraly

 Initial dose: 30 mcg IM daily for 5 to 10 days Maintenance dose: 100 to
200 mcg IM monthly.

 Prophylactic therapy is indicated in patients with Total

gastrectomy and Ileal resection

Folate deficiency

 Dose: Folic acid 5 mg Po daily

 Prophylactic therapy is indicated in pregnancy, sever hemolytic

anemia, in patients with dialysis, and premature newborns
By: Jemal B. 12/20/2024
 Anemia Of Chronic Disease
95

It can be focused on treating the underlying disease.

Iron and vitamin supplements don't help

If symptoms become severe, a blood transfusion or

injections of synthetic erythropoietin, may help stimulate

RBC production.

By: Jemal B. 12/20/2024

 Sickle Cell Anemia
96

 Rx for this incurable anemia include:

♣Cancer drug hydroxyurea (Droxia)
♣A bone marrow transplant
♣Blood transfusions
➢Supportive:
♣Administration of oxygen
♣Pain-relieving drugs
♣Oral and intravenous fluids
By: Jemal B. 12/20/2024
 Prevention Of Anemia
97

➢ Eat foods high in iron

➢ Make sure to consume enough folic acid and vit. B12

➢ “Don't drink coffee or tea with meals”.

➢ Talk to doctor about taking iron pills (supplements):

ferrous and ferric.

By: Jemal B. 12/20/2024

98

Thank you!!

By: Jemal B. 12/20/2024