N211: Health Differences Across the Lifespan I • Activity intolerance related to reduced oxygen delivery to body tissues Nursing Interventions Diet high in iron, fiber, and protein with increased fluids. Avoid teas and coffee which reduces the absorption of iron. Increase the intake of vitamin C. Interventions includes iron injection deep into the muscle using Z-track technique to avoid subcutaneous irritation and discoloration from leaking drug. Provide frequent rest periods. Administer oral iron (ferrous sulfate). Teach client to take iron on an empty stomach, give with citrus juices (vitamin C), use dropper or straw to avoid discoloring teeth. Teach that stools will become tarry. Do not give with any dairy products. Teach client to limit milk to less than 32 oz. /day. Teach about dietary sources of iron such as meat, green leafy vegetables, fish, liver, whole grains, and legumes. For infants iron fortified cereals and formulas. 1.27 Pernicious Anemia Pernicious Anemia is a chronic, progressive, macrocytic anemia caused by a deficiency of the intrinsic factor which prevents the absorption of dietary vitamin B12. Without intrinsic factor red blood cells are defective as they mature. Nursing Assessments Includes tingling and paresthesia of hands and feet, weight loss, anorexia and dyspepsia. Diagno cs Bone marrow aspiration shows increased megaloblasts, few maturing erythrocytes and defective leukocyte maturation. Peripheral blood smear reveals oval, macrocytic, hyperchromic erythrocytes. N rsing Inventions Diet high in iron and protein and restricting highly seasoned or extremely hot foods. Supplemental vitamins of B12, B6, Vitamin C and folic acid. 1.28 Sickle Cell Anemia Sickle Cell Anemia is a congenital hematologic disease that causes impaired circulation, chronic ill health and premature death. Sickle cell anemia is an inherited recessive disorder of hemoglobin. It occurs primarily in African populations and persons from Puerto Rico, Turkey, India, the Middle East and the Mediterranean. It usually appears after 6 months of age. Hemoglobin S (HgbS) replaces all or part of the normal Hgb, which causes the red blood cells to sickle when oxygen is released into the tissues. Sickles cells cannot flow through capillary beds. Dehydration promotes sickling. HgbS has a less than normal life span (less than 40 days), which leads to chronic anemia. Tissue ischemia causes widespread pathologic changes in the spleen, liver, kidneys, bones and CNS.
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