Anemia, a condition characterized by a deficiency in red blood cells or their impaired function, leads to reduced hemoglobin levels and insufficient oxygen delivery throughout the body. This condition arises from various factors, including blood loss, decreased red blood cell production, or increased red blood cell destruction. Anemia can range from mild and temporary to severe and chronic, stemming from causes such as poor nutrition, genetic predispositions, cancer, autoimmune disorders, exposure to toxins, infections, or as a consequence of other chronic illnesses. Understanding the nuances of anemia diagnosis and care planning is crucial for healthcare professionals.
Types of Anemia: A Clinical Overview
Nurses frequently encounter and manage diverse types of anemia, categorized broadly by their underlying causes:
- Nutritional Deficiency Anemias:
- Iron-deficiency anemia: The most prevalent form, often due to inadequate iron intake or absorption.
- Pernicious anemia: Caused by vitamin B12 deficiency, typically due to impaired absorption in the stomach.
- Megaloblastic anemia: Characterized by large, abnormal red blood cells, often due to folate or vitamin B12 deficiency.
- Genetic Anemias:
- Sickle cell anemia: An inherited condition causing red blood cells to be sickle-shaped, leading to chronic anemia and pain crises.
- Thalassemia anemia: Genetic disorders resulting in reduced or absent globin protein synthesis, crucial for hemoglobin.
- Fanconi anemia: A rare genetic disease causing bone marrow failure and various congenital abnormalities.
- Diamond-Blackfan anemia: A rare inherited bone marrow failure syndrome primarily affecting red blood cell production.
- Anemias from Abnormal RBC Function, Production, or Destruction:
- Hemolytic anemia: Characterized by the premature destruction of red blood cells.
- Aplastic anemia: A condition where the bone marrow fails to produce sufficient blood cells, including red blood cells.
- Macrocytic anemia: Anemia with abnormally large red blood cells, often overlapping with megaloblastic anemia.
- Microcytic anemia: Anemia with abnormally small red blood cells, commonly seen in iron deficiency and thalassemia.
- Normocytic anemia: Anemia where red blood cells are of normal size and shape but are insufficient in number, often seen in chronic diseases.
The Nursing Process in Anemia Care
Anemia is frequently a secondary condition resulting from a more significant underlying health issue. Treatment strategies are tailored to the specific type of anemia and its root cause. For instance, acute anemia from blood loss may necessitate immediate volume resuscitation with blood products. Conversely, sickle cell anemia, a chronic and severe form, requires specialized inpatient management during pain crises. Nurses play a pivotal role in assessing, diagnosing, and managing anemia effectively.
Comprehensive Nursing Assessment for Anemia
The initial step in nursing care is a thorough assessment, encompassing physical, psychosocial, emotional, and diagnostic data. This section details subjective and objective data relevant to anemia diagnosis and care planning.
Review of Health History: Subjective Data Collection
1. Identifying General Anemia Symptoms. Nurses should inquire about and document the following common symptoms of anemia:
- General Symptoms: Fatigue, generalized weakness and lack of stamina are common patient complaints.
- Central Nervous System (CNS) Manifestations: Dizziness, lightheadedness, and persistent headaches.
- Head, Ears, Eyes, Nose, and Throat (HEENT) Indicators: Patients may report a pulsatile tinnitus, described as a pounding or “whooshing” sound in one or both ears.
- Respiratory Symptoms: Dyspnea (shortness of breath) and tachypnea (rapid breathing).
- Cardiovascular Symptoms: Fast or irregular heartbeat (palpitations), chest discomfort, and chest pain.
- Integumentary System Changes: Pale skin, cool skin to the touch, reports of feeling consistently cold, numbness or tingling in hands and feet, and brittle nails.
2. Medical History Review. A detailed medical history is crucial. Nurses should pay close attention to pre-existing conditions that impact bone marrow function, such as a history of leukemia or other hematological cancers, as the bone marrow is the site of red blood cell production. Chronic conditions like chronic kidney disease and rheumatoid arthritis are also significant, as they can frequently lead to anemia.
3. Medication Review. Certain medications can induce hemolytic anemia. A thorough medication review should note the use of drugs such as:
- Cephalosporin antibiotics
- Levodopa
- Levofloxacin
- Nitrofurantoin
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Penicillin antibiotics
4. Activity and Risk Factor Assessment. Patient interviews should include questions about occupation and hobbies to identify potential environmental exposures. Inquire about exposure to tranquilizers, pesticides, paints, solvents, or hair dyes, which are known environmental risk factors for anemia.
5. Gynecological History for Women. For female patients, it’s important to ascertain gynecological status, including the presence of heavy menstrual bleeding (menorrhagia), history of recent abortion, or current pregnancy, all of which can contribute to anemia.
6. Assessment of Bowel Movement Bleeding. Patients must be educated on the importance of reporting changes in bowel habits, particularly regarding blood in the stool. Inquire about dark, tarry stools (melena), visible blood on toilet paper or in the toilet bowl after defecation, diarrhea with blood, or bleeding from hemorrhoids, noting whether it is bright red.
7. Gastrointestinal History. A history of gastrointestinal problems is pertinent, as several conditions are associated with bleeding and subsequent anemia. These include:
- Diverticulitis
- Hiatal hernias
- Peptic ulcers
- Gastroenteritis
- Gastrointestinal cancers
- Inflammatory bowel disease
8. Urinary Changes Assessment. Changes in urine color can be indicative of bleeding in the genitourinary system. Nurses should ask patients about any observed changes in urine color.
9. Dietary Assessment. A thorough review of the patient’s typical diet is essential. A diet deficient in essential vitamins and minerals increases the risk of nutritional anemias. Conversely, excessive alcohol consumption can also predispose individuals to conditions leading to anemia. It’s also important to assess dietary choices such as vegan or vegetarian diets, which may require careful planning to ensure adequate intake of iron and vitamin B12.
10. Socioeconomic Status Considerations. Economic factors play a role in nutritional status. Assessing a patient’s economic situation is important, as living in a food desert or financial inability to afford nutritious food increases the risk of nutritional anemias.
Physical Assessment: Objective Data Collection
1. Identifying Nutritional Deficiency Signs. Physical manifestations of nutritional deficiencies can provide objective data. Nurses should assess for:
- Iron Deficiency Indicators:
- Pale skin (pallor)
- Brittle fingernails (koilonychia)
- Tachycardia (elevated heart rate)
- Vitamin B12 Deficiency/Pernicious Anemia Signs:
- Bleeding gums
- Pale or jaundiced skin (yellowish discoloration)
- Unexplained weight loss
- Muscle weakness
- Megaloblastic Anemia Indicators:
- Pale skin
- Diarrhea
- Inflamed tongue (glossitis)
2. Assessing for Bleeding and Bleeding Disorders. Physical examination should include assessment for signs of bleeding or bleeding disorders. Conditions like hemophilia, gastrointestinal ulcers, or medication use (e.g., aspirin, warfarin) can lead to bleeding. Nurses should monitor for unusual skin bleeding, such as purpura, bruising, or petechiae, and assess for any signs of trauma or injury.
3. Neurological Assessment. Anemia’s impact on oxygen delivery to the brain can result in neurological changes. Nurses must closely monitor for:
- Vision disturbances
- Memory loss
- Poor coordination
- Headaches
- Irritability
- Paresthesias (abnormal skin sensations like tingling or numbness)
4. Eye Examination. Examination of the eyes can reveal signs of anemia. Low iron levels may cause pallor in the conjunctiva, making the vascular area of the eyes appear pale pink or even white. A bluish tint to the sclera may also indicate iron-deficiency anemia.
5. Cardiopulmonary Assessment. Anemia impacts both the heart and lungs. Nurses should assess for:
- Chest discomfort or pain
- Dyspnea
- Tachycardia
- Tachypnea
- Hypoxia (low oxygen saturation)
The cardiopulmonary assessment is vital as anemia increases the risk of heart failure.
6. Lymph Node Palpation. A thorough palpation of lymph nodes is necessary to detect any enlargement, which could indicate infection or neoplasia. Both infection and cancer can suppress red blood cell production.
Diagnostic Procedures for Anemia
1. Blood Tests for Anemia Type Identification. Blood tests are fundamental for diagnosing anemia and differentiating its type. Key tests include:
- Complete Blood Count (CBC) with Differential:
- Red blood cell count (RBC)
- Hemoglobin (Hgb) and Hematocrit (Hct) levels
- Reticulocyte count (immature red blood cell count)
- Mean Corpuscular Volume (MCV) – red blood cell size
- Red Cell Distribution Width (RDW) – variability in red blood cell size
- Platelet count
- Iron Profile: Measures serum iron, ferritin (iron storage protein), and total iron-binding capacity (TIBC).
- Folate and Vitamin B12 Levels: To assess for nutritional deficiencies.
Additional lab tests to investigate underlying conditions causing anemia may include:
- Coagulation screenings (aPTT, PT/INR)
- Lead levels
- Factor assays (for bleeding disorders)
- Coombs test (to detect antibodies against red blood cells in hemolytic anemia)
2. Imaging Scans. Imaging is used, especially in acute anemia cases, to identify underlying causes or complications.
- Ultrasonography: Rapidly evaluates for intraperitoneal bleeding.
- Chest X-rays: Useful in severe anemia causing cardiomyopathy (heart muscle disease).
- CT scans of the Abdomen: Detect masses, internal bleeding, or abnormalities of the spleen and other abdominal organs.
- Esophagogastroduodenoscopy (EGD): Diagnoses upper gastrointestinal (GI) bleeding.
- Outpatient Colonoscopy: Considered for diagnosing lower GI bleeding.
3. Bone Marrow Aspiration Preparation. While not routinely needed, bone marrow analysis may be necessary if lab results are inconclusive, particularly in cases of suspected bone marrow disorders.
Alt Text: Nurse expertly drawing a blood sample from a patient’s arm for diagnostic testing, crucial in anemia care plan diagnosis.
Nursing Interventions for Anemia
Nursing interventions and comprehensive care are vital for patient recovery. This section outlines key nursing interventions in anemia management.
1. Identify and Manage the Underlying Cause. Anemia is often secondary to other conditions affecting RBC production or causing RBC destruction. Identifying and addressing the root cause is paramount. Common causes and corresponding interventions include:
- Acute blood loss: Requires immediate hemorrhage control and volume replacement.
- Nutritional deficiencies (iron, vitamin B12, folate): Supplementation and dietary modifications are needed.
- Bone marrow disorders: May require specialized treatment such as bone marrow transplantation or medications.
- Chronic renal disease: Erythropoietin-stimulating agents and management of kidney disease are crucial.
- Hemophilia: Management of bleeding episodes and factor replacement therapy.
- Autoimmune and rheumatological conditions: Treatment focuses on managing the underlying autoimmune disease.
- Increased red blood cell destruction (mechanical heart valves, hemolytic anemia, DIC): Specific treatments based on the cause of hemolysis.
- Medication side effects: Medication review and potential adjustments.
2. Administer Intravenous (IV) Fluids. IV fluid administration is crucial in cases of trauma or acute blood loss to increase intravascular volume and stabilize hemodynamics.
3. Blood Transfusion Administration. Packed red blood cells (RBCs) transfusion is indicated for actively bleeding patients or those with severe, symptomatic anemia, typically with a hemoglobin level of 7 g/dL or less. Transfusion decisions should be based on clinical assessment and guidelines.
4. Oxygen Therapy. Given that red blood cells are oxygen carriers, anemic patients may experience hypoxia or dyspnea. Supplemental oxygen should be administered as needed to maintain adequate oxygen saturation.
5. Supplement Administration. Supplementation is tailored to the specific nutritional deficiencies identified. This may include:
- Oral or IV iron supplements for iron-deficiency anemia.
- Oral or intramuscular vitamin B12 for pernicious anemia.
- Oral, IV, or intramuscular folate for folate deficiency.
6. Patient Education on Oral Iron Supplementation. For patients prescribed oral iron, comprehensive education is essential for maximizing effectiveness and managing side effects. Key points include:
- Common side effects: Gastrointestinal issues like constipation, black, tarry stools, and metallic taste are typical.
- Administration guidelines:
- Best taken on an empty stomach for optimal absorption.
- Administer with water or fruit juice (vitamin C source) to enhance absorption.
- Take 1 hour before or 2 hours after meals; may take with food if gastrointestinal upset occurs but absorption may be reduced.
7. Erythropoietin Administration for Renal Disease Patients. In chronic kidney disease, impaired erythropoietin production leads to anemia. Synthetic erythropoietin (EPO) administration stimulates red blood cell production and is a standard treatment.
8. Preparation for Bone Marrow and Stem Cell Transplantation. For severe aplastic anemia or other bone marrow failure syndromes, bone marrow or stem cell transplantation may be considered. Younger patients with a matched donor (often a sibling) are generally the best candidates.
9. Dietitian Referral. Registered dietitians play a crucial role in patient education regarding dietary modifications to address nutritional deficiencies. They can provide tailored advice on iron, vitamin B12, and folate-rich foods.
10. Guidance on When to Seek Immediate Medical Attention. Patients should be instructed to seek prompt medical care if symptoms worsen despite treatment. Emergency department visits are warranted for:
- Breathing difficulties
- Lightheadedness or syncope
- Chest discomfort or pain
- Bright red bleeding in stool or significant bleeding from any site
Nursing Care Plans for Anemia
Once nursing diagnoses are identified for anemia, nursing care plans guide the prioritization of assessments and interventions to achieve short-term and long-term care goals. Examples of nursing care plans for common anemia-related issues are detailed below.
Acute Pain Care Plan (Specific to Sickle Cell Anemia)
Acute pain is a primary nursing diagnosis in sickle cell anemia. Sickled red blood cells cause vaso-occlusion, leading to ischemia and severe pain crises.
Nursing Diagnosis: Acute Pain
Related to:
- Sickling of red blood cells causing vascular occlusion
- Ischemia and hypoxia in affected tissues
As evidenced by:
- Intense pain complaints in various body areas
- Pain described as stabbing, sharp, or throbbing
- Limited physical activity due to pain
- Restlessness and agitation
- Distraction behaviors (pacing, watching TV excessively, constant talking)
Expected Outcomes:
- Patient will report pain reduction to a manageable level (e.g., ≤ 2/10 on a pain scale) by discharge.
- Patient will verbalize understanding of factors that trigger pain crises.
- Patient will adhere to the prescribed pain management regimen.
Assessments:
1. Comprehensive Pain Assessment. Utilize a numeric or FACES pain scale. Assess pain characteristics (quality, location, intensity), duration, frequency, precipitating factors, and effectiveness of current pain management strategies.
2. Acute Chest Syndrome Monitoring. Be vigilant for acute chest syndrome, a life-threatening vaso-occlusive complication in pulmonary vasculature. Monitor for chest pain, fever, dyspnea, and pulmonary infiltrates on chest X-ray.
3. Pain Medication Regimen Review. Assess the patient’s current pain medication regimen, adherence, dosages, and frequency, as inadequate pain management is a common cause of sickle cell pain crises.
Interventions:
1. Hydration Management. IV hydration is a priority in sickle cell crisis treatment. Adequate hydration helps to decrease red blood cell sickling and alleviate pain. Encourage oral fluid intake as tolerated.
2. Analgesic Administration. Sickle cell patients often require high doses of analgesics, including narcotics, due to high pain tolerance during crises. Patient-controlled analgesia (PCA) may be used. Closely monitor for pain relief and avoid over-sedation.
3. Blood Transfusion Consideration. Blood transfusions may be necessary to improve hemoglobin levels, prevent complications, and manage anemia. Some patients require chronic, monthly transfusions as part of outpatient management.
4. Patient Education on Sickle Cell Crisis Prevention. Educate patients about triggers for sickle cell crises, such as dehydration, infection, cold exposure, stress, and non-adherence to medications. Emphasize preventive strategies like maintaining hydration, preventing infections, avoiding cold, managing stress, and medication adherence.
Alt Text: Illustration of a patient experiencing acute pain, a common symptom requiring a detailed anemia care plan diagnosis and management, especially in sickle cell anemia.
Decreased Cardiac Output Care Plan
Anemia can lead to decreased cardiac output due to reduced blood volume and oxygen-carrying capacity, increasing cardiac workload.
Nursing Diagnosis: Decreased Cardiac Output
Related to:
- Reduced blood volume and preload
- Decreased oxygen supply to the heart muscle
- Inadequate cardiac muscle contraction force
- Increased afterload due to compensatory mechanisms
- Myocardial strain due to increased workload
- Severe blood loss
- Reduced red blood cell mass
As evidenced by:
- Measurable decrease in cardiac output
- Tachycardia (compensatory response)
- Hypotension or hypertension (variable, depending on stage and compensation)
- Cardiac arrhythmias (irregular heart rhythms)
- Chest pain (angina)
- Weak or diminished peripheral pulses
Expected Outcomes:
- Patient will maintain blood pressure and heart rate within acceptable limits.
- Patient will exhibit a stable, regular heart rhythm on ECG.
- Patient will report absence of chest pain or angina.
Assessments:
1. Vital Signs Monitoring. Anemia triggers compensatory mechanisms like increased heart rate and blood pressure. Monitor for persistent tachycardia and hypertension, which can lead to cardiac fatigue and heart failure if uncontrolled.
2. Cardiovascular History Review. Obtain a detailed cardiovascular history, noting any pre-existing conditions that may compromise blood supply to the heart. Co-existing cardiovascular disease and anemia exacerbate cardiac strain.
3. Cardiovascular Status Assessment. Anemia significantly impacts the progression of heart failure. Assess for signs of heart failure, as anemia reduces oxygen delivery and increases cardiac workload.
4. Red Blood Cell Count Review. Review CBC and peripheral blood smear results to evaluate RBC volume, size, and shape. RBC characteristics directly affect oxygen-carrying capacity and cardiac output.
5. Electrocardiogram (ECG) Monitoring. Anemia can cause arrhythmias, which can be detected on ECG. The heart works harder to compensate for reduced oxygen, potentially leading to rhythm disturbances.
Interventions:
1. Cardiac Stress Reduction. Minimize cardiac workload. Anemia increases heart rate and stroke volume, reduces renal blood flow, and can cause fluid retention, further straining the heart.
2. Anemia Treatment Based on Type. Manage anemia according to its specific type and cause. Correcting anemia can restore organ function and improve cardiac output.
3. Blood Transfusion Preparation. Severe anemia may necessitate blood transfusion to augment cardiac output and improve oxygen delivery.
4. Address the Underlying Cause of Anemia. If anemia is secondary to a reversible cause (e.g., medication-induced, chemotherapy-related), address or discontinue the causative agent as ordered to support cardiac function.
Fatigue Care Plan
Fatigue is a common and debilitating symptom of anemia due to reduced oxygen delivery to tissues.
Nursing Diagnosis: Fatigue
Related to:
- Decreased hemoglobin levels and reduced oxygen-carrying capacity
As evidenced by:
- Reports of overwhelming exhaustion
- Inability to maintain usual physical activity levels
- Increased need for rest and sleep
- Subjective reports of lack of energy
- Lethargy and decreased motivation
Expected Outcomes:
- Patient will verbalize and implement energy conservation techniques.
- Patient will report a perceived increase in energy levels and improved ability to perform daily tasks.
Assessments:
1. Complete Blood Count (CBC) Monitoring. Review CBC results, particularly red blood cell count and hemoglobin levels, which are typically low in anemia.
2. Assessment for Chronic Conditions Worsening Anemia. Identify and assess for chronic conditions (pregnancy, cancer, autoimmune diseases) that can contribute to or exacerbate anemia. Treating underlying conditions is crucial for managing anemia-related fatigue.
3. Fatigue Impact Assessment. Assess the extent of fatigue’s impact on daily life, including activities the patient can and cannot perform, effects on roles and responsibilities, and current coping strategies.
Interventions:
1. Energy Conservation Education. Instruct patients on energy conservation techniques, such as planning rest periods, delegating tasks, clustering activities, and prioritizing tasks for periods of peak energy.
2. Oxygen Therapy Administration. Hospitalized patients with severe anemia may require supplemental oxygen to alleviate fatigue related to hypoxia.
3. Blood Transfusion Administration. For severe anemia or anemia due to blood loss, blood transfusions can rapidly improve oxygen-carrying capacity and reduce fatigue.
4. Erythropoietin Injections Administration. Erythropoietin-stimulating agents (e.g., epoetin alfa, darbepoetin alfa) may be prescribed to stimulate bone marrow production of red blood cells, particularly for patients with chronic kidney disease, cancer, or HIV-related anemia.
Alt Text: Visual representation of fatigue, a key symptom addressed in anemia care plan diagnosis, showing a person appearing tired and needing rest.
Imbalanced Nutrition: Less Than Body Requirements Care Plan
Nutritional anemias, like iron-deficiency and vitamin-deficiency anemias, result from inadequate dietary intake or malabsorption of essential nutrients.
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements
Related to:
- Inadequate absorption of iron or vitamins
- Dietary deficiency of vitamin B12 and folate
- Increased nutritional needs (e.g., pregnancy)
- Malabsorption syndromes (e.g., gastric bypass, inflammatory bowel disease)
- Restrictive diets (e.g., strict vegetarian or vegan diets without proper supplementation)
As evidenced by:
- Pale skin
- Subjective reports of feeling cold
- Fatigue and weakness
- Rapid heartbeat
- Brittle nails
- Hair loss
- Pica, particularly craving for ice (pagophagia)
- Headaches
Expected Outcomes:
- Patient will demonstrate improvement in iron, vitamin B12, and folate levels on repeat laboratory testing.
- Patient will incorporate three or more foods rich in iron, vitamin B12, and folic acid into their daily diet.
- Patient will verbalize understanding of anemia signs and symptoms and when to seek medical advice.
Assessments:
1. Laboratory Value Monitoring. Regularly monitor red blood cell count, hemoglobin, hematocrit, ferritin, serum iron, and total iron-binding capacity to identify and track nutritional deficiencies.
2. Dietary History Assessment. Obtain a detailed dietary history to identify nutritional gaps, food preferences, cultural dietary practices, and any food allergies or intolerances.
3. Access to Healthy Foods Assessment. Assess socioeconomic factors that may limit access to nutritionally balanced foods, such as food insecurity and food desert residence.
Interventions:
1. Dietary Education. Provide comprehensive education on iron-rich foods (dark green leafy vegetables, nuts, eggs, lean meats), vitamin B12-rich foods (meat, dairy products), and folate-rich foods (legumes, citrus fruits, dark green leafy vegetables).
2. Supplementation Recommendations. Recommend oral iron, vitamin B12 (cyanocobalamin), or folate supplements as prescribed. Vitamin B12 injections may be needed for patients with pernicious anemia or malabsorption issues.
3. Prenatal Vitamin Education. Educate pregnant patients about the importance of prenatal vitamins containing iron and folate for maternal and fetal health.
4. Strategies to Improve Iron Absorption. Educate patients on strategies to enhance iron absorption, such as consuming heme iron sources (meat, seafood), combining non-heme iron sources (plant-based) with vitamin C-rich foods, and avoiding iron absorption inhibitors like tannins in tea and coffee, especially when consumed with meals.
Ineffective Tissue Perfusion Care Plan
Ineffective tissue perfusion occurs in anemia due to reduced oxygen-carrying capacity of the blood, leading to hypoxia.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Bone marrow suppression
- Nutritional deficiencies (iron, vitamin B12, folate)
- Reduced supply of oxygenated red blood cells
- Acute blood loss
- Impaired oxygen transport
- Chronic conditions (chronic kidney disease, rheumatoid arthritis, cancer)
- Autoimmune destruction of red blood cells
As evidenced by:
- Lightheadedness or dizziness
- Persistent headache
- Fatigue and weakness
- Changes in mental status or mentation
- Pallor (pale skin)
- Cold extremities
- Prolonged capillary refill time
- Chest pain (angina)
- Shortness of breath (dyspnea)
- Low hemoglobin levels
Expected Outcomes:
- Patient will demonstrate improved tissue perfusion evidenced by warm, dry skin with color appropriate for ethnicity and brisk capillary refill.
- Patient will report relief of symptoms such as shortness of breath, chest pain, and fatigue.
- Patient will achieve and maintain a hemoglobin level > 10.0 g/dL or as individually appropriate.
Assessments:
1. Medical and Family History Review. Determine if anemia is acute or chronic, and assess for family history of inherited anemias or presence of chronic conditions known to cause anemia.
2. Physical Assessment for Perfusion Deficits. Assess for objective signs of poor tissue perfusion, including pale, cool skin, respiratory changes (tachypnea, dyspnea), orthostatic hypotension, and chest pain.
3. Hemoglobin Level Monitoring. Regularly review hemoglobin levels to assess the severity of anemia and response to treatment.
Interventions:
1. Chest Pain and Palpitation Investigation. Promptly investigate reports of chest pain or palpitations. Obtain an ECG to assess for cardiac arrhythmias and ischemia.
2. Oxygen Therapy Administration. Administer supplemental oxygen to maintain SpO2 > 95% to improve tissue oxygenation.
3. Safety Precautions Implementation. Implement fall precautions and safety measures due to potential dizziness, lightheadedness, vision changes, and muscle weakness, which increase fall risk.
4. Epoetin Injections Administration. Administer epoetin alfa or other erythropoietin-stimulating agents as prescribed to stimulate red blood cell production and improve tissue perfusion, especially in chronic kidney disease-related anemia.
