Nursing Care Diagnosis for Anemia: Comprehensive Guide for Healthcare Professionals

Anemia, a condition characterized by a deficiency of red blood cells or hemoglobin in the blood, leads to inadequate oxygen delivery throughout the body. This common health issue can stem from various causes, including blood loss, decreased red blood cell production, or increased red blood cell destruction. Understanding the nuances of anemia and its related nursing care diagnoses is crucial for effective patient management and improved outcomes. This article provides a comprehensive guide for healthcare professionals, focusing on nursing diagnoses, assessments, interventions, and care plans for patients with anemia.

Types of Anemia

Nurses encounter and manage diverse types of anemia, categorized based on their underlying causes:

• Nutritional Deficiency Anemias:

  • Iron-deficiency anemia: The most prevalent type, often due to insufficient iron intake, blood loss, or malabsorption.
  • Pernicious anemia: Caused by vitamin B12 deficiency, typically due to impaired absorption in the stomach.
  • Megaloblastic anemia: Characterized by large, abnormal red blood cells, frequently resulting from folate or vitamin B12 deficiency.

• Genetic Anemias:

  • Sickle cell anemia: An inherited blood disorder causing red blood cells to become rigid and sickle-shaped, leading to pain and complications.
  • Thalassemia anemia: Genetic disorders that reduce hemoglobin production, resulting in varying degrees of anemia severity.
  • Fanconi anemia: A rare genetic disease causing bone marrow failure and various congenital abnormalities.
  • Diamond-Blackfan anemia: A rare bone marrow failure syndrome primarily affecting red blood cell production.

• Anemias due to Abnormal RBC Function, Production, or Destruction:

  • Hemolytic anemia: Premature destruction of red blood cells, which can be inherited or acquired.
  • Aplastic anemia: Bone marrow failure resulting in decreased production of all blood cell types, including red blood cells.
  • Macrocytic anemia: Anemia characterized by abnormally large red blood cells, often related to vitamin B12 or folate deficiency.
  • Microcytic anemia: Anemia characterized by abnormally small red blood cells, commonly associated with iron deficiency or thalassemia.
  • Normocytic anemia: Anemia where red blood cell size is normal, but the overall number of red blood cells is reduced, often seen in chronic diseases.

Nursing Process in Anemia Care

Anemia is often a secondary condition arising from a broader health issue. Nursing care is tailored to the specific type of anemia and its root cause. For instance, acute anemia due to blood loss necessitates immediate volume resuscitation, potentially with blood products. Conversely, managing chronic anemias like sickle cell anemia requires a comprehensive approach, particularly during painful crises. The nursing process provides a structured framework for addressing the needs of patients with anemia, encompassing assessment, diagnosis, planning, implementation, and evaluation.

Nursing Assessment for Anemia

The nursing assessment is the cornerstone of effective care, involving the systematic collection of subjective and objective data to understand the patient’s condition comprehensively.

Review of Health History

1. General Symptom Evaluation: Inquire about common anemia symptoms, such as:

• General: Persistent fatigue, generalized weakness and malaise.
• Central Nervous System (CNS): Dizziness, lightheadedness, and frequent headaches.
• Head, Eyes, Ears, Nose, Throat (HEENT): Pulsatile tinnitus, described as a pounding or “whooshing” sound in the ear.
• Respiratory: Dyspnea (shortness of breath) and tachypnea (rapid breathing).
• Cardiovascular: Palpitations, fast or irregular heartbeat, chest discomfort, and chest pain.
• Integumentary: Pale and cool skin, reports of feeling cold, numbness or tingling in hands and feet, and brittle nails.

2. Medical History Review: Pay close attention to pre-existing conditions that may contribute to anemia:

• History of bone marrow disorders like leukemia or other blood cancers, as these directly impact red blood cell production.
• Chronic conditions such as chronic kidney disease or rheumatoid arthritis, which are known to cause anemia as a secondary complication.

3. Medication Review: Identify medications that may induce hemolytic anemia:

• Common culprits include cephalosporins, levodopa, levofloxacin, nitrofurantoin, NSAIDs, and penicillins.

4. Activity and Risk Factor Interview: Explore potential environmental or occupational exposures:

• Inquire about exposure to tranquilizers, pesticides, paints, solvents, or hair dyes, which can be environmental triggers for anemia.

5. Gynecological History for Women: Assess for gynecological factors contributing to anemia in female patients:

• Determine the presence of heavy menstrual bleeding (menorrhagia), history of recent abortion, or current pregnancy, all of which can increase anemia risk.

6. Bowel Movement Bleeding Inquiry: Emphasize the importance of recognizing and reporting changes in bowel habits:

• Specifically ask about dark, tarry stools (melena), visible blood on toilet paper or in the toilet bowl (hematochezia), diarrhea with bleeding, or hemorrhoids causing bright red rectal bleeding.

7. Gastrointestinal History Assessment: Investigate gastrointestinal conditions that are common sources of bleeding and subsequent anemia:

• Consider conditions like diverticulitis, hiatal hernias, peptic ulcers, gastroenteritis, cancer, and inflammatory bowel disease as potential causes.

8. Urine Changes Assessment: Question patients about any alterations in urine color:

• Abnormal urine color, particularly dark or reddish, can indicate bleeding within the genitourinary system.

9. Dietary Assessment: Thoroughly review the patient’s usual dietary intake:

• Assess for diets deficient in essential vitamins and minerals, increasing the risk of nutritional anemias.
• Evaluate alcohol consumption, as excessive intake can predispose individuals to conditions causing anemia.
• For patients following vegan or vegetarian diets, assess their intake of iron and vitamin B12 to ensure adequacy.

10. Socioeconomic Status Consideration: Evaluate the patient’s economic circumstances and access to food:

• Determine if the patient resides in a food desert or faces financial constraints limiting access to quality, nutritious food, increasing their risk of nutritional anemias.

Physical Assessment

1. Nutritional Deficiency Physical Signs: Assess for physical manifestations of nutritional deficiencies:

• Iron deficiencies: Pale skin, brittle fingernails, and tachycardia (rapid heart rate).
• Vitamin B12 deficiency/pernicious anemia: Bleeding gums, pale skin or jaundice, unexplained weight loss, and muscle weakness.
• Megaloblastic anemia: Pale skin, diarrhea, and glossitis (inflamed tongue).

2. Bleeding and Bleeding Disorder Assessment: Evaluate for signs of bleeding or bleeding disorders:

• Assess for unusual bleeding tendencies, such as purpura, bruising, or petechiae.
• Monitor for any evidence of recent trauma or injuries.
• Be aware of conditions like hemophilia, intestinal ulcers, or medication use (aspirin, warfarin) that increase bleeding risk.

3. Neurological Assessment: Evaluate neurological function due to the brain’s sensitivity to reduced oxygen supply:

• Monitor for vision disturbances, memory loss, poor coordination, headaches, irritability, and paresthesias (abnormal sensations like tingling or numbness).

4. Eye Examination: Inspect the eyes for signs of anemia:

• Low iron levels can cause pallor in the conjunctiva, making the vascular area appear pale pink or white.
• A bluish tint to the sclera (whites of the eyes) may indicate iron-deficiency anemia.

5. Cardiopulmonary Assessment: Assess cardiovascular and respiratory systems due to their direct impact from reduced oxygen carrying capacity:

• Evaluate for chest discomfort or dyspnea.
• Assess for tachycardia, tachypnea, and hypoxia (low oxygen saturation).
• Recognize the increased risk of heart failure in patients with anemia.

6. Lymph Node Palpation: Systematically palpate lymph nodes:

• Conduct a thorough examination for any palpable lymph node enlargement, which may indicate infection or neoplasia (cancer). Both infection and cancer can suppress red blood cell production.

Diagnostic Procedures

1. Blood Tests for Anemia Type Identification: Utilize blood tests to differentiate and classify anemia types:

• Complete Blood Count (CBC) with differential: Provides crucial information including:

  • Red blood cell count
  • Hemoglobin and hematocrit levels
  • Reticulocyte count (immature red blood cells)
  • Mean Corpuscular Volume (MCV) – red blood cell size
  • Red Cell Distribution Width (RDW) – variation in red blood cell size
  • Platelet count

• Iron Profile: Measures iron, ferritin, and total iron-binding capacity to assess iron status.

• Folate and Vitamin B12 Levels: Determine levels of these essential vitamins.

• Additional Lab Tests for Underlying Conditions: Consider tests to identify underlying causes of anemia:

  • Coagulation screenings (aPTT, PT/INR) to assess for bleeding disorders.
  • Lead levels to rule out lead poisoning as a cause of anemia.
  • Factor assays for specific clotting factor deficiencies.
  • Coombs test to detect antibodies causing hemolytic anemia.

2. Imaging Scans for Underlying Causes: Employ imaging techniques, particularly in acute anemia cases:

• Ultrasonography: Rapidly evaluates for intraperitoneal bleeding in cases of acute blood loss.
• Chest X-rays: Useful in severe anemia suspected of 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 acute upper gastrointestinal (GI) bleeding.
• Outpatient colonoscopy: Considered for diagnosing lower GI bleeding.

3. Bone Marrow Aspiration Preparation: Prepare patients for bone marrow aspiration if indicated:

• While not routinely needed, bone marrow analysis may be necessary when lab results are inconclusive in determining the cause of anemia.

Nursing Interventions for Anemia

Effective nursing interventions are crucial for patient recovery and managing anemia effectively.

1. Cause Identification and Management: Address the underlying cause of anemia as the primary intervention:

• Recognize that anemia is often secondary to other conditions affecting RBC production or destruction.
• Tailor interventions to specific causes, including:
  • Acute blood loss: Manage bleeding and restore blood volume.
  • Nutritional deficiencies (iron, vitamin B12, and folate): Implement dietary modifications and supplementation.
  • Conditions affecting bone marrow: Manage underlying bone marrow disorders.
  • Chronic renal disease: Address kidney disease and its impact on erythropoietin production.
  • Hemophilia: Manage bleeding disorders and provide necessary factor replacement.
  • Autoimmune and rheumatological conditions: Treat underlying autoimmune diseases.
  • Increased red blood cell destruction (faulty mechanical valves, hemolytic anemia, DIC): Manage specific causes of hemolysis.
  • Side effects of medications: Adjust or discontinue offending medications when possible.

2. Intravenous Fluid Administration: Administer IV fluids as prescribed:

• IV fluids are essential to increase intravascular volume, particularly in cases of trauma or acute blood loss leading to anemia.

3. Blood Transfusion Administration: Transfuse blood products as ordered:

• Packed red blood cells (RBCs) transfusions are typically indicated for actively bleeding patients and those with severe, symptomatic anemia, generally with a hemoglobin level of 7 g/dL or less.

4. Oxygen Therapy: Provide supplemental oxygen as needed:

• Anemia reduces oxygen-carrying capacity; therefore, patients may experience hypoxia or dyspnea. Apply supplemental oxygen to maintain adequate oxygen saturation.

5. Supplement Administration: Administer prescribed supplements based on identified deficiencies:

• Supplementation strategies depend on the specific nutrient deficiency:
  • Oral or intravenous iron for iron deficiency.
  • Oral or intramuscular vitamin B12 for vitamin B12 deficiency.
  • Oral, intravenous, or intramuscular folate for folate deficiency.

6. Oral Iron Supplementation Education: Educate patients on optimal oral iron supplementation:

• Provide comprehensive education regarding:
  • Common side effects, including gastrointestinal issues like constipation, black, tarry stools, and a metallic taste.
  • Administration guidelines:
    • Take on an empty stomach to maximize absorption.
    • Take with water or fruit juice (vitamin C source) to enhance absorption.
    • Administer 1 hour before or 2 hours after meals; may take with food if gastrointestinal upset occurs.

7. Erythropoietin Administration for Renal Disease: Administer erythropoietin for patients with chronic kidney disease:

• In renal disease, kidneys produce insufficient erythropoietin (EPO), a hormone essential for red blood cell production. Synthetic EPO stimulates RBC production.

8. Bone Marrow and Stem Cell Transplant Preparation: Prepare patients for potential bone marrow or stem cell transplantation:

• For severe aplastic anemia, healthy stem cells from a donor can replace the patient’s damaged bone marrow. Younger patients with a matched donor (often a sibling) are the best candidates for these procedures.

9. Dietitian Referral: Refer patients to a registered dietitian:

• Dietitians provide expert guidance and education on dietary modifications to address nutritional deficiencies (iron, vitamin B12, and folate) and optimize nutrient intake.

10. Patient Education on Seeking Medical Attention: Advise patients on when to seek immediate medical care:

• Instruct patients to consult a healthcare provider if symptoms worsen despite treatment.
• Emphasize the need to go to the nearest emergency department for:
  • Breathing difficulties.
  • Lightheadedness or dizziness.
  • Chest discomfort.
  • Bright red bleeding in the stool.

Nursing Care Plans for Anemia

Nursing care plans are essential for prioritizing assessments and interventions based on identified nursing diagnoses. They guide both short-term and long-term goals of care for patients with anemia. Here are examples of nursing care plans for common nursing diagnoses associated with anemia:

Acute Pain (Specific to Sickle Cell Anemia)

Nursing Diagnosis: Acute Pain

Related to:

• Sickling of red blood cells leading to blood vessel occlusion.
• Reduced perfusion and oxygenation to tissues and extremities.

As evidenced by:

• Patient’s intense pain complaint, localized anywhere in the body.
• Pain description as stabbing, sharp, or throbbing.
• Reduced physical activity due to pain.
• Restlessness and agitation.
• Distractive behaviors (pacing, watching TV excessively, talking on the phone constantly).

Expected outcomes:

• Patient will report a pain level reduction to 2/10 or less by discharge.
• Patient will verbalize understanding of triggers that can precipitate a pain crisis.
• Patient will adhere to the prescribed pain medication regimen.

Assessment:

1. Pain Assessment: Conduct a comprehensive pain assessment using a numeric or FACES pain scale. Evaluate pain characteristics (quality, location), duration, frequency, precipitating factors, and effectiveness of current pain management interventions.
2. Acute Chest Syndrome Assessment: Monitor for acute chest syndrome, a vaso-occlusive crisis in the pulmonary vasculature, which is life-threatening and a leading cause of mortality in sickle cell patients. Assess for chest pain, fever, dyspnea, and monitor chest x-ray results for infiltrates.
3. Pain Medication Regimen Assessment: Evaluate the patient’s pain medication regimen, including adherence, dosage, and frequency. Many sickle cell pain crises are triggered by missed medication doses or inadequate pain management plans.

Interventions:

1. Fluid Administration: Prioritize IV hydration during a sickle cell crisis. IV fluids help to slow or halt the sickling process and alleviate pain. Encourage oral fluid intake as well.
2. Analgesic Administration: Administer analgesics as prescribed. Sickle cell patients often have high pain tolerance and may require high doses of narcotics. Some may benefit from a PCA pump for better pain control. Closely monitor patients for adequate pain relief while avoiding over-sedation.
3. Blood Transfusion Administration: Depending on hemoglobin levels and clinical status, blood transfusions may be necessary to prevent complications and correct anemia. Some patients require long-term monthly transfusions on an outpatient basis.
4. Patient Education on Crisis Prevention: Educate patients about sickle cell crisis triggers and preventative measures. Emphasize maintaining hydration, preventing infections, avoiding cold weather exposure, managing stress, and adhering to prescribed medications to manage sickle cell anemia effectively.

Decreased Cardiac Output

Nursing Diagnosis: Decreased Cardiac Output

Related to:

• Inadequate blood volume filling the heart chambers.
• Reduced oxygenated blood supply to the heart muscle.
• Inadequate cardiac muscle contraction strength.
• Low blood pressure reducing effective pumping force.
• Increased workload on the heart to compensate for anemia.
• Severe blood loss leading to circulatory compromise.
• Reduced circulating red blood cells.

As evidenced by:

• Measurable decrease in cardiac output.
• Tachycardia (rapid heart rate).
• Hypertension (elevated blood pressure).
• Cardiac arrhythmias (irregular heartbeats).
• Chest pain.
• Diminished peripheral pulses.

Expected outcomes:

• Patient will demonstrate blood pressure and pulse rates within normal limits for their age and condition.
• Patient will exhibit a normal sinus rhythm on ECG monitoring.
• Patient will report absence of chest pain.

Assessment:

1. Vital Signs Monitoring: Continuously monitor vital signs, particularly heart rate and blood pressure. Anemia triggers compensatory mechanisms like increased heart rate and blood pressure. Monitor for signs of heart fatigue, which can lead to heart failure if tachycardia and hypertension are uncontrolled.
2. Cardiovascular History: Obtain a detailed cardiovascular history, noting any pre-existing cardiovascular diseases that may affect blood supply to the heart. Co-existing cardiovascular disease and anemia significantly increase cardiac workload.
3. Cardiovascular Status Assessment: Assess overall cardiovascular status. Anemia can significantly exacerbate heart failure progression by reducing oxygen-carrying capacity and compromising blood circulation.
4. Red Blood Cell Count Review: Review RBC count from the complete blood count (CBC) and peripheral blood smear. RBC volume, size, and shape characteristics directly impact cardiac output and overall blood circulation.
5. Electrocardiogram (ECG): Obtain an ECG to assess heart rhythm. Anemia can cause arrhythmias, including fast and irregular heartbeats, as the heart attempts to compensate for reduced oxygen by pumping more blood.

Interventions:

1. Cardiac Stress Reduction: Implement measures to reduce cardiac stress. Anemia increases heart rate and stroke volume, and can lead to reduced blood flow to the kidneys and fluid retention, all increasing strain on the heart.
2. Anemia-Specific Treatment: Treat anemia based on its specific type and underlying cause. Correcting the anemia will help restore organ function and improve cardiac output as circulating volume normalizes.
3. Blood Transfusion Preparation: Prepare for potential blood transfusion in cases of severe anemia to supplement cardiac output and improve oxygen delivery throughout the body.
4. Cause of Anemia Management: Identify and address the underlying cause of anemia. If anemia is a side effect of treatment (e.g., chemotherapy), consider discontinuing or adjusting treatment as ordered if it’s causing life-threatening complications. Reducing iatrogenic causes allows the heart to rest and function optimally.

Fatigue

Nursing Diagnosis: Fatigue

Related to:

• Decreased hemoglobin levels resulting in reduced oxygen-carrying capacity.

As evidenced by:

• Reports of overwhelming exhaustion.
• Inability to maintain usual physical activity levels.
• Increased need for rest and sleep.
• Reported lack of energy and motivation.
• Lethargy and sluggishness.

Expected outcomes:

• Patient will verbalize and implement energy conservation techniques.
• Patient will report an increase in energy levels and improved ability to perform daily tasks.

Assessment:

1. Complete Blood Count (CBC) Monitoring: Monitor the patient’s CBC, particularly red blood cell count and hemoglobin levels, to assess the severity of anemia-related fatigue. Low hemoglobin levels are directly associated with fatigue.
2. Chronic Condition Assessment: Assess for underlying chronic conditions that can worsen anemia and contribute to fatigue, such as pregnancy, cancer, or autoimmune diseases. Addressing these underlying conditions is crucial for managing fatigue.
3. Fatigue Impact Assessment: Evaluate the extent of fatigue’s impact on daily life. Inquire about activities the patient can or cannot perform, how fatigue affects their responsibilities and roles, and their current strategies for managing fatigue symptoms.

Interventions:

1. Energy Conservation Education: Instruct patients on energy conservation techniques. Recommend planning rest periods throughout the day, delegating tasks to others when possible, clustering activities to minimize energy expenditure, and prioritizing activities for times when energy levels are highest.
2. Oxygen Administration: For hospitalized patients with severe anemia and very low hemoglobin levels, supplemental oxygen may be required to alleviate fatigue and improve oxygenation.
3. Blood Transfusion Administration: In cases of severe anemia or significant blood loss, blood transfusions may be indicated to improve oxygen-carrying capacity and reduce fatigue.
4. Erythropoietin Injections: Administer erythropoietin injections (e.g., Epogen, Procrit) as prescribed. These medications stimulate bone marrow to produce red blood cells and are often used for patients with cancer, HIV, or kidney disease-related anemia to combat severe fatigue.

Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements

Related to:

• Inability to absorb iron or essential vitamins.
• Insufficient dietary intake of vitamin B12 and folate.
• Increased nutritional demands during pregnancy.
• Malabsorption issues post-gastric bypass surgery.
• Inflammatory bowel diseases affecting nutrient absorption.
• Vegetarian or vegan diets lacking key nutrients.

As evidenced by:

• Pale skin.
• Reports of feeling cold.
• Fatigue and weakness.
• Rapid heartbeat.
• Brittle nails.
• Hair loss.
• Unusual cravings for ice (pagophagia).
• Frequent headaches.

Expected outcomes:

• Patient will demonstrate improved iron and vitamin B12 levels through follow-up lab testing.
• Patient will incorporate at least three 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.

Assessment:

1. Laboratory Value Assessment: Monitor relevant lab values, including red blood cell count, hemoglobin, hematocrit, ferritin, iron, and total iron-binding capacity, to identify nutritional deficiencies contributing to anemia.
2. Dietary History Assessment: Thoroughly assess the patient’s usual dietary intake, identifying nutritional gaps and potential deficiencies. Obtain a detailed history of foods typically consumed and any food allergies or intolerances.
3. Access to Healthy Foods Assessment: Evaluate the patient’s access to healthy, nutritious foods. Assess if socioeconomic factors or geographical location limit their ability to obtain a balanced diet rich in essential vitamins and minerals.

Interventions:

1. Healthy Diet Instruction: Provide detailed instruction on a healthy, balanced diet rich in iron, vitamin B12, and folate. Recommend iron-rich foods like dark green leafy vegetables, nuts, and eggs. Suggest vitamin B12 sources such as meat and dairy products. Advise on folate-rich foods like legumes, citrus juices, and dark green leafy vegetables.
2. Supplement Consideration: Consider nutritional supplements as prescribed. Oral iron or vitamin B12 (cyanocobalamin) supplements may be necessary if dietary intake is insufficient. Vitamin B12 injections may be required for patients with absorption issues.
3. Prenatal Supplement Encouragement: For pregnant patients, emphasize the critical importance of prenatal vitamins containing iron and folate. These supplements are essential for supporting a healthy pregnancy and preventing neural tube defects.
4. Iron Absorption Improvement: Educate patients on strategies to improve iron absorption. Explain that heme iron (from meat and seafood) is more easily absorbed than non-heme iron (from vegetables, grains, and seeds). Advise taking vitamin C-rich foods with meals to enhance iron absorption and avoiding tannins in tea and coffee during meals, as they can inhibit iron absorption.

Ineffective Tissue Perfusion

Nursing Diagnosis: Ineffective Tissue Perfusion

Related to:

• Bone marrow suppression reducing red blood cell production.
• Poor dietary intake or deficiency in iron or vitamin B12.
• Low 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.
• Headache.
• Fatigue and weakness.
• Changes in mental status or mentation.
• Pallor (pale skin).
• Cold extremities.
• Prolonged capillary refill time.
• Chest pain.
• Shortness of breath.
• Low hemoglobin levels.

Expected outcomes:

• Patient will demonstrate evidence of adequate tissue perfusion, indicated by warm skin and skin color within normal range for their ethnicity.
• Patient will report relief from shortness of breath, chest pain, and fatigue.
• Patient will achieve and maintain a hemoglobin level greater than 10.0 g/dL.

Assessment:

1. Medical and Family History: Obtain a thorough medical and family history. Certain types of anemia are inherited or develop secondary to chronic conditions. Determine if anemia is acute or chronic to guide management strategies.
2. Physical Assessment: Perform a comprehensive physical assessment. Red blood cells are vital for all body processes. Low red blood cell counts (anemia) lead to decreased oxygenated blood in tissues, causing hypoxia and impaired bodily functions. Monitor for pale, cold skin, changes in respiration (tachypnea, dyspnea), orthostatic hypotension, and chest pain.
3. Hemoglobin Level Review: Review current hemoglobin levels. Low hemoglobin directly indicates a lack of oxygenated blood available for tissue perfusion.

Interventions:

1. Chest Pain and Palpitation Investigation: Thoroughly investigate reports of chest pain or palpitations. Obtain an ECG to monitor for cardiac arrhythmias and assess cardiac function if chest pain is present.
2. Oxygen Administration: Administer supplemental oxygen as prescribed. Hypoxia may result from reduced oxygen-carrying capacity. Maintain SpO2 levels above 95% with supplemental oxygen.
3. Safety Precautions Implementation: Implement fall and safety precautions due to potential central nervous system effects of anemia, such as lightheadedness, dizziness, vision changes, and muscle weakness, which increase the risk of falls and injuries.
4. Epoetin Injections Administration: Administer epoetin alfa injections as ordered. Epoetin alfa is a synthetic form of erythropoietin that stimulates red blood cell production in the bone marrow, improving tissue perfusion over time.