DISEASE SPECIFIC INFORMATION DISEASE Anemia: a blood condition in which there are too few red blood cells

or the red blood cells are deficient in hemoglobin, resulting in poor health. PATHOPHYSIOLOGY Anemia usually is grouped into 3 etiologic categories: decreased red blood cell (RBC) production, increased RBC destruction, and blood loss. CLINICAL MANIFESTATIONS (SIGNS & SYMPTOMS)

Fatigue decreased energy weakness shortness of breath lightheadedness palpitations (feeling of the heart racing or beating irregularly)

looking pale COMMON TREATMENT Anemia treatment depends on the cause:

Iron deficiency anemia. This form of anemia is treated with changes in your diet and iron supplements. If the underlying cause of iron deficiency is loss of blood other than from menstruation the source of the bleeding must be located and stopped. This may involve surgery. Vitamin deficiency anemias. Folic acid deficiency anemia is treated with folic acid supplements. If your digestive system has trouble absorbing vitamin B12 from the food you eat, you may receive vitamin B-12 injections. Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue.

Aplastic anemia. Treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells. Anemias associated with bone marrow disease. Treatment of these various diseases can range from simple medication to chemotherapy to bone marrow transplantation. Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Short courses of treatment with steroids or immune suppressant medications can help suppress your immune system's attack on your red blood cells. Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure.

Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors may also recommend blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia.

DIAGNOSTICS

CBC. Physical Exam

COMMON NURSING INTERVENTIONS Increase of good hand washing; by care givers and patients. Rational: to prevent cross-contamination / bacterial colonization. Note: patients with severe anemia / aplastic can be risky due to the normal flora of the skin. Maintain strict aseptic technique in the procedure / treatment of injuries. Rational: reducing the risk of colonization / infection of bacteria. Provide skin care, perianal and oral carefully. Rational: reducing the risk of damage to the skin / tissue and infection. Motivation changes in position / ambulation frequently, coughing and breathing exercises that deep. Rational: to improve the ventilation of all lung segments, and help mobilize secretions to prevent pneumonia. Increase adequate fluids. Rational: to assist in the dilution of respiratory secretions to facilitate the spending and prevent stasis of body fluids such as respiratory and kidney. Monitor / limit visitors. Provide insulation if possible. Rational: to limit exposure to the bacteria / infection. Protection of insulation required in aplastic anemia, when the immune response is disrupted. Monitor body temperature. Note the chills and tachycardia with or without fever. Rational: the process of inflammation / infection require evaluation / treatment. Observe erythema / wound fluid. Rational: indicators of local infection. Note: the formation of pus may not exist when granulocytes depressed. Take specimens for culture / sensitivity as indicated (collaboration) Rational: differentiate an infection, identify the specific pathogen and affect treatment options. Give a topical antiseptic; systemic antibiotics (collaboration). Rational: propilaktik may be used to reduce colonization or for the treatment of local infection process. Reference: Swearingen, Pamela L. Manual of Medical-surgical Nursing Care: Nursing Interventions and Collaborative Management. St. Louis, MO: Mosby / Elsevier, 2007.

DISEASE SPECIFIC INFORMATION DISEASE Diabetes mellitus (DM) or simply diabetes, is a chronic health condition in which the body either fails to produce sufficient amount of insulin or responds abnormally to insulin. PATHOPHYSIOLOGY The pathophysiology of diabetes mellitus (all types) is related to the hormone insulin, which is secreted by the beta cells of the pancreas. This hormone is responsible for maintaining glucose level in the blood. It allows the body cells to use glucose as a main energy source. However, in a diabetic person, due to abnormal insulin metabolism, the body cells and tissues do not make use of glucose from the blood, resulting in an elevated level of blood glucose or hyperglycemia. Over a period of time, high glucose level in the bloodstream can lead to severe complications, such as eye disorders, cardiovascular diseases, kidney damage and nerve problems. CLINICAL MANIFESTATIONS (SIGNS & SYMPTOMS) Type 1 Diabetes

Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue and Irritability

Type 2 Diabetes*

Any of the type 1 symptoms Frequent infections Blurred vision Cuts/bruises that are slow to heal Tingling/numbness in the hands/feet

Recurring skin, gum, or bladder infections COMMON TREATMENT

insulin exercise diet

DIAGNOSTICS

Bedside glucose Hemoglobin A1C

COMMON NURSING INTERVENTIONS Monitor Blood glucose levels Teach about medication, monitoring, disease Monitor for S&S of DKA Administer insulin per protocol/sliding scale Reference: Swearingen, Pamela L. Manual of Medical-surgical Nursing Care: Nursing Interventions and Collaborative Management. St. Louis, MO: Mosby / Elsevier, 2007.