1. Pathophysiology
   1. A general Dx term that refers to a decrease in total number of circulating RBCs
   2. associated with decreased erythrocyte production
      1. nutritional deficiency anemias
   3. acute or chronic blood loss
   4. increased erythrocyte destruction
      1. sickle cell anemia, enzyme deficiencies, transfusion reactions
2. Treatment
   1. Medications
      1. erythropoetin
      2. iron, folic acid
      3. Vit B 12 for Pernicious Anemia
   2. Diet Therapy
   3. Blood Transfusion
3. Deficient Knowledge
   1. S/S
      1. Signs & Symptoms
      2. many questions
      3. verbalized misconceptions
      4. lack of questions
   2. NICs
      1. assess understanding of diagnosis, possible causative factors, disease process, and treatment
      2. explain hematological vocabulary and functions of blood elements (PRBCs, WBCs, platelets)
      3. instruct to avoid causative factors if known
      4. explain necessity for diagnostic procedures
      5. For nutritional deficiency anemia:
         1. explain use of diet therapy and medications
         2. teach food sources of iron, folic acid, vit B12
         3. teach about replacement therapy with iron and folic acid
         4. explain the need for Vit B12 replacement
      6. for Blood Loss Anemaia:
         1. teach re: meds that stimulate RBC production (erythropoetin)
         2. teach re: blood transfusion if indicated
4. Fatigue
   1. S/S
      1. report of weakness or fatigue
      2. exertional discomfort or dyspnea
      3. inability to maintain usual routine
      4. decreased performance
   2. NICs
      1. assess current activity level
      2. assess specific cause of fatigue
      3. monitor Hemoglobin, Hematocrit, RBC count
      4. teach energy conservation principles
      5. assist in planning ADLs
      6. Stress importance of frequent rest periods
      7. refer the pt to OT
      8. instruct re: meds that stimulate RBC production
      9. anticipate need for transfusion of packed RBCs
      10. institute supplemental oxygen therapy
5. Ineffective Protection
   1. R/T
      1. Bleeding
      2. Thrombocytopenia
   2. NICs
      1. monitor platelet count
      2. assess skin for evidence of petechiae or bruising
      3. assess for frank bleeding from nose, gums, vagina, or urinary, or GI tract
      4. monitor stool and urine for occut blood
      5. instruct pt re: bleeding precautions
      6. avoid rectal procedures that may cause trauma or bleeding ( enemas, suppositories, rectal temp )
      7. instruct pt to shave with electric razor and use soft toothbrush