Anemia

A. Definition
Anemia is an condition of where rate of Hb and/or count lower eritrosit of normal price. Told as anemia when Hb < 14 g/dl and Ht < 41% at man and Hb < 12 g/ dl and Ht < 37 % at woman. (Arif Mansjoer,Dkk. 2001)
Anemia is decreasing of amount of eritrosit and also the amount of haemoglobin in 1mm3 blood or decreasing compacted cell volume (volume cells red packed) in 100 blood ml. (Ngastiyah, 1997)

B. Etiology
Anemia caused by various disease type, but all the damage by significant will lessen to the number of oxygen which available to tissue. According to Brunner and of Suddart (2001), some cause of anemia in general for example:
a. Physiologically anemia happened when there are lacking amount of haemoglobin to transport oxygen to tissue
b. Effect of premature red corpuscle or crushing of abundant red corpuscle
c. Red corpuscle production falling short
d. Other factor cover losing of blood, lack of nutrisi, clan factor, chronic disease and lacking of ferrum.

C. Classification
By patophisiology anemia consist of:
1. Degradation of production : deficiencies anemia, anemia of aplastic
2. Make-Up of crushing : anemia because blood, anemia of hemolitik.
Generally anemia grouped become:
1. Mikrositik hipokrom anemia
a. Deficiencies iron anemia
To make red corpuscle needed ferrum (Fe). Requirement of Fe about 20 mg/day, and only about 2 mg absorbent. Full scale of Fe in body about 2-4 mg, about 50 mg/kg of BB at man and 35 mg/kg of BB at woman. This anemia generally caused by chronic bleeding. In Indonesia many because of hookworm infestation (ankilostomiasis), it will not cause anemia when do not accompany by malnutrisi. This anemia type is also caused by:
1) Diet which fall short
2) Downhill imbibition
3) Requirement which mounting at pregnant woman and suckle
4) Bleeding at channel digest, menstruating, blood transfussion
5) Hemoglobinuria
6) Depository of iron decrease, like pulmo hemosiderosis.
b. Chronic anemia disease
This anemia recognized also by the name of anemia sideropenic of with siderosis reticuloendothelial. This disease attributed to many various disease of infection like kidney infection, pulmo (abscess, empisema, etc).

2. Anemia of Makrositik
a. Anemia of Pernisiosa
Anemia that happened by lack of vitamin of B12 effect of intrinsic factor because trouble of absorbtion representing disease of autoimun herediter and also factor of ekstrinsik for lack of vitamin B12 suply
b. Deficiencies of folat acid anemia
This anemia generally relate to malnutrisi, but degradation imbibition of folat acid seldom be found because imbibition happened in all channel digest. Folat acid there are in flesh, milk, and green leaf
3. Anemia because bleeding
a. Acute bleeding
Possible when expenditure of blood quite a lot, while degradation of Hb rate happened a few days later
b. Chronic bleeding
Expenditure of blood usually a little so that unknown by patient. For example caused by peptikum ulcus, menometroragi, channel blood digest, and epistaksis.
4. Hemolitik anemia
Hemolitik anemia happened degradation of red corpuscle age (normal 120 day), good whereas or continuously. This anemia caused by disparity of membrane, disparity of glikolisis, disparity of enzyme, immured system disorder, infection, hipersplenisme, and singe. Patient usually ikterus and of splenomegali.
5. Aplastik anemia
Happened because bone marrow can not form corpuscles. Its cause can be congenital, idiopatik, kemoterapi, radiotherapy, toxin, etc.

D. Clinical Manifestation
At anemia, because all organ system can involve hence can generate wide of clinical manifestation. This manifestation base on
a. Speed of anemia occurence
b. Duration
c. Requirement of pertinent client metabolism
d. Existence of defect or other disparity
e. Certain complication or situation causing anemia.
Because red blood count decrease, hence is slimmer delivered oxygen to tissue. Losing of blood which quickly counted 30% can cause vascular kolaps at same individual. But degradation of hemoglobin and hematokrit without visible symptom or clear disability step by step usually earn tolerance until 50%. Compensation body mechanism work through
a. Bulk improvement of respiration and heart, in consequence add delivery of oxygen to tissues by red corpuscle
b. Improving release of haemoglobin and oxygen
c. Developing plasma volume attractively dilution from tissue
d. Redistribusi blood stream to vital organs.
Individual which have experienced of sufficient anemia during with haemoglobin rate between 9-11 g/dl, only experiencing of a few symptom or no symptom at all besides light takikardi during practice. Takikardi depict work load and pour heart which mounting. Dispnea practice usually happened when hemoglobin rate below/under 7,5 g/dl representing manifestation decrease delivery of oxygen. Weakness only happened when haemoglobin rate below/under 6 g/dl. Dispnea take a rest when below/under 3 g/dl and fail heart only at very low rate 2-2,5 g/dl, this matter caused by heart muscle which lacking of inadaptable oxygen x'self with heart work load which mounting.
One of the most sign often related to anemia is turning pale. This resulted decreasing blood volume, and hemoglobin of vasokontriksi to enlarge delivery of oxygen to vital organs. Nail colour, palm, tire of mukosa trap and konjungtiva can be used to assess paleness.

E. Supporter Data
At laboratory test result met
a. Amount of lower Hb from is normal (12-14 g/dl)
b. Rate of Ht downhill (normal 37-41)
c. Make-Up of total bilirubin (hemolitik anemia)
d. Seen and retikulositosis of sferositosis at edge blood5. There are pansitopenia, empty bone marrow changed by fat (aplastik anemia)

F. Threatment
Threatment of anemia addressed to look for cause and change missing blood. Anemia threatment pursuant to its type, that is
a. Aplastik anemia
The threatment cover bone marrow transplantation and therapy of immunosupresif with globulin antithimocyte (needed ATG) through central band during 7-10 day. Ugly prognosis if bone marrow transplantation fail to. If needed can be given by transfusion of RBC low and platelet leucocyte (Phipps, Cassmeyer, Sanas & Lehman, 1995)
b. Deficiencies iron anemia
Overcome by curing its cause and change ferrum by farmakologis during one year. Men require 10 mg/day, woman menstruating 15 mg/and day of postmenaupouse require 10 mg/day
c. Megaloblastik anemia
For the anemia of caused by megaloblastik is vitamin deficiencies of B12 (anemia of pernisiosa) and sour deficiencies of folat dosed with giving vitamin of B12 and oral folat acid 1 mg/day
d. Cell scythe anemia
Its medication include giving hydration and antibiotic swiftly and big dose. Gife sour addition of folat every day needed to fill lacking of acid folat caused by the existence of kronik hemolisis. Transfusion only needed during happened crisis of aplastik or hemolitik. Education and continuous tuition including tuition of genetik, conducted important for the prevention of and medication of scythe cell anemia.

G. Complication
There are three common complication happened at anemia that is failing heart, and spastic of parestesia (feeling which digressing like feeling burnt and ant).


NURSING CARE PLAN FORMAT

A. ASSESSMENT
1. Activity/Rest
a. Iethargy, weakness, common malaise
b. Losing of productivity, dispiriting to work
c. Tolerance to low practice
d. Requirement more for the rest and sleep
2. Sirculation
a. History losing of chronic bleeding
b. History of endokarditis chronic infektif
c. Palpitasi
3. Integrity Ego
Confidence of culture or religion influence election of medication, for example: deduction of blood tranfusi
4. Elimination
a. History of Pielonenepritis, fail kidney
b. Flatulen, syndrome of malabsobsi
c. Hematemesi, melana
d. Diarrhoea or constipation
5. Food/dilution
a. Passion eat downhillly
b. Queasy/puking
c. Downhill body weight
6. Pain/freshment
Location pain especially abdomen area and head
7. Respiration
Short breath at rest or doing actifity
8. Seksualitas
a. Change of menstuasi for example menoragia, amenore
b. Downhill of sexual function
c. Impotent

B. DIAGNOSA TREATMENT
1. Trouble tissue perfusion relate to degradation of oxygen supply/nutrition to cell, marked with:
a. Palpitasi,
b. Pale husk, dry mukosa membrane, brittle hair and nail,
c. Cool ekstremitas
d. Change of blood pressure, tardy capillary admission filling
e. Disability of have concentration, disorientasi
Target: showing adekuat tissue perfusion
2. Intoleran activity relate to oxygen supply imbalance, marked with:
a. Weakness and fatigue
b. Complaining degradation of actifity/practice
c. More needing rest/sleep
d. Palpitasi,Takikardi, make-up of blood pressure
Target: happened the make-up of tolerance of aktifitas
3. Change of nutrition less than requirement relate to failure to digest, food absorbtion, Marked with:
a. Degradation of normal body weight
b. Degradation of husk turgor, change of mouth mukosa.
c. Passion eat downhillly, queasy
d. Losing of muscle tonus
Target: requirement of nutrisi fufilled which followed by make-up of body weight.
4. Constipation or diarrhea relate to degradation of food amount, change of ingestion , side effects usage of drug, Marked with :
a. Existence of fesesfrequency, characteristic, and amount change
b. Queasy, puking, degradation of passion eat
c. Abdomen pain
d. Peristaltic disorder
Target: pattern of eliminasi normal as according to its function
5. High risk of infection relate to defence of skunder which inadekuat, Marked by can not be applied by the existence of symptom and marking-symptom making actual diagnosa.
Target of: happened degradation of infection risk.


C. INTERVENCE
Diagnosa 1
1. Vital sign study, husk colour, mukosa membrane, nail elementary
2. Give semi fowler position
3. Study pain scale and existence of palpitasi
4. Maintaining ambient temperature and patient body
5. Avoid usage of hot water or warmer.
Kolaboration
1. Monitor laboratory test result for example Hb/amount and ht of SDM
2. Give complete SDM blood/pocket
3. Give additional O2 as according to indication

Diagnosa 2
1. Study ability of patient actifity
2. Vital sign study when doing actifity
3. Assist requirement of patient actifity if needed
4. Suggest to patient to discontinue actifity if happened palpitasi
5. Use energy thrift technics for example bath sat

Diagnosa 3.
1. Study history of nutrisi the including food took a fancy to
2. Observation and note patient food input
3. Deliberate body weight every day
4. Giving food a few/little and frequency which often
5. Observation for queasy, puking, other related symptom and flatus
6. Assist and give good mouth hygiene
Kolaborasi
1. Consul at nutritionist
2. Give drug as according to indication for example: mineral and vitamin of suplemen
3. Give nutrisi suplemen.

Diagnosa 4
1. Observ colour of feses, consistency, amount and frequency
2. Sound intestine study
3. Dilution giving 2500-3000 ml/day in heart tolerance
4. Avoid to eat gasiform
5. Study condition of husk of perianal
Kolaborasi
1. Consul nutritionist for giving well-balanced diit
2. Give laksatif
3. Give anti diarrhea drug

Diagnosa 5
1. Improving to clean hand better
2. holding up of aseptic technics tighten in each action
3. Assist treatment of husk of perianal and of oral carefully
4. Limit visitor
Kolaborasi
1. Take spesemen for culture
2. Give topikak antiseptic, systematical antibiotic.


SOURCE

Brunner & Suddarth. 1997. Buku Ajar Keperawatan Medikal Bedah. Jakarta : EGC.
Doenges, Marilynn, dkk. 1993. Rencana Asuhan Keperawatan, Pedoman Untuk Perencanaan dan Pendokumentasian Perawatan Pasien. Jakarta : EGC.
Long, Barbara C.1996. Perawatan Medikal Bedah ( Suatu Pendekatan Proses Keperawatan ). Bandung : Yayasan Ikatan Alumni Pendidikan Keperawatan Pajajaran Bandung.
Manjoer, Arief. 2001. Kapita Selekta Kedokteran. FK UI : Media Aeskulatius
Ngastiyah. 2001. Ilmu Keperawatan Anak. Jakarta : EGC.