megaloblastic anemia(group 4)
TRANSCRIPT
MEGALOBLASTIC ANEMIA
What is Megaloblastic Anemia ?
•In addition to the cells being large ,the inner contents of each cell are
not completely developed.
•This malformation cause the bone marrow to produce fewer cell ,and
sometimes the cells die than the 120 day life expentancy.
•Instead of being round or disc-shaped ,the red blood cells can be oval.
•Megaloblastic anemia also that a results from inhibition of DNA
synthesis in red blood cell production.
•This is often due to deficiency of vitamin B12 and folic acid.
•Megaloblastic anemia not due to hypovitamosis may be caused by
antimetabolites that poison DNA production ,such as alcohol and some
chemotherapeutic or antimicrobial drugs.
•Megaloblastic anemia is a type of anemia characterized by very large
red blood cells.
Pathophysiology
•Megaloblastic states result from defective DNA synthesis.
•RNA synthesis continues ,resulting in a large cell with a large nucleus.
•All cell lines have dyspoiesis ,in which cytoplasmic maturity is greater
than nuclear maturity.
•This dyspoiesis produces megaloblasts in the marrow before they appear
in the peripheral blood.
•Dyspoiesis results in intramedullary cell death ,making erythropoiesis
innefecctive and causing indirect hyperbilirubinemia and hyperuricemia.
•Because dyspoiesis affects all cell lines ,retilocytopenia and during later
stages leukopenia and thrombocytopenia develop.
•Large or oval RBCs (macro-ovalocytes) enter the circulation.
Etiology
1. Megaloblastic anemia is an anemia (of macrocytic classification) that result from
inhibition of DNA synthesis in RBC productions. This is often due to deficiency of
vitamin B12 and folic acid. Vitamin B12 deficiency will not cause the syndrome in
the presence of sufficient folate for the mechanism is loss of B12 ,dependent the
folate recycling ,followed by folate deficiency loss of nucleic acid synthesis
leading to the defect in DNA synthesis.
2. Other causes are:
• Alcohol abuse.
• Chemotherapy drugs.
•Inherited disorder.
•Myelodysplastic syndrome.
Sign and Symptom
1) Change in skin colour.
•One of the most noticeable is a
gradual change in skin color. The skin
will start to become pale all over the
body.
2) Loss of appetite
•Will cause a loss of appetite which
lead to weight loss. If the condition
continuous ,the weight loss could
become significant.
3) Mouth and tongue
•The mouth and tongue become sore.
The tongue also may start to smooth
and change color to bright red.
4) Numbness
•Another progressive symptom of the
disease is a tingling sensation in the
hand and the feet. If the condition
goes untreated this tingling may
return to numbness.
5) Nausea
After a while ,the condition will begin
to affect the digestive system and
this will create a persistent felling of
nausea that may be a accompanied by
vomiting.
MOUTH AND TONGUE SORE LOSS OF APPETITE
NUMBNESS
Diagnostic Test
A. Complete blood count (FBC ,CBC).
B. Serum B12 level .
C. Serum folate level.
D. Serum methylmalonic acid .
E. Schilling test. • Injection or tablet of nonradioactive vitamin B12 . • Then urine sample are collected.
F. Bone marrow examination.
TreatmentSpecific treatment for Megaloblastic (pernicious) anemia will be determined by your physician based on :
Based on client age ,overall health condition and medical history extend
of the disease.
Your tolerance for specific medication ,procedure or therapies.
Expectation for the course of the disease.
Your opinion or preference.
Treatment may include :
• Vitamin B12 oral supplement (for replacement and severe anemia).
• Intramuscular injection (for malabsorbtion disorder or lack of intrinsic factor).
Problem identified
Expected outcome
Planning Implementation with rationale
Evaluation
Δnutrition imbalance less than body requirement due to loss appetite r/t disease process
•pt regain good appetite within 24 hour.
•Assess pt condition
• diet and nutrition control.
•Encourage home food.•Monitoring i/o chart.
•Medication.
•Assess the daily weight at the same time, same scale and same pt. R :to detect any changes of body weight.
•Encourage pt to take small amount of food but frequent R :to maintain metabolic rate.
•Serve food rich in folic acid and vitamins B12 eg: eggs ,meat ,milk and poultry as a supplement .
•To promote pt appetite.•To evaluate intake amount of food.
•Administer medication follow doctor order eg: vitamin B complex R: to regain pt appetite
•Pt able to tolerate with food.
Nursing Care Plan
Nursing Care PlanProblem identified
Expected outcome
Planning Implementation with rationale
Evaluation
Δdiarrhea r/t dysfunction of bowel absorption.
•pt stop diarrhea within 4 hour.
•assess pt condition.
•Monitoring bowel sound by palpate and auscultate.
•Diet and nutrition control.
•Do the observation.
•Medication.
•Assess by taking vital sign eg: temperature and pulse. R: to obtain baseline data so that nurses can plan further treatment.
•To evaluate the severity of diarrhea.
•Give IV therapy to pt by doctor prescription. R: to rest the bowel and prevent dehydration.
•Observe the characteristic of stool including the color ,odor, volume and amount. R: to detect bacteria that causes the disease.
•Give antidiarrhea drug follow doctor order eg: loperamide @ imodium R: to treated the diarrhea by decreasing digestion tract peristalsis.
•No complaint of diarrhea after 4 hour.
Problem identified
Expected outcome
Planning Implementation with rationale
Evaluation
Δnausea r/t stomach disturbance
•Stomach disturbance reduce within 2 hour.
•Assess pt condition.
•Monitoring i/o chart.
•Positioning.
•Do the observation.
•Encourage CRIB
•Assess the symptom of vomiting to. R: obtain baseline data so that nurses can plan further treatment.
•Monitor every 2 hour. R: to evaluate output and detect loss of fluid if pt vomit.
•Prop up pt to avoid choking.
•Inform the physician if nausea or vomiting persist to treat the disease immediately.
• promote fully rest to reduce weakness.
•No complaint of nausea after treatment.
Nursing Care Plan
GROUP MEMBERS :
HAMASJULIANA
LYSAMELISATINEY