INTRODUCTION

Everyone knows that we can't live without blood.

Without blood, our organs couldn't get the oxygen and
nutrients they need to survive, we couldn't keep warm or
cool off, we couldn't fight infections, and we couldn't get rid
of our own waste products. Without enough blood, we'd
weaken and die.
There are diseases and conditions involving the blood.
The most common is anemia. An anemia is a condition in
which the number of red blood cells (RBC) or the amount of
hemoglobin (the protein in red blood cells that carries
oxygen throughout the body) is below normal. Megaloblastic
Anemia (MGA), also known as Pernicious Anemia, is a rare
blood disorder characterized by the presence of large,
structurally and visually abnormal, immature red blood cells
(megaloblasts). Decreased numbers and immaturity of white
blood cells (leukocytes) and blood platelets (thrombocytes)
may also occur.
Megaloblastic Anemias are usually caused by a
deficiency or defective absorption of either vitamin B12
(cobalamin) or folic acid. As a result, they are also known as
the vitamin deficiency anemias. In most cases, the
fundamental flaws leading to the several forms of MGA
caused by vitamin deficiencies are present at the time of
birth and exist as a result of a genetic defect. In addition,
certain immunosuppressive drugs may also cause
Megaloblastic Anemia.
As student nurses, we must be aware of the signs and
symptoms of the disease so we could be more effective in
doing our duties.

OBJECTIVES
GENERAL:
 To improve our skills, knowledge and attitude necessary
to care for our patients with megaloblastic anemia.
SPECIFIC:
1. To understand the disease process, its etiology, signs

and symptoms, pathophysiology and diagnostic

procedures,
2. To discuss and describe interventions for health
promotion, prevention and treatment of patients with
megaloblastic anemia.
3. To develop a teaching program that will educate
patients especially those who are susceptible to anemia
by reiterating the importance of good and healthy
nutrition.
4. To assist patients in overcoming the anxiety and
depression brought about by the condition.
5. To promote awareness to individuals by imparting
knowledge so they could learn and understand more
about megaloblastic anemia.
Biographic data:

Name: Mr. X
Address: Caloocan City
Age: 40 years old
Sex: Male
Marital Status: married
Religion: Roman Catholic
Health Care financing: United Healthcare
Usual Source of Medical Care: Health personnel
Chief Complaints: Weakness
Medical Diagnosis: Megaloblastic Anemia
Doctor: Dr. Romeo Rivera
History of present illness:

According to the patient, he was first diagnosed with

Megaloblastic anemia last June of 2006 when he was
hospitalized for 3 days at the Martinez Memorial Hospital.
He was admitted with chief complain of body weakness. He
received blood transfusion when hematology laboratory
results revealed decreased blood count. From then on, he
needed blood transfusion every time his blood count would
fall below normal.

He was again hospitalized recently in the same

institution. According to him, his appetite was decreased and
had difficulty walking which is a common manifestation of
anemia because of weak muscles. He was also pale and
noticeably irritable. The laboratory results showed an
alarming decrease in blood components. His hemoglobin
count was 8.2 g/dl as compared to normal adult male range
of 14 - 18 g/dl; hematocrit of 25% compared to normal adult
male range 40 - 54% and RBC count of 2.5 mill/mcl, normal
adult male range 4.2 - 5.6 mill/mcl.

Past history

According to Mr. X, he had measles when he was young,

aside from the usual fever and cough. He doesn’t remember
having immunizations although his mother has told him
before that he completed his immunization vaccines when
he was young,
He is not allergic to drugs, animals, insects, food or
other agents.

Accidents and Injuries:

No accidents and injuries.

Family History Illness:

Hypertension and diabetes on his mother side.

Lifestyle and Personal Habits

 Mr. X is a non-smoker but was a heavy drinker. When he
was hospitalized two years ago, he stopped drinking under
his physician’s advice. He doesn’t drink coffee or tea. He
drinks soda once in awhile. He only takes drugs prescribed to
him by his physician.

Social data:

Mr. X has a good relationship with regards to his family

and relatives. He loves to travel. Before he was diagnosed
with megaloblastic anemia, they would go to his hometown
province and spend a few days there. Summer was his
children’s favorite time of the year because they would often
go out of town. But because of his condition, his lifestyle was
changed. He tires easily aside from the fact that blood
transfusion and hospital bills affect his family’s financial
status.

Diet:

Mr. X eats 3-4 times a day. He prefers to eats fish and

vegetables but would sometimes eat meat also.

Sleep/Rest Pattern:

According to him, he has ample time to rest

although sometimes, because of stress brought about by his
condition, he has difficulty falling asleep.

Ethnic affiliation:

Mr. X grew up in the province and is a believer of nuno

sa punso, dwarfs and other superstitious beliefs He also
believes in herb or quack doctors and faith healers.

Educational History:

Mr. X is a high school graduate from Mindoro.

Occupational History:
 Mr. X has a small business painting cars. It is enough to
make both ends meet for him, his wife and 3 children. He
earns roughly about P30,000 - P40,000 every month. But
since he was diagnosed with anemia, he works less and
naturally earns less. His wife helps him by being a retail
person for Avon and Saralee among others.

Economic Status:

Having a medical insurance helps him pay his medical

bills. His family helps too in whatever way they can.

Psychological Data:

What troubles Mr. X most is his family’s financial

concern. He doesn’t want to see his family suffer because of
his condition. He wants to see his 3 children to grow up and
be professionals some day.

GORDON’S FUNCTIONAL HEALTH PATTERNS

PATTERN OF HEALTH PERCEPTION AND HEALTH MANAGEMENT

Mr. X is very particular about his and his family’s health.

He believes in the saying that health is wealth. When he
started feeling weak and had difficulty breathing after doing
some light activities, he went to see his doctor right away.
No one in his family was ever hospitalized so it is a bit
difficult for him to accept the fact that he, supposedly the
head and pillar of the family is sick. At first, he had no clue
about what his condition is. But as time goes by, he learns a
lot from his doctors and his nurses.

NUTRITIONAL – METABOLIC PATTERN

Height : 5’7”
 TIME FRAME WEIGHT BMI INTERPRETATION
Before illness 136 lbs 20.64 Normal
During illness 122 lbs 18.66 Normal
Weight as of Feb. 1, 2007 122 lbs 18.66 Normal

Basis of Interpretation:

 BMI of < 18.5 is classified as underweight

 BMI of 18.5 to 24.9 is classified as normal
 BMI of 25 to 29.9 is classified as overweight
 BMI of 30 to 39.9 is classified as obesity

*BODY MASS INDEX (BMI) = weight (kg) / height (m⅔)

Although Mr. X lost 14 lbs from the time prior to his

illness up to the present, his body weight is still within the
normal range based on his BMI.

DIETARY PATTERN

BEFORE ILLNESS PRESENT

MEALS AMOUNT FOODS/DRINKS AMOUNT FOODS/DRINKS
Breakfast 2-3 cups Rice 1 cup Rice
3-5 pieces Boiled/scrambled 1 serving Fish/vegetables
eggs 1 glass Juice
2 glasses water 1 glass Water
Lunch 2-3 cups Rice 1 cup Rice
1 serving Pork/fish/vegetables 1 serving Pork/fish/vegetables
2 glasses water 2 glasses water
Snacks 1-2 pieces Sandwich 1 serving Pancit canton/
1-2 glasses Cola drinks 2 glasses sopas
water
Dinner 2 cups Rice 1 cup Rice
1 serving Fish/vegetables 1 serving Fish/ vegetables
2 glasses water 2 glasses water

Favorite Foods : Dishes like pinakbet, sinigang na baboy or bangus,

Vegetables like eggplant, ampalaya, and cabbage.
Fruits like mango, apple and orange.
Vitamins : Folic Acid

VISIT TO FAST FOOD

RESTAURANTS : 2-3 x a week
 (Jollibee, McDonalds, KFC)
Allergies to Foods : None

PATTERN OF ELIMINATION
Bowel Elimination Before illness Present
Frequency Once a day Once a day
Character of stool Brownish, solid Brownish, solid
Problem Encountered None None

Urinary Elimination Before illness Present

Frequency 8 -10 x a day 8 -10 x a day
Character of urine Aromatic, pale yellow Aromatic, pale yellow
Problems Encountered None None

PATTERN OF ACTIVITY AND EXERCISE

 Typical activity for the day prior to admission
Time Activity
6:00 – 7:00 AM > Wakes up
7:00 – 8:00 AM > prepare and eat breakfast
8:00 – 11:00 AM > Work
11:00-11:30 AM > Rest
11:30 – 12:00 NN > Eat lunch
12:00 – 1:30 AM > rest and sleep
1:30 – 5:00 PM > Work
5:00-6::00 PM > Socialize with neighbors and friends
6:00 – 7:00PM > Helps prepare dinner
7:00 - 8:00 PM > Eat dinner with family
8:00 – 11:00PM > Watch TV/Read
11:00 PM > Bed time

COGNITIVE – PERCEPTION PATTERN

We see no problem about the way he communicates.
He could comprehend easily and could recall past as well as
recent events in his life. He talks with sense and explains
things logically.
PATTERN OF SELF PERCEPTION AND SELF CONCEPT
Mr. X has a positive outlook about life in general. He
doesn’t take it against himself or against anybody for what
happened to him. He is very optimistic that he would be
better. In fact he is willing to undergo any medical
interventions to alleviate his sufferings and to prolong his
life. He has his family’s support and that is what’s giving him
strength to battle towards recovery.
ROLE RELATIONSHIP PATTERN
Mr. X married his childhood sweetheart. He lives with
wife and 3 children, 2 boys and 1 girl, all of them are going
in a nearby public school. He is close with all of his kids
because he sees to it that he spends quality time with them
even though he tires easily. His wife is very supportive with
what he is going through.
SEXUALITY PATTERN
According to Mr. X, although the quantity is lessened,
he and his wife still enjoy sex even after having 3 children
and being married for almost 15 years. His wife is
“malambing” and thoughtful. She never misses to let him
feel how much she loves him and how much they need him.
He admitted that his family is not a perfect one but he and
his wife made it a point to iron things out before it gets
worse.

PATTERN OF COPING AND STRESS TOLERANCE

 Mr. X views his problem more as a trial than an
obstacle. Even though it affected his work, it did not dampen
his spirit and trust in the Lord. According to him, it made him
a better person. Now he realized the value of what he has.
The only thing that stresses him out is about his family’s
finances. But as of now, they could still manage. They still
could eat 3-4 meals a day and he can still send his children
to school despite the hospital bills. Before his diagnosis, he
copes stress by drinking and playing basketball with his
sons. Now, he feels relax when he watches the television or
listens to the radio. He plans on doing some gardening too
because according to one of his friends, gardening is one of
the best way to relieve stress.
PATTERN OF VALUES AND BELIEFS
He believes in God and that God won’t give him
problems he could not bear. When he is not in the hospital,
they go and hear mass as a family. He also has strong ties
with his mother and siblings. They don’t see each other as
much as they used to but because of the technology that we
have now, the communication lines remain open. In spite of
his condition, he still provides for his family because that is
what his own father instilled in his mind when he was
growing up. The man should be the head and the pillar of the
family. According to him, to be able to be called a man, one
has to provide, support and defend his family.

PHYSICAL ASSESMENT
I. GENERAL APPEARANCE
a. Body Build : Medium Frame
b. Height and weight : 5’7”; 122 lbs
c. Posture : erect and straight body posture
d. Hygiene and grooming : clean and neat
e. Body breath and odor : none
f. Appearance : appears weak
g. Mental status: clear and intact memory both recent and remote,
oriented to person, time and place
h. Attitude : cooperative
i. Mood and affect : appropriate to situation
j. Organization of speech : understandable, moderate pace
k. Relevance and organization: has logical sequence and sense of
reality of thought

II. VITAL SIGNS

a. Temperature : 36.6’ C
b. Pulse Rate : 75 bpm
c. Respiration Rate : 18 bpm
d. Blood Pressure : 110/70 mmHg

III. INTEGUMENT
A. Skin
a. Color complexion : fair complexion
b. Skin moisture : dry, slightly wrinkled, dry lips
c. Skin temperature : normal
d. Skin turgor : slightly poor skin turgor

B. Nails
a. Fingernail plate shape : convex
b. Texture : smooth
 c. Bed color : pink
d. Capillary refill : pink in color returns after 5 secs.
- Intact epidermis around the nail
IV. HEAD
A. Hair
a. Color : black
b. Distribution : evenly distributed
c. Texture and oiliness : silky, fine and oily
- Thin strands of hair
B. Scalp
- Absence of drandruff
- No lesions, masses, deformities, swelling and tenderness.
C. Skull
- Normocephalic
- Smooth, uniform consistency; absence of nodules or masses
D. Face - symmetrical facial features and movements
E. Eyes and Vision
a. Eyebrows : eyebrows are black, evenly distributed and
symmetrically aligned
b. Eyelashes : equally distributed, slightly curled outward
c. Eyelids : skin is intact, lids close symmetrically
d. Bulbar conjunctiva : transparent, capillaries are not
evident, sclera appears yellowish
e. Palpebral conjunctiva: shiny, smooth, and slightly yellowish
f. Lacrimal gland : no edema, or tenderness over the gland
g. Pupils : black in color, iris appears yellowish
h. Visual acuity : decreased visual acuity, difficulty in
reading prints in near vision (farsighted 65 degree)
i. Visual field : decreased peripheral vision
j. Consensual reaction to light and accommodation: normal
constriction of pupil upon the presence of light ( PERRLA)
F. Ears and hearing
 a. Auricles : symmetrical, skin color is same with facial
skin, aligned with outer canthus of the eye; movable, firm
and tender, recoils back after it is folded
b. External ear canal : with scant amount of cerumen and few
cilia
c. Gross hearing acuity test: able to hear normal voice and
able to hear whisper voice within 6 inches (15. 24 cm)

V. NECK : No area of tenderness

-No masses found
-Range of motion is done actively within
normal limits and pain free
VI. CHEST
a. Anterior chest : intact skin with uniform color,
-no area of tenderness,
-no mass is found with visible bone
prominence
-Symmetrical chest expansion
b. Posterior Chest : fair complexion
- smooth skin
- no evidence of enlargement
- no area of tenderness
- no mass is found
VII. UPPER EXTREMITIES
a. Shoulder : range of motion on right shoulder is actively
done within normal limits and pain free.
- Left shoulder’s range of motion are done in
active assistive with restricted motions due to
IV line
b. Elbows : range of motion on left elbow is actively done
within normal limits and pain free.
 -Right elbow’s range of motion is done actively
with normal limits and pain free.
c. Wrist and hands : range of motion of right wrist and fingers are
actively done within normal limit and pain free.
- Left wrist and fingers are not movable due to
inserted IV line.
d. Muscles : No tenderness found

VIII. ABDOMEN : soft abdomen, no masses and areas of

tenderness
-Uniform in color with no evidence of
enlargement of liver and spleen.
-Umbilicus is in the normal position between
the xiphoid process and symphysis pubis with Normal
Abdomen Bowel Sound (NABS)

IX. LOWER EXTREMITIES : fair complexion, smooth skin,

symmetrical\muscles, intact skin, warm to touch with good muscle tone
-Range of motion on joints is done within normal limits
and pain free.
-Toe nails: with good capillary refill upon blanch tests
(<5 secs), convex, pinkish nail beds with intact skin
around the nails.

REVIEW OF SYSTEMS:

1. Hematopoietic system:

Normal Value Result Interpretation

a. Hemoglobin 14 - 18 g/dl 8.2 Decreased
b. Hematocrit 40 - 54% 25 Decresed
c. RBC 4.2 - 5.6 mill/mcl 2.5 Decreased
d. WBC 3.8 - 10.8 thous/mcl 5.1 Normal

2. Genito-Urinary System
 - Urinates 8-10 times per day, having a characteristic of aromatic pale
yellow with no burning sensation.

3. Respiratory System:

Normal Result
Respiratory rate 12-20 bpm 18 bpm(normal)

4. Cardiovascular system:
Normal Result
Pulse rate 60-100 bpm 75 bpm( normal )
Blood pressure 120/180 mmHg 110/70( normal )

5. Integumentary System:

Normal Result
Temperature 37.5 36.6( normal)

6. Digestive System:
- No constipation, no diarrhea and no allergies found.
- Eliminates once a day (am), having a characteristic of brownish solid
and doesn’t experience any pain sensation.

7. Reproductive System:
- No. of child: 3
- Reproductive organs are well-functioning. No inflammations found.
However, having such condition lessened the number of times that
they make love.

LABORATORIES
Date Taken: Feb. 1, 2008
Hospital: Martinez Memorial Hospital
Hematology Report

Normal Values Results Interpretation

Hemoglobin 14 - 18 g/dl 8.2 Decreased. In case of
megaloblastic
anemia are abnormally
large cells predominate,
thicker as well as larger
 in diameter than normal
RBC it appear
supersaturated with
hemoglobin. The RBC
count is reduced more
than proportionately as
compared with
hemoglobin
Hematocrit 40 - 54% 25 Decreased. Indicated by
a reduced volume of
packed red cells
followed by RBC counts
and hemoglobin. Blood
smear examination
found evidences of
macrocytes and
nucleated red cells.
RBC 4.2 - 5.6 mill/mcl 2.5 Decreased. Disturbed
red cell formation
WBC 3.8 - 10.8 thous/mcl 5.1 Normal
Platelet 150 - 450 245 Normal
Neutrophil 0.500 – 0.700 0.692 Normal
Lymphocyte 0.200 – 0.500 0.328 Normal
Eosinophil 0 – 0.060 0.022 Normal
Monocyte 0.020 – 0.090 0.021 Normal
Basophil 0 – 0.20 0.002 Normal

Blood type : A
Rh : (+)

ANATOMY AND PHYSIOLOGY

The
 The production of red blood cells is referred to as erythropoiesis.
Mature red blood cells develop from haemocytoblasts. This development
takes about 7 days and involves three to four mitotic cell divisions, so that each
stem cell gives rise to 8 or 16 cells.
The various cell types in erythrocyte development are characterised by
the gradual appearance of haemoglobin and disappearance of ribonucleic
acid (RNA) in the cell
the progressive degeneration of the cell's nucleus which is eventually
extruded from the cell
the gradual loss of cytoplasmic organelles, for example mitochondria
a gradual reduction in cell size
The young red cell is called a retlculocyte because of a network of
ribonucleic acid (reticulum) present in its cytoplasm. As the red cell matures the
reticulum disappears. Between 2 and 6% of a new-born baby's circulating red
cells are reticulocytes, but this reduces to less than 2% in the healthy adult.
However, the reticulocyte count increases considerably in conditions in which
rapid erythropoiesis occurs, for example following haemorrhage or acute
haemolysis of red cells. A reticulocyte normally takes about 4 days to mature into
an erythrocyte.
In health, erythropoiesis is regulated so that the number of circulating
erythrocytes is maintained within a narrow range. Normally, a little less than l% of
the body's total red blood cells are produced per day and these replace an
equivalent number that have reached the end of their life span. However that still
represents a huge 200,000,000,000 cells
Erythropoiesis is stimulated by hypoxia (lack of oxygen). However, oxygen
lack does not act directly on the haemopoietic tissues but instead stimulates the
production of a hormone, erythropoietin. This hormone then stimulates
haemopoietic tissues to produce red cells.
Erythropoietin is a glycoprotein. It is inactivated by the liver and excreted
in the urine. It is now established that erythropoietin is formed within the kidney
by the action of a renal erythropoietic factor erythrogenin on plasma protein,
erythropoietinogen.
Erythrogenin is present in the juxtaglomerular cells of the kidneys and is
released into the blood in response to hypoxia in the renal arterial blood supply.
Various other factors can affect the rate of erythropoiesis by influencing
erythropoietin production.
Thyroid hormones, thyroid-stimulating hormone, adrenal cortical steroids,
adrenocorticotrophic hormone, and human growth hormone (HGH) all promote
erythropoietin formation and so enhance red blood cell formation
(erythropoiesis). In thyroid deficiency and anterior pituitary deficiency, anaemia
may occur due to reduced erythropoiesis.
 Polycythaemia (excess red blood cell production) is often a feature of
Cushing's syndrome. However, very high doses of steroid hormones seem to
inhibit erythropoiesis.
Androgens (male hormones) stimulate and oestrogens (female hormones)
depress the erythropoietic response. In addition to the effects of menstrual blood
loss, this effect may explain why women tend to have a lower haemoglobin
concentration and red cell count than men.
Plasma levels of erythropoietin are raised in hypoxic conditions (low oxygen
levels). This produces erythrocytosis (increase in the number of circulating
erythrocytes) and the condition is known as secondary polycythaemia.
A physiological secondary polycythaemia is present in the foetus (and residually
in the new-born) and in people living at high altitude because of the relatively low
partial pressure of oxygen in their environment.
Secondary polycythaemia occurs as a result of tissue hypoxia in diseases such
as chronic bronchitis, emphysema and congestive cardiovascular abnormalities
associated with right-to-left shunting of blood through the heart, for example
Fallot's tetralogy.
Erythropoietin is also produced by a variety of tumours of both renal and other
tissues.
The oxygen carrying capacity of the blood is increased in polycythaemia but so is
the thickness (viscosity)of the blood. The increased viscosity produces circulatory
problems such as raised blood pressure.
Ther is a condition known as primary polycythaemia (polycythaemia rubra vera),
where there are increases in the numbers of all the blood cells, and plasma
erythropoietin levels are normal. The cause of this condition is unknown.
The underlying cause of secondary polycythaemia is treated with the aim of
eliminating hypoxia. Venesection (blood letting) is sometimes employed to
reduce red cell volume to normal levels. Frequently blood is removed,
centrifuged to remove cells and the plasma returned to the patient
(plasmapheresis).
In anaemia there is a reduction in blood haemoglobin concentration due to a
decrease in the number of circulating erythrocytes and/or in the amount of
haemoglobin they contain. Anaemia occurs when the erythropoietic tissues
cannot supply enough normal erythrocytes to the circulation. In anaemias due to
abnormal red cell production, increased destruction and when demand exceeds
capacity, plasma erythropoietin levels are increased. However, anaemia can also
be caused by defective production of erythropoietin as, for example, in renal
disease.
 Gastritis

Faulty Dietary Intake

Dysfunctional Parietal Cell of the Stomach

Lack of Intrinsic Factor (GLYCOPROTEIN)

Malabsorption of Vitamin B12

Dysfunctional Binding of Transcobalamin II

Vitamin B12 Deficiency

Ineffective Erythropoiesis

Abnormal Erythroblast Hypersegmented Neutrophils

Megaloblast

Megaloblastic Anemia

Decreased Nutrients to Cells Decreased Oxygenation RBC Count 2.5 (decreased)

Abnormal Cell Metabolism Tissue Hypoxia Hemoglobin 8.2 (deceased)

Decreased production of energy Body Weakness Pallor

Poor Skin Turgor Weight Loss 122 lbs

 DRUG STUDY

DRUG ACTION INDICATION CONTRA SIDE ADVERSE DRUG NURSING

INDICATIO EFFECTS REACTION INTERACTION RESPONSIBILITIES
N
Generic • Compet • Allergy • Lower • Drowsines • Depressio • No known • Warn the patient
Name: es with • Prophylacti respirato s, n, drug-drug to avoid alcohol
Antamin histamin c drug for ry tract hypnosis, • Irritability interaction. and hazardous
e for possible BT disease gastro , activities that
Classification: • Recepto reaction intestinal hallucinat require alertness
Anti r sites ion, until CNS effects
histamine on muscular of drug.
/ antiallergic effector weakness • Observe for the 10
cells , incoor R’s of the drug
Dosage: • Drug dination,
1 amp. IV prevents headache
prior to BT but
doesn’t
reverse
histamin
e
mediate
d
response
.
 DRUG STUDY

DRUG ACTION INDICATION CONTRAINDICATION SIDE ADVERSE DRUG NURSING

EFFECTS REACTION INTERACTION RESPONSIBILITIES
Generic Unknown, fever Long term use in Skin rashes Hematologic No known drug- -Warn the patient
Name: Aeknil thought anemia and other anaphylaxis, drug that high doses of
to allergic tinnitis interaction long term use can
Classification produce reactions,G cause liver damage.
: analgesic I
Non-oploid by disturbance -Observe for the 10
analgesic blocking R’s of the drug
pain administration
Dosage: impulses
1 amp. IV
PRN
ANST(-)
 DRUG STUDY

DRUG ACTION INDICATION CONTRA SIDE ADVERSE DRUG NURSING

INDICATION EFFECTS REACTION INTERACTION RESPONSIBILITIES
Generic -It is converted Treatment of Use in aplastic, Allergies, Erythema, No known drug- -Take only as
Name: Folic to megalo-blastic hormocytic or rashes, general drug directed. Avoid
Acid tetrahydrofolic anemia and pernicious itching malaise, interaction alcohol.
acid which is a nutritional anemia. abdominal
Classification: cofactor in the deficiency distention, -Drug may discolor
Vitamin B biosynthesis of flatulence, urine into a deep
complex purines and bitter or yellow.
thymidylates of bad taste
Dosage: nucleic acid. -Add dietary sources
OD of folic acid which
-Synthetic folic includes: green leafy
acid is absorbed vegetables, beans,
from the GI milk, fortified
tract even if the breads and cereals
client suffers
from -Observe for the 10
malabsorption R’s of the drug
syndrome. administration

DRUG STUDY
 DRUG ACTION INDICATIO CONTRA SIDE ADVERSE DRUG NURSING
N INDICATION EFFECT REACTION INTERACTION CONSIDERATION
Brand Name: -3 to 5 times Erythroblasto Contraindicated Weight Vertigo, No known drug- -Take only as
Pred 20 as potent as penia with infections, gain, insomia, drug interaction directed. Avoid
cortisone or especially TB, headache depression, alcohol.
Generic hydrocortisone fungal infections, cataracts,
Name: varicella. peptic ulcer -Observe for the 10
Prednisone -May cause R’s of drug
moderate fluid administration
Classificatio: retention.
Anti -Report for any
inflammatory -Metabolized adverse reaction.
in the liver to
Dosage: prednisone,
1 tab TID the active
form

NURSING CARE PLAN

ASSESSMENT NURSING RATIONALE PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS
 Subjective: “sa Knowledge Deficiency of The patient - Determine - To determine Goal is met:
totoo lang di ko deficit related cognitive will be able to client’s ability the cognitive After 2 hrs of
talaga alam to lack of information attain right to learn. ability of the nursing
kung ano ang information regarding the information and patient. intervention,
leukemia” as resources as etiology as well knowledge the patient
verbalized by manifested by as the signs and about the - Provide - To add new gained correct
the patient. verbalization of symptoms of nature of illness information information information
situation the disease. within 2 hours. relevant to the relevant to the and knowledge
reflecting situation. condition of the regarding his
ignorance. patient. condition.

- Use team and - So that the

group teaching patient will be
as appropriate easily gain
some relevant
information
because they
can share
information

NURSING CARE PLAN

ASSESSMENT NURSING RATIONALE PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS
- 4 secs of nail Risk for In case of The patient - Give blood - To replace - After 4 hours
blanch test ineffective megaloblastic will be able to transfusion as the of nursing
tissue perfusion anemia there increase his ordered by the decreased intervention,
- pallor (peripheral) is an abnormal RBC and Hgb physician. count of the laboratory
related to production of concentrations RBC and results showed
- decreased decreased Hgb enlarged but within 4 hours. - Instruct the Hgb. an increase in
count of concentration few RBC, the patient to limit the patient’s
hematocrit (25) in the blood as Hgb decreases his physical - Extreme Hgb and RBC
manifested by thus lowering activities. activities count.
- decreased decreased the oxygen- consume a
count of hemoglobin(8.2) carrying greater
hemoglobin(8.2) capacity of concentrati
the blood that - Encourage the on of O2.
- decreased is at risk for patient to eat
count of failure to foods rich in Vit. - Vit.B12 is
RBC(2.5) nourish the B12, protein and required
tissues at Iron. for for
capillary level healthy
RBC; iron is
important
for the
delivery of
O2 to tissues
and blood
- Instruct the components;
patient to take protein to
folic acid and as build and
prescribed by repair tissues.
the doctor. - Folate is
required for
the
nucleoprotein
synthesis and
maintainance
of normal
erythropoiesis
 NURSING CARE PLAN

ASSESSMENT NURSING RATIONALE PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS

Subjective: Activity Any anemia in Within 2 days -Teach the client the -To educate Goal met:
“para akong intolerance which there is a of my duty, preventive measures and help the The patient
nauupos na related to predominant the patient and the possible client to have was able to
kandila.” As insufficient number of will be able cause of his illness. awareness demonstrate
verbalized by oxygen megaloblasts, to regarding his increase in
the patient. delivery to the erythroblasts and demonstrate illness. strength and
body parts relatively few increase in -Encourage the was showed no
Objectives: secondary to normoblasts strength and client to take a rest -For faster signs of
- Weakness production of among the hyper- ability to and follow medical recovery. difficulty in
abnormally plastic erythroid perform advice. breathing.
-Dyspnea large RBC as cells in the bone activities
evidenced by marrow without -Assist the client in
-Pallor body characterized by difficulty in his nutritional -For the client
weakness. numbness and breathing. intake. to know what
-Decreased tingling,weakness, food to avoid.
activity level a soar smooth -Encourage the
tongue as well as client to practice -To promote
dyspnea after self-care. wellness.
slight exertion,
faintness, pallor -Assist in IV
of the skin and infusion. -To prevent
mucuous fluid and
membrane, electrolyte
anorexia, imbalance
diarrhea, loss of
weight .
 DISCHARGE PLAN

MEDICATION: Folic Acid and Prednisone

EXERCISE:
• Perform passive ROM exercise like flexion, extention of the
extremities.
• Brisk walking every morning.

TREATMENT:
• Blood transfusion if blood count falls below normal.
• Folic acid injection if available.

HEALTH TEACHING:
• Encourage participation in recreation and regular exercise
program
• Provide appropriate level of environmental stimulation (e.i;
music, TV/ radio, personal possessions and visitors)
• Suggest use of sleep aid/ promote normal sleep/rest.

OPD: Return to OPD for further check-up when there are changes

on physical strength.
DIET:
• High fiber diet like vegetables and fruits.
• Protein rich diet
 • Folic and vitamin B12 rich foods such as : liver, dried beans,
peas, wheat products, spinach, dark leafy vegetables, meat,
eggs, milk

SIGNS/SYMPTOMS:
Observe for signs and symptoms such as body weakness,
poor skin turgor, pallor and weight loss.

Prognosis

The prognosis of the patient is expected to be good and will

respond well to treatment usually within two months. Although
anemia is considered incurable, regular Vit. B12 shots will
alleviate symptoms and reverse the complications. Some
symptoms will disappear as soon as treatment begins.

The client must be instructed about the medications he must

take and reinforce all the medical advice given by the attending
physician. Diet would play a vital part in his recovery, hence must
be strictly implemented. Although he displayed willingness to get
better, continuous monitoring of his blood components must be
strictly observed.