LESSON PLAN

ON

NUTRITIONAL ANEMIA

SUBMITTED TO: SUBMITTED BY:

SISTER DIPTI MRS. REKHA PARIDA

PRINCIPLE LECTURER
H.I.I.N.E H.I.I.N.E
 ANDHERI (E) ANDHERI (E)

TOPIC- NUTRITONAL DEFICIENCY ANAEMIA.

DATE- 26.03.2012

TIME – 10.00 AM

VENUE- Lecture Hall - II

METHODS OF TEACHING - LECTURE CUM DICUSSION.

AUDIO-VISUAL AIDS- CHARTS, POSTERS, FLASH CARDS AND FLIPP CHARTS.

NAME OF THE GUIDE- Sister Dipti.

NAME OF THE TEACHER – SMT.. REKHA PARIDA

PREVIOUS KNOELEDGE OF GROUP-

THE GROUP AWARES ABOUT ANAEMIA AND ITS PREVENTIVE MEASURES.

GENERAL OBJECTIVE:

AT THE END OF PRESENTATION, GROUP WILL BE ABLE TO UNDERSTAND NUTRITIONAL DEFICIENCY,

ANAEMIA AND ITS PREVENTION.

SPECIFIC OBJECTIVES:
AT THE END OF PRESENTATION, GROUP WILL BE ABLE TO-
 DEFINE OR TELL THE MEANING OF ANAEMIA.
 CLASIFY THE ANAEMIA.
 KNOW REQUIREMENT OF IRON FOR DIFFERENT AGE GROUPS.
 EXPLAIN CAUSES AND CLINICAL FEATURES OF NUTRITIONAL DEFICIENCY ANAEMIA
 EXPLAIN ASSESMENT AND DIAGNOSTIC FINDINGS.
 DESCREIBE THE TREATMENT OF NUTRITIONAL DEFICIENCY ANAEMIA
S. N. SPECIFIC TIME CONTENT TEACHING A.V. BLACK EVALUTION
OBJECTIVE LEARNING AIDS BOURD
ACTIVITY ACTIVITY

INTRODUCTION:

03 Iron deficiency anemia is a common blood disorder

mins in India. the main effect of iron deficiency is
decreased Hb and reduced oxygen carrying capacity
of blood.

DEFINITION:-
1 Group will be 05 Lecture cum Chart What is
able to define mins Anemia is a condition of a Lower then normal level Anemia ?
discussion.
anemia. of hemoglobin, reflect fewer than normal RBcs.
Within the circular. As a result the amount of O2
delivered to body tissue is also diminished.

CLASSIFICATION OF ANEMIA
2 Group will be 10 Lecture cum Flash Lecture What are the
able to mins There are many kinds of anemia but all can discussion Card classification
classify of Anemia ?
be classified in to three etiologic categories:-
anemia.

1) Hypo proliferative ( Resulting from defective

RBc production )
 Iron deficiency
 Vitamin B12 deficiency
 Folate deficiency
 Decreased erythropoietin production
 Cancer \ inflammation
2) Bleeding (Resulting from RBc loss)
 Bleeding from GI tract menorrhagia,
epistaxis, trauma.
3) Hemolytic (Resulting from RBc distraction )
 Altered erythropoiesis (SCA,
thalassemia, other hemoglobinopathies)
 Hypersplanism (Hemolysis)
 Drug included anemia
 Autoimmune anemia
 Mechanical heart valve related anemia.
 REQUIRMENT OF IRON FOR DIFFERENT
AGE GROUP
Group will be
3 able to know Lecture cum Flash Lecture
the 10 discussion Card
AGE GROUP IRON IN mg(DAILY)
requirement mins
of iron in
different age
Infant(5-12mth) 0.7
groups.
Children (1-12yrs) 1.0
Adolescent(13-16yrs) 1.8(male)
2.4(Female)
Adult male 0.9
Adult female
Menstruation 2.8
Pregnancy Ist half 0.8
IInd half 3.5
Lactation 2.4
Post menopause 0.7

CLINICAL MANIFISTATION OF ANEMIA

 Slight tachycardia
4 Group will be 10  Fatigue and exertion Questioning Flip Lecture What are the
able to mins Book sign &
 Dysponea
explain symptoms of
clinical  Muscle pain or cramping anemia ?
features.
 Cardiac and pulmonary disease
 Anorexia
 Giddiness
 Swelling of legs
CAUSES OF ANEMIA
Iron deficiency anemia is very much prevalent in
the tropics particularly amongst women of the child
5 Group will be 15
able to mins bearing age, specially in the under privileged sector. Discussion Flash Lecture Write the
explain causes Card different
I. Faculty dietetic habit:- there is no
of anemia. causes of
deficiency of iron in the diet but the diet is Anemia ?
rich in carbohydrate high phosphate and
phytic acid help in the formulation of
insoluble iron phosphate and phytic in the
gut, there by reducing the absorption of
iron.
II. Faculty absorption mechanism because
of high prevalence of intestinal infestation,
there is intestinal hurry which reduces the
 iron absorption, hypochlorhydaria often
associated with malnutrition also hinder
absorption.
III. Iron loss
 More iron is lost through sweat to the
extent of 15mg/month
 Repeated pregnancies of short intervals.
 Excessive blood loss during menstruation.
 Hook worm infestation.
 Chronic malaria.
 Bleeding piles and dysentery.
ASSESSMENT AND DIAGNOISIS FINDING
 HB, hematocrit, reficulocyte count, red cell
incise, MCV evaluation.
 Iron studies (serum iron level, total iron
6 Group will be 10 Lecture Black Which are the
binding capacity), percent saturation and
able to mins Board methods of
explain fortune. diagnosing
assessment Anemia ?
 Vit. B12 deficiency test
and diagnostic
findings.  Erythropoietin level
 CBC test
 Bone marrow aspiration
  Urine and stool examination
COMPLICATION:
 Congestive heart failure
 Paresthesias and confusion
PROPHYLACTIC
The prophylactic includes
1. Avoidance of frequent child birth
2. Supplementary iron therapy
3. dietary prescription- the foods rich in
7 Group will be 15 Lecture Flash Discussion
iron are liver, meat, eggs, green
able to mins Card
describe vegetables, green peas, fish, whole wheat,
treatment.
Green plantains, onion, jiggery etc.
4. Adequate treatment: It should be
instituted to eradicate the illness likely to
Cause anemia. These are hookworm
infestation, dysentery, malaria, bleeding
piles, urinary tract infection latent as
Overt.
5. Early detection of falling HB level is to
be made.
CURATIVE
 Hospitalization:-
1. Ideally all patients having HB level is
less than 10gm/100ml should be
admitted for investigation and treatment.
2. Associated obstratical- medical
complication even with moderate degree
of anemia.
 General treatment
1. Diet:- realistic balanced diet which is rich in
protein, ion and vitamin which is easily
assimilate is prescribed.
- To improve the appetite and facilities digestion-
dilute HCL acid 2ml along with twice the
amount of glycerin acid pepsin may be given
TDS after meal.
- To eradicate even a minimal septic focus by
appropriate antibiotic therapy.
- Effective therapy to cure the disease
contributing to the cause of anemia.
2. specific therapy
The principle is to raise the HB level as near to
 normal as possible.
IORN THERAPY
- oral therapy
- potential therapy

IRON SUPPLIMENTATION
Several iron preparation- ferrous sulfat, ferrous
glunate &ferrous fumarate –are available for
treating iron deficiency anemia. One tablets of
iron sulfate provide 60 mg of elemental iron. Thus
it is important to continue iron for as long as 6-12
month..
In some cases, oral iron is poorly
absorbed or poorly tolerated or needed in large
amount. In this situation IM or IV of iron dextron
may be needed. Iron dextron should be injected
deeply into each buttock using the z track
technique.
NURSING MANAGEMENT
- Preventive education is important because iron
deficiency anemia is common in menstruating
 and pregnant women.
- Taking iron rich food with a source of vit-C
enhances absorption of iron.
- Nutritional counseling can be providing.
- The nurse encourage patient to continue
Iron therapy as long as is prescribed.

HOW TO TAKE IRON SUPPLEMENTORY

1. Take iron on an empty stomach (one hrs before
meal, two hrs after meal) iron absorption is reduce
with food especially dairy product.
2. If iron cause gastric upset the following schedule
may work better.
- Start with only one tablet /day for a few days
then increase 2 tablets /day, then 3 tablets /day.
This method permitted to body to adjust to the
iron.
1. Increase the intake of vitamin-c as it
enhances iron absorption.
2. Eat food high in fiber to diminish
problem with constipation.
 3. Remember stool with become quit dark
form iron.
4. If liquid form of iron are taken, they
May be better tolerated than solid forms.
However, they can discolor teeth.
5. Use a strew or place spoon at the back of
the mouth to take the supplement, rinse
the mouth thoroughly afterward.

ALLEVIATE AND CONROLE THE

CAUSE
Relive manifestation
1. Oxygen therapy:- oxygen therapy may be
prescribed for client with severe anemia
because their blood has a reduced capacity
for oxygen. O2 help prevent tissue hypoxia
and lessen the work load of the heart.
2. Erythropoietin:- s/c of erythropoietin can be
given to treat anemia’s of chrowc disease.
3. Blood transfusion:- severe anemia(Hb <6gm
 dl)

MEGALOBLASTIC ANEMIA
Anemia cause by vitamin B12 deficiency and folic
acid are called megaloblastic anemia because they
are characterized by the appearance of
megaloblastic (large primitive RBCs ) in blood and
bone marrow.
Common feature of megaloblastic anemia
- Leucopenia, a decreased number of WBCs.
- Thrombocytopenia, a decreased number of
platelet.
- Oral, GI and neurological manifestations.
- A favorable response to injections of either
vitamin B12 or folic acid.

PERNICIOUS ANEMIA
Pernicious anemia is a type of narcotic anemia
caused by failure of absorption vitamin B -12. Lack
of gastric acid may lead to pernicious anemia.
Causes-
1.lack of gastric acid
2. Autoimmune response.
3. Surgical removal of ileum.

Clinical manifestation
-low Hb, haematocrit and RBC level.
-neurological disorder.
-absence of HCL.
-Low volume gastric acid secretion.

Outcome management
1.Vitamin B-12
Client with pernicious anemia need both immediate
and life long therapy with maintenance of vitamin
B-12.during the acute phase of illness, client may
be given vitamin B12 injection. Peripheral nerve
function may improve the treatment.
2.iron supplement
Injection of vitamin B-12 may cause rapid
regeneration of RBC that depletes iron.
3.folic acid
It is some time given with vitamin B-12 to client
with a history of poor nutrition.
4.digestants
Dagestan’s to enhance the metabolism of vitamin
such as HCL diluted in water and given with meal,
are often used during the first few weeks of vitamin
B-12 therapy.

FOLIC ACID DEFICIENCY ANAEMIA

Anemia associated with folic acid deficiency is very
common.
Causes-
1. Inadequate intake of folic acid.
2. Increased demand.
3. diminished absorption.
4. Abnormal demand.
5. Failure of utilization.
6. diminished storage.
Clinical manifestation
1.pallor
2. Ulceration of mouth.
3. enlarged liver and spleen.
4. Thin and emaciated client.
5. Cirhosis of liver.
Diagnostic findings
 Hb level less than 10 gm %
 Stained blood film
 Serum B12 level.
 Bone marrow aspiration test
 Gastric secretion.

OUTCOME MANAGEMENT

For correction of anemia caused by Folate

deficiency, the client receives oral dose of folic acid
0.1-5 mg/day until blood profile improved or until
the cause of intestinal malabsorption corrected.
Client with malabsorption may need parenteral folic
acid initially followed by matainance therapy with
oral doses. Folic acid is administered IM in form of
folinic acid.additionaly vitamin C is sometime
 prescribed because it increase the role of folic acid
in promoting erythropoiesis.

CONCLUSION

Nutritional deficiency anemias are common in

females in reproductive age groups. This increases
the mortality rates in females in India. So
preventive measures are very important to cure the
anemia in females.

BIBLIOGRAPHY

 Black M. Joyce, Medical Surgical Nursing,Volume-2,6th Edition,Pp-2103-2105

 Brunnner And Suddarths,Medical Surgical Nursing, 9th Edition,Pp-741-742.

 Dutta D. C,Obstetrics And Midwifery,Pp-273-275.

 Joshi Shubhangini A, Nutrition And Dietetics,2nd Edition.Pp-273.390.