Editing Medical-Surgical Nursing (section)

=== Anemias ===

Iron deficiency anemia produces fatigue, pallor, and a microcytic hypochromic picture. Teach that oral iron is best absorbed on an empty stomach and with a source of vitamin C, that it causes dark stools and constipation, and that liquid forms are taken through a straw to protect the teeth.

Pernicious anemia results from lack of intrinsic factor with vitamin B12 malabsorption and adds neurologic findings such as paresthesia, ataxia, and impaired proprioception. It requires lifelong parenteral or high-dose supplementation, because oral standard replacement alone does not correct the absorption defect.

Sickle cell disease causes red cells to sickle under hypoxia, dehydration, infection, cold exposure, acidosis, and stress, occluding vessels and causing vaso-occlusive crisis with severe pain, swelling, and organ ischemia. Nursing care in crisis is hydration, oxygen, aggressive analgesia including opioids, warmth, and rest. Never apply cold, which promotes further sickling, and avoid constrictive measures.