nursing interventions for low hemoglobin

Nursing2020 Critical Care15(4):34-35, July 2020. A . Prompt therapy is made possible by an early diagnosis. It is important to instruct the patient to eat foods that contain essential nutrients which are needed to promote RBC formation. Assess the patients oxygen saturation.Activity intolerance and fatigue may be precipitated by decreased oxygen saturation. Provide supplemental oxygen therapy as needed.Oxygen saturation should be kept at 90% or greater. Since most people arent exposed to the medical jargon used by health practitioners, its critical to make an effort to make sure that the patient is informed of their disease anemia. Reticulocytes are immature red blood cells, and due to their lack of biconcave shape, their stability cannot be guaranteed in the sheer stress it would be subjected to in the blood circulation. Iron studies include total-iron binding capacity, ferritin, percent saturation, serum iron level, folate, and serum vitamin B12 determination. Option A: Abnormality in the circulation of plasma occurs because of the premature destruction of hemoglobin. Normal: 0.4% - 1.0%FXN: Phagocytic antigen/antibody responce-Alergic responce Asthma. Check and monitor the patients oxygen saturation level and encourage deep breathing exercises and provide oxygen as prescribed by the physician. Please enable scripts and reload this page. Your message has been successfully sent to your colleague. ), Anemia due to extrinsic causes (e.g., lead poisoning, hypersplenism, spur cell hemolytic anemia, autoimmune diseases, etc.). Treatment Potassium replacement po or in IV fluid bag, check patient for S&S of overhydration, monitor K level for patients taking diuretics, increase dietary intake of high K foods bananas, tea, dried fruits, meat, nuts, 1. your express consent. Energy conservation techniques may help the patient learn new skills and priorities for the desired activities of daily living. You may have low levels of iron. d) Walk for a minute or two in a room daily. v. nursing interventions 1. these focus on the second part of the nursing diagnosis statement - the etiologies. Each gram of Hb can carry 1.34 mL of oxygen per 100 mL of blood. Maintenance of adequate tissue perfusion. Second, the use of medications and chemical agents results in bone marrow destruction, leading to a lack of erythrocyte production. Many things can cause low hemoglobin, and most of the time you cant manage low hemoglobin on your own. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Sometimes, conditions and diseases affect your bone marrows ability to produce or support enough red blood cells. To eradicate the infection. Examine the patients current knowledge of the illness, its progress, causative variables, diagnosis, and treatment. The patient should be taught about time management and organization that will help the patient conserve and reduce fatigue. Medical-surgical nursing: Concepts for interprofessional collaborative care. It is used to screen for disease associated with anemia, to determine the severity of anemia, to monitor the response to treatment for anemia, and to evaluate polycythemia. Hemoglobin is a specialized protein found in the blood, concurrently carried by the red blood cells or erythrocytes. Although 150 mg or more of daily elemental iron was previously recommended, studies show improved absorption and tolerability with lower dosing or every-other-day dosing. Patients may experience low hemoglobin as a result of bleeding or coagulation abnormalities. H. pylori can also cause atrophic gastritis, but it can be diagnosed noninvasively. Interpretation of Urinalysis Abnormalities Cont. Nursing Care Plans: Nursing Diagnosis and Intervention. Treatment for iron deficiency anemia may include iron supplements or changes in diet to increase iron intake. This threshold has 85% sensitivity and 92% specificity for iron deficiency. St. Louis, MO: Elsevier. 1. Reviewed: November 02, 2022. such as citrus fruits and fresh raw vegetables such as dark green leafy vegetables. Hypoxia from normocytic anemia and other medical problems and situations may cause fatigue in the patient and may compromise the patients activity tolerance. Advise and assist the patient when planning the schedule for his or her daily activities and stress the importance of frequent rest periods. The patient should be advised a low-bacterial diet to protect him or her from being exposed to pathogens. In order to detect changes in the patients condition before they become life-threatening, it is necessary to compare serial laboratory values to track the patients disease progression. Observe the patients stool and urine for the presence of occult blood. If aplastic anemia is the underlying cause, instruct patients to refrain from receiving blood transfusions from potential marrow donors and advise undergoing HLA typing. A physiologic approach classifies anemia according to whether the deficiency in erythrocytes is caused by a defect in their production, by their destruction, or by their loss. Medical-surgical nursing: Concepts for interprofessional collaborative care. 4. Examples of hypoproliferative anemia are the following: Hemolytic Anemia this anemia is due to hemolysis of the red blood cells, causing hemoglobin to be released into the plasma. Low hemoglobin levels can be detrimental to a patients performance, mobility, and overall health. 2. Instruct the patient and their visitors on proper handwashing techniques. e) Walk through the length of the house, adding steps until the patient reaches the outdoors, conserving energy when returning. The proper use of nutritional supplements should be explained to the patient and his/her family, as excessive intake will not help to improve anemic symptoms. Desired Outcomes: Women with menstrual periods and pregnant women commonly have low hemoglobin counts. Ask the patient and the family members about their knowledge about the condition, the disease process, possible causative factors, and treatment. 2. Manner of proliferation If there is an increase in infiltration and production of immature red blood cells in the bone marrow, it could indicate certain kinds of anemia. The patient will express understanding of the factors that affect activity tolerance. This article helped me a lot, its simplified and easy to memorize. It is a biopharmaceutical drug given to clients who have low hemoglobin related to anemia. Nursing Diagnosis: Fluid Volume Deficit related to blood volume loss secondary to bleeding as evidenced by hematemesis, low platelet count, HB of 70, skin pallor, blood pressure level of 85/58, and lightheadedness. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Paul Martin R.N. It demonstrates how to match nursing diagnoses with client assessment findings, established medical or psychiatric diagnoses, and the current treatment plan. The patient will show a reduced risk of infection as evidenced by the absence of fever, normal white blood cell count, and normal vital signs. Enforce strict compliance in taking iron supplements as prescribed by the physician. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Lack of hemoglobin change may be because of low adherence, malabsorption, or blood loss. Nursing Interventions Nursing interventions are based on the data assessed by the nurse and on the symptoms that the patient manifests. Intervention: Steadily increase the patients activity through progressively advancing the following (note: increase workout repetition and frequency than intensity): a) In-bed activities to improve range of motion (ROM). In certain pathophysiologic states such as severe anemia, the rate of adequate oxygen delivery is impaired. This will develop the patients endurance and will help prevent complications due to prolonged bed rest. Assess for signs of activity intolerance.Signs of activity intolerance, fatigue, and reduced tissue oxygenation include dyspnea on exertion, dizziness, headaches, palpitations, and pallor. Nielsen OH, Ainsworth M, Coskun M, Weiss G. Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease: A Systematic Review. Hello Reassess your patient if signs and symptoms of hypoxia return. Evaluate the patients ability to carry out ADLs and the capacity to do his/her usual routine tasks. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! The patient will express his or her ability to perform activities of daily living and will be able to use energy conservation techniques. Many things affect hemoglobin levels. Advice the patient to perform a gradual increase of activities and range of motion exercises as tolerated by the patient. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. Learn about the nursing care management of patients with anemia. Administer oxygen as ordered to maintain oxygen saturation above 90%. Nursing Diagnosis: Fatigue related to lack of decreased oxygen-carrying capacity of blood due to decreased hemoglobin levels, secondary to anemia, as evidenced by frequent rest periods, dyspnea or pain during exercise, and verbalized exhaustion. Check and monitor the hemoglobin, hematocrit, RBC counts, and reticulocyte levels. Wolters Kluwer Health PMID: 28403561. Based on a systematic review, the AGA recommends using a ferritin threshold value of less than 45 ng per mL (45 mcg per L) for diagnosing iron deficiency in patients with anemia. Insist on the need to take frequent breaks from each task. When there is increased erythrocyte destruction, anticipate the development of tissue hypoxia and the production of erythropoietin as a compensatory response of the body. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. The Hb determination is part of a complete blood cell count. Desired Outcome: The patient will be able to explain his/her own illness and treatment options verbally. c) Sit properly, ensuring that the spine is aligned or straight for 30 minutes three times every day. 1. Treating H. pylori infection improves the benefit of iron supplementation in anemia. Assist the patient in prioritizing activities and establishing balance between activity and rest that would be acceptable to the patient. Record and document the patients response to the activities. These medications treat certain viruses. Cleveland Clinic Cancer Center provides world-class care to patients with cancer and is at the forefront of new and emerging clinical, translational and basic cancer research. Patient will identify factors that aggravate feelings of tiredness and weakness. The patient will demonstrate improved wellness as indicated by the absence of fever and within the normal WBC count. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Table of Contents hide 1 Classification of anemias 1.1 Hypoproliferative anemias (due to deficient red cell production). PMID: 26061331; PMCID: PMC4616486. RR/SOB is a better better VS indicator for anemia. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Bowel sounds are likely to be hypoactive or absent. 2. Nursing Care Plan for: Activity Intolerance, Anemia, Low Hemoglobin, Sickle Cell Anemia, Iron Deficiency, Pernicious, Aplastic Anemia, Folic Acid Deficiency, and Thalassemia. It is composed of amino acids that form a single protein called globin, and a compound called heme, which contains iron atoms and the red pigment porphyrin. Iron deficiency anemia is a common type of anemia that is caused by a lack of iron in the body. C. 9 to 11 g/dL. Patient will demonstrate hemoglobin, hematocrit, and coagulation values within acceptable limits. Placing the patient in a private room is needed and advise the people who have contact with the patient to use masks, gowns, and gloves to avoid the risk of infection. You often lose some blood during hemodialysis treatments and blood testing. Nursing diagnoses handbook: An evidence-based guide to planning care. Fatigue. 2. Pernicious anemia This type of anemia is characterized by the inefficiency of the body to absorb vitamin B12 due to a pre-existing autoimmune disease. Educating the patient and their family and helping them better comprehend their illness and course of treatment is critical if we want to raise their level of awareness and comprehension of what theyre dealing with. If required, adjust O 2 levels. She earned her BSN at Western Governors University. Monitoring the patients response to the activities and interventions will serve as a guide for the optimal progression of the activity and condition. 5. iron deficiency, thalassemia, pernicious anemia, hemoglobinopathies, reactions to physical agents (severe burns, artificial heat valves), occurs after transfusions, hemorrhages, burns. Transfusion can often be avoided by ordering bedrest while therapy is initiated for a client with correctable anemia, such as pernicious anemia (Maakaron & Besa, 2021). Option D:Indirect bilirubin is elevated because the released hemoglobin is converted in large part to bilirubin. If you have blood test results that show your hemoglobin level is lower than normal, it means you have fewer red blood cells doing essential work that is, carrying oxygen throughout your body. Your body produces red blood cells and white blood cells in your bone marrow. The oxygen-combining capacity of the blood is directly proportional to the Hb concentration rather than to the RBC count because some RBCs contain more Hb than others. Get new journal Tables of Contents sent right to your email inbox, Caring for hospitalized patients with alcohol withdrawal syndrome, Privacy Policy (Updated December 15, 2022). Give IV fluids to the dehydrated pt.3. 7. The ultimate reference for nursing diagnoses from experts at NANDA-I has been updated in a new edition. 2. The patient will be able to express understanding about the use of energy conservation principles and techniques. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Precautionary steps that decrease the risk of skin breaking would also reduce the likelihood of bleeding. Assess bowel sounds. Check dietary protein intake, 1. Cleveland Clinic is a non-profit academic medical center. Youre not getting enough essential nutrients like iron and vitamins B12 and B9. Intravenous iron may be appropriate with malabsorption, inflammatory bowel disease, chronic kidney disease, or ongoing blood loss. Nursing Care Plans Related to Low Hemoglobin Fatigue A low hemoglobin level means the patient cannot transport adequate oxygen to the different body organs and tissues, causing the patient to feel weak, tired, and easily fatigued. Causes excessive dietary or IV intake, renal failure, Addison's disease, taking a K sparing diuretic Aldactone, hemolysis of RBCs, blood transfusion with hemolyzed blood, infection, acidosis, dehydration, Decreased Values Hypokalemia >6.5meq/l, 1. 4. Nursing care plans: Diagnoses, interventions, & outcomes. From: Low Hemoglobin. Keep it up, this article is so important to Nursing students , big up yourselves ,God bless you, C. Defect in the erythrocyte count. Red meat (beef) and meat from the organs, like liver. For patients with decreased WBC &/or neutrophils, protect them from infection. Kumar A, Sharma E, Marley A, et al. B. Long-term needs, and who is responsible for actions to be taken. With decreased hemoglobin that serves as the pigment in the red blood cells, the patient may becomepale because of the lack or decrease in the pigment that is hemoglobin. Maegan Wagner is a registered nurse with over 10 years of healthcare experience. S&S EKG peaked t waves, widen QRS, Depressed ST segment; irritability, nausea, vomiting, intestinal colic, bradycardia, decreased UO, numbness, tingling, 2. Anna Curran. As an Amazon Associate I earn from qualifying purchases. Celiac disease is another common cause of iron deficiency. Cleveland Clinic. Provide supplemental oxygen.If cells and tissues are not receiving adequate oxygenation, supplemental oxygen may be required. for dehydration - tachycardia, hypotension, low UO, dry skin2. 6. 3. Other causes of blood loss include menstrual excess or frequency, gastrointestinal bleeding, inflammatory bowel disease, and hematuria. They may recommend you try to follow an iron-rich diet. Clients with nutritional anemia due to iron deficiency should be educated on food that is rich in iron. Milk and cheese. 4. The hemoglobin level is lower than normal, reflecting a decrease in number or derangement in the function of red blood cells within the circulation. Guideline source: American Gastroenterological Association, Systematic literature search described? Patient will report the ability to perform activities of daily living without dyspnea or extreme fatigue. It is usually possible to determine whether the presence of anemia is caused by destruction or inadequate production of erythrocytes on the basis of the following factors. Proper hygiene, mouth care, and perineal hygiene are important to avoid skin breakdown and lessen the risk of infection. Several common conditions associated with IDA can be diagnosed noninvasively, before or after endoscopy. For the purpose of ensuring tissue compatibility for organ transplantation, HLA typing should be performed. 5. Bone Marrow response the BM compensates for the decrease in erythrocyte level, hence the increase in the production and release of reticulocytes in the blood circulation. The etiology of anemia depends on whether the anemia is hypoproliferative or hyperproliferative. It is important to check and evaluate the laboratory values to decrease the risk of having life-threatening situations. The AGA also suggests endoscopy in premenopausal women with IDA because malignancy is diagnosed in 1% of this population. NurseTogether.com does not provide medical advice, diagnosis, or treatment. There are numerous forms and representations of anemia, each with its own variability and cause. Please see our Privacy Policy, The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Otherwise, scroll down to view this completed care plan. Saunders comprehensive review for the NCLEX-RN examination. It has been so helpful. During the planning stages, consider the use of antibiotics, antifungal drugs, and antiviral medications in advance. ACCN Essentials of Critical Care Nursing. Curtailing the precipitating exercise and using shoes with reinforced soles are helpful in preventing this form of hemoglobinuria (Maakaron & Besa, 2021). Oral iron supplementation should be provided for most patients with iron deficiency. To prevent hemorrhages in patients. Treatment Low K diet, Kayexalate po or enemas, Lasix , Check I&O, IV infusion of glucose & insulin solution to move K back into the cells, create, study and share online flash cards, Click here to study/print these flashcards, Normal: 80 - 98/um3 (cubic micro meters) Size of RBC. Hello , Rationale: As the patient progressed and had successfully finished the given activities, it is best to insert a few more tasks to practice the patients tolerance and to maintain their improvements. The pathophysiology of anemias is drawn according to the cause of the disease. Some factors that affect that lifespan include: Healthcare providers treat low hemoglobin by diagnosing the underlying cause. Low Hgb/Hct leads to anemia. Nursing Diagnosis: Fatigue related to metabolic acidosis secondary to liver cirrhosis as evidenced by reports of a persistent lack of energy and difficulty keeping up with daily activities, reduced performance, and increase in physical complaints. 2. with renal failure4. Nursing care includes patient education of the cause, prognosis, and complications of the condition, provision of iron supplementation, adherence to an iron-rich diet, monitoring of symptoms, and lifestyle modifications. hi, Im a nursing student in Lambton college here in Canada, and I really thank you for putting this together, it has been helpful to me and my peers al through clinical placements. See your doctor if you suspect that you have anemia. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms. Tiredness and fatigue Headaches and dizziness Lack of concentration and memory Shortness of breath Heart palpitations and other heart problems Visible enlargement of the heart Pale skin and pale nails Swelling of arms and legs Excessive sweating Set realistic goals.Help the patient plan tasks and set limits for each day. However, the universal treatment scheme is through careful medical management and supportive therapy. Opportunistic infections may occur in patients with a weakened immune system. Bleeding typically occurs if platelet counts fall below 20,000 per mm3. Bleeding gums. However, the most typical manifestation is activity intolerance. Yes, Recommendations based on patient-oriented outcomes? St. Louis, MO: Elsevier. Although autoimmune atrophic gastritis can be diagnosed by gastric biopsy, it has not been shown to improve long-term outcomes. Smaller increase hepatic tumor, hepatotoxic drugs, hepatitis, bone tumor, new bone growth, rheumatoid arthritis, Piagets disease, MI, C. Interventions for a Patient with an Elevated Value check for S&S of liver or bone disease, check patients medication list for liver toxic medications, IV Albumin can increase the value by 5 10 times normal, NV: 0.1 - 1.2 mg/dlCritical Values Adult > 12 mg/dl, Increased Level of Conjugated (Direct Bilirubin) gallstones, extra hepatic duct obstruction, extensive liver metastases, Increased Level of Unconjugated (Indirect) Bilirubin hepatitis, cirrhosis, neonatal hyperbilirubinemia, transfusion reaction, Treatment low protein diet for patients with liver disease, check skin & sclera for jaundice, Interventions for Decreased Values high protein diet if not in liver failure, assess patient for ascites & peripheral edema, transfuse with albumin as orderedIncreased, Intervention for Increased Value Rehydrate the patient with oral or IV fluids, NV: 70 - 110 mg/dlCritical Values < 40 or > 400 mg/dl, Decreased Values insulinoma, hypothyroidism, liver disease, insulin overdose, starvation, 1. Without anemia, the ferritin threshold for iron deficiency is uncertain. Baseline and subsequent assessment findings to include signs and symptoms. The American Gastroenterological Association (AGA) developed guidelines for the evaluation of IDA in adults. Although there are several tests to directly determine the RBC mass, these tests are expensive and somewhat cumbersome. Organization and time management can help the client conserve energy and reduce fatigue. The following are symptoms of anemia except: A. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Epub 2017 Apr 12. Suggest that the client shower while sitting on a chair and sitting when performing tasks. Inability to maintain the usual level of physical activity. This is a hemoglobin test. Clients with severe anemia should curtail their activity until the anemia is partially corrected. Decrease in the reticulocyte count. They may recommend you try to follow an iron-rich diet. Cleveland Clinics Robert J. Tomsich Pathology & Laboratory Medicine Institute touches virtually every patient at Cleveland Clinic and thousands of patients across the world. brings his wealth of experience from five years as a medical-surgical nurse to his role as a nursing instructor and writer for Nurseslabs, where he shares his expertise in nursing management, emergency care, critical care, infection control, and public health to help students and nurses become the best version of themselves and elevate the nursing profession. Silvestri, L. A. For hospitalized patients, the nurse should provide a private room for protective isolation. Hb variants can cause variation in measured Hb: Relative polycythemia: an increase in Hb, HCT, or RBC count caused by a decrease in the plasma volume (dehydration, spurious erythrocytosis from stress or smoking), appropriate (an appropriate bone marrow response to physiologic conditions), inappropriate (an overproduction of RBCs not necessary to deliver oxygen to the tissues), hypoproliferative anemias (inadequate production of RBCs), hyperproliferative anemias (decreased Hb or HCT despite an increased production of RBCs), hemolytic: a premature, accelerated destruction of RBCs. Treatments for anemia could be achieved by practicing a varied healthy diet, taking certain drugs and supplements, and performing urgent medical procedures, which could improve a persons response towards this serious illness. Treatment give a concentrated glucose source & a long acting CH2O, do not skip meals, check for S&S of hypoglycemia nervous, weak, confusion, cold, clammy skin, tachycardia, Increased Values diabetes mellitus (DM), acute stress response, Cushings disease, acute pancreatitis, drug therapy with diuretics or corticosteroids, 1. Most patients have a rudimentary understanding of the hematological system and terminology. Healthy adult hemoglobin values are generally 13.2 to 16.6 grams per deciliter for men and 11.6 to 15 grams per deciliter for women. The most serious complications of severe anemia arise from tissue hypoxia. Assess if there are certain times or other factors that contribute to fatigue. A low hemoglobin level may not be a cause for alarm. For example, if your hemoglobin levels are low, your healthcare provider may do tests that reveal you have iron-deficiency anemia. Anemia has general complications and this includes: A number of hematologic studies are performed to determine the type and cause of anemia. Normal findings Women: 12.0 to 16.0 g/dL or 120 to 160 g/L Men: 14.0 to 17.4 g/dL or 140 to 174 g/L. Hb also serves as an important buffer in the extracellular fluid. NurseStudy.net is a participant in the Amazon Services LLC Associates Program. Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. Instruct on low-impact ways the client can stay active such as short walks, stretching, or light yoga. Inadequate blood flow can slow peristalsis and digestion of the intestines. For men, a normal level ranges between 14.0 grams per deciliter (gm/dL) and 17.5 gm/dL. GI Tests NPO 8 hours before the test, a. ask the patient if (s)he is allergic to shellfish or iodine, b. the patient should be well-hydrated before & after the exam, 3. Low hemoglobin limits the bodys capacity to transport oxygen, causing fatigue and reducing work or exercise capacity. Have them prioritize and complete the most important tasks when energy reserves are highest. Raw food, raw vegetables, and uncooked meat can harbor bacteria. The body makes hemoglobin through iron, a natural component of red blood cells (RBC). The hemoglobin level is lower than normal, reflecting a decrease in the number or derangement in the function of red blood cells within the circulation. 5. Ask the patient about his or her manifestation of activity intolerance and ask him or her to rate perceived exertion on a scale of 0-10. Diseases, conditions and other factors that affect red blood cell production include: Your bone marrow constantly produces red blood cells. Precautionary measures for bleeding should be taught to the patient these measures include: Instruct the patient to avoid using a razorUse a toothbrush that is soft when brushing the teethRectal procedures should be avoided such as suppositories, enemas, and temperature taking in the patients rectum. Check pt. Option C:Fatigue is a sign of anemia but it is not a complication. This series is coordinated by Michael J. Arnold, MD, contributing editor. Women: 12.0 to 16.0 g/dL or 120 to 160 g/L. Patient will identify interventions to reduce activity intolerance. The AGA suggests serologic testing for celiac disease in patients with iron deficiency, especially those with a family history of the disease, a personal history of autoimmune diseases, or gastrointestinal symptoms. 4. Nursing Interventions for Abnormal Platelet Values Definition Decreased Values At risk for bleeding Apply pressure to venipuncture sites for at least 5 mins. Instruct the patient to consume iron-rich foods to help build-up hemoglobin stores. The 12th edition has been extensively revised and updated with the latest NANDA-I approved nursing diagnoses from 2018-2020. Explain that this increases their risk of injury and will further worsen activity intolerance and fatigue. To manage fatigue: Prioritize activities. Annals of the New York Academy of Sciences,1450(1), 1531. & pulse, redness, swelling, drainage, tenderness4. Ask the patient if he or she is experiencing frank. Iron deficiency anemia can occur due to a variety of factors, including poor diet, chronic blood loss, and pregnancy. Provide information about alternative forms of activities that relieve fatigue, such as acupressure and yoga.Acupressure is a component of traditional Chinese medicine that uses pressure via finger, thumb, or device to stimulate specific acupoints for therapeutic purposes. Educate energy-conservation techniques.Clients and caregivers may need to learn skills for delegating tasks to others, setting priorities, and clustering care to use the available energy to complete desired activities. Hello!,I am a nurse from Jimma University this article had prepared well and it helped me,thank you for ur preparation. September 2020;159(3):10851094, Available at:https://www.gastrojournal.org/action/showPdf?pii=S0016-5085%2820%2934847-2. A nurse should know that a diagnosis of hemolytic anemia is associated with all of the following except: A. Abnormality in the circulation of plasma.

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