Anemia
Anemia
ABSTRACT
The purpose of this paper is to briefly describe the initial core diagnostic questioning and core set of diagnostic testing related to the patient presenting with anemia. Subjective information and recommended testing are written with consideration of the scope of practice of the family nurse practitioner. In addition, three specific case studies are examined.
Anemia
Core set of subjective questions
The healthcare provider should initially obtain a history of any previous anemia or blood disorders and records, if possible, providing results of any previous blood tests as these can help determine the duration of the disorder. It will be important to examine any family medical history, particularly questioning about jaundice, cholelithiasis, splenectomy, bleeding disorders, and abnormal blood test results (Maakaron, 2011). Questions regarding occupation, hobbies, prior medical history, medications including over the counter preparations, and household product exposure can help identify possible noxious agents (Maakaron, 2011). Specifically ask questions regarding medical conditions known to cause anemia such as rheumatoid arthritis and renal disease (Schrier, 2012). Questions addressed to medication use should include intake of NSAIDS and corticosteroids as both are associated with anemia due to gastrointestinal damage (Zaiden & Rana, 2012). In addition, some antibiotics are associated with lowered platelet levels (Zaiden & Rana, 2012). Alcohol intake should also be explored. If the patient is female and the healthcare provider is concerned about possible blood loss, specific questions regarding menstrual periods and details regarding previous pregnancies and/or abortions are important to ask. “Estimates of menstrual losses are notoriously inaccurate if only routine inquiry is made” (Maakaron, 2011). Inquiries regarding the color of stools and urine assist in identifying gastrointestinal blood loss, hepatic disease, and/or hemolytic
ABSTRACT
The purpose of this paper is to briefly describe the initial core diagnostic questioning and core set of diagnostic testing related to the patient presenting with anemia. Subjective information and recommended testing are written with consideration of the scope of practice of the family nurse practitioner. In addition, three specific case studies are examined.
Anemia
Core set of subjective questions
The healthcare provider should initially obtain a history of any previous anemia or blood disorders and records, if possible, providing results of any previous blood tests as these can help determine the duration of the disorder. It will be important to examine any family medical history, particularly questioning about jaundice, cholelithiasis, splenectomy, bleeding disorders, and abnormal blood test results (Maakaron, 2011). Questions regarding occupation, hobbies, prior medical history, medications including over the counter preparations, and household product exposure can help identify possible noxious agents (Maakaron, 2011). Specifically ask questions regarding medical conditions known to cause anemia such as rheumatoid arthritis and renal disease (Schrier, 2012). Questions addressed to medication use should include intake of NSAIDS and corticosteroids as both are associated with anemia due to gastrointestinal damage (Zaiden & Rana, 2012). In addition, some antibiotics are associated with lowered platelet levels (Zaiden & Rana, 2012). Alcohol intake should also be explored. If the patient is female and the healthcare provider is concerned about possible blood loss, specific questions regarding menstrual periods and details regarding previous pregnancies and/or abortions are important to ask. “Estimates of menstrual losses are notoriously inaccurate if only routine inquiry is made” (Maakaron, 2011). Inquiries regarding the color of stools and urine assist in identifying gastrointestinal blood loss, hepatic disease, and/or hemolytic
References: Kohler, J. (2011). Primary care for transgender people. Department of Family and Community Medicine University of California. Retrieved from www.hawaii.edu/hivandaids/haetc05-2.ppt. Maakaron, J. (2011). Anemia clinical presentation. Medscape. Retrieved from http://emedicine.medscape.com. Mahmet, E., Aybike, K., Ganidagli, S., & Mustafa, K. (2011). Characteristics of anemia in subclinical and overt hypothyroid patients. Endocrine Journal. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22200582. Schrier, S. (2012). Approach to the adult patient with anemia. UpToDate. Retrieved from www.uptodate.com. Somervaille, T. (2012). Chronic myelgenous leukemia. Epocrates Online. Retrieved from https://online.epocrates.com. Zaiden, R. & Rana, F. (2012). Evaluation of anemia. Epocrates Online. Retrieved from https://online.epocrates.com.