18

ADAMSON UNVERSITY
College of Nursing

CASE SCENARIO
APLASTIC ANEMIA
Patient A, a 14-year old male, was admitted to the hospital with complaints of progressive
weakness and shortness of breath with minimal physical effort. He has experienced recurrent
fevers reaching 38C. Physical examination reveals a well-developed adolescent with good
nutritional status and in no acute distress. There is no lymphadenopathy or organomegaly. Many
petechial hemorrhages cover her chest and legs. Several bruises are found on her legs and
thighs. Laboratory tests were ordered on admission.

Admission laboratory data for patient:

RBC
HGB
HCT
PLT
WBC
Differential:
Lymphocytes
Monocytes
Reticulocytes

RESULTS
2.42 x 106/L
7.1 gd/L
24%
61x 109/L
1.2 x 109/L

NORMAL VALUES
4.0 x 106/L to 4.9 x 106/L
12.015.0 g/dL
36-44%
9
100 10 /L to 450 109/L
4.2 109/L to 9.9 109/L

94%
15%
4%

54 - 62%
18-44%
5-12%

For the past 3 months, patient As family physician has been following her recovery from
viral hepatitis. His recovery was uneventful, with her liver enzyme levels returning to normal
within two months. He has no other past medical history. There is no family history of
hematologic disorders.

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Patient A was referred to a hematologist who ordered a bone marrow examination. The
aspirate obtained was inadequate for evaluation due to lack of marrow. Only a single site could
be aspirated. Preps made from the aspirate showed a markedly hypocellular marrow with very
few hematopoietic cells. Cells present consisted of lymphocytes, plasma cells, and stromal cells.
There were no malignant cells present.

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College of Nursing

OBJECTIVES
General Objectives
To be able to apply what we have learned theoretically at the community and clinical
setting and after that study, we can be able to understand this disease deeper together with
the help of our Clinical Instructor and community health provider and able to provide
optimum or standard quality care to the patient through making of the nursing
intervention and health education regimen.
Specific Objectives
Student-Nurse Centered:
To gain knowledge about the disease process, predisposing factors, clinical manifestation
and the disease management
To gain skills and appropriate attitudes needed to function as a student-nurse in the
community
Identify problems: Develop a teaching plan and strategies appropriate for the goal
attainment
To be able to use the nursing process as framework for care of the patient
To develop and establish interpersonal relationship while the case is ongoing

Client Centered:

To manage his disease

To know the importance of his compliance to his disease
To prevent and manage the potential complication that might occur
Performed emphasized health teaching and following dietary instruction and restriction as
well as performing appropriate exercise

INTRODUCTION

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ADAMSON UNVERSITY
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This is a case of a 14-year-old male patient who was diagnosed with Aplastic Anemia.
Aplastic Anemia is a rare disease caused by a decrease in or damage to marrow stem cells,
damage to the microenvironment within the marrow, and replacement within the marrow with
fat. The precise etiology is unknown, but it is hypothesized that the bodys T-cells mediate
inappropriate attack against the bone marrow, resulting in bone marrow Aplasia. Therefore, in
addition to severe anemia, significant neutropenia and thrombocytopenia are also seen.
The following are the most common symptoms of Aplastic anemia. However, each child
may experience symptoms differently
Symptoms may include:

Headache
Dizziness
Nausea
Fever
Enlarged liver or spleen
Shortness of breath
Bruising
Lack of energy or tiring easily (fatigue)
Abnormal paleness or lack of color of the skin
Blood in the urine
Blood in stool
Nosebleeds
Bleeding gums
Oral thrush

In Aplastic Anemia, the patient has pancytopenia (i.e. anemia, neutropenia and
thrombocytopenia) resulting in decrease of all formed elements. The diagnosis can only be
confirmed on bone marrow examination. Before this procedure is undertaken, a patient will
generally have had other blood exam to find diagnostic clues, x-ray, CT-scans or ultrasound
imaging tests, and liver tests.
Aplastic anemia is a serious illness and treatment usually depends on the underlying cause.
For certain causes, recovery can be expected after treatment, however, relapses can occur. To
treat the low blood counts, initially treatment is usually supportive.

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Supportive therapy may include:

Blood transfusion (both red blood cells and platelets)

Antibiotic therapy
Medications
Immunosuppressive therapy

It is presumed that the lymphocytes of patients with Aplastic anemia destroy the stem cells
and consequently impair the production of erythrocytes, leukocytes and platelets. Despite its
severity, Aplastic Anemia can be treated in most people. Those who are younger than 60 years,
who are otherwise healthy, and who have a compatible donor can be cured of the disease by a
bone marrow transplant(BMT) or Peripheral Blood Stem Cell Transplant(PBSCT).
Internationally, the annual incidence in Europe as detailed in large, formal epidemiologic
studies is similar with that in the United States, with two cases per million populations. Aplastic
anemia is thought to be more common in Asia than in the west. The incidence was accurately
determined to be four cases per million in Bangkok but it may be closer to six cases per million
populations in the rural areas in Thailand, then and as high as 14 cases per million populations in
Japan based on prospective studies.
The major causes of morbidity and mortality from Aplastic anemia include infection and
bleeding. No racial predisposition reported in the US, however, the prevalence is increased in the
Far East. The male-to-female ratio for Aplastic anemia is approximately 1:1 and occurs in all age
groups but Aplastic anemia peaks in people aged 20 to 25 years and a subsequent peak is
observed in people older than 60 years.
In Philippines, a 3-year prospective study done at UP-PGH Adult Hematology section
last 1979 - 1981 and there were 70 cases of aplastic anemia documented. For the latest study, a 6year review of the patient census of UP-PGH Adult Hematology section last 2010 2015, there
were 80 new cases of aplastic anemia documented.
Etiology of Aplastic Anemia
Acquired
Idiopathic (91%)

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Exposure to chemicals and drugs (5%)
Autoimmune (1%)
Pregnancy (1%)
Hepatitis (1%)

Etiology of Aplastic Anemia

Exposure to chemicals and drugs; 5%Autoimmune; 1%

0%
; 1%
Pregnancy ; 1%HepatitisFanconi;

Idiopathic; 91%

Constitutional (Fanconi) (1%)

Theoretical Framework
The Environmental Theory by Florence Nightingale defined Nursing as the act of
utilizing the environment of the patient to assist him in his recovery. It involves the nurses
initiative to configure environmental settings appropriate for the gradual restoration of the
patients health, and that external factors associated with the patients surroundings affect life or
biologic and physiologic processes, and his development.

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chose

this

theory

because

The

Environmental

Theory of Nursing is a patient-care theory which is a primary goal of patients having APLASTIC
ANEMIA. It focuses in the alteration of the patients environment in order to affect change in his
or her health. Caring for the patient is of more importance rather than the nursing process, the
relationship between patient and nurse, or the individual nurse.
In this way, the model must be adapted to fit the needs of individual patients. The environmental
factors affect different patients unique to their situations and illnesses, and the nurse must
address these factors on a case-by-case basis in order to make sure the factors are altered in a
way that best cares for an individual patient and his or her needs.

PATIENTS DATA
Name: Patient A
Address: Fourth Estate Subd. Sucat Paranaque City
Age: 14 y/o

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Gender: Male
Civil Status: Single
Date of Birth: May 8, 2002
Place of Birth: Paranaque City
Educational Attainment: Elementary Graduate
Religion: Roman Catholic
Nationality: Filipino
Date of Admission: November 21, 2016
Time of Admission: 6:35 pm
Mode of Arrival: Ambulatory
Ward: Pedia
Admitting Physician: Dr. Cortes

NURSING HISTORY
Chief Complaint
Progressive weakness and shortness of breath with minimal physical effort.

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Present History
Last July 10 2016, he had an episode of nosebleeds upon going home from school. They
immediately went to Uni-Health Medical Center for check-up. The patient A undergone a
complete blood count. The doctor whom they consulted made a referral to Paranaque Doctors
since he noticed that the patients blood profile has decreased from its normal value, but because
of many household chores and since they are busy in their work and also due to lack of finance,
they decided not to go to Paranaque Doctors. Last November 20, 2016 patient A was admitted to
the Paranaque Doctors with complaints of progressive weakness and shortness of breath with
minimal physical effort. Many petechial hemorrhages cover her chest and legs. Several bruises
are found on her legs and thighs. Laboratory tests were ordered on admission. The result of his
blood exam is still low so his mother decided to have him admitted at the Emergency room for
observation. On November 21, 2016, the patient A was admitted at pedia ward. According to the
patient he sometimes feels easy fatigability and experienced difficulty of breathing then the
doctor ordered oxygen therapy. He was given the first pack of PRBC. Patient A was referred to a
hematologist who ordered a bone marrow examination.
Past History
For the past 3 months, patient As family physician has been following her recovery from
viral hepatitis. Aside from viral Hepatitis, patient A never experienced any major illness. He
experienced mild fever, common colds, and cough. His recovery with Viral Hepatitis was
uneventful, with her liver enzyme levels returning to normal within two months. He has no other
past medical history. There is no family history of hematologic disorders.

Personal and Social History

According to patient A, he was strong and doesnt have any complains of difficulties and
pain or any problem physically or emotionally. In fact, he is a member of the track and field
since he was in grade 5 and received different awards. He had a good relationship with his
parents and siblings. He is very active in school and community by engaging in different
activities.

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Blood Pressure
Pulse Rate
Respiratory Rate
Temperature

ADAMSON UNVERSITY
College of Nursing
Vital Signs
110/80mmHg
110bpm
29cpm
38C

Developmental History
With regards, to his psychosocial development he is under identity vs. Role confusion
and in psychosexual theory he is under the latency stage. In cognitive development theory, he is
in formal stage, in which the child learns to think and reason in abstract terms. According to his
mother, the patient doesnt want to be disturbed when he is doing something. He wants to work
with his own. He always speaks out his needs whenever he asks for something.
Feeding History
Patient A has a good appetite in eating. He is not choosy regarding foods and doesnt
have any food allergies. He eats 3-6 times a day including merienda and drinks 8-9 glasses of
water. He is not taking any food supplements. He is fond of eating streets food such as Fishballs,
Kwek-Kwek, BBQ, and etc. outside their school campus.
Immunization History
According to his Mother, patient A received complete immunization.
Physical Examination History
General Survey: Body built is proportionate to its weight and height.
Posture: Relaxed, erect posture, coordinated movements
Overall hygiene: Clean and neat
Facial Expression: No distress noted
Health Appearance: Good health appearance
Attitude: Cooperative and willing to learn
Quality of speech and organization: Understandable and exhibits through association

ASSESSED

TECHNIQUE

NORMAL

ACTUAL

ANAYSIS

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AREA
Color

USED
Inspection

FINDINGS
SKIN
Light to deep

FINDINGS

Brown skin

color
petechial

brown

Internal bleeding

hemorrhages
cover her
chest and

legs
several
bruises are
found on her
legs and

Smooth
Skin springs

thighs.
Smooth
Skin springs

back

back

immediately

immediately

when pinched
Uniform with

when pinched
Uniform with

normal range

high range of

Palpation

No edema

temperature
No edema

Normal

Color
Distribution

Inspection
inspection

HAIR
Brown to black
Evenly

Black
Evenly

Normal
Normal

Hair thinness

Inspection

distributed
thin or thick

distributed
Thick hair

Normal

and thickness
Texture

Palpation

Smooth and

Smooth and

Normal

silky
No lice
NAIL
Pinkish

silky
No lice

normal

Pale

Poor blood

Texture
Skin turgor

Temperature

Presence of

Palpation
Palpation

Palpation

Normal
Normal

Fever

edema

Presence of lice

Inspection

Color

Inspection

circulation

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ADAMSON UNVERSITY
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Shape and

Inspection and

Smooth, convex

Smooth, convex

Normal

texture
Capillary Refill

palpation
Performed

in curvature
Prompt return of

in curvature
Returns within 4

Poor circulation

blanched test

pink or usual

seconds

Inspection

color (1-2 secs)

HEAD
Rounded

Rounded

(normocephalic)

(normocephalic)

symmetric, with

symmetric, with

frontal, parietal

frontal, parietal

and occipital

and occipital

Size, shape and

symmetry

Presence of

Inspection

mass or nodules

Normal

prominences
prominences
Smooth, uniform Smooth, uniform Normal
in consistency,

in consistency,

absence of

absence of

nodules and

nodules and

mass.
Symmetric or

mass.
Symmetric facial Normal

(symmetry of

slightly

features

structures)

asymmetric

Facial features

Inspection

facial features
Head movement

Can lift head

Can lift head

slightly and turn

slightly and turn

them from side

them from side

to side
EYES
Hair evenly

to side

distribution and

distributed, skin

distributed, skin

alignment

intact, eyebrows

intact, eyebrows

symmetrically

symmetrically

aligned
Equally

aligned
Equally

distributed,

distributed,

Eyebrows: hair

Eyelashes:
evenness of

Inspection

Inspection

inspection

Hair evenly

Normal

Normal

Normal

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ADAMSON UNVERSITY
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distribution and

curled slightly

curled slightly

direction of curl

outward.

outward.

Skin intact, no

Skin intact, no

discharge, no

discharge, no

discoloration
Bulbar

discoloration
Bulbar

Poor blood

conjunctiva is

conjunctiva is

circulation

clear with tiny

clear with tiny

capillaries

capillaries

visible,

visible,

palpebral

palpebral

conjunctiva is

conjunctiva is

pink, no

pink, no

discharge, sclera

discharge, sclera

Eyelids: surface

Inspection

characteristics
Conjunctiva and

Inspection

sclera

Lacrimal gland,

Inspection and

is white
No edema, no

is white
No edema, no

nasolacrimal

palpation

tenderness and

tenderness and

duct
Pupils: color,

Inspection

no tearing
Round, black,

no tearing
Round, black,

equal in size

equal in size

Illuminated

Illuminated

light

pupils constrict

pupils constrict

Symmetry,

NOSE
Symmetrical,

Symmetrical,

shape and color

straight and

straight and

Occurrence of

uniform in color
Pink mucosa, no

uniform in color
Pink mucosa, no

redness,

discharge and

discharge and

swelling and

swelling free of

swelling free of

discharge
Facial sinus

lesion
No tenderness

lesion
No tenderness

shape and
equality
Response to

Inspection

Inspection

Inspection

Palpation

Normal

Normal

Normal

Normal

Normal

Normal

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Lips:

Inspection

MOUTH
Symmetry of

Symmetry,

inspection

contour uniform

contour,

symmetry. Pale

Color,

palpation

pink color,

pale

due Poor blood

tenderness
Gums:

Inspection

No tenderness
Pink,

no tenderness
Pale,

circulation
Pale due to Poor

moist

moist

blood

Color

symmetrical

Normal in

moisture

circulation.
Normal moisture
EARS
Color is same as

Color is same as

Color, symmetry

the color of the

the color of the

of size and

face;

face;

position

symmetrical

symmetrical

auricles align in

auricles align in

Auricles:

Inspection

Normal

the outer canthus the outer canthus

of the eyes
Mobile, firm, no

of the eyes
Mobile, firm, no

elasticity and

tenderness,

tenderness,

areas of

pinna recoils

pinna recoils

tenderness
Auditory

after it is folded
Able to turn

after it is folded
Able to turn

head and eyes

head and eyes

toward the

toward the

sound
Normal voice

sound
Normal voice

tone audible

tone audible

Inspection

Able to repeat

Able to repeat

Inspection

whispered words whispered words

NECK
Symmetrical and Symmetrical and Normal

Presence of

moves freely
no tenderness

Texture,

Palpation

Inspection

function

Response to

Inspection

normal voice
tones
Response to
whispered voice
Appearance and
movement
Presence of

moves freely
No tenderness

Normal

Normal

Normal

Normal

Normal

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tenderness,

tenderness,

lesion

lesion

Color

Inspection

and no lesions

and no lesions

THORAX
Light to deep

brown

Brown;
petechial

Normal
Internal

hemorrhages

Bleeding
Normal
Dyspnea

Chest shape
Respiratory

Inspection
Inspection

Rounded
16-20 cpm

cover her chest

Rounded
29 cpm

pattern
Position of

Inspection

midline

midline

Normal

sternum
Breath sound

Auscultation

Vesicular,

Vesicular,

Normal

Broncho-

Broncho-

vesicular and

vesicular and

bronchial
HEART
60-100 bpm

bronchial

Cardiac rate

Auscultation

110 bpm

Compensatory
mechanism of
the heart due to
increase need for
oxygen

Skin color

Inspection

ABDOMEN
Light to deep

Contour
Bowel sound

Inspection
Auscultation

brown
Rounded
High pitched

Light to deep

Normal

brown
Rounded
Hypoactive

Normal
Decrease

irregular gurgles, irregular gurgles

Size
Strength and

hyperactive
UPPER & LOWER EXTREMITIES
Inspection
Equal in size
Equal in size
Inspection
Can flex and
Can flex and

tone

extend arms and

extend arms and

Mobility
Temperature

legs
Mobile
Same with body

legs
Mobile
Uniform with

temp within

high range of

Inspection
Palpation

peristalsis

Normal
Normal

Normal
Fever

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ADAMSON UNVERSITY
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Appearance

Inspection

normal range
temperature
Light to deep petechial

brown
No lesions

hemorrhages

and

legs
several

discoloration

Internal
Bleeding

present her

bruises are
found on her
legs and
thighs.
GENITALIA
No lesion,

No lesion,

glans penis for

nodules,

nodules,

lesion, nodules,

swelling or

swelling or

swelling and

inflammation

inflammation

No swelling,

No swelling,

for swelling,

inflammation,

inflammation,

inflammation,

and discharge

and discharge

No tenderness,

No tenderness,

nodules,

thickening,

thickening,

thickening

nodules are not

nodules are not

palpable

palpable

Penile shaft,

inflammation
Urethral meatus

and discharge
Tenderness,

Inspection

Inspection

Palpation

COURSE IN THE WARD

Normal

Normal

Normal

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DOCTORS
ORDER

RATIONALE

NURSING
RESPONSIBILITY

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ADAMSON UNVERSITY
College of Nursing
11-21-16
6:35 PM

Please admit to

Admitting a pt. in

Let the patient

Pedia ward under

the ward is essential

sign the informed

the service of Dr.

for continuous

consent. Make a

Cortes

monitoring

chart.

treatment/
management &
evaluation.
Secure consent for
admission &

For legal purposes

management

Let the S.O. of

the patient sign
the informed

Monitor Vital Signs

consent.

q shift & record

To have a baseline

To obtain/monitor

data & monitor for

the vital signs

untoward s/sx that

closely. Record &

can be an indication

plot properly then

of possible

report any

complication

abnormal finding

DAT

to the physician
Instruct the
To meet metabolic
demands

Diagnostic Exams
a) CBC

patient to eat well

balanced diet
Obtain a blood

To determine the
levels of different
blood components
as well as the
deviations from

sample from the

patient and send
to the lab

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ADAMSON UNVERSITY
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normal values
b) BMA
obtain informed
To check if there if

consent; prepare

there is an

set & assist the

abnormality in the

physician during

marrow that can be

an indicator of a

the procedure
Post BMA- apply

certain blood

pressure to the

problem

punctured site;
note for signs of
infection.

c) Blood Typing
Obtain blood
To determine blood
type for

sample then send

to the lab

compatibility prior
to BT
Treatment
a) Hook PNSS 1L x
KVO

Insert IV line &

Route for drug

b) Secure 2 units of
PRBC properly
typed & cross
matched then
transferred each
unit for 2 hours,

establish correct

administration & to

flow rate; check

address fluid &

IV for patency &

nutritional needs

signs of infection

To replace for the

Secure consent

lacking specific

for BT; prepare

blood component

set. Send request

to the blood bank.

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ADAMSON UNVERSITY
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6 hours apart
once available
PNSS is the only
IVF to KVO while
on BT (PNSS)

isotonic solution
compatible for BT.

Maintain patent
IV line and
regulate properly;
note for signs of

for immediate
Watch out for BT
reaction

infection

intervention or
management

monitor v/s
closely, if
reaction occurs
stop the
transfusion then
open the
mainline; report
immediately to
the physician

Furosemide
20mg/IV mid BT

To prevent fluid
overload/ congestion
Obtain BP prior

with BP precautions

to administration,
if less than 90/60
do not administer
to establish baseline
monitor v/s q 4
hours and record

data and monitor

undue s/sx that may
indicate untoward
s/sx

monitor v/s
strictly and record

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ADAMSON UNVERSITY
College of Nursing
provide important
monitor I & O q
shift and record

data on pt.s fluid

electrolytes balance

obtain the I & O

of the patient
accurately then

to meet O2 demand
O2 inhalation @ 1-2

of the pt.

L/min per nasal

record
properly regulate
the O2 flow rate.

cannula

Instruct SO not to
smoke, avoid use
of volatile,
flammable
materials, oils,
grease, alcohol
and acetone.
for immediate

watch out for DOB,

vomiting and

management and
intervention

monitor the
patient closely

seizures

To meet metabolic
Diet as Tolerated

demands

Instruct the
patient to eat well
balanced diet

9:30 PM

Route for drug

cont. PNSS x KVO

administration & to
address fluid &

Maintain patent
IV line and

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ADAMSON UNVERSITY
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nutritional needs

regulate properly;
note for signs of
infection

to meet O2 demand
maintain O2

of the patient

properly regulate

inhalation @ 1-2

the O2 flow rate.

L/min via nasal

Instruct SO not to

cannula

smoke, avoid use

of volatile,
flammable
materials, oils,
grease, alcohol
for further

refer

and acetone.

assessment

replace for the

facilitate BT once
available

lacking specific
component of blood

10:40 PM

Secure consent
for BT; prepare
set, watch out for
BT reactions,
monitor v/s
strictly

to det. Improvement
ff. up other labs

from previous blood

profile
for further

refer

assessment

get results from

the laboratory

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Route for drug
cont. PNSS x KVO

Maintain patent

administration & to

IV line and

11-22-16

address fluid &

regulate properly;

4:30 AM

nutritional needs

note for signs of

infection

replace for the

facilitate BT once
available

Secure consent

lacking specific

for BT; prepare

component of blood

set, watch out for

BT reactions,
monitor v/s
strictly. Send
request to the
blood bank

to establish baseline
cont. v/s monitoring

monitor v/s

data and monitor

strictly and

undue s/sx that may

record. Report

indicate untoward

any abnormal

s/sx or possible

findings

complications

maintain O2

to meet O2 demand
of the patient

properly regulate
the O2 flow rate.

inhalation @ 1-2

Instruct SO not to

L/min via nasal

smoke, avoid use

cannula

of volatile,
flammable
materials, oils,
grease, alcohol

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ADAMSON UNVERSITY
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and acetone.
for further
refer

assessment
replace for the

once PRBC is
available revise
8:30 PM

Secure consent

lacking specific

for BT; prepare

component of blood

set, watch out for

transfusion to run

BT reactions,

each unit for 3 hours

monitor v/s

every 6 hours

strictly. Send

interval

request to the
blood bank.
for further

refer
secure 3 units of
platelet concentrate
11-23-16

type O+ specific and

9:25 AM

transfuse as FP once
available.
cont v/s monitoring

assessment
replace for the
lacking specific

BT, prepare set.

component of blood

to establish baseline
data and monitor
undue s/sx that may
indicate untoward
s/sx or possible
complications
for further

refer

secure consent for

assessment

monitor v/s
strictly and record

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To check if there if
for BMA

obtain informed

there is an

consent; prepare

abnormality in the

set & assist the

11-24-16

marrow that can be

physician during

10:00 AM

an indicator of a
certain blood
problem

the procedure
Post BMA- apply
pressure to the
punctured site;
note for signs of
infection

for further
refer

assessment
for

start hydrocortisone

immunosuppression

observe 10 Rights
of medication

80mg/ IV q 6 hours
5:00 PM
Antibiotic
isoniazid 400 mg/
tab; 1 tab ODBB

prophylaxis for

1 cap OD

of medication

further infection
promote cell growth

folicard B-complex

observe 10 Rights

and division,

observe 10 Rights
of medication

including RBC that

help prevent anemia
to establish baseline

cont. v/s monitoring

data and monitor

undue s/sx that may
indicate untoward

monitor v/s
strictly and record

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s/sx or possible
complications
for further
refer

assessment

ANATOMY AND PHYSIOLOGY

Blood is a specialized bodily fluid that delivers necessary substances to the body's cells such as
nutrients and oxygen and transports waste products away from those same cells. In vertebrates,
it is composed of blood cells suspended in a liquid called blood plasma. Plasma, which
comprises 55% of blood fluid, is mostly water (90% by volume), and contains dissolved
proteins, glucose, mineral ions, hormones, carbon dioxide (plasma being the main medium for

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excretory product transportation), platelets and blood cells themselves. The blood cells present in
blood are mainly red blood cells (also called RBCs or erythrocytes) and white blood cells,
including leukocytes and platelets. The most abundant cells in vertebrate blood are red blood
cells. These contain hemoglobin, an iron-containing protein, which facilitates transportation of
oxygen by reversibly binding to this respiratory gas and greatly increasing its solubility in blood.

Function of the blood

Transports:

Dissolved gases (e.g. oxygen, carbon dioxide);

Waste products of metabolism (e.g. water, urea);

Hormones;

Enzymes;

Nutrients (such as glucose, amino acids, micro-nutrients (vitamins & minerals), fatty
acids, glycerol);

Plasma proteins (associated with defense, such as blood-clotting and anti-bodies);

Blood cells (incl. white blood cells 'leucocytes', and red blood cells 'erythrocytes').

Maintains Body Temperature

Controls pH

The pH of blood must remain in the range 6.8 to 7.4, otherwise it begins to damage cells.

Removes toxins from the body

The kidneys filter all of the blood in the body (approx. 8 pints), 36 times every 24 hours.
Toxins removed from the blood by the kidneys leave the body in the urine.
(Toxins also leave the body in the form of sweat.)

Regulation of Body Fluid Electrolytes

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Excess salt is removed from the body in urine, which may contain around 10g salt per
day
(such as in the cases of people on western diets containing more salt than the body
requires).

Composition of the Blood

1. RED BLOOD CELLS
Red blood cells are the most common cells found in blood. There are about 5 million red
blood cells in each cubic millimeter of blood or approximately 250 million red blood cells in
every drop of blood. This number varies with individuals in accordance to heredity, gender and
state of health. These cells are produced by the bone marrow and have a lifespan of 3-4 months.
When they die, they are destroyed by macrophages in the liver and spleen. This process releases
iron to be stored in the liver and bile pigments to be excreted.
Functions:
Red blood cells are important in the process of respiration. Gases involved in respiration are
carried around the body through these cells. Oxygen readily combines with hemoglobin to form
oxy-hemoglobin in the lungs where there is high concentration of oxygen. However, oxyhemoglobin is an unstable compound and will break down to release oxygen when there is low
concentration of oxygen in the surroundings. Hence there will be an even distribution of oxygen
to all parts of the body. Red blood cells also carry part of the carbon dioxide waste from the cells
through most is transmitted through plasma as soluble carbonates.
2. PLASMA
Plasma is a pale yellowish fluid with a total volume of 2-3 liters in a normal adult.
3. WHITE BLOOD CELLS
White blood cells are responsible for the defense system in the body. There are
approximately 6,000 white blood cells per millimeter of blood or a million white blood cells in

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every drop of human blood. White blood cells fight infections and protect our body from foreign
particles, which includes harmful germs and bacteria. White blood cells, the red blood cells are
formed from the stem cell of the bone marrow. It has a life-span of a couple of days. When they
die, they are destroyed by surrounding white blood cells and replaced with new ones.

Types of WBC:
Neutrophils make up 55%-70% of the total white blood count in the bloodstream. They
have a segmented nucleus and it is said to be C shaped. Neutrophils can be most commonly
found near sites of infection or injury where they will stick to the walls of the blood vessels and
engulf any foreign particles that try to enter the bloodstream. They can also be found in the pus
of wounds.
Eosinophils make up 2%-5% of the total blood count and mainly attacks parasites and
any antigen complexes. These cells are also responsible for allergic response within the blood.
Basophils make up less than 1% of the total white blood count. They secrete anticoagulant and antibodies, which mediate hypersensitivity reactions within the blood. They are
known to have phagocytory features though they are more often related to immediate immune
reaction against external germs and diseases.
Monocytes, though having only 5%-8% in the total white blood count, are the largest of
the 5 types of white blood cells. They act as tissue macrophages and remove foreign particles and
prevent the invasion of germs which cannot be effectively dealt with by the neutrophils. They
have been known to have phagocytic functions.
Lymphocytes produce anti-bodies against toxins secreted by bacteria and infecting
germs. These antibodies will be excreted into the plasma to kill bacteria in the blood as well as
act as anti-toxins. These anti-bodies will cause the foreign particles to cluster together, rendering
them easily engulfed by the phagocytes. However, the nature of lymphocytes is highly specific
and they can only recognize certain antigens.

4. PLATELET

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Platelets are granular non-nucleated fragments of cytoplasm in the form of oval discs. A
platelet consists of two parts, a clear outer ground substance occupying the greater part of the
platelet and a central part that contains granules.
Function:
They secrete a hormone called serotonin which constricts torn blood vessels. They also have a
major role in accumulating at sites of injury sticking together to plug gaps in broken blood
vessels. They are rich in a certain activator that activates some proteins found in plasma. These
proteins are thrown out in the form of fibers as a network. This network traps the escaping RBCs
and forms a clot that will seal the cut blood vessels and so bleeding is stopped.

PATHOPHYSIOLOGY
Normal
Physiology:
Hypoxi
Erythropoietin is produced in the kidney and liver in response to
Erythropoie

Bone

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Hematopoietic Stem Cells
(hemocytoblasts)
Myeloid Stem

Lymphoid Stem

Megakaryoc

Reticulocyt

Monocyt

Thrombocyt

Erythrocyt

Macrophag

Prevent
bleeding

With
hemoglobi
n that
carries
Oxygen

Phagocytosis
of small
pathogenic
microorganis

IgA

Eosinoph

Plays a part in
inflammatory
and allergy
reaction

Fight
parasitic
infection
s

IgM

Involved in
1st antibody
memory
synthesized
response to
in the
antigen
primary
already
immune
encountere
response
Antigen
receptors
on
lymphocyte
surface

Small

B-

T-

Humoral
adaptive
immunity

Cellmediated
immunity

Helper
T cells

Produce
cytokines

Cytotoxic
T Cells

Stimulates
proliferation
of cytotoxic
T-cells and
activate
macrophag
es
Attach
Killer to
abnormal
Cells
cells and
release
chemicals
called
Lymphokine
s which
helps to

Phagocytosi

Basophils

Neutroph

Plasma

IgG

Myelobla

Memory B

IgE

IgD
Involved
primary
response to
a newly
sensed
pathogen
Allergic
symptoms in
immediate
hypersensiti
vity

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Suppress
or T Cells

Involved
in
winding
down a
successf
ul
immune

Memory
T Cells

Provide
rapid
defense
to any
subsequ
ent
invasion
by the
same

Exposure to viral
infection
(Hepatitis A Virus)

Humoral Immune
Response

Cellular Immune
Response

B-Lymphocytes binds
with the Antigen/Virus

Once T helper cells

detects a virus, it
activates and divides.
Some stays as a
memory cells

Plasma cells releases

antibodies

Cytokines

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Cytotoxic t-cells are
activated to kill virus

Viral elimination

Some stays
as a
memory

Macrophages are
stimulated
B cells are stimulated
to produce antibodies
which binds to the
Suppressor T cells are
stimulated to slow
down immune
response once virus is
cleared

History:

Viral Hepatitis A (Viral Infection)

No family history of hematologic
disorders
Laboratory
and
Diagnostic
Exam Results:
No other
past
medical history
Complete Blood Count:
RESULTS
NORMAL VALUES
Predisposing
RBC Precipitating Factor:
2.42 x 106/L
4.0 x 106/L toFactor:
4.9 x 106/L
HGB
7.1 gd/L
12.015.0 g/dL
Viral Infection (Hepatitis A)
Age: 14 y/o (Major peak in teens and
HCT
24%
36-44%
twenties)
Life style: Eating street foods
9
9
PLT
61x 10 /L
100 10 /L to 450 109/L
9
WBC
1.2 x 10 /L
4.2 109/L to 9.9 109/L
Differential:
Lymphocytes
94%
54 - 62%
Chief Complaint:
Monocytes
15%
18-44%
Reticulocytes
4%
5-12%
Progressive weakness and shortness of breath with minimal
physical effort.
Bone Marrow Examination:
Aspirate showed a markedly hypocellular marrow with very few
hematopoietic cells. Cells present consisted of lymphocytes, plasma cells,
and stromal cells. There were no malignant cells present.

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Hypocellu

Normocellul

Clinical Significance:

Complete Blood Count:

All CBC parameters are low.

Decrease in RBC, HGB, and HCT suggest to Anemia
Decrease in WBC suggest to infection
Decrease in Platelet suggest to Petechial hemorrhages and bruising

Bone Marrow Examination:

A markedly hypoplastic (Very few) bone marrow is a confirmatory test of

aplastic anemia.

Uneventful recovery to viral

hepatitis A
Viral hepatitis A progresses

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Increase number of TSevere Imbalance in TCytotoxic T-cells and Helper T-Cells alteration
Helper T-cells releases Anti-Hematopoietic
Stimulates proliferation of Cytotoxic T-cells to the
Hematopoietic Stem Cells and destroying it by
producing toxin causing them to lyse.

Activate destruction of hematopoietic

Failure of the bone marrow to produce

stem cells, the initial form of all blood
Bone Marrow
Pancytopenia

Decrease RBC

Decrease WBC

Decrease
Platelet

Low Hgb, Low

Hct

Lower immune
defenses

Decrease
clotting ability

Decrease O2
supply to cells

Weakness
Fever

Pallor

Heart
Compensates

Fatigue

Heart increases
cardiac output
by pumping out
more blood

Temp:

38C

Bruising
Petechial
hemorrhag
es

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Dyspnea

RR: 29 cpm

compensatory
tachycardia

RR: 110 bpm

Clinical Manifestations / Signs and Symptoms:

Pancytopenia
Anemia (Low RBC): Pallor, Fatigue, Dyspnea
Neutropenia (Low WBC): Fever, Weakness
Thrombocytopenia (low Platelet): Petechial
hemorrhages, Bruising

Nursing Care Plan:

1. Risk for infection r/t decreased resistance and
increased susceptibility secondary to
neutropenia
2. Risk for bleeding r/t decreased platelet count
3. Ineffective tissue perfusion related to decrease
in hemoglobin count

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LABORATORY EXAMINATIONS
Complete Blood Count:
RBC
HGB
HCT
PLT
WBC
Differential:
Lymphocytes
Monocytes
Reticulocytes

RESULTS
2.42 x 106/L
7.1 gd/L
24%
61x 109/L
1.2 x 109/L

NORMAL VALUES
4.0 x 106/L to 4.9 x 106/L
12.015.0 g/dL
36-44%
9
100 10 /L to 450 109/L
4.2 109/L to 9.9 109/L

94%
15%
4%

54 - 62%
18-44%
5-12%

Clinical Significance:

All CBC parameters are low.

Decrease in RBC, HGB, and HCT suggest to Anemia
Decrease in WBC suggest to infection
Decrease in Platelet suggest to Petechial hemorrhages and bruising

Bone Marrow Examination:

The accompanying aspirate smear is markedly hypocellular, composed mostly of
scattered myeloid and erythroid elements.

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Clinical Significance:

A markedly hypoplastic (Very few) bone marrow is consistent with a diagnosis of aplastic

anemia.
If malignant cells were present, a diagnosis of metastatic disease or lymphoma would have
been likely. Bone marrows of patients with leukemia or myelodysplastic syndromes
typically are hyperplastic with increased numbers of hematopoietic blasts present.

Clinical Manifestations:
Anemia (Low RBC): Pallor, Fatigue, Dyspnea
Nursing Responsibilities:
1.
2.
3.
4.
5.

Restrict fluid intake

Administer Oxygen inhalation 2-3LPM as ordered
Place patient in fowlers position
Encourage deep breathing exercise
Encourage intake of food rich in Iron+B12

Neutropenia (Low WBC): Fever, Increase risk to Infection

Nursing Responsibilities:
1.
2.
3.
4.
5.
6.

Monitor vital signs specially temperature

If fever is present provide TSB
Encourage fluid intake
Encourage Iron Supplements
Emphasized personal hygiene, adequate rest and sleep period
Inspect for the presence of wounds, if present provide wound care, abrasion, or ulcer

of mucous membrane or skin as a potential site of infection

7. Wear mask to serve as protection

Thrombocytopenia (low Platelet): Petechiae, Bruising, Risk for Bleeding

Nursing Responsibilities:
1. Instruct about the accompanying risk of hemorrhage and thrombosis

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2.
3.
4.
5.

Prevent falls by ambulating with the patients as necessary

Encourage exercise regularly
Check for any signs of bleeding
Place in bleeding precaution; provide meticulous site care of intravenous sites or

wounds, and avoid trauma

6. Instruct about using of soft toothbrush and razor

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DRUG STUDY
DRUG
Generic Name:
Furosemide
Generic Name:
Lasix
Classification:
Loop Diuretic

DOSAGE
20mg / IV

ACTION
Furosemide
inhibits
reabsorption of Na
and chloride
mainly in the
medullary portion
of the ascending
Loop of Henle.
Excretion of
potassium and
ammonia is also
increased while
uric acid excretion
is reduced. It
increases plasmarenin levels and
secondary
hyperaldosteronis
m may result.
Furosemide
reduces BP in
hypertensives as
well as in
normotensives. It
also reduces
pulmonary edema
before diuresis has
set in.

INDICATION

NURSING

RESPONSIBILITIES
Reduce dosage if given
with other
antihypertensive;
readjust dosage
gradually as BP
responds.
IV:
Administer with food or
acute Pulmonary
milk to prevent GI
Edema
upset.
Give early in the day so
Oral:
that increased urination
Hypertension
will not disturb sleep.
Avoid IV use if oral use
Blood transfusions
is at all possible.
are often
WARNING: Do not mix
complicated by
parenteral solution with
water retention,
highly acidic solutions
which may
with pH below 3.5.
worsen lung
Do not expose to light,
function, heart
may discolor tablets or
function and/or
solution; do not use
kidney function.
discolored drug or
Loop diuretics,
solutions.
medications that
Discard diluted solution
reduce body water
after 24 hr.
by making the
Refrigerate oral
kidneys excrete
solution.
more urine, are
Measure and record
thought to prevent
weight to monitor fluid
Oral, IV: Edema
associated with
heart failure,
cirrhosis, Renal
disease.

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water retention.

DRUG
Generic Name:
Hydrocortisone
Generic Name:
Hydrocortisone
Sodium
Phosphate
Classification:
Antiinflammatory;
Synthetic
Hormone;
Adrenal
Corticosteroids;
Glucocorticoid;
Mineralocorticoi
d

DOSAGE
80 mg / IV
q 6 hours

ACTION
Short-acting
synthetic steroid
with both
glucocorticoid and
mineralocorticoid
properties that affect
nearly all systems of
the body.
Antiinflammatory
(glucocorticoid)
action: Stabilizes
leukocyte lysosomal
membranes; inhibits
phagocytosis and
release of allergic
substances;
suppresses fibroblast
formation and
collagen deposition;
reduces capillary
dilation and
permeability; and
increases
responsiveness of
cardiovascular
system to circulating
catecholamines.
Immunosuppressiv

INDICATION

changes.
Arrange to monitor
serum electrolytes,
hydration, liver and
renal function.
Arrange for potassiumrich diet or
supplemental potassium
as needed.

NURSING

RESPONSIBILITIES
Replacement
Establish baseline and
therapy in
continuing data on BP,
adrenocortical
weight, fluid and
insufficiency; to
electrolyte balance,
reduce serum
and blood glucose.
calcium in
Lab tests: Periodic
hypercalcemia, to
serum electrolytes
suppress
blood glucose, Hct
undesirable
and Hgb, platelet
inflammatory or
count, and WBC with
immune responses,
differential.
to produce
Monitor for adverse
temporary
effects. Older adults
remission in
and patients with low
nonadrenal disease,
serum albumin are
and to block ACTH
especially susceptible
production in
to adverse effects.
diagnostic tests.
Be alert to signs of
Use as
hypocalcemia (see
antiinflammatory
Appendix F).
or
Ophthalmoscopic
immunosuppressiv
examinations are
e agent largely
recommended every
replaced by
23 mo, especially if
synthetic
patient is receiving
glucocorticoids that
ophthalmic steroid
have minimal
therapy.
mineralocorticoid

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e action: Modifies
activity.
immune response to
various stimuli;
reduces antibody
titers; and suppresses
cell-mediated
hypersensitivity
reactions.
Mineralocorticoid
action: Promotes
sodium retention, but
under certain
circumstances (e.g.,
sodium loading),
enhances sodium
excretion; promotes
potassium excretion;
and increases
glomerular filtration
rate (GFR).
Metabolic
action: Promotes
hepatic
gluconeogenesis,
protein catabolism,
redistribution of
body fat, and
lipolysis.

Monitor for persistent

backache or chest
pain; compression and
spontaneous fractures
of long bones and
vertebrae present
hazards.
Monitor for and report
changes in mood and
behavior, emotional
instability, or
psychomotor activity,
especially with longterm therapy.
Be alert to possibility
of masked infection
and delayed healing
(antiinflammatory and
immunosuppressive
actions).
Note: Dose
adjustment may be
required if patient is
subjected to severe
stress (serious
infection, surgery, or
injury).
Note: Single doses of
corticosteroids or use
for a short period (<1
wk) do not produce
withdrawal symptoms
when discontinued,
even with

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DRUG

DOSAGE

ACTION

INDICATION

NURSING

Folic acid is a
substrate for an
important reaction
that involves
vitamin B12 and it
is necessary for the
synthesis of DNA,
and so required for
all dividing cells.
The pathway
leading to the
formation of
tetrahydrofolate
(FH4) begins when
folic acid (F) is
reduced to
dihydrofolate
(DHF) (FH2),
which is then
reduced to THF.

Folate deficiency,
macrocytic
anemia, aplastic
anemia and
megaloblastic
anemias
associated with
malabsorption
syndromes,
alcoholism,
primary liver
disease,
inadequate dietary
intake, pregnancy,
infancy, and
childhood.

Obtain a careful
history of dietary
intake and drug and
alcohol usage prior
to start of therapy.
Drugs reported to
cause folate
deficiency include
oral contraceptives,
alcohol, barbiturates,
methotrexate,
phenytoin,
primidone, and
trimethoprim. Folate
deficiency may also
result from renal
dialysis.
Keep physician
informed of patient's
response to therapy.
Monitor patients on
phenytoin for sub
therapeutic plasma
levels

RESPONSIBILITIES
Generic Name:
Vitamin B
Complex + Folic
Acid
Generic Name:
Folicard B-Plus
Classification:
Vitamins and
minerals

1cap OD

It is required for

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the manufacture of
nucleic acids and
therefore for
growth and
reproduction, as
well as the
formation of red
blood cells and the
function of the
central nervous
system.

NURSING CARE PLAN

Assessment

Diagnosis

Planning

Intervention

Rationale

Evaluation

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Subjective:
Complaints
of
progressive
weakness
and
shortness of
breath with
minimal
physical
effort
Objective:
Pallor
Fatigue
Dyspnea
RR: 29 cpm
PR: 110bpm
Poor
capillary
refill
Decreased
RBC count

Ineffective
tissue
perfusion
related to
decrease in
RBC count

After 2 days
of nursing
interventions
, the patient
will be able
to maximize
tissue
perfusion

Monitored v/s

for baseline
comparison & took
prompt
intervention for
any deviation

Administer
Oxygen
inhalation 2-3
L/min as
ordered

to meet Oxygen
demand

Place patient in
fowlers
position

to increased lung
expansion

Encourage
deep breathing
exercise

To facilitate good
respiration

Encourage
intake of food
rich in
Iron+B12

promote cell
growth and
division, including
RBC that help
prevent anemia

Promote Bed
rest

to decreased
oxygen demand

Provided a
conducive
environment

to allow the patient

for enough rest

Administer
Iron+B12
Supplement as
ordered

promote cell
growth and
division, including
RBC that help
prevent anemia

After 8 hours
of nursing
interventions,
the patient
was able to
maximize
tissue
perfusion as
evidenced by
pinkish
colored lips,
conjunctiva,
nail beds, and
gums.

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Assessment
Subjective:

Objective:
Decreased
WBC count
Pallor
Fatigue

Diagnosis
Risk for
infection r/t
decreased
resistance
and
increased
susceptibility
secondary to
neutropenia

Planning
After 8 hours
of nursing
intervention,
the patient
will be able
to verbalize
understandin
g and identify
intervention
to prevent or
reduced risk
of infection.

Intervention
Monitor vital
signs specially
temperature

Rationale
For early
management and
protection of the
client against the
susceptibility.

If fever is
present provide
TSB

To reduce body
temperature

Encourage fluid
intake

To provide
hydration. Fluids
promote diluted
urine and
frequent
emptying of
bladder;
reducing stasis
of urine, in turn,
reduces risk of
bladder infection
or urinary tract
infection (UTI).

Encourage
intake of
protein- and
calorie-rich
foods.
Assess
nutritional
status, including
weight, history
of weight loss,
and serum
albumin.

This maintains
optimal
nutritional status

Patients with
poor nutritional
status may be
anergic, or
unable to muster
a cellular
immune
response to
pathogens and
are therefore
more susceptible
to infection.

Evaluation
After 8 hours
of nursing
intervention,
the patient
was able to
verbalize
understanding
and identify
intervention
to prevent or
reduced risk
of infection.

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Stressed proper
hand washing

Emphasized
personal
hygiene,
adequate rest
and sleep period

to reduce the
risk of
transmitting
pathogen from
the area of the
body
To lessen the
risk of acquiring
infection

Limit visitor

Wear mask
Teach patient to
take antibiotics
as prescribed

to reduce the
transmission of
pathogen to the
patient at risk for
infection
to serve as
protection
Most antibiotics
work best when
a constant blood
level is
maintained; a
constant blood
level is
maintained when
medications are
taken as
prescribed. The
absorption of
some antibiotics
is hindered by
certain foods;
patient should be
instructed
accordingly.

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Assessment
Subjective:

Objective:
petechial
hemorrhag
es cover
her chest
and legs
several
bruises are
found on
her legs
and thighs.
Low
platelet
pallor

Diagnosis
Risk for bleeding
r/t decreased
platelet count /
thrombocytopeni
a

Planning
After 8 hours
of nursing
interventions
, the patient
will be able
to identify
risk and
engage in
appropriate
behaviors or
lifestyle
changes to
prevent
bleeding

Intervention
Monitor
platelet count
daily
Assess skin
for evidence
of petechiae
or bruising
and bleeding

Prevent
falls by
ambulating
with the
patients as
necessary

Rationale
Significant
decrease on
platelet can
affect blood
clotting.

Evaluation
After 8 hours
of nursing
interventions,
the patient
was able to
identify risk
and engage in
Early detection
of bleeding helps appropriate
behaviors or
prevent
significant blood lifestyle
changes to
loss and
prevent
potential shock
bleeding
To avoid injury

Encourage
exercise
regularly

To promote
physical healthy
being

Check for
any signs
of bleeding

For early
management and
protection of the
client against the
susceptibility.

Place in
For safety and to
bleeding
avoid injury or
precaution;
trauma that
provide
might lead to
meticulous
bleeding
site care of
intravenou

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s sites or
wounds,
and avoid
trauma
Instruct
about
using of
soft
toothbrush
and razor

Increases risk in
bleeding
following even
minor trauma

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DISCHARGE PLANNING
Medication
Instruct client and her significant others to continue take her prescribed medications
Orient the client together with her significant others about the name of drugs, their
actions, the exact dosage, the frequency and the route of administration.
Instruct client and significant others to follow the instruction when administering
medication.
Encourage the significant others not to leave the client during medication
Explain to the client and significant others the side effects and adverse effects of the
drugs she takes by prescribing its manifestations.
Encourage the client and significant others not to stop intake of prescribed medications,
unless approved by the physician.
Encourage the client and significant others to report to the physician immediately if any
adverse effects or side effects had occurred.
Exercises
Instruct client to balance activities with adequate rest periods.
Encourage early ambulation, assist the client if needed.

Treatment
Educate client and significant others the importance of drug compliance.
Discuss to the client and significant others the complication of the condition because
knowledge about the condition supports learning that will decrease deficit and anxiety.

Hygiene
Encourage client and significant others to do daily hygiene.
Discuss to the client and significant others the importance of proper hygiene to promote
enhancement of knowledge regarding its importance.
Encourage client to ask assistance if needed.

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Outpatient orders
Call the doctor if any of the following occur:

Have itchy skin and develop skin rashes.

Experience nausea and vomiting.
You heart is beating fast or you are breathing fast.
You have a seizure (convulsion).
You have chest pain or trouble breathing all of a sudden.
You have questions or concerns about your care, medicine, or treatment.

Diet
To promote wellness, eat a balanced diet rich in fresh fruits and vegetables.
Eat high caloric foods and rich in protein to maintains optimal nutritional status

Spiritual
Always ask God for guidance in everything, especially with her condition.
Praying also for all the people who are helping her with her ups and downs.

IMPLICATIONS OF THE CASE STUDY TO THE

FOLLOWING AREAS:
Nursing Research

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This study can be used as a reference point information for further research of the existing management of
patients with Aplastic Anemia. There might be some info in this study that can use for future research.
Aside from being advantageous as a simple academic educational material, this study might serve as a
guide for orienting people about the element of the disease, and how this disease affects people.

Nursing Education
This study can be used as a reference to develop understanding of the nursing care and management for
patients with Aplastic Anemia. This case study will enable the students to learn how to assess patients
with any signs of Aplastic Anemia and be able to provide appropriate nursing care and management.
Moreover, the students will learn about the nursing interventions and have an knowledge of the rationale
behind its actions. They can apply these interventions in the real setting when they encounter the same or
similar condition. In this manner, they are getting more knowledge about the disease that they can use to
further develop their skills as student nurses and future nurses. It may open a new door in the practice of
getting quality care. This study might also inspire other individuals to come up with their own research
about this disorder or any similar condition.

Nursing Practice
This study will serve as a guide to health care providers to know what are the possible and appropriate
nursing interventions for a client having Aplastic Anemia. This study can give a good introduction to the
disorder so that an established nursing action can be quickly utilized.

BIOBLIOGRAPHY
WEBSITES
http://study.com/academy/lesson/lymphocytes-definition-functions-types.html
https://www.cliffsnotes.com/study-guides/anatomy-and-physiology/the-immune-system-andother-body-defenses/lymphocytes

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https://www.boundless.com/physiology/textbooks/boundless-anatomy-and-physiologytextbook/immune-system-21/adaptive-immunity-198/lymphocytes-978-6984/
https://www.hindawi.com/journals/crihep/2014/216570/
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2009.04060.x/pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052191/
http://www.medscape.com/viewarticle/590644
http://www.medicalnewstoday.com/articles/139028.php
http://www.empiremedicare.com/pdf/combined/mmr2008-1.pdf Medicare Monthly Review
ttp://www.cahabagba.com/part_b/msp/providers_general_info.htm Cahaba GBA