Anemia Nursing Care Plan

Nursing Diagnosis 1: Activity Intolerance

Activity Intolerance related to Anemia: Hgb < 13 g/dL men, < 12 g/dL women, < 11 g/dL pregnancy (WHO); reduced oxygen-carrying capacity as evidenced by Imbalance between oxygen supply and demand from low Hgb; Dyspnea on exertion with < 50 ft ambulation; Patient-reported fatigue and weakness; HR rise > 20 bpm from baseline with minimal exertion; SpO₂ drop > 4% with activity.

Interventions

• Monitor vital signs (HR, BP, RR, SpO₂) before, during, and after activity per facility protocol.
• Obtain orthostatic vital signs (lying, sitting, standing) before first ambulation each shift when ordered or per facility protocol.
• Assess patient-reported dyspnea and fatigue on a 0 to 10 scale before and after activity.
• Observe for signs of overexertion: pallor, diaphoresis, chest pain, palpitations, or syncope.
• Trend Hgb, Hct, and reticulocyte count per provider order.
• Assist with ADLs as needed; cluster cares to allow uninterrupted rest periods.
• Coordinate with physical therapy on a progressive mobility plan per provider order and facility protocol.
• Pause activity and reassess for SBP drop > 20 mmHg, HR rise > 20% above resting, SpO₂ fall < 92%, new chest pain, or new dyspnea; escalate per facility protocol.
• Administer supplemental oxygen as ordered when SpO₂ falls below ordered parameters during activity.
• Keep call light, water, and frequently used items within reach.
• Educate on energy-conservation techniques: pace activities, prioritize tasks, sit while performing tasks when possible.
• Teach the patient to recognize their dyspnea threshold and pause to rest before reaching it.
• Reinforce that prolonged bed rest can accelerate deconditioning; encourage consistent low-level activity within ordered parameters.
• Teach signs requiring 911: chest pain, syncope, severe new dyspnea, confusion, or palpitations.
• Notify the provider for Hgb drop, new chest pain, syncope, or persistent tachycardia at rest.
• Coordinate cardiac evaluation per provider order if symptoms persist after Hgb correction.

Outcome: Patient ambulates within ordered activity parameters without significant dyspnea; HR returns toward baseline within a reasonable interval after activity, per facility protocol; SpO₂ remains within ordered parameters during ambulation.

Nursing Diagnosis 2: Activity Intolerance

Fatigue related to Anemia: Hgb < 13 g/dL men, < 12 g/dL women, < 11 g/dL pregnancy (WHO); reduced oxygen-carrying capacity as evidenced by Patient-reported persistent tiredness unrelieved by rest; Hgb < 10 g/dL; Decreased participation in ADLs; Sleep disturbance (poor sleep quality, daytime somnolence); Verbal reports of being ‘wiped out’ after minimal activity.

Interventions

• Assess fatigue severity using a 0 to 10 scale at the start of every shift and PRN.
• Identify contributing factors: pain, poor sleep, depression, medication side effects, ongoing blood loss.
• Assess sleep quality and duration daily; identify environmental or symptomatic disruptors.
• Review diet history for iron-, B₁₂-, and folate-rich food intake when appropriate to the cause.
• Monitor labs trend (Hgb, Hct, reticulocyte count, iron studies, B₁₂, folate) per provider order.
• Cluster nursing care to allow uninterrupted rest blocks when clinical state allows.
• Administer ordered iron, B₁₂, folate, ESA, or blood products as ordered per provider direction, pharmacy guidance, and facility protocol.
• Coordinate registered-dietitian consult per provider order or facility protocol.
• Limit nonessential nighttime stimuli (overhead lights, loud conversations, unnecessary alarms) per facility protocol.
• Teach iron-rich foods (e.g., lean red meat, organ meats, beans, lentils, dark leafy greens, fortified cereals) per dietary preference and any provider-directed restrictions.
• Teach to pair iron-rich foods with a vitamin C source (e.g., citrus, peppers, strawberries, tomatoes) when consistent with the patient’s diet.
• Teach to separate iron intake from tea, coffee, milk, and calcium-rich foods by an interval consistent with provider direction.
• Teach B₁₂ sources (e.g., meat, fish, eggs, dairy, fortified foods) and folate sources (e.g., leafy greens, legumes, fortified grains) per diet pattern.
• Teach energy-conservation: pacing, prioritization, rest before fatigue peaks, delegation of nonessential tasks.
• Notify the provider for worsening fatigue despite ordered therapy, new neurologic symptoms (e.g., paresthesia, ataxia), or signs of bleeding.
• Coordinate follow-up CBC at the interval ordered by the provider team.

Outcome: Patient reports decreased fatigue on a 0 to 10 scale; Patient participates in ADLs with appropriate assistance; Patient reports improved sleep quality.

Nursing Diagnosis 3: Bleeding Risk

Bleeding Risk related to Anemia: Hgb < 13 g/dL men, < 12 g/dL women, < 11 g/dL pregnancy (WHO); reduced oxygen-carrying capacity as evidenced by Known or suspected active bleeding source (GI, GU, surgical, menstrual); Anticoagulant or antiplatelet therapy; Thrombocytopenia (platelets < 100 K/µL); Coagulopathy (INR > 1.5, prolonged PTT); History of recurrent bleeding.

Interventions

• Assess for overt bleeding each shift: gums, nose, IV sites, surgical sites, stool, urine, emesis, and menstrual flow.
• Monitor vital signs per facility protocol; obtain orthostatic vitals before first ambulation when ordered.
• Inspect skin for petechiae, ecchymoses, and hematomas; note any new or expanding bruising.
• Test stool and emesis for occult blood per facility protocol and provider order.
• Trend Hgb and Hct on the interval ordered by the provider team when active bleeding is suspected.
• Monitor PT/INR, PTT, platelet count, and fibrinogen per provider order.
• Implement bleeding precautions per facility protocol: soft toothbrush, electric razor, avoidance of rectal temps or suppositories when feasible, and minimization of IM injections.
• Apply prolonged manual pressure to venipuncture and injection sites per facility protocol.
• Hold anticoagulants and antiplatelets only when ordered; document the hold and the provider’s rationale.
• Maintain large-bore IV access when ordered for possible volume or blood product resuscitation.
• Coordinate with blood bank for type & screen or type & cross per provider order; prepare blood products per facility protocol.
• Administer ordered reversal agents (e.g., vitamin K, FFP, prothrombin complex concentrate, platelets) as ordered per provider direction, pharmacy guidance, and facility protocol.
• Teach the patient and family bleeding precautions: avoid OTC NSAIDs and aspirin unless prescribed, use a soft toothbrush, and avoid contact sports.
• Teach when to seek emergency care: vomiting blood or coffee-ground material, black or bloody stools, heavy menstrual flow soaking pads quickly, severe headache, or syncope.
• Notify the provider promptly for SBP drop, sustained tachycardia, falling Hgb, or any new overt bleeding.
• Coordinate GI, GU, or surgical consultation per provider order based on the suspected bleeding source.

Outcome: No new or worsening bleeding identified during shift; Hgb and Hct stable or trending up on serial labs; Vital signs monitored and reported within ordered parameters.

Nursing Diagnosis 4: Impaired Self Feeding

Body Nutrition Deficit Risk related to Anemia: Hgb < 13 g/dL men, < 12 g/dL women, < 11 g/dL pregnancy (WHO); reduced oxygen-carrying capacity as evidenced by Iron, B₁₂, or folate intake below recommended daily allowance; Restrictive diet (vegan, vegetarian without supplementation); Malabsorption (celiac, IBD, gastric bypass, atrophic gastritis); Increased demand (pregnancy, lactation, growth); Chronic alcohol use.

Interventions

• Obtain a 24-hour diet recall and a typical-week diet history.
• Assess for nutrition-related risk factors: vegetarian or vegan diet, gastric bypass, celiac or IBD, alcohol use, age > 65, pregnancy.
• Screen for food insecurity using a standardized screening tool per facility protocol.
• Monitor weight, BMI, and albumin/prealbumin trends as available.
• Trend serial iron studies, B₁₂, folate, and reticulocyte count per provider order.
• Administer oral or parenteral iron, B₁₂, and folate as ordered per provider direction, pharmacy guidance, and facility protocol.
• Support oral-iron timing per provider direction (commonly 1 hour before or 2 hours after meals, paired with a vitamin C source when ordered).
• Coordinate registered-dietitian consult per provider order or facility protocol.
• Coordinate referrals to food-assistance programs (e.g., SNAP, WIC, food banks) when food insecurity is identified, per facility social-work workflow.
• Teach iron-rich foods appropriate to the patient’s diet (e.g., lean red meat, liver, poultry, fish, beans, lentils, tofu, fortified cereals, spinach, pumpkin seeds).
• Teach to pair non-heme iron with a vitamin C source (e.g., bell peppers, citrus, strawberries, tomatoes, broccoli) when consistent with the patient’s diet.
• Teach to separate oral iron from coffee, tea, milk, calcium supplements, and antacids by an interval consistent with provider direction.
• Teach B₁₂ sources (e.g., animal products, fortified plant milks, nutritional yeast) and folate sources (e.g., leafy greens, legumes, fortified grains, citrus) appropriate to the patient’s diet.
• Teach common side effects of oral iron and self-management strategies (e.g., constipation, dark stools, GI upset).
• Reinforce that lab improvement can be gradual (reticulocytes commonly rise within 7 to 10 days, Hgb within 2 to 4 weeks, ferritin over months).
• Notify the provider for limited response to oral iron after 4 weeks of therapy or for new neurologic symptoms that may suggest B₁₂ deficiency.
• Coordinate follow-up CBC, ferritin, B₁₂, and folate on the interval ordered by the provider team.

Outcome: Patient verbalizes iron-rich foods and B₁₂/folate sources appropriate to their diet before discharge; Patient demonstrates oral-iron timing with a vitamin C source and separation from calcium/tea/coffee when consistent with provider direction; Hgb, ferritin, B₁₂, and folate are monitored and trended on follow-up labs per provider order.

Nursing Diagnosis 5: Risk For Fall

Fall Risk related to Anemia: Hgb < 13 g/dL men, < 12 g/dL women, < 11 g/dL pregnancy (WHO); reduced oxygen-carrying capacity as evidenced by Orthostatic hypotension from anemia and volume status; Fatigue and generalized weakness; Tachycardia and reduced oxygen delivery to brain; Age > 65; Polypharmacy (sedatives, antihypertensives, diuretics).

Interventions

• Complete a fall-risk assessment (e.g., Morse or equivalent) on admission and at intervals matched to facility protocol.
• Obtain orthostatic vital signs before first ambulation each shift when ordered or per facility protocol.
• Assess gait, balance, and lower-extremity strength.
• Review the medication list for fall-risk drugs (e.g., sedatives, antihypertensives, diuretics, opioids).
• Implement the facility fall-prevention bundle: bed in low position, brakes locked, call light within reach, non-skid socks, adequate lighting.
• Place a high-fall-risk identifier (e.g., band, signage) per facility policy.
• Implement scheduled toileting (e.g., every 2 hours) for patients with urinary urgency, per facility protocol.
• Provide standby or contact-guard assistance for transfers and ambulation until activity tolerance is established, per facility protocol.
• Teach the patient to dangle on the edge of the bed for an interval (commonly at least 1 minute) before standing, per facility protocol.
• Teach the patient to call for help before getting out of bed, even for the bathroom.
• Teach home fall-prevention strategies: remove loose rugs, install grab bars when feasible, use night-lights, keep walkways clear.
• Educate the family on safe transfer and supervision techniques.
• Notify the provider for any fall (witnessed or unwitnessed); complete a post-fall assessment and incident report per facility protocol.
• Coordinate PT/OT consult per provider order for gait, balance, and home-safety evaluation.

Outcome: No falls during admission; Patient uses call light before getting out of bed; Patient demonstrates safe position-change technique (e.g., dangle before standing).

Nursing Diagnosis 6: Knowledge Deficit

Knowledge Deficit related to Anemia: Hgb < 13 g/dL men, < 12 g/dL women, < 11 g/dL pregnancy (WHO); reduced oxygen-carrying capacity as evidenced by New diagnosis of anemia or new chronic-anemia management plan; Unfamiliarity with iron, B₁₂, or folate replacement and expected timeline; Limited prior teaching on transfusion or ESA therapy; Language, literacy, or cultural barriers to standard teaching materials; Patient or family request for additional information.

Interventions

• Assess the patient’s current understanding of their anemia, including their understanding of the cause and the plan of care.
• Assess preferred language, literacy level, and learning style.
• Assess cultural, religious, and dietary considerations that may affect the teaching plan.
• Identify potential teaching barriers: pain, fatigue, anxiety, cognitive impairment, sensory deficits.
• Use teach-back to confirm understanding of each major teaching point.
• Provide written, picture-based, or video teaching materials at an appropriate reading level, in the patient’s preferred language per facility resources.
• Coordinate interpreter services per facility protocol for patients with limited English proficiency.
• Reinforce teaching at each interaction, in small segments matched to the patient’s stamina.
• Teach the patient about their specific type of anemia in plain language, using the cause and plan their provider team has shared.
• Teach the role, expected effect, and common side effects of each ordered therapy (e.g., oral iron, IV iron, B₁₂, folate, ESA, transfusion), in coordination with the provider team and pharmacy.
• Reinforce realistic timelines for improvement (reticulocytes commonly rise within 7 to 10 days, Hgb within 2 to 4 weeks, and iron stores over months).
• Teach when to call the clinic vs. when to seek emergency care: black or bloody stools, vomiting blood, heavy bleeding, chest pain, syncope, severe new dyspnea.
• Reinforce the importance of follow-up labs and clinic visits per the provider team’s plan.
• Notify the provider when the patient or family verbalizes a significant misunderstanding or a barrier the nurse cannot resolve at the bedside.
• Coordinate referrals to diabetes education, dietitian, pharmacist, or chronic-disease management programs when ordered or available per facility protocol.

Outcome: Patient and family verbalize the cause of the patient’s anemia in their own words; Patient verbalizes the role of any ordered therapy (e.g., oral iron, IV iron, B₁₂, folate, ESA, transfusion) per provider teaching; Patient verbalizes signs that should prompt a call to the clinic or emergency care.

Anemia is a reduction in circulating red blood cell mass that lowers the blood’s oxygen-carrying capacity. Three mechanisms drive it. Decreased production: iron, B₁₂, or folate deficiency; bone-marrow failure (aplastic, infiltrative, MDS); chronic kidney disease with low erythropoietin (EPO); and anemia of chronic disease. Increased destruction (hemolysis): sickle cell, thalassemia, autoimmune hemolytic anemia, G6PD deficiency, and mechanical fragmentation. Blood loss: acute trauma, GI bleeding, menstrual loss, or surgical hemorrhage. MCV classifies anemia morphologically: microcytic (< 80), including iron deficiency, thalassemia, late anemia of chronic disease, and sideroblastic patterns; normocytic (80 to 100), including acute blood loss, early anemia of chronic disease, CKD, and hemolysis; macrocytic (> 100), including B₁₂/folate deficiency, hypothyroidism, liver disease, MDS, and drug-induced patterns. Tissue hypoxia can drive compensatory tachycardia, tachypnea, and peripheral vasoconstriction; sustained chronic anemia can produce high-output cardiac failure. Acute anemia is tolerated far worse than gradual chronic anemia. Workup and transfusion thresholds follow ASH guidance and the AABB 2023 transfusion recommendations; specific thresholds and replacement decisions are set by the provider team and facility protocol.

• Transfusion threshold (AABB 2023): Hgb < 7 non-bleeding stable; < 8 cardiac/symptomatic
• Ferritin (iron deficiency): < 30 ng/mL diagnostic; < 100 with inflammation
• Reticulocyte %: > 2% can support appropriate response; < 2% can suggest production failure
• MCV classification: < 80 micro · 80 to 100 normo · > 100 macro
• Acute vs chronic: Chronic Hgb 7 may be asymptomatic; acute drop can be dangerous

• Makic, M. B. F., & Martinez-Kratz, M. R. (Eds.). (2023). Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (13th ed.). Elsevier.
• Carson, J. L., Stanworth, S. J., Guyatt, G., et al. (2023). Red Blood Cell Transfusion: 2023 AABB International Clinical Practice Guidelines. JAMA, 330(19), 1892–1902.
• Camaschella, C. (2019). Iron Deficiency. Blood, 133(1), 30–39.
• Stoffel, N. U., Cercamondi, C. I., Brittenham, G., et al. (2017). Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. The Lancet Haematology, 4(11), e524–e533.