5 Nursing care plan for Anemia and Anemia nursing management - Nurse Mitra Low Hemoglobin NCLEX Review and Nursing Care Plans. From kenya, Hey,Im a BsN student at kabarak university,Kenya.this article has been of great help.Thanks. Apply pressure over the site as appropriate when bleeding occurs.Bleeding can be stopped by applying pressure to allow blood to clot. (2020). Low hemoglobin levels can be detrimental to a patients performance, mobility, and overall health. Maintenance of adequate tissue perfusion. your express consent. The patient will express understanding about the different methods to decrease activity intolerance. hi, Im a student nurse from Malawi, thank you for putting this together. Hypotension occurs in anemia because of hypoperfusion. 3rd Edition. In certain pathophysiologic states such as severe anemia, the rate of adequate oxygen delivery is impaired. Locate the cause and stop the bleeding.Early identification and intervention through imaging, procedures, or surgery can prevent internal bleeding and worsening complications. Hemoglobin level : Nursing2020 Critical Care - LWW Nielsen OH, Ainsworth M, Coskun M, Weiss G. Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease: A Systematic Review. Instruct on low-impact ways the client can stay active such as short walks, stretching, or light yoga. 4. Increased LDH 5 hepatitis, cirrhosis, liver cancer, NV: 8 - 38 u/lDecreased Values acute renal disease, beriberi, DM, ketoacidosis, pregnancy, Increased Values MI, post cardiac surgery, liver disease ( hepatitis, cirrhosis, cancer, tumor); skeletal muscle disease, pancreatitis, Interventions for Increased Values check patients medication list for liver toxic drugs, IM injections cause false high values, assess patient for S&S of liver disease & MI, 1. Your red blood cells carry oxygen throughout your body. She found a passion in the ER and has stayed in this department for 30 years. Need Help with Careplan low Hemoglobin from surgery. Impaired Gas Exchange Nursing Diagnosis & Care Plan Medical-surgical nursing: Concepts for interprofessional collaborative care. Anemia can be temporary or long term and can range from mild to severe. If that's your situation, they'll treat your anemia with supplements. Fatigue can affect a person's motivation to perform activities and makes him/her vulnerable to a sedentary lifestyle. Give IV fluids to the dehydrated pt.3. Nursing Diagnosis: Ineffective Tissue Perfusion (Renal) related to low levels of cellular components required for oxygen delivery secondary to chronic anemia as evidenced by hemoglobin level of 6.9 g/dL. 3. Nursing Care Plans: Nursing Diagnosis and Intervention. Instruct the client about medications that may stimulate RBC production in the bone marrow.Recombinant human erythropoietin (rHuEPO), a hematological growth factor, increases hemoglobin and decreases the need for RBC transfusions. To promote compliance with prescribed therapy: Included in the expected patient outcomes are the following: Health education is the main focus during discharge and for the home care. 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. The article has been of great help well summarized and easy to understand, good work thank. The patient should be taught about time management and organization that will help the patient conserve and reduce fatigue. A value greater than 20 g/dL (200 g/L) can lead to obstruction of the capillaries as a result of hemoconcentration. Learn how your comment data is processed. Option D:Indirect bilirubin is elevated because the released hemoglobin is converted in large part to bilirubin. Enforce strict compliance in taking iron supplements as prescribed by the physician. Hemoglobin (Hb), the main component of erythrocytes (red blood cells [RBCs]), serves as the vehicle for the transportation of oxygen and carbon dioxide. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. A patient with thrombocytopenia or low platelet count is caused by the patients bone marrow deficiencies that happen because of nutritional deficiencies, drugs, viral causes, or aplastic anemia. Hemodial Int. The client will verbalize the reduction of fatigue, as evidenced by reports of increased energy and ability to perform desired activities. Nursing Diagnosis: Risk for Infection related to low hemoglobin secondary to pernicious anemia. Clinical alert An Hb value less than 5.0 g/dL (50 g/L) can lead to heart failure and death. Included below are affiliate links from Amazon at no additional cost from you. In 2010, anemia accounted for 68.4 million years of life lived with disability or 9% of the total global disability burden from all conditions. To promote WBC production. 7. Encourage the patient to ask for help.The patient may be reluctant to ask for help with self-care or household responsibilities. Stress the need for regular medical and laboratory follow-up to evaluate disease progression and response to therapies. Healthcare providers treat low hemoglobin by diagnosing the underlying cause. 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. Get useful, helpful and relevant health + wellness information. 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. You often lose some blood during hemodialysis treatments and blood testing. A patient with anemia has decreased hemoglobin levels of 9 to 11 g/dL. Administer blood products as indicated.A blood transfusion may be indicated for patients with low hemoglobin and bleeding. 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). 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. Check and monitor the patient platelet count and check for the presence of thrombocytopenia. The client will verbalize understanding of the use of energy conservation principles. GI Tests iodine contrast dyes should be scheduled before bariumstudies, 2. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! The patient will demonstrate improved wellness as indicated by the absence of fever and within the normal WBC count. St. Louis, MO: Elsevier. Adequate rest periods can reduce fatigue and promote activity tolerance. Yes, Published source:Gastroenterology. Desired Outcome: The patient will express comprehension of energy conservation. B. Ecchymosis. Patients with IDA should receive noninvasive testing for H. pylori and celiac disease. Women: 12.0 to 16.0 g/dL or 120 to 160 g/L. Low Hemoglobin Nursing Diagnosis and Nursing Care Plan - NurseStudy.Net It is the iron pigment that combines readily with oxygen and gives blood its characteristic red color. Sometimes, women have low hemoglobin levels when they have their periods. Silvestri, L. A. And determine if the patient or their family members are able to comprehend the new medical terminology. The therapist also can help the client and family evaluate the need for additional energy-conservation measures in the home setting. Based on the assessment data, major nursing diagnosis for patients with anemia include: The major goals for a patient with anemia include: Nursing interventions are based on the data assessed by the nurse and on the symptoms that the patient manifests. Aerobic exercise significantly reduces fatigue; however, the role of resistance training and alternative forms of exercise are less clear (Shambhavi & Lobo, 2021). Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. 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. Cleveland Clinic is a non-profit academic medical center. Fatigue. 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. Anemia is usually discovered and quantified by measurement of the RBC count, hemoglobin concentration, and hematocrit (Maakaron & Besa, 2021). Metabolic Acidosis Nursing Diagnosis and Nursing Care Plan, Hypothermia Nursing Diagnosis and Nursing Care Plan. This threshold . The following are measures to prevent anemia, especially in highly vulnerable patient groups: 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. In this article we will discuss nursing care and anemia nursing care plans. 2018. 2. C. 9 to 11 g/dL. In severe cases, blood transfusions may be necessary. Reviewed: May 4, 2022. Many things affect hemoglobin levels. Changes in O 2 percentages should be in 5% to 10% increments. 2. Have them prioritize and complete the most important tasks when energy reserves are highest. Anemia. The patient will be able to express decreased fatigue, as evidenced by increased energy and ability to do desired activities and tasks. Please try again soon. During esophagogastroduodenoscopy, routine gastric biopsies are not recommended. Other causes of low hemoglobin include: Signs and symptoms of low hemoglobin include: A complete blood count, including red blood cell count and hemoglobin level, can help confirm low hemoglobin and other blood cell abnormalities. 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. Although autoimmune atrophic gastritis can be diagnosed by gastric biopsy, it has not been shown to improve long-term outcomes. S&S cardiac dysrhythmias, flattened T waves, prominent U waves, weakness, paralysis, dizziness, hyporeflexia, ileus, decreased bowel sounds and deep tendon reflexes, confusion, 2. The nurse should instruct and explain that these risk factors should be avoided. Explain to the patient the importance of proper daily hygiene, mouth care, and perineal care. 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. 8. Low Hgb/Hct leads to anemia. Iron is necessary for the production of hemoglobin, which carries oxygen in the blood. Inability to maintain the usual level of physical activity. Otherwise, scroll down to view this completed care plan. Advice the patient to perform a gradual increase of activities and range of motion exercises as tolerated by the patient. Option B:Dyspnea occurs in anemia because the body is starving for oxygen that should have been carried by hemoglobin in the red blood cells towards the body tissues. The presence of bruises and petechiae usually happens when the patients platelet counts drop. Its simple and well summarised. After negative bidirectional endoscopy results, the AGA suggests noninvasive testing and treatment for H. pylori in IDA by urea breath testing, although stool antigen testing and serology can also be used. D. Hypertension. Your message has been successfully sent to your colleague. to maintaining your privacy and will not share your personal information without This handbook is designed for practicing nurses and nursing students, providing guidance in selecting appropriate nursing diagnoses and writing care plans. These medications treat certain viruses. The patient will practice preventative actions such as hand washing to lower the risk of infection. Treatment for Low Hemoglobin - Health Hearty Nursing diagnoses handbook: An evidence-based guide to planning care. Fatigue can be brought on by a variety of medical disorders including anemia that results in the patients inability to tolerate physical activities and exercise, but in particular, tissue hypoxia caused by normocytic anemia is a known cause of fatigue. Hb also serves as an important buffer in the extracellular fluid. Check the patients skin for the presence of bruises and petechiae. 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. Ensure that the patients physical function improves over time and that activities be gradually raised to the point of tolerance. Check and monitor the patients oxygen saturation level and encourage deep breathing exercises and provide oxygen as prescribed by the physician. 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. The pathophysiology of anemias is drawn according to the cause of the disease. [Updated 2022 Aug 8]. As an Amazon Associate I earn from qualifying purchases. Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. Examples of hemolytic anemia are the following: Based on the following indicators, it is usually feasible to determine whether anemia is caused by the destruction or decreased production of erythrocytes. Nursing Diagnosis Risk for bleeding related to low iron and abnormal RBC production as evidenced by low hemoglobin, hematocrit, and platelets. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/anemia), (https://www.ncbi.nlm.nih.gov/books/NBK558904/?msclkid=b8076e40a9e111eca812a958c9ddec1b). Buy on Amazon. Other causes of blood loss include menstrual excess or frequency, gastrointestinal bleeding, inflammatory bowel disease, and hematuria. St. Louis, MO: Elsevier. In anemic conditions Hgb will be 100% saturated, theres just not enough RBCs to effeciently exchange gas. March hemoglobinuria is a rare hemolytic disorder usually observed in young males. 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. ACCN Essentials of Critical Care Nursing. Same as EosinophilsDecreased Values - allergic reaction, hyperthyroidism, stressIncreased Values - Myeloproliferative diseases (cancer), leukemia, inflammatory process, healaing process, post surgery, asthma, cold. Goal/Desired Outcomes Short-term goal: The patient's vital signs and labs will remain stable with no worsening signs of bleeding by the end of the shift NANDA International Nursing Diagnoses: Definitions and Classification, 2021-2023, 12th Edition, has been fully revised and edited by T. Heather Herdman, Shigemi Kamitsuru, and Camila Tako Lopes. Fatigue Nursing Diagnosis and Nursing Care Plan - NurseStudy.Net This article has made it easy for me to understand. If required, adjust O 2 levels. Advise and educate the patient to eat foods rich in iron, folic acid, and vitamin B12. St. Louis, MO: Elsevier. This series is coordinated by Michael J. Arnold, MD, contributing editor. St. Louis, MO: Elsevier. A strict vegetarian diet requires iron and vitamin B12 supplementation (Maakaron & Besa, 2021). Celiac disease is another common cause of iron deficiency. B. Check the cause and the level of the patients fatigue. Shock, hypotension, or coronary and pulmonary insufficiency can occur, mostly in older adult individuals with underlying pulmonary and cardiovascular disease (Maakaron & Besa, 2021). Instruct the patient and their visitors on proper handwashing techniques. Achieve accuracy in nursing care plans with ease and confidence using Ackleys Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care, 12th Edition. Oral iron formulations appear to be similarly effective and tolerated. 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. It demonstrates how to match nursing diagnoses with client assessment findings, established medical or psychiatric diagnoses, and the current treatment plan. The patient will express his or her ability to perform activities of daily living and will be able to use energy conservation techniques. Stress the importance of frequent rest periods.Energy reserves may be depleted unless the client respects the bodys need for increased rest. Suppose the patient identifies and has signs of exertion (e.g., dyspnea, dizziness, palpitations, etc.). 1. Thank you a lot for the great work you are doing and may God bless you! Normal: 0.4% - 1.0%FXN: Phagocytic antigen/antibody responce-Alergic responce Asthma. 3. Because the red blood cells are responsible for the transport of oxygen throughout the body, it is essential that they can do their role. Monitor the patients blood indices such as hematocrit, hemoglobin, RBC counts, and special tests such as reticulocyte counts. 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. Nursing Care Plan for Low Hemoglobin 1 Fatigue Nursing Diagnosis: Fatigue related to low hemoglobin secondary to iron deficiency anemia as evidenced by dyspnea, inability to maintain usual level of physical activity, increased rest requirements, and patient's report of fatigue and lack of energy. However, the most typical manifestation is activity intolerance. Hullo, I am a student at the Aga Khan University in Uganda, Kampala doing BScM. Instruct the patient and the family members about the replacement therapy with folic acid and iron. What is considered low will vary between facilities and patients. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! #Blacklivesmatter: Leveraging family collaboration in pain management, Social media use and critical care nursing: Implications for practice. Milk and cheese. 4. In that case, the patient should stop or reduce their activity until these signs are completely reduced or diminished. There are many forms of anemia, each with its own cause. Iron deficiency anemia occurs when iron deficiency is . The patient should be advised a low-bacterial diet to protect him or her from being exposed to pathogens. D. Whole grain bread. Option C:Erythrocytes are being destroyed thus resulting in defect of erythrocyte count. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Please read our disclaimer. D. Jaundice. Monitoring the presence of systemic infections will help in preventing the risk of complications. 2. She has worked in Medical-Surgical, Telemetry, ICU and the ER. doi: 10.1097/MD.0000000000000963. Minimum hemoglobin levels are associated with fatigue while hospitalized and may help identify clients for interventions to address anemia-related fatigue (Prochaska et al., 2017). 5. 1. 2. Without anemia, the ferritin threshold for iron deficiency is uncertain. Intervention: Examine the patient for any indicators of infection and monitor his/her white blood cell count. Guidelines support transfusing clients with symptoms of anemia, such as fatigue, on the assumption that the increased oxygen delivery will improve the symptoms of anemia (Prochaska et al., 2017). We may earn a small commission from your purchase. Administer medications as indicated.Medications like iron supplements and erythropoietin replacement can help improve low hemoglobin and iron, reducing symptoms of fatigue and activity intolerance. It is critical to compare serial laboratory values to evaluate the clients progression or deterioration and identify changes before they become life-threatening. A plan that balances periods of activity with rest periods can help the client complete desired activities without adding fatigue levels. Normal hemoglobin levels are different for men and women. Individual cultural or religious restrictions and personal preferences. The AGA defines anemia as a hemoglobin level of less than 13 g per dL (130 g per L) in men and less than 12 g per dL (120 g per L) in patients who are not pregnant. On a scale of 0 to 10, ask the patient to rate his/her perceived level of exertion. The patient will express understanding about his or her condition and possible causative factors. 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. Check UO for pt. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. Nursing Interventions Nursing interventions are based on the data assessed by the nurse and on the symptoms that the patient manifests. Administer oxygen as ordered to maintain oxygen saturation above 90%. Evaluate the patients ability to carry out ADLs and the capacity to do his/her usual routine tasks. There are a few easily distinguishable symptoms of low hemoglobin and anemia, which are as follows. 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. Encourage the client to engage in physical exercise as tolerated.There is growing evidence that provides a strong indication that exercise is advantageous to cancer clients with anemia. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. These are blood disorders that affect your bodys ability to make hemoglobin and red blood cells. Observe the patients stool and urine for the presence of occult blood. The nurse should use words and languages that the patient and the family members will easily understand. doi: 10.1111/hdi.12561. As an outpatient department nurse, she has honed her skills in delivering health education to her patients, making her a valuable resource and study guide writer for aspiring student nurses. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public. Suggest that the client shower while sitting on a chair and sitting when performing tasks. Nursing Interventions and Rationales Assess for and control obvious signs of bleeding External bleeding Heavy menstruation (>1 pad per hour) GI bleed Excessive loss of blood results in decreased oxygenation and poor perfusion. 3. The patient may need a nasal cannula or other devices such as a venturi mask or opti-flow to maintain an oxygen saturation above 90%. 5. The management of anemia by nurses should be accurate and appropriate so that objectives and goals would be achieved. 9. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499994/. The most frequent symptom and complication of anemia is: A. Last reviewed by a Cleveland Clinic medical professional on 05/04/2022. 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. Assess the clients ability to perform activities of daily living (ADLs) and the demands of daily living.Fatigue can limit the clients ability to participate in self-care and perform their role responsibilities in family and society, such as working outside the home. 4. Red blood cells live about 120 days in your bloodstream. 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. Nursing interventions for Abnormal HGB Values - Flashcard Machine After normal bidirectional endoscopy, small bowel video capsule endoscopy is not recommended without symptoms because evidence of benefit is lacking. From: Low Hemoglobin. Generally speaking, a balanced diet with a focus on important nutrients is the best way to maintain healthy red blood cells and hemoglobin. Anemia is the most common hematologic disorder. Instruct and teach the patient about the bleeding precautions. Raw food, raw vegetables, and uncooked meat can harbor bacteria. The nurse should evaluate the patients ability to participate, perform self-care, and do his or her responsibilities in the family and society because this may be affected by fatigue. Elsevier, Inc. 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. Every age and every stage can be affected by anemia, and though others may consider this as a simple condition, it could blow out of proportion if left untreated. 6. The patient will show decreased risk for bleeding as evidenced by adequate levels of the platelet. Anemia - Symptoms and causes - Mayo Clinic Causes: Anemia can be caused by blood loss, decreased blood cell production, increased blood cell destruction, and hemodilution. Healthcare providers diagnose low hemoglobin by taking samples of your blood and measuring the amount of hemoglobin in it. b) Take three or more deep breaths a day. Nursing2020 Critical Care15(4):34-35, July 2020. Instruct the patient to consume iron-rich foods to help build-up hemoglobin stores. 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). Nursing Diagnosis: Deficient Knowledge related to low hemoglobin level secondary to aplastic anemia evidenced by inaccurate follow-through of instructions, questioning members of the health care team, and verbalization of inaccurate information. Term MCV - Mean Corpuscular Vol Bidirectional endoscopy (esophagogastroduodenoscopy and colonoscopy) is the primary means of evaluation for IDA, although evidence of patient-oriented benefit is lacking. Insist on the need to take frequent breaks from each task. Men: 14.0 to 17.4 g/dL or 140 to 174 g/L. 2017 Jun;21 Suppl 1:S78-S82. 5. For women, a normal level ranges between 12.3 gm/dL and 15.3 gm/dL. Low levels of platelet may occur because of the bone marrow. Usually, fatigue hinders the patients capacity to participate and fulfill their societal and familial responsibilities (e.g., working away from home), which makes it difficult to perform certain tasks. Complete blood count This blood test measures a wide range of blood components. For example, if your hemoglobin levels are low, your healthcare provider may do tests that reveal you have iron-deficiency anemia. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). St. Louis, MO: Elsevier. Hypoxia from normocytic anemia and other medical problems and situations may cause fatigue in the patient and may compromise the patients activity tolerance. Causes decreased dietary intake, IV fluid deficit, burns, diarrhea, vomiting, diuretics, hyperaldosteronism, renal disease, ascites, 3. PMID: 26061331; PMCID: PMC4616486. For men, a normal level ranges between 14.0 grams per deciliter (gm/dL) and 17.5 gm/dL. She received her RN license in 1997. Encourage the patient to verbalize feelings about his or her limitations. 1. Diagnostic procedures are important to help in diagnosing the type of anemia which will be based on the changes in the RBC levels and the findings in the bone marrow aspiration. Examine the patients current knowledge of the illness, its progress, causative variables, diagnosis, and treatment. Lack of hemoglobin change may be because of low adherence, malabsorption, or blood loss. Prepare for the possibility of a platelet transfusion when the patients platelets reach critical levels. Curtailing the precipitating exercise and using shoes with reinforced soles are helpful in preventing this form of hemoglobinuria (Maakaron & Besa, 2021). 3. Hemoglobin is a protein in the blood that carries oxygen and carbon dioxide to and from the tissues and organs back to the lungs. 21 to 25 g/dL. Results of a study demonstrate that minimum hemoglobin during hospitalization is associated with fatigue in hospitalized clients over 50 years old, and the association is stronger among clients without either sickle cell and/or gastrointestinal bleeding as comorbidities (Prochaska et al., 2017).
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