الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 235 |  |  |
| | | from | 235 | | |
Abstract
Hospital-acquired anemia (HAA) is anemia that is directly attributable to hospitalization. It is a reduction of Hb during hospitalization, as compared with the Hb on admission. There are two main factors that contribute to HAA in critically ill patients: RBCs loss and insufficient production of RBCs. Loss of RBCs can be therapeutic in the form of sampling, insertional blood loss, drugs associated with bleeding complications and situational one. Decrease RBCs production can be caused by nutritional deficiencies, erythropoietin impairment and drugs that may suppress bone marrow activity (Hayden et al., 2012).
Critical care nurses play a crucial role in reducing HAA subsequently decrease negative impact of this anemia on critically ill patients. So, CCN must be aware of the factors contributing to HAA and prevention of this factors as minimizing blood loss through excessive blood sampling or invasive line, assess patients nutritional status, evaluating the adequacy of nutritional support, and reasons impeding adequate delivery, monitoring drugs that patients may be taking that associated with increase blood loss as thrombolytic and NSAIDs drugs (Asfour et al., 2016).
Aim of the study:
This study aimed to:
Assess factors contributing to hospital acquired anemia among critically ill patients.
Research question:
This study was conducted for answering the following question:
What are the factors contributing to hospital acquired anemia among critically ill patients?
Research design:
A descriptive exploratory design was utilized for the conduction of this study.
Setting:
The present study was conducted in the critical care units at Beni –Suief University Hospital that include; general ICU, cardiac care unit (CCU) and chest ICU.
Subject:
A purposive sample of 75 newly admitted adult critically ill patients from the above mentioned sitting were included in the study according to inclusion criteria.
Tools used to accomplish the aim of this study:
Three tools were used in the current study as follows:
Tool 1-Patients’ assessment sheet:
This tool used to assess studied patients on admission, it was developed by the investigator based on literature review Smeltzer et al., (2014), and it consisted of two parts:
Part (I): Patients’ demographic data:
The investigator was assessed demographic characteristic of the studied patients as (age and gender).
Part (II): Patients’ clinical data:
The investigator recorded laboratory investigation for studied patients from patients sheets on admission as (hemoglobin, hematocrit level, total leukocyte count, red blood cells), to determine the included patients in study, in addition to their current diagnosis.
Tool 2- Factors contributing to hospital acquired anemia Assessment tool:
This tool was used to assess factors contributing to hospital acquired anemia associated intervention, and it was consist of four parts:
Part (I) Nutritional and fluid balance-related Factors:
This tool was developed by investigator after reviewed related literature Lynn, (2015) & Skipper, (2012), It was consist of two sections:
Section I: Nutrition- related factors:
The actual and ideal caloric requirements were recorded and compared daily from admission by investigator after reviewing the dietitian to determine nutritional status of studied patients
Section II: Fluid balance – related factors
The investigator recorded daily fluid intake and output for each subject patient from patients sheet to assess patients hydration status and calculate balance between intake and out put.
Part (II): Drugs –related factors:
This tool was adapted from Asfour et al., (2016) and modified by the investigator after reviewed related literature Ferris, (2017), the investigator recorded daily prescribed medication to patients during ICU stay that affects RBCs production or increase RBCs loss
Part (III): Sepsis –related factors:
This tool was developed by the investigator based on related literature Smeltzer et al. (2014), the investigator assessed indicators of sepsis for subjected patients from patients files as Temp, HR, BP, WBCs and results of ant types of cultures done for patients as (blood, sputum or urine culture).
Part (IV) blood loss –related factors (Estimation of blood loss volume):
This part was used to estimate blood loss volume during ICU stay that contribute to developing of HAA. It was consist of four sections:
Section (1) Sampling blood loss volume.
Section (2) Estimation of blood loss volume from puncture site (Invasive procedure).
Section (3) Hematoma measurement scale.
Section (4) Estimation of blood loss volume from gastrointestinal system.
Tool 3-Indicators for Hospital acquired anemia:
This tool was used to monitors indicators of HAA in critically ill patients, it was consisted of two parts:
Part (I) Hemodynamics indicators:
The investigator measured and recorded hemodynamic parameters daily from admission and assessed changes in hemodynamic parameters that considered indicator for occurring of HAA as tachycardia, tachypnea, hypotension, hypoxia, if patients connected to central venous catheter the researcher measured central venous pressure (CVP) to assess hydration status of patients because hypovolemia increase with anemic patients.
Part (II) laboratory investigation indicators:
In This part the investigator assessed laboratory investigation that considered indicators for occurrence of HAA, daily from patients files.
Results:
The results of the study showed that:
• The mean age of patients included in the study were 42±13.4 and 50.6 % of them were male as well 32.5% of anemic patients had cardiovascular disease, while 2.5% of them had gastrointestinal disorder.
• More than half (53.3%) of the studied patients had hospital acquired anaemia, and 32.5% of them had this anemia in the 5th day from admission to hospital, while 25% of them had anemia in the 3rd day from admission.
• More than three quarters (82.5%) ofstudied anemic patients were inadequate feeding as well majority (72.5) of them were enteral feeding and more than one third (35 %) of them had sepsis.
• Nearly two third (70.3%) of studied anemic patients they taken drugs increase red blood cells loss had hospital acquired anemia and more than half (68.4%) of them taken thrombolytic and anticoagulant drugs.
• The mean score of blood loss from phlebotomy at anemic patients were 153.2 ± 73.4 ml while in non anemic were 83.9± 37.1 ml. The mean of blood loss from invasive procedure in anemic patients were 71.3±132.4 ml while 11.1 ± 8.4ml in non anemic patient. The mean of blood loss from gastrointestinal tract were 287 ± 149.6ml in anemic patient while in non anemic patient were 50 ± 6.3ml.