A patient presents with pale skin, conjunctival pallor, and mild pitting edema. Laboratory results indicate microcytic anemia with low serum ferritin and elevated TSH levels. Despite iron supplementation, anemia persists. What should the nurse prioritize in the assessment to address the underlying cause of anemia?

B) Assess for signs of gastrointestinal bleeding or malabsorption.

A) Evaluate the patient’s dietary intake and adherence to iron supplements.

B) Assess for signs of gastrointestinal bleeding or malabsorption.

C) Monitor the patient’s thyroid hormone levels more frequently.

D) Increase the dosage of iron supplements without further investigation.

A patient with a history of hypothyroidism and anemia presents with pallor, delayed capillary refill, and lightheadedness upon standing. The lab results indicate a hemoglobin level of 9.2 g/dL, low MCV, and reduced serum ferritin, with a mildly elevated TSH. Which nursing intervention is most appropriate to address the patient's current symptoms?

B) Educate the patient on the importance of taking iron supplements with vitamin C to enhance absorption.

A) Increase dietary intake of iron-rich foods and monitor for improvement.

B) Educate the patient on the importance of taking iron supplements with vitamin C to enhance absorption.

C) Encourage the patient to take levothyroxine with meals to improve thyroid function.

D) Advise the patient to rest frequently and avoid sudden position changes to manage lightheadedness.

A patient with newly diagnosed celiac disease is experiencing persistent anemia despite oral iron supplementation. Which of the following nursing interventions is most appropriate to address her condition?

B) Educate the patient on adhering to a strict gluten-free diet to promote intestinal healing.

A) Advise the patient to take oral iron supplements with meals to enhance absorption.

B) Educate the patient on adhering to a strict gluten-free diet to promote intestinal healing.

C) Recommend increasing dietary intake of foods rich in vitamin C to improve iron absorption.

D) Suggest discontinuing iron supplements as they are ineffective for this patient.

A patient with newly diagnosed celiac disease is receiving counseling on dietary changes to improve her nutrient absorption. Which nursing intervention is most appropriate to support the patient in managing her condition?

B) Educate the patient on identifying and avoiding foods containing gluten.

A) Instruct the patient to increase fiber intake to aid in digestion.

B) Educate the patient on identifying and avoiding foods containing gluten.

C) Suggest the patient limit fluid intake to prevent bloating.

D) Recommend a high-calcium diet to prevent osteoporosis.

A patient with celiac disease on a gluten-free diet and intravenous iron therapy presents with intermittent abdominal discomfort, diarrhea, and mild hypokalemia. Fecal calprotectin levels are elevated, suggesting intestinal inflammation. What is the most appropriate nursing intervention to address the patient's hypokalemia in the context of her symptoms?

A) Encourage the patient to consume potassium-rich foods such as bananas and spinach.

B) Administer oral potassium supplements as prescribed by the physician.

C) Instruct the patient to increase fluid intake to prevent further dehydration.

D) Recommend a gluten-free, high-fiber diet to manage diarrhea symptoms.

A patient with celiac disease on a gluten-free diet presents with new symptoms of intermittent abdominal discomfort and diarrhea. Lab results show mild hypokalemia and elevated fecal calprotectin levels. Which of the following nursing interventions is most appropriate to address the patient's current condition?

B) Collaborate with the dietitian to increase the patient's dietary potassium intake and monitor electrolyte levels.

A) Educate the patient on the importance of strict gluten avoidance to prevent further intestinal inflammation.

B) Collaborate with the dietitian to increase the patient's dietary potassium intake and monitor electrolyte levels.

C) Advise the patient to restrict their fluid intake to manage diarrhea and prevent electrolyte imbalances.

D) Encourage the patient to increase fiber intake to promote normal bowel movements and alleviate diarrhea.

A patient with suspected Type 1 refractory celiac disease is being considered for corticosteroid therapy to manage intestinal inflammation. Which nursing action is most important to prioritize when initiating corticosteroid treatment in this patient?

A) Monitor the patient's blood glucose levels regularly.

B) Educate the patient on the importance of a gluten-free diet.

C) Encourage the patient to increase fluid intake.

D) Schedule regular weight measurements to assess for weight gain.

A patient with refractory celiac disease is experiencing increased diarrhea, abdominal pain, fatigue, and mild weight loss despite adherence to a gluten-free diet. The healthcare team is considering the introduction of corticosteroids to manage her intestinal inflammation. Which nursing intervention is most important to implement in conjunction with corticosteroid therapy?

B) Monitor the patient's blood sugar levels regularly.

A) Educate the patient on the importance of reducing sodium intake.

B) Monitor the patient's blood sugar levels regularly.

C) Encourage the patient to increase fluid intake to prevent dehydration.

D) Instruct the patient to avoid all sources of dietary gluten.

A patient undergoing corticosteroid therapy for inflammatory bowel disease reports new symptoms of dizziness and palpitations upon standing. Her recent laboratory results indicate hypokalemia and mild anemia. What is the most appropriate nursing intervention to prioritize in this scenario?

D) Administer prescribed oral potassium supplements to address hypokalemia.

A) Increase dietary fiber intake to address abdominal symptoms.

B) Educate the patient on the importance of slowly changing positions to manage orthostatic hypotension.

C) Recommend the patient to increase fluid intake to manage dehydration.

D) Administer prescribed oral potassium supplements to address hypokalemia.

A patient on corticosteroid therapy for chronic abdominal pain reports new symptoms of dizziness upon standing and palpitations. Laboratory tests show hypokalemia and mild anemia. Which nursing intervention should the nurse prioritize to address these symptoms?

C) Monitor orthostatic vital signs and instruct the patient on slow position changes.

A) Educate the patient about increasing dietary intake of potassium-rich foods.

B) Administer prescribed iron supplements to correct anemia.

C) Monitor orthostatic vital signs and instruct the patient on slow position changes.

D) Recommend a high-protein diet to improve nutritional status.

anemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Reduced red blood cell (RBC) production occurs when the bone marrow fails to produce enough RBCs, often due to deficiencies in essential nutrients like iron, vitamin B12, or folate, leading to impaired oxygen transport capacity.

• Secondary mechanism: Increased RBC destruction, known as hemolysis, can be triggered by conditions such as autoimmune disorders or genetic abnormalities (e.g., sickle cell disease), causing premature RBC breakdown and leading to a shortage of functional RBCs.

• Key complication: Decreased oxygen delivery to tissues results in symptoms like fatigue, pallor, and shortness of breath, as the body struggles to meet its metabolic needs due to insufficient oxygen supply.

Patient Profile

Demographics:

45-year-old female, school teacher

History:

• Key past medical history: Iron-deficiency anemia diagnosed 2 years ago, hypothyroidism

• Current medications: Levothyroxine 75 mcg daily, ferrous sulfate 325 mg once daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Fatigue and shortness of breath

• Key symptoms: Dizziness, palpitations, pale skin, mild swelling in the ankles

• Vital signs: Blood pressure 105/70 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 98.6°F

Section 1

As the patient's evaluation progresses, the initial assessment findings reveal a concerning pattern. On physical examination, the patient's skin appears noticeably pale, and conjunctival pallor is evident. Her capillary refill time is slightly delayed, suggestive of poor peripheral perfusion. Auscultation of the heart reveals a soft systolic murmur, likely a flow murmur secondary to anemia. Her lung examination is unremarkable, with clear breath sounds bilaterally, despite her reported shortness of breath. Observations of her lower extremities confirm mild pitting edema in the ankles. Neurologically, the patient exhibits no focal deficits, but she reports feeling lightheaded when moving from sitting to standing positions.

Laboratory tests are ordered, and the results highlight further concerns. The complete blood count (CBC) shows a hemoglobin level of 9.2 g/dL, a decrease from her last recorded level of 11.5 g/dL six months ago. Her mean corpuscular volume (MCV) is low at 75 fL, consistent with microcytic anemia. Serum ferritin levels are significantly reduced, indicating a possible depletion of iron stores. Additional tests reveal a mildly elevated thyroid-stimulating hormone (TSH) level at 6.8 mIU/L, hinting at potential suboptimal thyroid function management, which could exacerbate her fatigue. The reticulocyte count is low, suggesting inadequate bone marrow response.

These findings prompt a review of her current management plan. The persistence of anemia despite iron supplementation raises questions about potential malabsorption issues or insufficient dosage. The combination of hypothyroidism and anemia requires careful balancing, as both conditions can contribute to her symptoms. As the team considers adjusting her treatment regimen, further investigations such as a gastrointestinal evaluation for potential sources of blood loss or malabsorption and a review of her adherence to medication and dietary recommendations are warranted. This comprehensive approach aims to address the underlying causes of her anemia and improve her overall condition.

Section 2

As the clinical team delves deeper into the patient's condition, a gastrointestinal evaluation is conducted to explore potential sources of blood loss or malabsorption. An upper endoscopy and colonoscopy reveal no overt sources of bleeding, such as ulcers or polyps. However, the small bowel biopsy obtained during the endoscopy shows histological changes consistent with celiac disease, which can lead to malabsorption of nutrients, including iron. This finding provides a critical insight into the underlying cause of her persistent anemia despite iron supplementation.

In light of the new diagnosis of celiac disease, the patient is counseled on the importance of adhering to a strict gluten-free diet to facilitate intestinal healing and improve nutrient absorption. The interdisciplinary team, including a dietitian, works closely with her to develop a personalized nutrition plan. Additionally, the patient is started on a higher dose of intravenous iron therapy to more effectively replenish her iron stores, given the impaired absorption through oral routes.

Over the next few weeks, the patient's response to interventions is closely monitored. Her hemoglobin levels gradually improve, reaching 10.0 g/dL, and she reports a noticeable reduction in fatigue and lightheadedness. Her thyroid function is also reassessed, and her levothyroxine dosage is adjusted to optimize thyroid hormone levels, further alleviating her fatigue. With these targeted interventions, the patient's overall condition stabilizes, and she experiences an improvement in her quality of life. This progress, however, emphasizes the need for ongoing monitoring and management of her celiac disease to prevent future complications and maintain her health.

Section 3

As the patient continues her gluten-free diet and intravenous iron therapy, the clinical team remains vigilant for any new developments. Despite initial improvements, a follow-up visit reveals that the patient has begun experiencing intermittent abdominal discomfort and diarrhea. Concerned about these new symptoms, the team orders a comprehensive metabolic panel and stool studies to evaluate her electrolyte balance and screen for potential infections or malabsorption issues unrelated to gluten intake.

Lab results indicate mild hypokalemia, with her potassium level dropping to 3.2 mEq/L, suggesting a possible electrolyte imbalance due to gastrointestinal losses. In addition, fecal calprotectin levels are elevated, indicating ongoing intestinal inflammation. These findings prompt the team to consider whether the patient might be experiencing additional complications, such as refractory celiac disease or another form of inflammatory bowel condition that could be exacerbating her symptoms.

Given the new data, the team decides to adjust the patient's treatment plan. She is referred to a gastroenterologist for further evaluation to rule out other gastrointestinal disorders. In the interim, her dietitian works with her to ensure adequate potassium intake through dietary modifications. The patient is also advised to maintain a symptom diary to help identify any potential dietary triggers or patterns that could be contributing to her condition. This ongoing assessment and tailored intervention aim to address the underlying issues while preventing further complications, ensuring the patient can maintain her improved quality of life.

Section 4

As the patient continues with her gluten-free diet and intravenous iron therapy, her symptoms evolve despite the team's vigilant monitoring. During a routine follow-up with the gastroenterologist, the patient reports increased frequency of diarrhea and persistent abdominal pain, now accompanied by fatigue and mild weight loss. Her vital signs indicate a slightly elevated heart rate of 98 beats per minute, while her blood pressure remains stable at 118/76 mmHg. The gastroenterologist conducts a physical examination, noting mild tenderness in the lower abdomen but no guarding or rebound tenderness.

The clinical team proceeds with an enhanced diagnostic approach, including an upper endoscopy with biopsies, to further investigate the possibility of refractory celiac disease or another underlying inflammatory condition. The results reveal persistent villous atrophy despite adherence to a gluten-free diet, raising suspicion for Type 1 refractory celiac disease. Additionally, serum studies demonstrate a slight increase in inflammatory markers, including a C-reactive protein level of 12 mg/L. These findings suggest ongoing inflammation that may not be solely attributed to gluten ingestion, warranting a more comprehensive exploration of her gastrointestinal health.

In light of these results, the team considers introducing corticosteroids to manage the intestinal inflammation while maintaining vigilant monitoring for potential side effects. The patient's dietary plan is further refined to ensure adequate caloric intake and nutritional balance, with particular attention to foods rich in potassium to address her mild hypokalemia. The patient is encouraged to continue her symptom diary, which, combined with the new diagnostic information, will guide future treatment adjustments. This strategic approach aims to alleviate her current symptoms and prevent further progression of any underlying conditions, ensuring her path to improved health is both informed and proactive.

Section 5

As the patient embarks on her new treatment regimen with corticosteroids, the clinical team closely monitors her response to this intervention. Over the next few weeks, she reports some improvement in abdominal pain and a slight decrease in the frequency of diarrhea, suggesting a partial response to the corticosteroids. However, she continues to experience significant fatigue and now presents with new symptoms, including occasional palpitations and dizziness upon standing. Her recent vitals show a heart rate that varies between 95 and 110 beats per minute, and her blood pressure is noted to have a postural drop, measuring 112/70 mmHg when supine but dropping to 98/66 mmHg upon standing, indicating orthostatic hypotension.

Laboratory tests reveal persistent mild anemia with hemoglobin levels at 10.2 g/dL, despite ongoing iron therapy, and a further decrease in serum potassium to 3.2 mmol/L, suggesting worsening hypokalemia. These findings prompt the team to reassess her electrolyte management and consider the potential side effects of corticosteroids, such as fluid shifts and electrolyte imbalances. Additionally, her serum albumin level is slightly decreased at 3.1 g/dL, raising concerns about her nutritional status and the effectiveness of her dietary modifications.

In response to these developments, the healthcare team intensifies their focus on electrolyte repletion and nutritional support, ensuring the patient receives adequate potassium supplementation and protein-rich dietary options. They also explore the possibility of adding a mineralocorticoid receptor antagonist to help manage her orthostatic symptoms. These adjustments aim to stabilize her condition and alleviate her new symptoms, reinforcing the need for a multifaceted approach to address both her chronic and emerging health challenges. The team remains vigilant in their follow-up, ready to adapt the treatment plan as necessary to optimize the patient’s recovery trajectory and improve her quality of life.