A patient with a history of iron deficiency anemia presents with pallor, dizziness, and a systolic murmur. Laboratory tests reveal microcytic anemia with low ferritin levels. Despite treatment with ferrous sulfate, her symptoms persist. Which of the following should the nurse prioritize in the care plan to address the suspected underlying issue?

D) Arrange for diagnostic tests to rule out gastrointestinal bleeding or malabsorption issues.

A) Increase the dosage of ferrous sulfate to improve hemoglobin levels.

B) Assess the patient's dietary intake and educate on foods high in iron to enhance absorption.

C) Schedule a blood transfusion to quickly raise hemoglobin levels.

D) Arrange for diagnostic tests to rule out gastrointestinal bleeding or malabsorption issues.

A nurse is planning discharge teaching for a patient with iron deficiency anemia, as described in the case. Which of the following dietary recommendations should the nurse emphasize to enhance the patient's iron absorption?

B) Consume foods high in vitamin C, such as citrus fruits, alongside iron-rich foods.

A) Increase intake of dairy products with each meal to boost calcium and vitamin D.

B) Consume foods high in vitamin C, such as citrus fruits, alongside iron-rich foods.

C) Drink coffee or tea with meals to aid in digestion and absorption of nutrients.

D) Focus on high-fiber foods alone to improve gastrointestinal health and iron absorption.

A patient with chronic anemia and recent findings of a gastric ulcer is experiencing increased fatigue, shortness of breath, and mild bilateral pitting edema. Which nursing intervention is most appropriate to prioritize in this situation?

B) Monitor the patient's vital signs and assess for signs of worsening heart failure.

A) Educate the patient on dietary sources of iron to improve anemia.

B) Monitor the patient's vital signs and assess for signs of worsening heart failure.

C) Encourage ambulation to prevent deep vein thrombosis due to lower extremity edema.

D) Administer oral iron supplements as prescribed to address the patient's anemia.

A patient with iron deficiency anemia and signs of congestive heart failure is being treated with intravenous iron therapy and proton pump inhibitors for a gastric ulcer. Which nursing intervention is most critical to prioritize in this patient's care plan?

A) Monitor the patient's blood pressure and heart rate closely to assess for potential cardiac complications.

B) Educate the patient on dietary sources of iron to enhance oral iron intake once stable.

C) Encourage the patient to increase physical activity gradually to improve cardiovascular fitness.

D) Schedule the patient for regular blood transfusions to maintain hemoglobin levels.

A patient with chronic anemia and recent bleeding events is experiencing symptoms of early systolic dysfunction and frequent premature ventricular contractions (PVCs). The medical team has initiated an ACE inhibitor and a beta-blocker. Which nursing intervention is most appropriate to address the patient's current condition?

B) Monitor the patient for signs of hyperkalemia due to ACE inhibitor therapy.

A) Encourage increased fluid intake to support cardiac output.

B) Monitor the patient for signs of hyperkalemia due to ACE inhibitor therapy.

C) Advise the patient to avoid all physical activity to prevent exacerbation of symptoms.

D) Suggest dietary sodium restriction to manage potential edema.

A patient with a history of chronic anemia and recent bleeding events is experiencing symptoms of heart failure, and an echocardiogram shows a mild reduction in left ventricular ejection fraction. The patient is on intravenous iron therapy and has been started on an ACE inhibitor and a beta-blocker. During a follow-up, the patient reports dizziness and palpitations. What is the most appropriate nursing intervention to address these symptoms?

D) Discuss with the healthcare provider the possibility of adjusting the beta-blocker dosage.

A) Educate the patient about the importance of adherence to the medication regimen.

B) Schedule the patient for regular ECG monitoring to assess the frequency of PVCs.

C) Advise the patient to increase dietary iron intake to improve anemia symptoms.

D) Discuss with the healthcare provider the possibility of adjusting the beta-blocker dosage.

A patient with a history of heart failure and iron deficiency anemia presents with persistent fatigue, occasional shortness of breath upon exertion, and frequent PVCs noted on Holter monitoring. The medical team has adjusted her beta-blocker dosage and emphasized lifestyle modifications. What should the nurse prioritize in the plan of care to address the patient's symptoms and prevent complications?

B) Educate the patient about the importance of adhering to the adjusted beta-blocker dosage and monitoring her heart rate.

A) Encourage the patient to increase fluid intake to improve hydration and reduce edema.

B) Educate the patient about the importance of adhering to the adjusted beta-blocker dosage and monitoring her heart rate.

C) Advise the patient to reduce physical activity to prevent exacerbation of shortness of breath.

D) Suggest the patient consume a high-sodium diet to maintain electrolyte balance and support cardiac function.

A patient with a history of iron deficiency anemia and cardiac arrhythmias is experiencing persistent fatigue and occasional shortness of breath upon exertion. Her recent Holter monitor indicated frequent PVCs, some in couplets. Which nursing intervention is most appropriate to address her current symptoms and potential complications?

B) Educate the patient on gradually increasing physical activity levels to enhance cardiovascular fitness.

A) Encourage the patient to increase dietary sodium intake to improve circulatory volume.

B) Educate the patient on gradually increasing physical activity levels to enhance cardiovascular fitness.

C) Suggest the patient reduce fluid intake to manage mild bilateral ankle edema effectively.

D) Advise the patient to avoid all physical activity until her cardiac symptoms completely resolve.

A patient with a history of anemia and cardiovascular issues presents with persistent fatigue and exertional dyspnea despite treatment adjustments. Recent lab results indicate a plateau in hemoglobin levels and a slight elevation in BNP. What should be the primary focus of the nurse's next assessment to address the patient's symptoms?

C) Assess for signs of fluid overload and heart failure exacerbation.

A) Evaluate the patient's adherence to the iron supplementation regimen.

B) Monitor the patient's response to the increased dosage of beta-blockers.

C) Assess for signs of fluid overload and heart failure exacerbation.

D) Review the patient's dietary intake to ensure adequate iron consumption.

A patient with a history of iron-deficiency anemia and PVCs is being evaluated for persistent fatigue and exertional dyspnea despite treatment adjustments. Her hemoglobin has plateaued at 11.2 g/dL, and serum ferritin is 65 ng/mL. Which nursing intervention is most appropriate to address her symptoms and potential underlying issues?

C) Monitor for signs of heart failure and collaborate with cardiology for tailored treatment adjustments.

A) Increase dietary intake of vitamin C to enhance iron absorption.

B) Implement a high-intensity exercise regimen to improve cardiovascular function.

C) Monitor for signs of heart failure and collaborate with cardiology for tailored treatment adjustments.

D) Discontinue beta-blocker therapy to reduce fatigue and improve energy levels.

Iron Deficiency Anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Iron deficiency anemia results from insufficient iron for hemoglobin synthesis, leading to reduced oxygen transport capacity. Iron is crucial for forming hemoglobin, the protein in red blood cells responsible for oxygen delivery to tissues.

• Secondary mechanism: Decreased iron availability often stems from inadequate dietary intake, malabsorption (e.g., celiac disease), or chronic blood loss (e.g., gastrointestinal bleeding). This insufficient iron supply disrupts erythropoiesis, causing the production of smaller, pale red blood cells (microcytic, hypochromic anemia).

• Key complication: The resulting anemia can lead to symptoms such as fatigue, pallor, and shortness of breath, affecting patients' daily activities and quality of life. If untreated, it may cause more severe complications like heart failure due to increased cardiac workload.

Patient Profile

Demographics:

32-year-old female, school teacher

History:

• Key past medical history: History of heavy menstrual bleeding, diagnosed with iron deficiency anemia 2 years ago

• Current medications: Ferrous sulfate 325 mg once daily, oral contraceptive pill

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and shortness of breath over the past month

• Key symptoms: Fatigue, dizziness, palpitations, pale skin, brittle nails, occasional headaches

• Vital signs: Blood pressure 100/60 mmHg, heart rate 105 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F

Section 1

As the clinical team conducted an initial assessment, they noted several critical findings that warranted further investigation. The patient's pallor was pronounced, and her conjunctiva appeared pale, consistent with her history of iron deficiency anemia. Auscultation of the heart revealed a systolic murmur, likely a result of increased cardiac output to compensate for reduced oxygen-carrying capacity. Given her symptoms of dizziness and palpitations, an ECG was performed, showing sinus tachycardia without other acute abnormalities. Despite being on ferrous sulfate and an oral contraceptive, which could have potentially mitigated her blood loss, her symptoms had progressed, suggesting a potential issue with iron absorption or additional sources of blood loss.

Initial laboratory results revealed a hemoglobin level of 8.5 g/dL, significantly lower than the normal range, and a mean corpuscular volume (MCV) of 72 fL, confirming microcytic anemia. Ferritin levels were markedly decreased at 10 ng/mL, indicating depleted iron stores. Further tests were ordered to rule out malabsorption syndromes such as celiac disease, as well as occult gastrointestinal bleeding, which could be contributing to her chronic anemia. The team also considered the possibility of increased menstrual bleeding despite the contraceptive pill, potentially necessitating a gynecological evaluation.

The medical team discussed these findings with the patient, emphasizing the need for dietary adjustments to enhance iron intake and adherence to her current treatment regimen. They also planned for a follow-up to re-evaluate her response to iron supplementation and to explore alternative treatments if her condition did not improve. This situation required careful monitoring to prevent progression to more severe complications, such as cardiac strain or heart failure, and to improve her overall quality of life. The team scheduled her for an upper and lower endoscopy to investigate potential sources of gastrointestinal bleeding, which could be a hidden cause of her persistent anemia.

Section 2

As the days progressed, the patient returned for a follow-up appointment, presenting with new symptoms that required immediate attention. She reported experiencing increased fatigue, shortness of breath during minimal exertion, and swelling in her lower extremities. On examination, her vital signs indicated a resting heart rate of 110 beats per minute and blood pressure of 100/60 mmHg. Notably, the patient had developed mild bilateral pitting edema, and her jugular venous pressure was elevated, suggesting early signs of congestive heart failure, likely exacerbated by her chronic anemia.

The results of the endoscopic procedures revealed a small gastric ulcer with signs of recent bleeding, potentially contributing to her iron deficiency. Additionally, the biopsy taken during the endoscopy showed evidence of atrophic gastritis, which could be impairing her ability to absorb iron. These findings necessitated a change in her treatment plan to address both the source of bleeding and the absorption issues. The medical team decided to initiate intravenous iron therapy to rapidly replenish her iron stores, while simultaneously managing her gastric ulcer with proton pump inhibitors and close monitoring for any further bleeding.

The patient's case highlighted the complexity of managing iron deficiency anemia with concurrent complications. The clinical team emphasized the importance of a multidisciplinary approach, involving a gastroenterologist for the management of her ulcer and a cardiologist to address her cardiac symptoms. This coordinated care aimed to stabilize her condition, prevent further deterioration, and improve her quality of life. The next steps included reassessing her cardiac function through an echocardiogram and scheduling regular follow-ups to monitor her response to the new interventions, ensuring timely adjustments to her treatment plan as necessary.

Section 3

As the patient continued her treatment, she was scheduled for an echocardiogram to assess her cardiac function, given the concerning symptoms of edema and elevated jugular venous pressure. The echocardiogram revealed a mild reduction in left ventricular ejection fraction, indicating early systolic dysfunction likely exacerbated by her chronic anemia and recent bleeding events. This finding further emphasized the need to optimize her cardiac output and manage her anemia aggressively. The cardiology team recommended the initiation of an ACE inhibitor to support cardiac function and potentially reduce the progression of heart failure symptoms.

In conjunction with the cardiac assessment, a follow-up complete blood count (CBC) and serum ferritin test were conducted to evaluate her response to the intravenous iron therapy. The CBC showed a slight increase in hemoglobin levels from 9.0 g/dL to 10.2 g/dL, indicating a positive response to the iron supplementation, although her hemoglobin was still below the normal range. Serum ferritin levels had increased to 50 ng/mL, suggesting improved iron stores but underscoring the need for continued therapy and monitoring.

Despite these improvements, the patient reported experiencing intermittent palpitations and dizziness, prompting further investigation. An electrocardiogram (ECG) was performed, revealing frequent premature ventricular contractions (PVCs), which could be linked to her anemia and altered cardiac function. The medical team decided to adjust her medications, adding a beta-blocker to help manage the arrhythmias and provide additional support for her heart. This adjustment aimed to alleviate her symptoms and prevent further cardiac complications, reinforcing the importance of a comprehensive and adaptive treatment plan. Regular follow-ups were scheduled to closely monitor her cardiac rhythm and overall progress, ensuring that any new developments could be swiftly addressed.

Section 4

As the treatment plan progressed, the patient returned for a scheduled follow-up appointment. During the initial assessment, the clinical team noted that her vital signs showed a blood pressure of 110/68 mmHg, a heart rate of 88 beats per minute, and a respiratory rate of 18 breaths per minute. Her oxygen saturation was 96% on room air. Physical examination revealed mild bilateral ankle edema, though less pronounced than during previous visits, suggesting some improvement in fluid retention. However, the patient reported persistent fatigue and occasional shortness of breath upon exertion. These symptoms, coupled with her ongoing palpitations, warranted a closer examination of her cardiovascular and hematologic status.

New diagnostic tests were ordered, including a repeat echocardiogram and a Holter monitor to evaluate her cardiac rhythm over 24 hours. The echocardiogram showed a stable left ventricular ejection fraction at 50%, with no significant change from previous assessments. However, the Holter monitor results indicated frequent episodes of PVCs, some occurring in couplets, which raised concerns for potential progression to more complex arrhythmias. Additionally, a repeat CBC demonstrated a further increase in hemoglobin levels to 11.0 g/dL, while serum ferritin reached 70 ng/mL, confirming a continued positive response to iron therapy.

Despite the favorable trend in hematologic parameters, the persistence of cardiac symptoms highlighted the need for further intervention. The medical team decided to adjust her beta-blocker dosage to better manage her arrhythmias and enhance her cardiac stability. They also emphasized the importance of lifestyle modifications, including dietary adjustments and a gradual increase in physical activity, to support her overall cardiovascular health. The plan included frequent monitoring and patient education on recognizing symptoms of worsening heart failure or arrhythmias, ensuring a proactive approach to her care. The patient's journey forward would focus on stabilizing her cardiac function while continuing to address her iron deficiency, aiming for a comprehensive management strategy that minimized complications and maximized quality of life.

Section 5

Several weeks later, the patient returned for another follow-up appointment, during which the clinical team conducted a thorough assessment to evaluate her response to the adjusted treatment plan. Her vital signs were stable, with a blood pressure of 112/70 mmHg, heart rate of 82 beats per minute, and respiratory rate of 16 breaths per minute. Oxygen saturation remained steady at 97% on room air. The physical examination revealed slightly reduced bilateral ankle edema, suggesting further improvement in fluid retention. Despite these positive signs, the patient reported that her fatigue persisted, albeit with less intensity, and she experienced less frequent palpitations. However, she noted that her shortness of breath on exertion had not improved, prompting the team to delve deeper into potential underlying causes.

New diagnostic results, including a second Holter monitor study, showed a decrease in the frequency of PVCs, with fewer couplets observed, indicating a partial response to the increased beta-blocker dosage. However, a repeat CBC revealed that her hemoglobin level had plateaued at 11.2 g/dL, and serum ferritin had slightly decreased to 65 ng/mL, suggesting the need for further optimization of her iron supplementation regimen. Additionally, a BNP test was ordered due to her symptoms of exertional dyspnea, which returned slightly elevated results, hinting at subclinical heart failure that required closer monitoring.

The persistence of these subtle cardiac symptoms, alongside the plateauing hematologic response, led the medical team to consider the potential for new complications, including the possibility of underlying heart failure exacerbated by her anemia. In response, a cardiology referral was initiated for a comprehensive evaluation, and a tailored exercise program was developed to cautiously enhance her physical activity tolerance without overburdening her cardiovascular system. The focus remained on a multidisciplinary approach to fine-tune her treatment plan, aiming to alleviate her symptoms and prevent further complications through vigilant monitoring and timely adjustments.