A patient with worsening anemia and a hemoglobin level of 8.5 g/dL presents with dizziness, palpitations, and an elevated heart rate. Given the current findings of low serum ferritin, low serum iron, and elevated TIBC, which nursing intervention is the most appropriate to prioritize in the care plan?

C) Advise the patient to rise slowly from a sitting or lying position to prevent dizziness.

A) Encourage the patient to maintain a high-calcium diet to support bone health.

B) Instruct the patient to take iron supplements with meals to minimize gastrointestinal upset.

C) Advise the patient to rise slowly from a sitting or lying position to prevent dizziness.

D) Suggest the patient increase fluid intake to manage the elevated heart rate.

A patient with iron deficiency anemia is experiencing dizziness and palpitations, particularly when standing. Her hemoglobin level is 8.5 g/dL, and she has been instructed to take iron supplements with vitamin C while avoiding calcium-rich foods. Which nursing intervention is most appropriate to address her symptoms of orthostatic hypotension?

C) Instruct the patient to rise slowly from a sitting or lying position to prevent dizziness.

A) Encourage the patient to increase her fluid intake to maintain blood volume.

B) Advise the patient to take her iron supplements with meals to enhance absorption.

C) Instruct the patient to rise slowly from a sitting or lying position to prevent dizziness.

D) Recommend the patient avoid physical activity until her hemoglobin levels improve.

A patient with anemia and orthostatic hypotension is receiving IV iron therapy and IV fluids. Which nursing intervention should the nurse prioritize to effectively address the patient's immediate hemodynamic instability?

C) Assist the patient to sit or stand slowly to prevent falls.

A) Monitor the patient's blood pressure and heart rate every four hours.

B) Encourage oral intake of fluids to complement the IV therapy.

C) Assist the patient to sit or stand slowly to prevent falls.

D) Administer oxygen therapy to support oxygen delivery to tissues.

A patient with confirmed anemia and orthostatic hypotension is being treated with IV iron therapy and IV fluids. Which additional nursing intervention should be prioritized to ensure the patient's safety and prevent complications?

C) Monitor the patient's orthostatic vital signs closely to assess for improvement.

A) Encourage the patient to ambulate frequently to improve circulation.

B) Educate the patient about increasing dietary iron intake to support IV therapy.

C) Monitor the patient's orthostatic vital signs closely to assess for improvement.

D) Prepare the patient for a blood transfusion to rapidly increase hemoglobin levels.

A patient with anemia and low blood pressure has developed increased abdominal pain and guarding in the epigastric region. What is the nurse's priority intervention at this time?

D) Notify the healthcare provider immediately about the change in condition

A) Increase the rate of IV fluids to address hypotension

B) Administer prescribed pain medication to manage abdominal pain

C) Prepare the patient for an urgent imaging study as ordered

D) Notify the healthcare provider immediately about the change in condition

A patient with a history of gastrointestinal bleeding is being monitored for anemia and has developed new symptoms of increased abdominal pain and guarding, with a palpable mass in the left upper quadrant. What is the nurse's priority action in response to these new findings?

B) Notify the healthcare provider immediately to report the new abdominal findings.

A) Administer additional IV fluids to stabilize the patient's blood pressure.

B) Notify the healthcare provider immediately to report the new abdominal findings.

C) Reassess the patient's hemoglobin and hematocrit levels to evaluate the need for more blood products.

D) Encourage the patient to stay in a supine position to prevent orthostatic hypotension.

A patient with a suspected bleeding gastric ulcer and potential perforation is experiencing tachycardia and hypotension despite fluid resuscitation. What is the nurse's priority intervention at this time?

B) Prepare the patient for emergent endoscopy

A) Administer additional IV fluids

B) Prepare the patient for emergent endoscopy

C) Monitor vital signs every 30 minutes

D) Request a complete blood count (CBC)

A patient presents with a 4 cm mass in the gastric antrum suggestive of a bleeding gastric ulcer, moderate free fluid in the abdominal cavity, and a hemoglobin level of 7.9 g/dL. The patient is tachycardic with a heart rate of 118 bpm and hypotensive at 88/54 mmHg. Despite fluid resuscitation, the patient's blood pressure remains low. What is the nurse's priority intervention to stabilize the patient while awaiting endoscopic intervention?

D) Transfuse packed red blood cells to manage ongoing blood loss.

A) Administer a vasopressor to maintain blood pressure.

B) Prepare the patient for immediate surgery as recommended by the surgical team.

C) Continue aggressive fluid resuscitation with crystalloid solutions.

D) Transfuse packed red blood cells to manage ongoing blood loss.

A patient presenting with a perforated gastric ulcer and signs of peritonitis is being prepared for surgical intervention. What nursing action is most critical to perform prior to surgery to prevent further deterioration of the patient's condition?

C) Insert a nasogastric tube for gastric decompression

A) Administer prescribed proton pump inhibitor intravenously

B) Monitor vital signs and assess for signs of shock

C) Insert a nasogastric tube for gastric decompression

D) Ensure the patient is adequately hydrated with IV fluids

A patient with a large bleeding gastric ulcer and suspected perforation is being prepared for potential surgical intervention. Which nursing intervention is most crucial in preventing further deterioration of the patient's condition at this time?

A) Administering a proton pump inhibitor to reduce gastric acid secretion.

B) Monitoring for signs of increased abdominal distension and pain.

D) Assessing the patient's pain level and administering analgesics as ordered.

IDA - Nursing Case Study

Pathophysiology

• Primary mechanism: Iron deficiency anemia (IDA) primarily occurs due to insufficient iron levels, which are essential for hemoglobin synthesis. Without adequate iron, the body cannot produce enough healthy red blood cells, leading to decreased oxygen transport capacity.

• Secondary mechanism: Chronic blood loss, often from gastrointestinal sources or heavy menstruation, exacerbates iron depletion. This ongoing loss depletes iron stores faster than they can be replenished through dietary intake or absorption.

• Key complication: Reduced oxygen delivery to tissues can lead to fatigue, pallor, and shortness of breath. If left untreated, IDA may cause significant impacts on cardiovascular function, increasing the risk of heart complications due to compensatory mechanisms like tachycardia.

Patient Profile

Demographics:

34-year-old female, school teacher

History:

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

• Current medications: Levothyroxine 50 mcg daily, ferrous sulfate 325 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and dizziness over the past month

• Key symptoms: Palpitations, shortness of breath on exertion, pale skin, brittle nails

• Vital signs: Blood pressure 100/60 mmHg, heart rate 112 bpm, respiratory rate 22 breaths per minute, temperature 98.6°F

Section 1

As the healthcare team continues to monitor the patient, a set of new diagnostic results reveals a hemoglobin level of 8.5 g/dL, significantly lower than the normal range, indicating worsened anemia. Serum ferritin, a marker of iron stores, is markedly low at 10 ng/mL, confirming depleted iron reserves. Additionally, the serum iron level is diminished at 30 mcg/dL, and the total iron-binding capacity (TIBC) is elevated at 450 mcg/dL, reflecting the body's compensatory effort to capture more iron from circulation. Thyroid function tests show a stable thyroid-stimulating hormone (TSH) level of 2.5 mIU/L, suggesting that hypothyroidism is not contributing to her current symptoms.

These findings prompt the clinical team to consider the possibility of ongoing chronic blood loss as a contributing factor to the patient's worsening condition. A fecal occult blood test is ordered to assess for gastrointestinal bleeding, while further gynecological evaluation is recommended to explore the possibility of menorrhagia. The patient is also advised to continue her iron supplementation and dietary modifications to enhance iron absorption, such as taking ferrous sulfate with vitamin C and avoiding calcium-rich foods around the time of iron intake.

Despite these interventions, the patient begins to experience new complications. She reports increased episodes of dizziness and palpitations, particularly when standing, suggesting orthostatic hypotension as a result of her anemia and low blood pressure. Her heart rate remains elevated, now consistently above 110 bpm, indicating the heart's increased workload to compensate for inadequate oxygen delivery. This progression highlights the critical need for identifying and addressing the underlying cause of her iron deficiency to prevent further cardiovascular strain and deterioration of her overall health status.

Section 2

As the patient's symptoms progress, the healthcare team conducts a more thorough assessment to evaluate her current status. Vital signs reveal a blood pressure reading of 88/56 mmHg when lying down and a significant drop to 76/48 mmHg upon standing, confirming the presence of orthostatic hypotension. Her heart rate is persistently elevated at 118 bpm, and she exhibits mild tachypnea with a respiratory rate of 22 breaths per minute. These findings are consistent with compensatory mechanisms for her anemia and highlight the need for immediate intervention to address her unstable hemodynamics.

A repeat complete blood count (CBC) shows a further decline in hemoglobin to 7.9 g/dL, while hematocrit is now at 24%, both reinforcing the severity of her anemia. Additional lab tests indicate an elevated reticulocyte count of 4.5%, suggesting that her bone marrow is responding to the anemia but is unable to keep up with the demand for new red blood cells. Electrolyte panel results are normal, ruling out electrolyte imbalances as a cause for her dizziness and palpitations. The fecal occult blood test returns positive, indicating a likely source of chronic gastrointestinal bleeding, necessitating further investigation through endoscopy.

In response to these findings, the clinical team prioritizes stabilizing the patient's condition while planning for endoscopic evaluation. Intravenous (IV) iron therapy is initiated to rapidly replenish her iron stores, given the ineffectiveness of oral supplementation due to ongoing blood loss. Additionally, the patient is placed on IV fluids to support her blood pressure and improve circulation. These interventions aim to alleviate her symptoms and prevent further cardiovascular complications. The team also consults with a gastroenterologist to expedite the investigation and management of the bleeding source, emphasizing the need for a multidisciplinary approach to prevent further deterioration of her health.

Section 3

Over the next 24 hours, the patient's response to the interventions is closely monitored. The administration of IV iron and fluids begins to yield some positive changes. Her hemoglobin levels show a modest improvement, rising to 8.3 g/dL, and her hematocrit increases to 26%. These changes, although slight, are a hopeful sign of stabilization. The patient reports feeling marginally less fatigued, and her dizziness has lessened somewhat, indicating an initial response to the treatment. However, her vital signs remain concerning, with her blood pressure still low at 92/58 mmHg while lying down and experiencing a significant drop upon standing. Despite the interventions, her heart rate remains elevated at 110 bpm, and her respiratory rate is 20 breaths per minute, which signals ongoing compensatory mechanisms.

As the team awaits the scheduled endoscopy, the patient's condition takes an unexpected turn. She begins to experience increased abdominal pain and tenderness, particularly in the epigastric region. Her abdominal examination reveals guarding and a palpable mass in the left upper quadrant, raising the suspicion of a potential complication such as a bleeding gastric ulcer or a mass effect from another source. This development prompts an urgent reevaluation of her condition, including additional imaging studies to assess for possible acute abdominal pathology that may need immediate surgical intervention.

The clinical team is faced with the challenge of addressing these new complications while continuing to manage her anemia and hemodynamic instability. They recognize the importance of swiftly identifying and resolving the source of her gastrointestinal bleeding to prevent further deterioration. This situation reinforces the need for a dynamic, multidisciplinary approach, involving close collaboration with gastroenterology and potentially surgical teams, to ensure comprehensive care and to guide the next steps in her treatment plan.

Section 4

As the clinical team continues to monitor the patient closely, they proceed with urgent imaging studies to further investigate the newly developed abdominal symptoms. A CT scan of the abdomen and pelvis is promptly conducted, revealing a concerning finding: a 4 cm mass in the gastric antrum with surrounding edema, suggestive of a bleeding gastric ulcer. The imaging also indicates a moderate amount of free fluid in the abdominal cavity, raising suspicion for potential perforation or significant hemorrhage. These new results necessitate immediate consultation with the gastroenterology and surgical teams to evaluate the need for urgent endoscopic intervention or possible surgical exploration.

In parallel, the patient's lab work exhibits further deterioration. Her hemoglobin level, previously showing slight improvement, has now decreased back to 7.9 g/dL, indicating ongoing blood loss. Her white blood cell count has risen to 15,000/mm³, signaling an inflammatory or stress response. The patient continues to experience tachycardia with a heart rate of 118 bpm, and her blood pressure remains precariously low at 88/54 mmHg despite fluid resuscitation efforts. These findings underscore the severity of her condition and the critical need for rapid intervention to stabilize her hemodynamic status and address the underlying cause of her gastrointestinal bleeding.

The clinical team, recognizing the urgency of the situation, decides to prioritize an emergent endoscopy, hoping to achieve both diagnostic clarity and therapeutic control of the bleeding site. The possibility of surgical intervention is also being considered, contingent on the endoscopic findings. This decision-making process highlights the importance of interdisciplinary collaboration and the need for swift, decisive action to prevent further complications. The patient's journey continues to unfold with the team poised to adapt their strategies in real-time based on her evolving clinical picture.

Section 5

As the clinical team moves forward with the emergent endoscopy, additional assessment findings provide critical insights into the patient's worsening condition. Upon physical examination, the patient's abdomen is noted to be increasingly distended with diffuse tenderness, particularly in the epigastric region, and rebound tenderness is observed, suggesting peritoneal irritation. Bowel sounds are hypoactive, which may indicate paralytic ileus or impending bowel compromise due to the suspected perforation. The patient's skin is cool and clammy, and her level of consciousness is slightly diminished, with episodes of confusion and lethargy, raising concerns about perfusion to vital organs.

The emergent endoscopy reveals a large bleeding ulcer in the gastric antrum, consistent with the imaging findings. Active arterial bleeding is noted at the ulcer base, prompting immediate endoscopic intervention with cauterization and clipping to achieve hemostasis. Despite these efforts, oozing persists, and visual confirmation of a small perforation at the ulcer site is obtained. This discovery necessitates urgent surgical consultation, as the risk of worsened perforation and generalized peritonitis remains high. Concurrently, the team initiates broad-spectrum antibiotics to mitigate the risk of infection and continues aggressive fluid resuscitation to maintain hemodynamic stability.

Laboratory tests post-intervention show a slight improvement in hemoglobin, now at 8.1 g/dL following transfusion, but the patient's inflammatory markers, including C-reactive protein and procalcitonin, are markedly elevated, confirming a significant inflammatory response. The patient's lactate level is also increased at 4.0 mmol/L, indicative of tissue hypoperfusion and potential sepsis. The evolving clinical picture underscores the complexity of her condition, necessitating close monitoring and potential surgical intervention to prevent further deterioration. The team remains vigilant, prepared to adapt their management strategies as they await the surgical team's assessment and decision for potential exploratory laparotomy.