A patient with iron deficiency anemia is admitted for intravenous iron therapy due to symptomatic anemia. Which nursing intervention is most critical to monitor for adverse reactions during the administration of intravenous iron?

B) Assess for signs of anaphylactic reaction during the first 15 minutes of infusion

A) Monitor blood pressure and heart rate every 30 minutes

B) Assess for signs of anaphylactic reaction during the first 15 minutes of infusion

C) Encourage increased fluid intake to prevent dehydration

D) Monitor hemoglobin levels daily to assess response to treatment

A patient with iron deficiency anemia is being treated with intravenous iron therapy due to significant symptoms and low serum ferritin levels. Which clinical finding would indicate a positive response to the treatment?

A) Decreased reticulocyte count

C) Presence of hyperchromic red blood cells

D) Persistent systolic flow murmur

A patient receiving intravenous iron therapy for anemia reports mild chest discomfort and increased dyspnea on the third day of treatment. Her hemoglobin shows modest improvement, but serum iron and transferrin saturation remain low. An ECG reveals sinus tachycardia without signs of ischemia, and her blood pressure has dropped slightly. What is the most appropriate initial nursing intervention?

C) Notify the healthcare provider about the potential cardiac strain.

A) Administer supplemental oxygen to alleviate dyspnea.

B) Increase the rate of intravenous iron infusion to improve hemoglobin levels.

C) Notify the healthcare provider about the potential cardiac strain.

D) Encourage the patient to increase ambulation to improve circulation.

A patient receiving intravenous iron therapy for anemia reports mild chest discomfort and dyspnea on the third day of treatment. Her hemoglobin shows modest improvement, but her serum iron levels and transferrin saturation remain low. What is the most appropriate nursing action to address her current symptoms and prevent further complications?

C) Notify the healthcare provider for further cardiac evaluation.

A) Administer supplemental oxygen to improve oxygenation.

B) Increase the rate of iron infusion to enhance hemoglobin recovery.

C) Notify the healthcare provider for further cardiac evaluation.

D) Encourage increased oral fluid intake to support blood volume.

A patient is receiving treatment for iron deficiency anemia secondary to chronic gastrointestinal blood loss. Despite interventions, the patient continues to experience elevated heart rate, mild dyspnea at rest, and episodes of lightheadedness. Which nursing intervention should be prioritized to address the patient's current symptoms?

B) Administer supplemental oxygen to improve tissue oxygenation

A) Encourage increased oral fluid intake to maintain hydration

B) Administer supplemental oxygen to improve tissue oxygenation

C) Educate the patient on slow position changes to prevent orthostatic hypotension

D) Increase the intravenous iron supplementation to enhance hemoglobin levels faster

A patient with gastric ulcers and active bleeding is being treated with proton pump inhibitors and intravenous iron supplementation. The patient reports lightheadedness upon standing and mild dyspnea at rest. Her heart rate averages 95 beats per minute, and blood pressure is 98/58 mmHg. Which nursing intervention should be prioritized to address the patient's current symptoms?

C) Suggest the patient perform slow position changes from lying to standing to prevent orthostatic hypotension.

A) Encourage increased fluid intake to maintain hydration and improve blood pressure.

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

C) Suggest the patient perform slow position changes from lying to standing to prevent orthostatic hypotension.

D) Monitor for signs of infection at the IV site to prevent complications from intravenous therapy.

A patient with chronic anemia is showing signs of cardiovascular strain, including dizziness, palpitations, and an elevated heart rate. Her hemoglobin levels have only modestly improved after intravenous iron supplementation, and her iron saturation remains low. What is the most appropriate nursing intervention to prioritize at this time?

C) Monitor vital signs closely and assess for symptoms of orthostatic hypotension.

A) Administer a blood transfusion to rapidly increase hemoglobin levels.

B) Encourage the patient to increase oral iron intake to boost iron stores.

C) Monitor vital signs closely and assess for symptoms of orthostatic hypotension.

D) Advise the patient to rest and avoid physical exertion to reduce cardiac workload.

A patient with chronic anemia has shown modest improvements in hemoglobin levels despite intravenous iron supplementation. She is experiencing episodes of dizziness and palpitations, with a repeat ECG showing occasional premature ventricular contractions. Her heart rate and blood pressure indicate orthostatic hypotension. What should be the nurse's priority action in managing this patient's condition?

D) Prepare the patient for a blood transfusion as ordered by the healthcare provider to address the low hemoglobin more rapidly.

A) Educate the patient about increasing dietary iron intake to support the current treatment plan.

B) Monitor the patient's orthostatic blood pressures and report significant changes to the healthcare provider.

C) Recommend the patient to rest and avoid activities that may exacerbate dizziness and palpitations.

D) Prepare the patient for a blood transfusion as ordered by the healthcare provider to address the low hemoglobin more rapidly.

A patient with chronic anemia due to angiodysplasia is experiencing persistent tachycardia and hypotension. As the nurse in the multidisciplinary team, what is the most appropriate priority intervention to address her current cardiovascular status?

B) Initiate a transfusion of packed red blood cells to rapidly increase hemoglobin levels.

A) Administer intravenous fluids to increase blood volume and improve blood pressure.

B) Initiate a transfusion of packed red blood cells to rapidly increase hemoglobin levels.

C) Implement a high-sodium diet to retain fluid and increase blood pressure.

D) Encourage bed rest and gradual mobilization to minimize cardiovascular strain.

A patient with chronic anemia and suspected angiodysplasia is undergoing evaluation and treatment. Her vital signs show tachycardia and hypotension, and she experiences fatigue with minimal exertion. Based on this case, what should the nurse prioritize when assessing this patient’s response to treatment interventions?

B) Check for stabilization of blood pressure and heart rate within normal limits.

A) Monitor for signs of improved exercise tolerance and reduced fatigue.

B) Check for stabilization of blood pressure and heart rate within normal limits.

C) Evaluate for resolution of gastrointestinal symptoms such as bleeding or abdominal pain.

D) Assess for better adherence and tolerance to iron supplementation regimen.

iron deficiency anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Iron deficiency anemia primarily results from inadequate iron supply, which is crucial for hemoglobin synthesis in red blood cells. Without sufficient iron, the body cannot produce enough healthy hemoglobin, leading to reduced oxygen transport capacity in the blood.

• Secondary mechanism: Compensatory increase in erythropoiesis occurs as the body attempts to produce more red blood cells to counteract the anemia. However, due to the lack of iron, these cells are often smaller and less effective (microcytic and hypochromic), further impairing oxygen delivery.

• Key complication: Chronic iron deficiency can lead to significant fatigue, decreased immune function, and in severe cases, it can cause cardiac stress as the heart works harder to supply adequate oxygen to tissues, manifesting in symptoms such as tachycardia and shortness of breath.

Patient Profile

Demographics:

42-year-old female, office manager

History:

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

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

• Allergies: Penicillin (rash)

Current Presentation:

• Chief complaint: Fatigue and shortness of breath

• Key symptoms: Dizziness, palpitations, pale complexion, and brittle nails

• Vital signs: Blood pressure 110/70 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 98.6°F, oxygen saturation 94% on room air

Section 1

As part of the initial assessment, the healthcare team conducts a thorough evaluation to better understand the severity of the patient's iron deficiency anemia and its impact on her overall health. Upon examination, the patient exhibits marked pallor, particularly noticeable in the conjunctiva and nail beds, consistent with anemia. Auscultation reveals a systolic flow murmur at the left sternal border, a common finding in patients with significant anemia due to increased cardiac output. Her capillary refill is slightly delayed, indicating potential poor peripheral perfusion.

Laboratory tests are ordered to assess the patient's current hematological status. The complete blood count (CBC) reveals a hemoglobin level of 8.5 g/dL and a hematocrit of 26%, confirming moderate anemia. Mean corpuscular volume (MCV) is notably low at 70 fL, indicative of microcytic anemia. Serum ferritin is significantly decreased at 10 ng/mL, reinforcing the diagnosis of iron deficiency anemia. Additionally, the peripheral blood smear shows hypochromic, microcytic red blood cells. The reticulocyte count is elevated, suggesting an ongoing compensatory response to anemia.

Based on these findings, the healthcare team recognizes the need to intensify management strategies to address the patient's anemia and its complications. Given the patient's symptomatic presentation, including tachycardia and dyspnea, the decision is made to initiate intravenous iron therapy to rapidly replenish iron stores. This is complemented by continued oral iron supplementation and monitoring of her menstrual cycle to assess if further intervention is needed to control her heavy periods. The team plans to reassess her clinical status and laboratory values in the coming days to evaluate the effectiveness of the treatment and make any necessary adjustments.

Section 2

In the days following the initiation of intravenous iron therapy, the patient's status is closely monitored for both improvement and potential complications. Initially, she reports a slight increase in energy levels, and her heart rate has decreased slightly, now measuring at 90 beats per minute. However, on the third day of treatment, the patient begins to experience new symptoms, including mild chest discomfort and an increase in dyspnea, particularly noticeable during ambulation. These developments raise concerns about potential cardiac strain, as her heart is working harder to compensate for the anemia.

A follow-up examination and additional diagnostic tests are promptly conducted. A repeat CBC shows a modest improvement in hemoglobin, now at 9.2 g/dL, indicating some response to the iron therapy. However, her serum iron levels remain low, and her transferrin saturation has not improved as expected, suggesting malabsorption or ongoing blood loss. An ECG is performed to assess the chest discomfort, revealing sinus tachycardia without signs of ischemia, but the increased cardiac workload remains a concern. Additionally, her blood pressure has dropped slightly to 100/60 mmHg, and her capillary refill time remains delayed.

The combination of these findings suggests that while the patient is responding to treatment, her underlying condition is more complex than initially anticipated. The healthcare team considers potential causes for her persistent symptoms, including gastrointestinal sources of blood loss or malabsorption issues, and plans for further diagnostic investigations such as an upper GI endoscopy. The team also discusses the possibility of consulting a cardiologist to ensure that her cardiac symptoms are adequately managed and do not escalate into more severe complications. This comprehensive approach aims to address both the primary and secondary causes of her anemia, ensuring a holistic management plan.

Section 3

Following the decision to pursue further diagnostic investigations, the patient undergoes an upper GI endoscopy, which reveals the presence of gastric ulcers with active bleeding, providing a potential source for her ongoing anemia. Biopsies are taken to rule out any malignant causes, and Helicobacter pylori testing is conducted. Concurrently, a fecal occult blood test is performed and returns positive, further supporting the suspicion of gastrointestinal blood loss. These findings suggest that the patient's iron deficiency anemia is likely secondary to chronic blood loss from the gastrointestinal tract.

In response to the new diagnostic results, the healthcare team initiates a treatment plan that includes proton pump inhibitors to promote ulcer healing and eradicate any potential Helicobacter pylori infection if present. The patient is also started on a more aggressive regimen of intravenous iron supplementation to replenish her iron stores more effectively. The cardiologist is consulted to monitor her cardiac status closely, ensuring that the heart is not unduly strained as her hemoglobin levels gradually improve.

Despite these targeted interventions, the patient's condition requires vigilant monitoring. Her heart rate remains elevated, averaging around 95 beats per minute, and she continues to experience mild dyspnea at rest. Her blood pressure remains at the lower end of normal, with readings of approximately 98/58 mmHg, and she reports episodes of lightheadedness upon standing. These symptoms indicate that while the source of blood loss is being addressed, her cardiovascular system remains under stress, necessitating ongoing evaluation and adjustment of her treatment plan. This comprehensive management strategy underscores the importance of addressing both the immediate complications and the underlying causes of her anemia, ensuring a trajectory towards recovery.

Section 4

As the healthcare team continues to monitor the patient's response to the interventions, new complications arise. Over the next few days, the patient's hemoglobin levels show only modest improvements, rising from 8.2 g/dL to 8.6 g/dL. Despite receiving intravenous iron supplementation, her iron saturation remains low at 12%, and ferritin levels are still below the expected range, indicating that iron stores are not being replenished as anticipated. There is concern that the chronic blood loss might be more significant than initially estimated or that absorption issues are present.

Additionally, the patient's symptoms evolve; she begins to experience more frequent episodes of dizziness and palpitations, particularly upon exertion. A repeat electrocardiogram (ECG) reveals occasional premature ventricular contractions, which may suggest that her cardiovascular system is under continued strain due to low hemoglobin levels and iron deficiency. Her heart rate remains elevated, now averaging 100 beats per minute, and her blood pressure dips further to 92/55 mmHg, raising concerns about orthostatic hypotension and increased cardiac workload.

Given these developments, the healthcare team decides to reassess her treatment plan. They consider the possibility of more aggressive interventions, such as a blood transfusion, to stabilize her hemoglobin levels more rapidly and alleviate cardiac stress. Additionally, further investigations, including a repeat endoscopy or capsule endoscopy, are contemplated to ensure no new sources of bleeding have developed. The team also explores the possibility of collaborating with a hematologist to fine-tune her iron supplementation strategy and evaluate her for less common causes of refractory anemia. These steps underscore the dynamic nature of her condition and the necessity for adaptive management strategies to prevent further complications.

Section 5

As the healthcare team decides to conduct further diagnostic evaluations, they initiate a capsule endoscopy to investigate potential sources of chronic blood loss that might have been missed in prior assessments. The results reveal multiple small vascular lesions in the small intestine, suggestive of angiodysplasia, which could account for the ongoing blood loss and refractory nature of her anemia. This finding prompts a multidisciplinary discussion involving a gastroenterologist to determine the most appropriate intervention, which may include endoscopic coagulation or other therapeutic approaches to address these lesions effectively.

In parallel, the collaboration with a hematologist leads to a reevaluation of her iron supplementation regimen. The hematologist recommends a more individualized approach, potentially incorporating higher doses of intravenous iron or exploring alternative formulations to enhance absorption and replenish iron stores more efficiently. Additionally, the hematologist suggests testing for less common conditions, such as iron-refractory iron deficiency anemia (IRIDA), to rule out genetic factors that could be contributing to the patient's persistent low iron levels despite supplementation.

The patient’s clinical status remains fragile, with her vital signs indicating continued cardiovascular strain. Her heart rate is persistently elevated, now averaging 105 beats per minute, and she experiences pronounced fatigue with minimal exertion. Her blood pressure remains low, fluctuating between 90/50 mmHg and 95/55 mmHg. These findings, coupled with her lab results and new diagnostic insights, guide the healthcare team in refining her management plan to prevent further complications and improve her overall condition. The next steps will involve continuous monitoring, targeted interventions for the identified intestinal lesions, and ongoing adjustments to her iron therapy to ensure her hemoglobin levels and iron stores improve adequately, thus mitigating the risk of further cardiovascular compromise.