A patient with iron deficiency anemia is receiving intravenous iron sucrose therapy. During administration, the patient reports chest discomfort and shortness of breath. Vital signs show a heart rate of 120 bpm and an SpO2 of 90% on room air. What is the nurse's priority action?

B) Stop the IV iron infusion immediately and notify the healthcare provider.

A) Administer supplemental oxygen to improve oxygenation.

B) Stop the IV iron infusion immediately and notify the healthcare provider.

C) Reassess the patient's vital signs in 15 minutes to monitor for changes.

D) Increase the rate of the IV infusion to expedite treatment.

A patient with iron deficiency anemia is experiencing chest discomfort and shortness of breath during IV iron sucrose therapy. Vital signs indicate tachycardia and reduced oxygen saturation. What should be the nurse's priority action?

A) Stop the IV iron infusion and notify the healthcare provider immediately.

B) Administer supplemental oxygen and monitor the patient's vital signs closely.

C) Reassure the patient that these symptoms are common and continue the infusion.

D) Increase the rate of IV iron infusion to quickly address the anemia.

A patient undergoing IV iron therapy for anemia experiences chest discomfort and shortness of breath, leading to a diagnosis of mild left ventricular hypertrophy and a positive stool guaiac test suggesting gastrointestinal bleeding. After an endoscopy reveals gastric erosions and a duodenal ulcer, which nursing intervention is most appropriate to address the patient's current needs?

B) Monitor the patient's cardiac status and report any worsening symptoms.

A) Administer oral iron supplements to enhance iron absorption.

B) Monitor the patient's cardiac status and report any worsening symptoms.

C) Encourage the patient to take antacids with meals to reduce gastric acidity.

D) Discontinue IV iron therapy to prevent further cardiac complications.

A patient receiving IV iron therapy develops chest discomfort and shortness of breath. After diagnostic evaluations, mild left ventricular hypertrophy and a positive stool guaiac test are noted. What is the most appropriate nursing intervention to prioritize at this time?

A) Administer supplemental oxygen and notify the healthcare provider.

B) Educate the patient on dietary modifications to increase iron intake.

C) Monitor vital signs closely and prepare for possible blood transfusion.

D) Schedule a follow-up echocardiogram to assess cardiac function.

A patient with iron deficiency anemia is experiencing increased fatigue, intermittent palpitations, and dizziness upon standing. The healthcare team adjusts the iron therapy and consults cardiology. What nursing intervention is most important to implement to help manage the patient's orthostatic symptoms?

C) Instruct the patient to rise slowly from sitting to standing.

A) Encourage the patient to increase fluid intake.

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

C) Instruct the patient to rise slowly from sitting to standing.

D) Recommend the patient avoid high-sodium foods.

A patient with iron deficiency anemia is experiencing increased fatigue, palpitations, and dizziness upon standing despite ongoing iron supplementation. The healthcare team has decided to adjust the patient's iron therapy and consult cardiology. Which nursing intervention is most appropriate to address the patient's symptoms of orthostatic hypotension?

A) Encourage the patient to increase daily fluid intake and rise slowly from sitting or lying positions.

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

C) Instruct the patient to consume iron-rich foods only once a day to prevent gastrointestinal upset.

D) Recommend the patient to take iron supplements with milk to enhance absorption.

A patient with chronic anemia and mild left ventricular hypertrophy is being managed with iron supplementation and a low-dose beta-blocker. Which nursing intervention is most appropriate to help manage the patient's fatigue and support cardiac function?

A) Encourage the patient to engage in short, frequent walks to improve cardiovascular endurance and reduce fatigue.

B) Advise the patient to increase their daily iron supplementation to accelerate hemoglobin improvement.

C) Recommend the patient avoid all physical activities to prevent exacerbating cardiac workload.

D) Suggest the patient limit fluid intake to reduce cardiac strain.

A patient with chronic anemia has been experiencing fatigue and palpitations. Recent diagnostic tests show mild left ventricular hypertrophy and low serum ferritin levels despite improved hemoglobin. The healthcare team decides to start a low-dose beta-blocker and continue iron supplementation. What is the most appropriate nursing action to prioritize in the care plan to address both the patient's anemia and cardiac symptoms?

B) Monitor the patient's blood pressure and heart rate regularly to assess the effectiveness of the beta-blocker therapy.

A) Educate the patient on dietary sources of iron and the importance of adherence to iron therapy.

B) Monitor the patient's blood pressure and heart rate regularly to assess the effectiveness of the beta-blocker therapy.

C) Encourage the patient to avoid physical activity to prevent cardiac strain.

D) Schedule frequent laboratory tests to monitor hemoglobin and ferritin levels only.

A patient with a history of left ventricular hypertrophy and iron deficiency anemia is exhibiting mild orthostatic hypotension after being on a beta-blocker. The healthcare team has adjusted her medication and dietary plan. Which nursing intervention is most appropriate to address her current symptoms and promote improved health outcomes?

B) Educate the patient on slowly changing positions from lying to standing to minimize dizziness.

A) Encourage the patient to drink more fluids to increase blood volume and reduce dizziness.

B) Educate the patient on slowly changing positions from lying to standing to minimize dizziness.

C) Advise the patient to take iron supplements with calcium-rich foods to enhance absorption.

D) Suggest increasing daily physical activity to improve cardiovascular health and reduce symptoms.

A patient on a beta-blocker for left ventricular hypertrophy presents with mild orthostatic hypotension and persistent iron deficiency despite supplementation. Which nursing intervention is most appropriate to address these issues?

A) Educate the patient on rising slowly from a sitting or lying position to minimize dizziness.

B) Suggest the patient increase fluid intake to counteract the blood pressure drop.

C) Encourage the patient to take iron supplements with milk to enhance absorption.

D) Advise the patient to engage in vigorous exercise to improve cardiovascular fitness.

Anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Insufficient red blood cell (RBC) production often due to deficiencies in essential nutrients like iron, vitamin B12, or folate, leading to inadequate hemoglobin synthesis and a reduced oxygen-carrying capacity of the blood.

• Secondary mechanism: Increased RBC destruction or loss, which may occur due to hemolytic anemia (where RBCs are destroyed prematurely) or through acute or chronic blood loss from conditions such as gastrointestinal bleeding, resulting in decreased circulating RBCs.

• Key complication: Reduced oxygen delivery to tissues can cause symptoms such as fatigue, pallor, and shortness of breath. Chronic anemia can lead to compensatory cardiovascular changes, like increased heart rate, to maintain oxygenation, potentially progressing to heart failure if untreated.

Patient Profile

Demographics:

42-year-old female, office worker

History:

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

• Current medications: Levothyroxine 100 mcg daily, Ferrous sulfate 325 mg twice daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Fatigue and shortness of breath

• Key symptoms: Dizziness, pale skin, heart palpitations, brittle nails

• Vital signs: Blood pressure 100/65 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 98.4°F, SpO2 94% on room air

Section 1

Following the initial assessment, further diagnostic tests were ordered to investigate the underlying causes of the patient's worsening symptoms. Complete blood count (CBC) results revealed a hemoglobin level of 8.5 g/dL and hematocrit at 28%, confirming significant anemia. Mean corpuscular volume (MCV) was noted to be 72 fL, indicating microcytic anemia consistent with iron deficiency. Ferritin levels were critically low at 10 ng/mL, suggesting inadequate iron stores, despite ongoing supplementation. Additionally, a peripheral blood smear demonstrated hypochromic, microcytic red blood cells. Serum iron was 30 mcg/dL, total iron-binding capacity (TIBC) was elevated, and transferrin saturation was markedly reduced, further supporting iron deficiency as a primary concern.

In response to these findings, the healthcare team initiated a more aggressive intervention strategy. Given the patient's refractory response to oral iron therapy, intravenous (IV) iron was considered to address the acute deficiency more effectively. However, during the initiation of IV iron sucrose therapy, the patient reported escalating chest discomfort and shortness of breath. Vital signs showed a further increase in heart rate to 120 bpm and a decrease in SpO2 to 90% on room air, indicating potential cardiovascular stress due to the anemia. An urgent electrocardiogram (ECG) was performed, revealing sinus tachycardia but no acute ischemic changes. The team recognized the need for careful monitoring and potential escalation of care, considering the risk of developing heart failure.

This change in patient status underscores the importance of timely and appropriate management of iron deficiency anemia to prevent severe complications. The clinical team must now consider additional diagnostic evaluations, such as echocardiography, to assess cardiac function and guide further treatment decisions. It is crucial to determine whether underlying factors, such as gastrointestinal bleeding or malabsorption, contribute to the continued deficiency and to adjust the therapeutic approach accordingly.

Section 2

Following the onset of chest discomfort and shortness of breath during IV iron therapy, the healthcare team prioritized further diagnostic evaluations. An echocardiogram was promptly conducted, revealing mild left ventricular hypertrophy with a preserved ejection fraction of 55%. This indicated some degree of cardiac adaptation to chronic anemia, but without immediate signs of overt heart failure. Additionally, the team ordered a stool guaiac test to investigate potential gastrointestinal bleeding as a source of iron loss. The test returned positive, suggesting the possibility of occult bleeding contributing to the patient's refractory anemia.

In response to these findings, the team decided to conduct an upper and lower gastrointestinal endoscopy to identify the bleeding source. The endoscopy revealed multiple small gastric erosions and a duodenal ulcer, which could explain the continued iron deficiency despite supplementation. Given these new complications, the patient's treatment plan was adjusted to include proton pump inhibitors to promote ulcer healing and continued IV iron therapy under close monitoring to stabilize hemoglobin levels.

This refined understanding of the patient's condition necessitates a multidisciplinary approach, involving gastroenterology for the management of gastrointestinal lesions and cardiology for ongoing cardiac monitoring. The clinical team aims to prevent further deterioration by addressing both the immediate need for iron repletion and the underlying cause of iron loss. The patient’s progress will be closely monitored, with regular follow-up assessments to evaluate response to the revised treatment strategy and prevent future complications.

Section 3

Several days into the revised treatment plan, the patient began experiencing new symptoms, including increased fatigue and intermittent palpitations. During a routine follow-up visit, a thorough assessment revealed a mild tachycardia with a heart rate of 102 beats per minute and a blood pressure reading of 110/70 mmHg. The patient reported feeling dizzy on standing, suggesting possible orthostatic hypotension. These symptoms raised concerns about the adequacy of the patient's cardiac adaptation to anemia and the potential for further cardiovascular strain.

Laboratory tests showed a hemoglobin level that had only marginally improved to 9.0 g/dL, indicating that the iron repletion strategy was not yet achieving optimal results. Serum ferritin was measured at 15 ng/mL, confirming persistent iron deficiency despite ongoing treatment. The team considered the implications of these findings, recognizing the need to reassess the rate and method of iron supplementation to avoid exacerbating cardiac workload while ensuring effective absorption and utilization.

In response to the evolving clinical picture, the healthcare team decided to adjust the iron therapy again, opting to increase the frequency of smaller doses to mitigate the risk of adverse reactions. Cardiology was consulted to evaluate the potential need for beta-blockers to manage the palpitations and support cardiac function. Additionally, the team emphasized the importance of patient education on lifestyle modifications, including dietary adjustments and hydration, to address orthostatic symptoms. The multidisciplinary approach remained critical, with continuous evaluation and coordination among specialists to tailor interventions that would stabilize the patient's condition and promote recovery.

Section 4

As the healthcare team continued to monitor the patient's response to the revised iron supplementation strategy, new diagnostic results provided insight into the effectiveness of the interventions. A follow-up complete blood count (CBC) revealed a slight improvement in the patient's hemoglobin level to 9.6 g/dL, indicating a positive but slow trend towards normalization. However, the patient's serum ferritin remained low at 18 ng/mL, suggesting that iron stores were still insufficiently replenished. Despite these marginal improvements, the patient's symptoms persisted, with continued reports of fatigue and palpitations, necessitating further investigation.

An echocardiogram was performed to assess cardiac function and evaluate the potential contribution of anemia to the patient's cardiac symptoms. The results showed mild left ventricular hypertrophy, a common compensatory adaptation to chronic anemia, indicating that the heart was working harder to deliver adequate oxygen to the tissues. This finding underscored the need for careful management of both the anemia and the cardiac strain it was causing. The cardiology team recommended initiating a low-dose beta-blocker to help control the palpitations and reduce cardiac workload, while continuing to monitor for any adverse effects.

In light of these developments, the healthcare team revisited the patient's treatment plan, emphasizing a balanced approach to managing both the anemia and its cardiovascular implications. The decision was made to maintain the adjusted iron therapy regimen, while supporting cardiac function through pharmacological and lifestyle interventions. The team also highlighted the importance of regular follow-up appointments to track the patient's progress and adjust the treatment plan as needed, ensuring a comprehensive strategy to address the intertwined challenges of anemia and cardiac adaptation.

Section 5

As the patient continued on the revised treatment plan, the healthcare team remained vigilant in monitoring her progress. At her next follow-up appointment, the patient reported a slight decrease in her fatigue levels, although she still experienced occasional palpitations. Vital signs were stable, with a blood pressure of 120/75 mmHg and a heart rate of 78 beats per minute while on the beta-blocker. The team conducted a repeat CBC, which showed further improvement in her hemoglobin level to 10.2 g/dL. However, her serum ferritin remained at 20 ng/mL, indicating persistent iron deficiency despite ongoing supplementation.

In addition to monitoring blood parameters, the team performed a repeat echocardiogram to assess any changes in cardiac function. The results revealed no significant worsening of the left ventricular hypertrophy, suggesting that the beta-blocker was effectively reducing cardiac strain. However, the patient began to exhibit signs of mild orthostatic hypotension, likely a side effect of the beta-blocker, characterized by dizziness upon standing and a drop in blood pressure from 120/75 mmHg to 100/65 mmHg.

Given these developments, the healthcare team decided to adjust the patient's management plan. They reduced the beta-blocker dosage slightly to alleviate orthostatic symptoms while maintaining its benefits for cardiac protection. Additionally, they initiated a more aggressive dietary counseling session to enhance iron absorption naturally, focusing on increasing intake of vitamin C-rich foods alongside iron sources. This multifaceted approach aimed to optimize the patient's iron levels and cardiac function further, with plans for another follow-up in four weeks to reassess her condition and response to the interventions.