A patient with iron deficiency anemia has lab results indicating a hemoglobin level of 8.5 g/dL and serum ferritin of 10 ng/mL. Despite oral iron supplementation, the patient's symptoms persist. Which nursing intervention is most appropriate to address this patient's condition and prevent further complications?

C) Collaborate with the healthcare provider to initiate intravenous iron therapy.

A) Increase the frequency of oral iron supplementation.

B) Educate the patient on consuming iron-rich foods and vitamin C concurrently.

C) Collaborate with the healthcare provider to initiate intravenous iron therapy.

D) Encourage the patient to take oral iron supplements with antacids to reduce gastrointestinal discomfort.

A 35-year-old female patient with a history of iron deficiency anemia presents with lab results showing a hemoglobin level of 8.5 g/dL, serum ferritin at 10 ng/mL, MCV at 70 fL, and MCH at 22 pg. She is experiencing increased fatigue, pallor, and shortness of breath. Given her lab results and clinical presentation, which intervention should the nurse prioritize to address her condition effectively?

C) Collaborate with the healthcare provider to consider intravenous iron therapy.

A) Recommend increasing oral iron supplementation dosage.

B) Initiate a blood transfusion to quickly elevate hemoglobin levels.

C) Collaborate with the healthcare provider to consider intravenous iron therapy.

D) Advise dietary modifications to increase iron intake through food sources.

A patient with iron deficiency anemia is receiving intravenous ferric carboxymaltose. Which clinical finding should the nurse prioritize monitoring to prevent potential complications from this treatment?

D) Decreased serum phosphate levels

A) Elevated blood glucose levels

D) Decreased serum phosphate levels

A patient with iron deficiency anemia being treated with intravenous iron therapy develops muscle weakness and bone pain. Laboratory tests confirm hypophosphatemia. Which nursing intervention is the most appropriate to address this complication?

A) Administer oral phosphate supplements as prescribed

B) Increase the patient's iron infusion rate

C) Encourage increased fluid intake to flush out excess iron

D) Discontinue intravenous iron therapy immediately

A patient undergoing treatment for iron deficiency anemia with intravenous iron therapy develops muscle weakness and bone pain. Laboratory tests confirm hypophosphatemia. What is the most appropriate nursing intervention to address the patient's condition?

B) Educate the patient on the importance of oral phosphate supplements and monitor adherence.

A) Increase the rate of intravenous iron infusion to quickly replenish iron stores.

B) Educate the patient on the importance of oral phosphate supplements and monitor adherence.

C) Restrict the patient's dietary intake of phosphate-rich foods to prevent further complications.

D) Discontinue intravenous iron therapy until serum phosphate levels normalize.

A patient undergoing phosphate supplementation reports intermittent palpitations and mild shortness of breath, and is found to have a potassium level of 3.4 mEq/L. What is the priority nursing intervention to address the patient's symptoms and prevent further complications?

B) Administer oral potassium supplements as prescribed

A) Increase the patient's fluid intake to prevent dehydration

B) Administer oral potassium supplements as prescribed

C) Encourage the patient to engage in regular cardiovascular exercise

D) Discontinue phosphate supplementation immediately

A patient receiving phosphate supplementation reports palpitations and shortness of breath. An ECG reveals sinus tachycardia, and lab results show a borderline low potassium level. What is the most appropriate nursing intervention to address the patient's symptoms?

C) Administer oral potassium supplements as prescribed

A) Discontinue phosphate supplementation immediately

B) Encourage the patient to take deep breaths and rest

C) Administer oral potassium supplements as prescribed

D) Increase the patient's fluid intake to improve electrolyte balance

A patient recovering from iron deficiency anemia is experiencing persistent fatigue and dizziness, particularly when standing up quickly. Her hemoglobin level slightly improved to 10.2 g/dL, and her MCV remains low at 72 fL. Which of the following nursing interventions is most appropriate to address these symptoms and support her recovery?

B) Advise the patient to incorporate vitamin C-rich foods into her diet to enhance iron absorption and improve anemia.

A) Encourage the patient to increase her dietary intake of calcium-rich foods to improve bone health and energy levels.

B) Advise the patient to incorporate vitamin C-rich foods into her diet to enhance iron absorption and improve anemia.

C) Suggest that the patient increase aerobic exercise to boost cardiovascular fitness and reduce dizziness.

D) Recommend the patient to limit fluid intake to prevent worsening of dizziness and fatigue.

A patient recovering from iron deficiency anemia presents with persistent fatigue and dizziness upon standing. Her CBC shows a hemoglobin level of 10.2 g/dL and a low MCV of 72 fL. Considering these findings, which nursing intervention is most appropriate to help manage her symptoms and promote recovery?

B) Suggest incorporating more rest periods and gradual physical activity adjustments.

A) Encourage the patient to increase her daily iron supplement dosage.

B) Suggest incorporating more rest periods and gradual physical activity adjustments.

C) Advise the patient to reduce her fluid intake to prevent dizziness.

D) Recommend a high-protein diet to improve energy levels.

iron deficiency anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Iron deficiency anaemia primarily occurs due to inadequate iron availability for hemoglobin synthesis, leading to reduced oxygen-carrying capacity of red blood cells. This can result from insufficient dietary intake, poor absorption, or chronic blood loss.

• Secondary mechanism: The body's iron stores, reflected by serum ferritin levels, become depleted over time. As iron is crucial for erythropoiesis, its deficiency impairs red blood cell production, causing microcytic and hypochromic anemia.

• Key complication: The impaired oxygen delivery to tissues can lead to fatigue, pallor, and reduced exercise tolerance, significantly affecting patients' quality of life and increasing the risk for cardiovascular strain.

Patient Profile

Demographics:

32-year-old female, office manager

History:

• Key past medical history: Diagnosed with iron deficiency anemia 2 years ago; history of heavy menstrual periods

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

• Allergies: Penicillin

Current Presentation:

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

• Key symptoms: Persistent fatigue, dizziness, pale skin, brittle nails, and palpitations

• Vital signs: Blood pressure 100/60 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 98.6°F

Section 1

New Diagnostic Results:

Following the initial assessment, the patient's lab results reveal a hemoglobin level of 8.5 g/dL, significantly lower than the normal range of 12-15.5 g/dL for females, indicating a worsening of her iron deficiency anemia. Her serum ferritin is measured at 10 ng/mL, far below the typical 12-150 ng/mL, confirming depleted iron stores. The mean corpuscular volume (MCV) is 70 fL, indicating microcytic anemia, while her mean corpuscular hemoglobin (MCH) is 22 pg, signifying hypochromic red blood cells. These findings align with her clinical presentation of increased fatigue, pallor, and shortness of breath, suggesting that her current regimen of oral iron supplementation may be insufficient.

Additionally, a peripheral blood smear was performed, showing anisocytosis and poikilocytosis, which further supports the diagnosis of iron deficiency anemia. The presence of these abnormal red blood cell shapes and sizes indicates that the patient's bone marrow is struggling to produce healthy erythrocytes due to inadequate iron availability. This raises concerns about her body's current ability to meet oxygen demands, especially given her elevated heart rate and respiratory rate, which suggest compensatory mechanisms are being taxed. The persistence of these symptoms and lab findings necessitates a reevaluation of her treatment plan, considering whether more aggressive interventions, such as intravenous iron therapy, may be warranted to quickly replenish iron stores and alleviate her symptoms.

These diagnostic results prompt the healthcare team to deliberate on the underlying causes of her iron deficiency, including reassessing her menstrual bleeding pattern and dietary iron intake. The goal is to address the root cause while optimizing her treatment to prevent further cardiovascular strain and improve her overall quality of life. This scenario encourages clinical reasoning focused on the balance between symptom management, addressing underlying causes, and considering potential risks associated with treatment changes.

Section 2

As the healthcare team deliberates on the patient's management plan, her clinical presentation begins to evolve, indicating a change in her status. Over the next few days, the patient experiences worsening symptoms, including more pronounced fatigue and episodes of dizziness upon standing, suggestive of orthostatic hypotension. Her vital signs reveal a resting heart rate of 110 bpm and a blood pressure of 100/60 mmHg, which further drops to 85/50 mmHg when she attempts to stand. These findings suggest her cardiovascular system is increasingly strained as it struggles to compensate for the low hemoglobin levels.

Given the persistent and worsening symptoms, the decision is made to initiate intravenous iron therapy. The patient is started on a regimen of ferric carboxymaltose, administered under close supervision due to potential risks such as allergic reactions or iron overload. Within 48 hours of starting the IV therapy, the patient reports a slight improvement in energy levels, and her orthostatic symptoms show signs of stabilization. Her follow-up lab tests reveal a modest increase in hemoglobin to 9.2 g/dL, while her serum ferritin begins to rise, indicating a positive response to treatment. Despite these improvements, the healthcare team remains vigilant for potential complications, such as hypophosphatemia, which can occur with intravenous iron administration.

As the patient's status stabilizes, attention shifts to investigating the underlying cause of her iron deficiency. A detailed review of her menstrual history reveals heavy menstrual bleeding, a potential contributing factor. The team collaborates with a gynecologist to explore strategies for managing menorrhagia, such as hormonal therapy or surgical options, to prevent recurrent anemia. Additionally, dietary counseling is provided to enhance her iron intake from food sources. This multifaceted approach aims to not only address the immediate concern of iron replenishment but also to implement long-term solutions to prevent future episodes of iron deficiency anemia.

Section 3

As the treatment for iron deficiency anemia progresses, the healthcare team closely monitors the patient for any new complications. Within a week of initiating intravenous iron therapy, the patient begins to experience muscle weakness and bone pain, particularly in her lower extremities. Recognizing these symptoms as potential signs of hypophosphatemia, a known complication of IV iron therapy, the medical team orders a series of laboratory tests to assess her phosphate levels. The results reveal a serum phosphate level of 1.8 mg/dL, significantly below the normal range, confirming the suspicion of hypophosphatemia.

This new finding prompts the healthcare team to quickly adjust the patient's management plan. Oral phosphate supplements are introduced to address the deficiency, and her dietary intake is reviewed to ensure adequate consumption of phosphate-rich foods. The patient is educated on the importance of maintaining balanced nutrition to support her recovery. Meanwhile, the team continues to monitor her hemoglobin and ferritin levels, which show a steady upward trend, indicating that the iron replenishment is effective despite the newly identified complication.

The patient's response to phosphate supplementation is positive, with a gradual resolution of muscle weakness and bone pain within a few days. Her phosphate levels normalize, and her energy levels continue to improve. With the immediate complications addressed, the healthcare team focuses on long-term strategies to manage her underlying menorrhagia and prevent future anemia episodes. This comprehensive approach, involving collaboration across specialties and patient education, positions the patient for a sustainable recovery and improved quality of life.

Section 4

As the patient progresses through her treatment, the healthcare team remains vigilant for any new complications. Within two weeks of initiating phosphate supplementation, the patient reports experiencing intermittent episodes of palpitations and mild shortness of breath, particularly during exertion. Recognizing these symptoms as potential signs of cardiac involvement, the team decides to conduct a thorough cardiovascular assessment. An electrocardiogram (ECG) is performed, revealing a sinus tachycardia with a heart rate of 115 beats per minute. Additionally, serum electrolyte levels are re-evaluated to rule out any imbalances that might contribute to her symptoms.

The lab results indicate a borderline low potassium level at 3.4 mEq/L, which could be contributing to her cardiac symptoms. This prompts the healthcare team to adjust her supplementation regimen, incorporating oral potassium supplements alongside her phosphate therapy. The patient is advised to increase her intake of potassium-rich foods, such as bananas and spinach, to help stabilize her electrolyte levels naturally. To ensure a comprehensive approach, the team also reviews her current medications and potential interactions that might exacerbate her symptoms.

Over the next several days, the patient shows a positive response to the modified treatment plan. Her heart rate gradually decreases to a normal range, and her episodes of palpitations and shortness of breath subside. Repeat laboratory tests confirm that her potassium levels have returned to normal, alleviating the immediate concern for cardiac complications. With her energy levels and overall stability improving, the healthcare team continues to balance her treatment for iron deficiency anemia with a focus on preventing further electrolyte disturbances. This careful management ensures that the patient remains on track for a full recovery while minimizing the risk of additional complications.

Section 5

As the patient continues her recovery, the healthcare team remains vigilant, conducting regular monitoring to anticipate and address any new complications. Approximately a week after her potassium levels have stabilized, the patient begins to experience new symptoms: a persistent feeling of fatigue and occasional dizziness, especially when standing up quickly. These symptoms prompt the team to conduct a further assessment, suspecting that her iron deficiency anemia may not be fully resolved or that another underlying issue may be present.

A complete blood count (CBC) is performed, revealing that her hemoglobin level has only slightly improved to 10.2 g/dL, indicating that while there has been progress, her anemia is still not fully corrected. Additionally, her mean corpuscular volume (MCV) remains low at 72 fL, suggesting that microcytic anemia persists. Given these findings, the healthcare team decides to reassess her iron supplementation regimen and dietary intake to ensure optimal absorption and effectiveness. They also consider potential gastrointestinal issues that may be hindering iron absorption, such as celiac disease or atrophic gastritis, and plan for further diagnostic testing to explore these possibilities.

Recognizing the importance of a holistic approach, the team discusses potential lifestyle adjustments with the patient to help manage her symptoms. They recommend incorporating more rest periods throughout the day and suggest gradual changes to her physical activity to accommodate her energy levels. The clinical team also emphasizes the importance of hydration and a balanced diet rich in iron and vitamin C to enhance iron absorption. These proactive measures are aimed at not only addressing the immediate symptoms but also ensuring sustainable improvement in her overall health as she continues her recovery journey.