Which of the following is an important dietary recommendation for a patient with iron deficiency anemia to enhance iron absorption?

B) Consume vitamin C-rich foods with iron supplements

A) Increase intake of calcium-rich foods

B) Consume vitamin C-rich foods with iron supplements

D) Increase intake of high-fiber foods

Which dietary advice should the nurse provide to a patient with iron deficiency anemia to enhance iron absorption from supplements?

C) Take iron supplements with a glass of orange juice.

A) Avoid vitamin C-rich foods when taking iron supplements.

B) Consume caffeine-rich beverages with meals.

C) Take iron supplements with a glass of orange juice.

D) Increase intake of dairy products with iron supplements.

Which dietary advice should the nurse provide to the patient taking ferrous sulfate to enhance iron absorption?

D) Take with a high-calcium meal

During a follow-up visit, a nurse is evaluating a patient who has been taking ferrous sulfate for iron deficiency anemia. The patient's hemoglobin level has improved slightly, and she reports feeling less fatigued. What is the most appropriate action for the nurse to take next?

C) Advise the patient to continue her current regimen and schedule another follow-up

A) Discontinue the ferrous sulfate and switch to a multivitamin

B) Encourage the patient to increase her intake of calcium-rich foods

C) Advise the patient to continue her current regimen and schedule another follow-up

D) Suggest the patient double her dose of ferrous sulfate for faster results

What is the most likely reason for the patient's improved energy levels and reduction in dizziness as noted during her follow-up appointment?

B) Compliance with iron supplementation

D) Use of antihypertensive medication

Which of the following assessment findings indicates an improvement in the patient's anemia?

B) The patient's hemoglobin level has increased to 12.3 g/dL.

A) The patient's blood pressure is 116/70 mmHg.

B) The patient's hemoglobin level has increased to 12.3 g/dL.

C) The patient's pulse is 74 beats per minute.

D) The patient's oxygen saturation is 98% on room air.

What is the most appropriate initial action the nurse should take after the patient reports an increase in heart palpitations?

C) Discuss the symptoms with the healthcare provider to rule out underlying issues

A) Reassure the patient that palpitations are normal and continue current treatment

B) Advise the patient to stop all medications immediately

C) Discuss the symptoms with the healthcare provider to rule out underlying issues

D) Increase the dosage of iron supplements to address potential anemia

What is the primary reason the nurse decides to discuss the patient's new symptoms of increased heart palpitations with the healthcare provider?

B) To rule out potential underlying issues such as electrolyte imbalances

A) To confirm that the patient is improving

B) To rule out potential underlying issues such as electrolyte imbalances

C) To adjust the patient's medication regimen immediately

D) To reassure the patient that palpitations are normal

When educating a patient on the importance of monitoring symptoms and maintaining a treatment regimen for iron deficiency anemia, which dietary advice should the nurse emphasize?

B) Consume vitamin C-rich foods such as oranges or strawberries with iron-rich meals

A) Increase intake of tea and coffee with meals to enhance iron absorption

B) Consume vitamin C-rich foods such as oranges or strawberries with iron-rich meals

C) Avoid all dairy products as they completely inhibit iron absorption

D) Only take iron supplements on an empty stomach to maximize absorption

During the follow-up visit, the patient reports persistent heart palpitations but denies any chest pain, dizziness, or shortness of breath. What should be the nurse's priority action based on this information?

C) Discuss the symptoms with the healthcare provider for further evaluation and testing

A) Reassure the patient that palpitations are normal and require no further action

B) Advise the patient to stop taking iron supplements immediately

C) Discuss the symptoms with the healthcare provider for further evaluation and testing

D) Instruct the patient to increase her exercise routine to reduce palpitations

anemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Anemia often results from decreased red blood cell production, frequently due to insufficient iron, vitamin B12, or folate. These nutrients are essential for making hemoglobin, the protein in red blood cells responsible for oxygen transport.

• Secondary mechanism: Increased red blood cell destruction can also cause anemia. This occurs in conditions like hemolytic anemia, where red blood cells are destroyed faster than they can be produced, often due to autoimmune diseases, infections, or inherited disorders.

• Key complication: Reduced oxygen delivery to tissues leads to symptoms like fatigue, weakness, and shortness of breath, impacting daily activities and overall quality of life.

Patient Profile

Demographics:

32-year-old female, elementary school teacher

History:

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

• Current medications: Daily oral iron supplement (ferrous sulfate 325 mg)

• Allergies: None

Current Presentation:

• Chief complaint: Fatigue and occasional dizziness

• Key symptoms: Mild fatigue, occasional lightheadedness, normal appetite

• Vital signs: Blood pressure 118/76 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F (37°C)

Section 1

Initial Assessment Findings:

During the initial nursing assessment, the patient, a 32-year-old female elementary school teacher, presents with mild fatigue and occasional dizziness. She is alert and oriented, with no signs of acute distress. Her skin appears pale, a common sign of anemia, but there are no visible petechiae or bruising. Her conjunctiva is slightly pale, which can indicate low hemoglobin levels. The patient reports maintaining a normal appetite and denies any significant weight loss or changes in bowel habits.

Upon reviewing her laboratory results, her hemoglobin level is 11.0 g/dL, which is below the normal reference range for adult females (12.0-15.5 g/dL), confirming the presence of anemia. Her ferritin level is slightly low at 25 ng/mL, which, though not severe, suggests depleted iron stores. Other lab values, such as her mean corpuscular volume (MCV), remain within the lower end of the normal range, consistent with iron deficiency anemia. She adheres to her prescribed daily ferrous sulfate supplement, indicating compliance with her treatment regimen.

The initial nursing assessment reinforces the need for continued monitoring of the patient's symptoms and lab values to prevent progression of her anemia. The nurse educates the patient on dietary sources of iron to complement her supplement intake, such as lean meats, beans, and leafy greens, and discusses the importance of vitamin C-rich foods to enhance iron absorption. The nurse also emphasizes the need for regular follow-up appointments to reassess her hemoglobin and ferritin levels, ensuring effective management of her condition.

Section 2

Two weeks later, the patient returns for a follow-up appointment. During this visit, the nurse conducts a thorough reassessment. The patient reports a slight improvement in her energy levels, noting that she experiences fatigue less frequently and that her dizziness has diminished. She continues to adhere to her ferrous sulfate regimen and has incorporated more iron-rich foods into her diet, as previously discussed. Her vital signs are stable: blood pressure is 118/72 mmHg, pulse is 76 beats per minute, and respiratory rate is 16 breaths per minute, with an oxygen saturation of 98% on room air. While her skin remains pale, her conjunctiva appears slightly more pink, suggesting a modest improvement in her hemoglobin levels.

The repeat laboratory tests show a slight increase in her hemoglobin level to 11.5 g/dL, indicating a positive response to the iron supplementation. Her ferritin level has also improved marginally to 30 ng/mL, reflecting better iron stores. However, her mean corpuscular volume (MCV) remains at the lower end of the normal range, reinforcing the need for continued monitoring and adherence to her current treatment plan. The patient expresses satisfaction with her progress and remains committed to her dietary and medication regimen.

In light of these findings, the nurse reinforces the importance of ongoing follow-up to ensure continued improvement in her anemia. The nurse also discusses potential signs of complications, such as increased fatigue, shortness of breath, or palpitations, which would necessitate immediate medical attention. The patient is encouraged to maintain her current dietary practices and supplement intake, while also being advised to avoid excessive consumption of calcium-rich foods or beverages around her supplement time, as they may hinder iron absorption. With a plan for another follow-up visit in four weeks, the patient leaves the clinic feeling optimistic about her recovery.

Section 3

Four weeks later, the patient returns for her scheduled follow-up appointment. Upon initial assessment, the nurse notes the patient has experienced a further improvement in her energy levels, with the patient reporting that she can now engage in her daily activities with minimal fatigue. She no longer experiences dizziness and feels more alert throughout the day. Her commitment to her prescribed regimen, including consistent intake of ferrous sulfate and iron-rich foods, remains steadfast.

The nurse performs a physical examination and finds that the patient's skin tone has a healthier hue, and her conjunctiva is now a normal pink color, a positive sign of her improving anemia. Her vital signs continue to be stable: blood pressure is 116/70 mmHg, pulse is 74 beats per minute, and respiratory rate is 16 breaths per minute, with an oxygen saturation of 98% on room air. These stable vital signs, along with the patient's subjective reports, suggest a favorable response to the ongoing treatment plan.

The latest laboratory tests reveal her hemoglobin level has increased to 12.3 g/dL, and her ferritin level has improved to 50 ng/mL, indicating a continued positive trend in her iron stores. The mean corpuscular volume (MCV) has risen slightly, nearing mid-normal range, reflecting a gradual normalization of red blood cell size. With these encouraging results, the nurse discusses the importance of maintaining her current dietary and supplement regimen and emphasizes the need for ongoing follow-up to ensure sustained improvement. The patient is advised to report any new symptoms promptly, and a follow-up visit is scheduled in six weeks to further monitor her progress and adjust the treatment plan as necessary. The patient leaves the clinic feeling encouraged and empowered to continue her journey toward full recovery.

Section 4

Six weeks later, the patient returns for another follow-up appointment, and the nurse begins the initial assessment by noting any changes since the last visit. The patient reports she has continued to feel more energetic and maintains her routine activities without experiencing fatigue. However, she mentions a slight increase in occasional heart palpitations, particularly when she is at rest or lying down, but denies any associated chest pain or difficulty breathing. These new symptoms prompt the nurse to investigate further, although the patient’s overall well-being remains stable.

During the physical examination, the nurse notes that the patient’s skin tone remains healthy and her conjunctiva is still a normal pink color. Her vital signs are as follows: blood pressure is 118/72 mmHg, pulse is 82 beats per minute, respiratory rate is 16 breaths per minute, and oxygen saturation is 98% on room air. The slight increase in pulse rate, although still within normal limits, is consistent with the patient’s report of palpitations.

The nurse reviews the latest laboratory results, which continue to show improvement. The patient's hemoglobin level has increased to 13.0 g/dL, and ferritin is now at 65 ng/mL. The mean corpuscular volume (MCV) is now firmly within the normal range, indicating a consistent and positive response to the treatment plan. Despite these encouraging lab results, the nurse decides to discuss these new symptoms with the healthcare provider to rule out any underlying issues, such as electrolyte imbalances or medication side effects, that might require attention. The patient is reassured and advised to continue her current regimen while monitoring her symptoms, with the understanding that adjustments to her treatment plan may be made after further evaluation. A follow-up appointment is scheduled in another six weeks, ensuring ongoing monitoring and support.

Section 5

Six weeks later, during the patient's scheduled follow-up visit, the nurse conducts a thorough assessment to evaluate the patient's current condition and response to the ongoing treatment plan. The patient reports she has been diligent in adhering to her iron supplementation and dietary modifications, and she continues to feel generally well. However, she notes that the occasional heart palpitations have persisted, albeit not increased in frequency or severity. The patient continues to deny any chest pain, dizziness, or shortness of breath, and she remains active in her daily routine without experiencing undue fatigue.

The nurse performs a detailed physical examination and observes that the patient's skin and conjunctiva retain their healthy appearance. Vital signs reveal a blood pressure of 120/74 mmHg, a pulse of 84 beats per minute, a respiratory rate of 18 breaths per minute, and an oxygen saturation of 98% on room air. While the pulse remains slightly elevated compared to previous visits, it still falls within normal limits. The nurse also performs a cardiac auscultation, which reveals a regular rhythm without murmurs or extra heart sounds, providing reassurance that there are no overt signs of cardiac distress.

To ensure comprehensive assessment and management, the nurse reviews the latest laboratory results. These show a continued improvement with a hemoglobin level of 13.2 g/dL and a ferritin level of 70 ng/mL, confirming the patient's positive response to treatment. The nurse discusses the persistent palpitations with the healthcare provider, who orders additional tests to assess electrolyte levels and thyroid function, considering these potential contributors to the patient's symptoms. The nurse educates the patient on the importance of monitoring her symptoms and maintaining her treatment regimen, while also advising her to report any new or worsening symptoms. A follow-up appointment is planned in six weeks, with the anticipation that these new diagnostic tests will provide further insight into the patient's condition and guide any necessary adjustments to her care plan.