A patient with iron deficiency anemia is experiencing palpitations and an elevated heart rate. Her diagnostic results show low hemoglobin, low serum ferritin, and elevated total iron binding capacity. Which nursing intervention is most appropriate to address her cardiac symptoms?

D) Collaborate with the healthcare provider to evaluate the need for intravenous iron therapy.

A) Encourage increased dietary intake of red meat and leafy green vegetables.

B) Administer prescribed oral iron supplements with orange juice to enhance absorption.

C) Instruct the patient to limit physical activity until her symptoms improve.

D) Collaborate with the healthcare provider to evaluate the need for intravenous iron therapy.

A patient with diagnosed iron deficiency anemia has a hemoglobin level of 9.5 g/dL and MCV of 72 fL. The healthcare team is considering intravenous iron therapy. Which clinical finding would most strongly support the decision to initiate intravenous iron therapy over oral supplementation?

A) Patient reports non-compliance with oral iron due to gastrointestinal side effects.

B) Serum ferritin level is 8 ng/mL, indicating depleted iron stores.

C) Echocardiogram shows mild left ventricular hypertrophy due to chronic anemia.

D) Total iron binding capacity (TIBC) is elevated at 450 µg/dL.

A patient with iron deficiency anemia is being switched from oral to intravenous iron therapy due to insufficient improvement in hemoglobin levels and persistent symptoms. Which nursing intervention is most critical to prioritize during the administration of intravenous iron to ensure patient safety?

A) Monitor the patient's heart rate and blood pressure closely.

B) Educate the patient on the importance of dietary iron intake.

C) Assess the patient's dietary history for potential allergens.

D) Schedule the patient's next follow-up appointment for laboratory tests.

A patient with iron deficiency anemia has been started on intravenous iron therapy after inadequate response to oral iron supplementation. What is the priority nursing intervention to monitor for adverse effects during the administration of intravenous iron?

D) Assess for signs of an allergic reaction, including rash and difficulty breathing.

A) Monitor the patient's blood pressure and heart rate every 15 minutes during the infusion.

B) Encourage the patient to increase fluid intake to enhance iron absorption.

C) Educate the patient on the importance of dietary sources of iron.

D) Assess for signs of an allergic reaction, including rash and difficulty breathing.

A patient with microcytic anemia due to heavy menstrual bleeding has been receiving intravenous iron therapy with some improvement in hemoglobin levels and symptoms. The healthcare team has decided to add a low-dose oral contraceptive to her treatment plan. What is the primary nursing consideration when monitoring this patient after the addition of the oral contraceptive?

A) Monitor for signs of venous thromboembolism due to increased risk with oral contraceptives.

B) Assess for weight gain, which is a common side effect of iron therapy.

C) Evaluate for increased fatigue and dizziness, potentially indicating iron overload.

D) Check for signs of gastrointestinal bleeding as oral contraceptives can irritate the gastric mucosa.

A patient on intravenous iron therapy reports mild improvement in symptoms and her latest lab results show an increase in hemoglobin and serum ferritin levels, but her MCV remains low. What is the most appropriate nursing intervention to support her treatment plan?

A) Encourage a diet high in vitamin C to enhance iron absorption

B) Educate the patient on the importance of hydration to reduce dizziness

C) Monitor the patient for signs of iron overload given her therapy

D) Recommend an increase in dietary fiber to manage potential constipation from iron supplements

A nurse is reviewing the plan of care for a patient with persistent microcytic anemia despite being on iron supplementation and a low-dose oral contraceptive. Which intervention should the nurse anticipate the healthcare provider considering next?

D) Initiate parenteral iron therapy

A) Increase the dosage of oral iron supplementation

B) Discontinue the oral contraceptive

C) Schedule a blood transfusion

D) Initiate parenteral iron therapy

A patient with microcytic anemia is on low-dose oral contraceptives and oral iron supplements. Despite treatment, she continues to experience fatigue and shortness of breath. Her latest lab results show hemoglobin at 11.2 g/dL, serum ferritin at 35 ng/mL, and MCV at 75 fL. What is the most appropriate nursing intervention to address her symptoms?

B) Educate the patient about increasing vitamin C intake to enhance iron absorption.

A) Increase the dosage of oral iron supplements.

B) Educate the patient about increasing vitamin C intake to enhance iron absorption.

C) Suggest the patient switch to intravenous iron therapy.

D) Recommend the patient increase dietary intake of iron-rich foods.

A patient with iron deficiency anemia continues to experience symptoms despite oral iron supplementation. The healthcare team decides to initiate intravenous iron therapy. Which nursing intervention is a priority during the administration of intravenous iron?

A) Monitor the patient's blood pressure and pulse closely.

B) Encourage the patient to increase dietary fiber intake.

C) Educate the patient about avoiding activities that require alertness.

D) Advise the patient to take iron supplements with vitamin C.

A patient with iron deficiency anemia is receiving oral iron supplements but shows inadequate response. After reviewing her diagnostic results, the healthcare team decides to initiate intravenous iron therapy. Which assessment finding should the nurse prioritize to determine the effectiveness of the new intervention?

A) Increased reticulocyte count

B) Decreased total iron binding capacity (TIBC)

C) Normalized endometrial thickness

D) Improved energy levels and reduction of fatigue

iron deficiency anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Iron deficiency anaemia primarily occurs due to inadequate iron supply, leading to reduced hemoglobin synthesis. This results in the production of smaller, paler red blood cells (microcytic, hypochromic) that are less effective at oxygen transport.

• Secondary mechanism: The body compensates for low oxygen levels by increasing heart rate and stroke volume, which can lead to increased cardiac workload and potential cardiac complications if left untreated.

• Key complication: Chronic iron deficiency can lead to fatigue, weakness, and impaired cognitive function due to insufficient oxygen delivery to tissues, impacting overall patient health and quality of life.

Patient Profile

Demographics:

45-year-old female, office manager

History:

• Key past medical history: History of heavy menstrual bleeding, previous episode of iron deficiency anemia 3 years ago

• Current medications: Oral contraceptive pill, ferrous sulfate 325 mg once daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent fatigue and shortness of breath

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

• 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 and persistent symptoms, further diagnostic tests were conducted to evaluate the extent of the iron deficiency anemia and its impact on the patient. A complete blood count (CBC) revealed a hemoglobin level of 9.5 g/dL, significantly below the normal range, and a mean corpuscular volume (MCV) of 72 fL, confirming microcytic anemia. Serum ferritin levels were critically low at 8 ng/mL, indicative of depleted iron stores. Total iron binding capacity (TIBC) was elevated at 450 µg/dL, further supporting the diagnosis of iron deficiency anemia. Additionally, her serum iron was measured at 25 µg/dL, which is below the normal range, suggesting insufficient iron availability for erythropoiesis.

The patient also underwent an echocardiogram due to her elevated heart rate and persistent palpitations. The results indicated mild left ventricular hypertrophy, a compensatory response to the increased cardiac workload resulting from chronic anemia. This finding underscores the need for prompt and effective management of her iron deficiency to prevent further cardiac complications. The healthcare team considered this data in the context of her ongoing symptoms and the potential for more severe consequences if the anemia remains unresolved.

The diagnostic results point to the necessity for an integrated management plan, including optimizing iron supplementation and addressing the underlying cause of her heavy menstrual bleeding. The team discussed the possibility of adjusting her oral contraceptive to better manage menstrual flow and considering intravenous iron therapy for more rapid replenishment of iron stores. This comprehensive approach aims to improve the patient's symptoms, prevent further cardiac strain, and restore her quality of life. The next step involves close monitoring of her treatment response and reevaluation of her symptoms and laboratory parameters in the coming weeks.

Section 2

As the management plan was implemented, the patient initially showed signs of improvement. Her oral iron supplementation was increased, and her oral contraceptive was adjusted to better regulate her menstrual cycle, aiming to reduce her menstrual bleeding. However, two weeks into the treatment, the patient reported experiencing increased fatigue, dizziness, and shortness of breath. During a follow-up visit, her vital signs indicated a heart rate of 110 beats per minute and a blood pressure of 100/60 mmHg, suggesting ongoing hemodynamic instability despite the interventions.

A repeat CBC showed minimal improvement in her hemoglobin level, now at 9.8 g/dL, and her serum ferritin remained low at 10 ng/mL, indicating that oral iron supplementation was insufficient in replenishing her iron stores. Her MCV continued to reflect microcytic anemia at 73 fL. Given these findings and her escalating symptoms, the healthcare team decided to initiate intravenous iron therapy to expedite the correction of her iron deficiency and alleviate the cardiac workload.

The team also explored potential underlying causes for her persistent anemia. An endometrial biopsy was considered to rule out any pathological causes of her heavy menstrual bleeding. The patient was counseled on the importance of adherence to treatment and the plan for close monitoring of her response to the intravenous iron therapy. The next steps involved reassessment of her clinical status and laboratory parameters after the completion of the iron infusions, aiming to evaluate the efficacy of the treatment and to determine any need for further adjustments in her management plan.

Section 3

Two weeks following the initiation of intravenous iron therapy, the patient returned for a follow-up appointment. She reported feeling somewhat better, noting a slight decrease in fatigue and dizziness, though she still experienced occasional shortness of breath with exertion. On examination, her vital signs indicated slight improvements; her heart rate was now 98 beats per minute, and her blood pressure was 105/65 mmHg. Despite these modest gains, her healthcare team remained vigilant for potential complications, given her initial lackluster response to oral iron supplementation.

A repeat CBC revealed further improvement in her hemoglobin level, now at 10.5 g/dL, suggesting a positive response to the intravenous iron therapy. Her serum ferritin had increased to 30 ng/mL, indicating a gradual replenishment of her iron stores. However, her MCV remained at 74 fL, reflecting ongoing microcytic anemia. These findings prompted the healthcare team to continue monitoring her iron levels and overall health closely. Additionally, results from the endometrial biopsy showed benign endometrial hyperplasia, contributing to her heavy menstrual bleeding and subsequently her anemia.

The team discussed these findings with the patient, emphasizing the importance of continued treatment and monitoring. They adjusted her management plan to include a low-dose oral contraceptive aimed at reducing menstrual flow further and minimizing the risk of anemia recurrence. Plans were made for another follow-up appointment in one month to reassess her hemoglobin levels, iron stores, and overall clinical status. The team remained focused on optimizing her treatment to achieve full resolution of her symptoms and avoidance of future complications.

Section 4

As the patient returned for her follow-up appointment one month later, she reported mixed changes in her symptoms. While the low-dose oral contraceptive had effectively reduced her menstrual flow, she still experienced intermittent episodes of fatigue and noted that her shortness of breath during exertion had not completely resolved. On examination, her vital signs showed a heart rate of 92 beats per minute and blood pressure of 110/70 mmHg, indicating stability but not a significant improvement from her last visit.

The repeat CBC demonstrated a hemoglobin level of 11.2 g/dL, showing a continued upward trend, while her serum ferritin had increased marginally to 35 ng/mL. However, her MCV remained low at 75 fL, suggesting persistent microcytic anemia. These results indicated that while her iron stores were gradually replenishing, the response was slower than anticipated, likely due to ongoing menstrual blood loss despite reduced flow. The healthcare team considered whether additional interventions, such as adjusting the iron therapy regimen or further addressing the endometrial hyperplasia, might be warranted.

To explore the underlying causes of her persistent symptoms more thoroughly, the team ordered a series of additional diagnostic tests, including a reticulocyte count and a complete iron panel, to assess her bone marrow's response to treatment and the efficiency of iron utilization. They also planned an ultrasound to evaluate the uterus more comprehensively, ensuring that no other gynecological issues were contributing to her anemia. The patient's management plan was updated accordingly, with plans for close monitoring of her response to the ongoing interventions.

Section 5

As the patient returned for her follow-up visit two weeks later, the healthcare team reviewed the new diagnostic results that had been ordered during the last appointment. The reticulocyte count was slightly elevated at 2.5%, indicating some degree of bone marrow response, but not as robust as expected, suggesting that the marrow was still struggling to compensate for the ongoing anemia. The complete iron panel revealed transferrin saturation at 18%, total iron binding capacity (TIBC) at 400 mcg/dL, and serum iron at 45 mcg/dL, consistent with continued iron deficiency despite oral supplementation. These findings pointed to a need for further optimization of her iron therapy, potentially considering intravenous iron administration to more rapidly replenish her iron stores and support erythropoiesis.

Meanwhile, the pelvic ultrasound provided additional insights into her gynecological status. It revealed a slightly thickened endometrial lining, consistent with the history of endometrial hyperplasia, but no other abnormalities such as fibroids or polyps were noted. This reassured the team that the primary issue remained related to her menstrual cycle, and that the current hormonal treatment was otherwise appropriate. The healthcare team discussed these findings with the patient, emphasizing the importance of adherence to her current treatment plan while considering the addition of a more aggressive iron supplementation strategy.

Given the patient's persistent symptoms and the slow response to oral iron, the decision was made to initiate a series of intravenous iron infusions to accelerate the correction of her iron deficiency. The patient was educated about the procedure, potential side effects, and the expected improvements in her energy levels and reduction of her anemia-related symptoms. The plan included close follow-up, with repeat CBC and iron studies scheduled for four weeks after her first infusion to assess the effectiveness of the new intervention and adjust the management plan as needed. The team remained vigilant for any signs of new complications, particularly watching for any adverse reactions to the intravenous therapy or changes in her menstrual cycle that could impact her overall health status.