A patient with iron deficiency anemia continues to exhibit symptoms despite oral ferrous sulfate therapy. Which clinical reasoning should guide the nurse to prioritize further action in this situation?

C) Assess for potential gastrointestinal malabsorption issues.

A) Increase the dosage of oral iron supplementation.

B) Evaluate the patient's dietary intake for iron-rich foods.

C) Assess for potential gastrointestinal malabsorption issues.

D) Suggest the use of vitamin C to enhance iron absorption.

A patient with a confirmed diagnosis of iron deficiency anemia is experiencing persistent symptoms despite oral iron supplementation. Which nursing intervention would be most appropriate to address this issue?

A) Encourage the patient to increase dietary intake of vitamin C-rich foods to enhance iron absorption.

B) Instruct the patient to take the iron supplement with a high-fiber meal to improve gastrointestinal tolerance.

C) Advise the patient to take a calcium supplement concurrently with iron to improve absorption.

D) Recommend switching to a daily multivitamin with iron to ensure adequate nutrient intake.

A patient with iron deficiency anemia due to heavy menstrual bleeding from uterine fibroids is undergoing intravenous iron therapy. Despite a modest increase in hemoglobin and hematocrit, her ferritin levels remain low. Which nursing intervention is most important to prioritize for improving the patient's anemia management while awaiting further gynecological intervention?

B) Monitor the patient's cardiac function closely.

A) Encourage the patient to increase dietary iron intake.

B) Monitor the patient's cardiac function closely.

C) Educate the patient on the signs of iron overload.

D) Recommend the patient start oral iron supplements.

A patient with iron deficiency anemia secondary to heavy menstrual bleeding due to uterine fibroids is receiving intravenous iron therapy. Her hemoglobin has increased slightly, but she continues to experience fatigue and elevated heart and respiratory rates. Which nursing intervention should be prioritized to address the patient's ongoing symptoms and prevent complications?

B) Monitor the patient's cardiac function closely and collaborate with the healthcare team to explore additional treatments for underlying causes of anemia.

A) Educate the patient on the importance of a diet high in iron-rich foods to support her therapy.

B) Monitor the patient's cardiac function closely and collaborate with the healthcare team to explore additional treatments for underlying causes of anemia.

C) Encourage the patient to increase physical activity to improve cardiovascular endurance and reduce fatigue.

D) Suggest the patient increase fluid intake to help improve circulation and reduce heart rate.

A patient undergoing intravenous iron therapy for chronic anemia presents with increased palpitations and dyspnea on exertion. Her ECG shows signs of left ventricular hypertrophy. What is the most appropriate nursing intervention to prioritize in this situation?

A) Administer supplemental oxygen and monitor respiratory status closely.

B) Encourage increased oral fluid intake to prevent dehydration.

C) Educate the patient on dietary sources of iron to improve ferritin levels.

D) Prepare the patient for immediate surgical intervention to address menorrhagia.

A nurse is evaluating a patient receiving intravenous iron therapy who presents with increased palpitations, dyspnea on exertion, and elevated vital signs. Which intervention should the nurse prioritize to address the underlying issue of her symptoms?

B) Collaborate with the healthcare team to expedite gynecological interventions to reduce menstrual blood loss.

A) Administer supplemental oxygen to improve respiratory status.

B) Collaborate with the healthcare team to expedite gynecological interventions to reduce menstrual blood loss.

C) Increase the dosage of intravenous iron therapy to rapidly correct anemia.

D) Initiate cardiac medications to manage heart rate and blood pressure.

A patient with a history of menorrhagia and confirmed uterine fibroids presents with signs of heart failure and left ventricular hypertrophy due to chronic anemia. Which nursing intervention is most appropriate to prioritize in the management plan to prevent further cardiac compromise?

B) Initiate beta-blocker therapy to reduce cardiac workload

A) Administer oral iron supplements to correct anemia

B) Initiate beta-blocker therapy to reduce cardiac workload

C) Schedule immediate surgical intervention for fibroid removal

D) Educate the patient on dietary modifications to reduce fluid retention

A patient with chronic anemia and newly diagnosed left ventricular hypertrophy is undergoing evaluation for heart failure management. Considering her concurrent condition of menorrhagia due to uterine fibroids, which nursing intervention is most critical in prioritizing her immediate care needs?

C) Monitoring vital signs and cardiac status closely for signs of decompensation.

A) Educating the patient on dietary modifications to increase iron intake.

B) Initiating a referral to a dietitian for nutritional counseling.

C) Monitoring vital signs and cardiac status closely for signs of decompensation.

D) Collaborating with the gynecology team to schedule uterine artery embolization.

A patient with worsening anemia and heart failure symptoms is being managed with intravenous iron therapy and cautious diuretic use. Which nursing intervention is most critical in monitoring the patient's response to these treatments and preventing potential complications?

B) Assess the patient's lung sounds and respiratory status regularly

A) Monitor the patient's blood glucose levels every 4 hours

B) Assess the patient's lung sounds and respiratory status regularly

C) Check the patient's capillary refill time and peripheral pulses

D) Measure the patient's abdominal girth daily

A patient with a history of menorrhagia and anemia is experiencing increased fatigue, shortness of breath during minimal exertion, and has vital signs indicating tachycardia and hypotension. After initiating intravenous iron therapy, what should the nurse prioritize when monitoring the patient's response to treatment?

B) Assess for improvements in blood pressure and heart rate.

A) Monitor for signs of fluid overload.

B) Assess for improvements in blood pressure and heart rate.

C) Check for electrolyte imbalances.

D) Evaluate for signs of an allergic reaction to iron therapy.

iron deficiency anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Iron deficiency leads to decreased hemoglobin synthesis, as iron is a critical component of hemoglobin, which results in reduced oxygen-carrying capacity of red blood cells, causing symptoms like fatigue and pallor.

• Secondary mechanism: Diminished iron stores in the bone marrow result in impaired erythropoiesis, leading to the production of smaller, hypochromic (pale) red blood cells, a condition known as microcytic anemia.

• Key complication: Chronic iron deficiency can lead to compensatory mechanisms such as increased cardiac output to meet tissue oxygen demands, potentially causing heart-related symptoms like tachycardia and shortness of breath.

Patient Profile

Demographics:

35-year-old female, office manager

History:

• Key past medical history: History of heavy menstrual periods, diagnosed with irritable bowel syndrome

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

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent fatigue and dizziness

• Key symptoms: Shortness of breath on exertion, pale skin, brittle nails, occasional heart palpitations

• Vital signs: Blood pressure 100/60 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 98.6°F

Section 1

In the initial assessment, further evaluation of the patient's symptoms and potential complications of iron deficiency anemia was conducted. Physical examination revealed conjunctival pallor and glossitis, indicative of severe anemia. The patient reported increased severity of fatigue, now significantly affecting her ability to perform daily activities at work. Her heart rate remained elevated at 110 bpm, and her respiratory rate was consistently at 24 breaths per minute, suggesting the body’s attempt to compensate for decreased oxygen delivery. Despite being on ferrous sulfate therapy, her symptoms seemed to persist, warranting further investigation into her iron absorption and overall gastrointestinal function, given her history of irritable bowel syndrome.

Laboratory investigations were ordered to provide a clearer picture of the patient's current hematological status. Complete blood count (CBC) results showed a hemoglobin level of 8.5 g/dL, hematocrit at 25%, and mean corpuscular volume (MCV) of 70 fL, confirming microcytic, hypochromic anemia. Serum ferritin levels were critically low at 10 ng/mL, and transferrin saturation was markedly reduced, indicating depleted iron stores and poor iron utilization. Additionally, a comprehensive metabolic panel was conducted to rule out other potential causes of her symptoms and assess her overall health status, with particular attention to renal and liver function, which remained within normal limits.

The persistence of symptoms despite iron supplementation suggested a possible malabsorption issue or inadequate intake relative to her ongoing blood loss. Given her history of heavy menstrual periods, the patient was advised to consult with a gynecologist for potential management of her menorrhagia. Meanwhile, an adjustment in her iron supplementation regimen was considered, with the potential transition to intravenous iron therapy to bypass gastrointestinal absorption issues. This approach aimed to rapidly replenish her iron stores and improve her symptomatic burden, while monitoring her response closely to prevent further cardiac strain and potential complications.

Section 2

Following the adjustment in her treatment plan, the patient began intravenous iron therapy to address the suspected malabsorption issues. Within a week of initiating this therapy, the patient noted a slight improvement in her energy levels, but she continued to experience significant fatigue, and her heart rate and respiratory rate remained elevated, suggesting ongoing cardiac strain. A follow-up CBC showed a modest increase in hemoglobin to 9.2 g/dL and hematocrit to 28%, indicating a positive but slow response to the intervention. However, the patient's ferritin levels remained low, and transferrin saturation had not improved significantly, hinting at an ongoing challenge in restoring adequate iron stores.

New diagnostic results from a gynecological evaluation revealed the presence of uterine fibroids, contributing to her heavy menstrual bleeding and consequently, her iron deficiency anemia. The gynecologist recommended considering options such as hormonal therapy or surgical intervention to manage the menorrhagia effectively, with the aim of reducing her chronic blood loss and allowing for better control of her anemia. This revelation provided a critical piece in understanding the persistent nature of her condition and underscored the need for a multidisciplinary approach in her care.

Additionally, the patient underwent a gastrointestinal evaluation to further explore potential absorption issues. An upper endoscopy and colonoscopy ruled out significant gastrointestinal pathologies such as celiac disease or inflammatory bowel disease, which could exacerbate her iron deficiency. This comprehensive assessment reinforced the multifactorial nature of her anemia, emphasizing the importance of addressing both the supply and loss of iron to improve her clinical status. As she continued with her iron therapy and awaited further gynecological intervention, careful monitoring of her cardiac function was prioritized to prevent further complications from prolonged anemia-induced stress.

Section 3

As the patient continued with her intravenous iron therapy and awaited gynecological intervention, her condition took a concerning turn. Within two weeks, she presented to the clinic with new symptoms, including increased palpitations and dyspnea on exertion, which were more pronounced than before. Her vital signs revealed a heart rate of 110 beats per minute and respiratory rate of 24 breaths per minute, both elevated compared to her baseline. Additionally, her blood pressure was noted at 140/92 mmHg, slightly higher than her usual readings. These changes indicated a potential exacerbation of cardiac strain, necessitating immediate clinical attention.

A repeat CBC showed a further increase in hemoglobin to 9.8 g/dL and hematocrit to 30%, suggesting a gradual improvement in her anemic state. However, serum ferritin remained persistently low at 10 ng/mL, and transferrin saturation was still below optimal levels at 12%. This imbalance highlighted the ongoing challenge in adequately replenishing her iron stores, suggesting that her heavy menstrual bleeding was outpacing the therapeutic benefits of the iron supplementation. Additionally, an electrocardiogram revealed signs of left ventricular hypertrophy, likely a result of chronic anemia-induced cardiac stress, further complicating her clinical picture.

These developments prompted the healthcare team to prioritize a multidisciplinary meeting to reassess her treatment strategy. The team considered the urgency of addressing her menorrhagia through more aggressive gynecological interventions, such as a myomectomy or uterine artery embolization, to curtail her blood loss and alleviate the cardiac burden. This situation underscored the necessity of integrating medical, gynecological, and possibly cardiological care to stabilize her condition and prevent further deterioration. The unfolding complexity of her case required careful balancing of interventions to optimize her overall health and improve her quality of life.

Section 4

As the multidisciplinary team reconvened to address the patient's complex presentation, their collective focus turned to the new diagnostic results that emerged from additional testing. An echocardiogram was performed to further evaluate the signs of left ventricular hypertrophy noted on the electrocardiogram. The echocardiogram confirmed the presence of concentric left ventricular hypertrophy, with a mildly reduced ejection fraction of 45%, indicating early signs of heart failure with preserved ejection fraction. This cardiac adaptation was consistent with the chronic strain imposed by persistent anemia and increased cardiac workload, highlighting the need for a more aggressive management plan to protect her cardiac function.

In parallel, a pelvic ultrasound was conducted to assess the extent of her uterine abnormalities contributing to menorrhagia. The results revealed multiple uterine fibroids, with the largest measuring 5 cm in diameter, corroborating the clinical suspicion of significant structural causes for her heavy menstrual bleeding. These findings necessitated an urgent consultation with the gynecology team to evaluate the feasibility and timing of interventions such as uterine artery embolization or myomectomy. The team also considered the potential need for temporary hormonal therapy to manage her bleeding and stabilize her hematologic status while awaiting surgical intervention.

Faced with these developments, the clinical team recognized the critical need for coordinated care. They initiated a heart failure management plan, incorporating beta-blockers to reduce cardiac workload and improve symptoms of palpitations and dyspnea. Concurrently, they expedited the gynecological intervention process, considering the high risk of continued cardiac compromise. This strategic planning emphasized the importance of addressing both the root cause of her anemia and its systemic manifestations, aiming to stabilize her condition and prevent further complications. As the patient's journey continued, the healthcare team remained vigilant, prepared to adapt to her evolving clinical needs.

Section 5

As the multidisciplinary team continued to monitor the patient's condition, they observed a change in her status that required immediate attention. Over the course of several days, the patient began exhibiting increased fatigue and shortness of breath, particularly during minimal exertion. Her vital signs revealed a heart rate of 110 beats per minute, blood pressure of 95/60 mmHg, and oxygen saturation of 92% on room air. Additionally, her hemoglobin levels, which were initially managed conservatively with oral iron supplementation, dropped further to 8.2 g/dL, indicating worsening anemia. This prompted a reassessment of her current management plan and the need for more aggressive interventions.

Recognizing the potential for worsening heart failure symptoms due to her anemia, the team decided to initiate intravenous iron therapy to rapidly improve her hemoglobin levels and reduce cardiac strain. The decision was made after careful consideration of her cardiac status and the potential benefits of enhancing oxygen delivery to tissues. Furthermore, given the patient's symptomatic bradycardia and hypotension, there was a discussion regarding the cautious use of diuretics to manage any fluid overload while avoiding exacerbation of hypotension. The team also coordinated with the gynecology department to prioritize the scheduling of her myomectomy, as controlling the source of her menorrhagia was crucial for long-term management of her anemia.

As the interventions were implemented, the team remained vigilant in monitoring her response. The patient's energy levels began to show slight improvement, and her dyspnea decreased with the initiation of targeted therapy. However, the team stayed alert for any signs of new complications, such as electrolyte imbalances or adverse reactions to the medications. The focus was on stabilizing her condition before the surgical intervention, emphasizing the importance of a multidisciplinary approach in addressing the interconnected nature of her health challenges. This phase of her treatment highlighted the delicate balance required to manage her complex presentation effectively, paving the way for her next steps towards recovery.