A 35-year-old female patient with a history of menorrhagia presents with severe iron deficiency anemia. Her laboratory results indicate microcytic, hypochromic anemia with low serum ferritin and elevated TIBC. A pelvic ultrasound reveals uterine fibroids. Which nursing intervention is most appropriate to address her current condition?

B) Administer oral iron supplements and provide education on their use and potential side effects.

A) Educate the patient on dietary sources of vitamin B12 to enhance red blood cell production.

B) Administer oral iron supplements and provide education on their use and potential side effects.

C) Recommend increased fluid intake to manage symptoms of anemia.

D) Suggest the use of a heating pad to alleviate abdominal discomfort from fibroids.

A patient with iron deficiency anemia secondary to uterine fibroids presents with symptoms of fatigue and pallor. Based on the diagnostic findings, which of the following nursing interventions should be prioritized to address her current condition?

B) Administer prescribed oral iron supplements and monitor for gastrointestinal side effects.

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

B) Administer prescribed oral iron supplements and monitor for gastrointestinal side effects.

C) Educate the patient on the importance of regular follow-ups with a gynecologist for fibroid management.

D) Initiate a blood transfusion to quickly increase hemoglobin levels.

A patient with persistent anemia, despite adherence to oral iron supplementation, presents with fatigue, dizziness, and increased heart rate. Her repeat CBC shows only modest improvement in hemoglobin levels. Considering the presence of uterine fibroids and the decision to initiate intravenous iron therapy, what is the most important nursing intervention to prioritize?

B) Monitor the patient's vital signs and symptoms for signs of an allergic reaction during the infusion.

A) Educate the patient on the potential side effects of intravenous iron therapy.

B) Monitor the patient's vital signs and symptoms for signs of an allergic reaction during the infusion.

C) Reinforce dietary modifications to enhance oral iron absorption.

D) Schedule regular follow-up appointments to assess the effectiveness of oral iron therapy.

A patient with iron deficiency anemia due to menorrhagia is being treated with intravenous iron therapy and is scheduled for a uterine artery embolization to address uterine fibroids. During a follow-up visit, which assessment finding would most indicate a need for immediate intervention?

D) New onset of severe pelvic pain

A) Hemoglobin level of 10.5 g/dL

B) Heart rate of 90 beats per minute

C) Blood pressure of 110/70 mmHg

D) New onset of severe pelvic pain

A patient with iron deficiency anemia due to uterine fibroids has shown improvement in symptoms after intravenous iron therapy. She is scheduled for uterine artery embolization to address her fibroids. Which nursing intervention is most appropriate prior to the procedure to ensure optimal patient outcomes?

B) Educate the patient about the potential post-procedure symptoms and necessary follow-up care.

A) Encourage the patient to increase oral iron intake the night before the procedure.

B) Educate the patient about the potential post-procedure symptoms and necessary follow-up care.

C) Advise the patient to discontinue all medications 24 hours before the procedure.

D) Instruct the patient to limit fluid intake to reduce the risk of complications.

A patient two weeks post-uterine artery embolization reports new lower abdominal discomfort and occasional mild cramping. The ultrasound reveals localized edema and mild inflammation, consistent with post-embolization syndrome. Which nursing intervention is most appropriate to address this condition?

B) Administer prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) and advise rest.

A) Encourage increased physical activity to improve circulation.

B) Administer prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) and advise rest.

C) Initiate a high-fiber diet to prevent constipation.

D) Apply cold compresses to the abdominal area to reduce swelling.

A patient who recently underwent uterine artery embolization reports new lower abdominal discomfort and occasional mild cramping. Based on this information and typical post-procedural care, which nursing intervention is most appropriate to address the patient's symptoms?

C) Recommend the use of a heating pad and prescribe analgesics to manage pain.

A) Advise the patient to take over-the-counter antacids and monitor for relief.

B) Encourage increased physical activity to promote circulation and reduce edema.

C) Recommend the use of a heating pad and prescribe analgesics to manage pain.

D) Suggest a high-fiber diet to prevent gastrointestinal discomfort due to medication.

A patient who had uterine artery embolization presents with increased lower abdominal pain, low-grade fever, and leukocytosis two weeks post-procedure. Which intervention should the nurse prioritize to address the current clinical findings?

A) Administer broad-spectrum antibiotics as prescribed.

B) Encourage increased oral fluid intake to promote hydration.

C) Apply a warm compress to the lower abdomen to relieve discomfort.

D) Educate the patient on signs of potential complications to monitor at home.

A patient who recently underwent uterine artery embolization returns with increased lower abdominal pain, low-grade fever, fatigue, leukocytosis, and elevated CRP levels. An ultrasound suggests a possible abscess formation near the embolized fibroids. What is the most appropriate initial nursing intervention in this situation?

C) Monitor the patient's vital signs and assess for signs of systemic infection

A) Administer prescribed analgesics to manage the patient's pain

B) Educate the patient on the importance of completing the full course of antibiotics

C) Monitor the patient's vital signs and assess for signs of systemic infection

D) Prepare the patient for immediate surgical intervention to drain the abscess

iron deficiency anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Iron deficiency anaemia occurs when there is insufficient iron available for hemoglobin production, resulting in decreased oxygen transport capacity. This can arise from inadequate dietary intake, poor absorption, or chronic blood loss, leading to reduced red blood cell production and smaller, paler cells (microcytic, hypochromic anaemia).

• Secondary mechanism: Compensatory increase in erythropoiesis is triggered by low oxygen levels, stimulating erythropoietin release. However, without adequate iron, this response is ineffective, exacerbating anaemia and causing fatigue, weakness, and pallor.

• Key complication: Prolonged iron deficiency can impair cognitive and immune functions, increase susceptibility to infections, and exacerbate chronic conditions, underscoring the importance of early detection and intervention in clinical settings.

Patient Profile

Demographics:

32-year-old female, school teacher

History:

• Key past medical history: History of heavy menstrual periods (menorrhagia), previous diagnosis of iron deficiency anemia 2 years ago

• Current medications: Oral contraceptive pill, over-the-counter iron supplements (irregular use)

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent fatigue and shortness of breath

• Key symptoms: Dizziness, palpitations, brittle nails, occasional chest discomfort

• Vital signs: Blood pressure 100/60 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 98.6°F, oxygen saturation 95% on room air

Section 1

New Diagnostic Results:

Following the patient's initial assessment, a set of lab tests was ordered to evaluate the extent of her iron deficiency anemia and to explore any underlying causes for her symptoms. The complete blood count (CBC) revealed a hemoglobin level of 8.5 g/dL, significantly lower than the normal range for women, indicating severe anemia. The mean corpuscular volume (MCV) was measured at 72 fL, consistent with microcytic anemia, and the mean corpuscular hemoglobin concentration (MCHC) was 28 g/dL, highlighting hypochromic red blood cells. Serum ferritin levels were critically low at 8 ng/mL, confirming depleted iron stores. Additionally, the total iron binding capacity (TIBC) was elevated at 450 mcg/dL, while serum iron was reduced to 30 mcg/dL, both suggestive of iron deficiency.

Further investigations included a pelvic ultrasound, which was performed to assess for potential sources of chronic blood loss related to her history of menorrhagia. The ultrasound revealed the presence of uterine fibroids, which were likely contributing to her heavy menstrual bleeding and ongoing anemia. These findings prompted a reconsideration of her current management plan, emphasizing the need for more effective iron supplementation and a possible referral to a gynecologist for further evaluation and treatment of the fibroids.

These results provide a clear clinical picture of the patient's condition and necessitate a multidisciplinary approach to address both the immediate hematological deficiencies and the underlying gynecological issues. Moving forward, the healthcare team must prioritize restoring her iron levels to alleviate symptoms and improve her quality of life, while also considering surgical or medical therapies to manage the fibroids and prevent recurrent anemia. This integrated strategy will be critical in preventing further complications and improving the patient's overall health outcomes.

Section 2

Change in Patient Status:

Several weeks into the treatment regimen, the patient returns for a follow-up appointment, reporting persistent fatigue, dizziness, and an increased heart rate, despite adherence to oral iron supplementation. Her vital signs reveal a heart rate of 110 beats per minute, which is elevated, and a blood pressure reading of 100/60 mmHg, slightly lower than her baseline. A repeat CBC shows only a modest improvement in hemoglobin, now at 9.0 g/dL, while other parameters such as MCV and MCHC remain largely unchanged, suggesting that her anemia is only partially responsive to the current treatment strategy.

Given these findings, the healthcare team must now reassess the effectiveness of the oral iron therapy and consider potential barriers to absorption or additional sources of blood loss. The patient's gastrointestinal health is explored further, revealing no significant history of malabsorption or gastrointestinal bleeding, which might interfere with iron absorption. However, the persistent nature of the anemia and presence of uterine fibroids raise concern for ongoing blood loss that may be outpacing the replenishment afforded by oral supplements.

At this juncture, the clinical team decides to escalate care by initiating intravenous iron therapy to more rapidly replenish her iron stores and improve her symptoms. Concurrently, a gynecological consultation is prioritized to discuss surgical options for the management of her fibroids, as medical therapy has not sufficiently mitigated her menorrhagia. This dual approach aims to address both the immediate hematological needs and the underlying gynecological cause, underscoring the importance of a comprehensive plan in preventing further anemia-related complications and enhancing her quality of life.

Section 3

Response to Interventions:

After initiating intravenous iron therapy, the patient returns for a follow-up appointment two weeks later. She reports a noticeable reduction in fatigue and dizziness, and her heart rate has decreased to 90 beats per minute, suggesting an improvement in her cardiovascular stability. Her blood pressure is now 110/70 mmHg, closer to her usual baseline. A repeat complete blood count (CBC) shows a more significant improvement in hemoglobin levels, now at 10.5 g/dL, indicating a positive response to the intravenous iron. The mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) have begun to show signs of normalization, suggesting enhanced erythropoiesis and improved red blood cell morphology.

However, the gynecological consultation reveals that the patient's uterine fibroids are larger than initially estimated, with imaging confirming multiple fibroids contributing to her menorrhagia. The gynecologist discusses the option of a minimally invasive surgical procedure, such as uterine artery embolization, to reduce fibroid size and address the excessive menstrual bleeding. The patient is counseled on the benefits and risks of the procedure, and after considering her options, she decides to proceed with the intervention in hopes of achieving a long-term solution to her anemia.

This dual strategy of intravenous iron supplementation and planned surgical intervention underscores the need for a multi-faceted approach in managing complex cases of iron deficiency anemia with underlying gynecological causes. The healthcare team continues to monitor her condition closely, emphasizing the importance of follow-up appointments to track her hematological status and the effectiveness of the fibroid treatment. This comprehensive management plan aims to prevent further complications and improve her overall quality of life.

Section 4

Two weeks following the uterine artery embolization, the patient returns for another follow-up appointment. She reports that her menstrual bleeding has significantly decreased in volume and duration, which is a promising sign of the procedure's success. Her energy levels have improved further, and she is experiencing less fatigue during daily activities. However, during the visit, she mentions experiencing new lower abdominal discomfort and occasional mild cramping, which she describes as different from her previous menstrual pain.

A physical examination reveals mild tenderness in the lower abdomen but no signs of acute distress. Her vital signs remain stable, with a heart rate of 88 beats per minute and blood pressure of 112/72 mmHg. A repeat CBC shows continued improvement in her hemoglobin level, now at 11.2 g/dL, and further normalization of MCV and MCHC values, supporting ongoing effective erythropoiesis. However, a follow-up ultrasound is ordered to assess the post-procedural status of the fibroids and to rule out any potential complications such as infection or ischemia related to the embolization.

The ultrasound reveals that while there is a reduction in the size of the fibroids, there is also localized edema and mild inflammation around the treated area, consistent with a post-embolization syndrome. This condition, common after uterine artery embolization, typically resolves with conservative management, including analgesia and anti-inflammatory medications. The healthcare team advises the patient to monitor her symptoms closely, encouraging rest and scheduled follow-up to ensure resolution of the discomfort. This phase highlights the importance of understanding potential post-procedural complications and reinforces the necessity of a comprehensive management plan to address both the immediate and longer-term issues associated with her condition.

Section 5

Two weeks later, the patient returns to the clinic with new concerns. Although her initial abdominal discomfort post-embolization had improved with conservative management, she now reports experiencing increased lower abdominal pain and a low-grade fever over the past few days. She also mentions feeling more fatigued than usual, despite her initial improvement in energy levels. During the physical examination, the patient exhibits increased tenderness in the lower abdominal region, and there is mild guarding upon palpation. Her vital signs show a slightly elevated heart rate of 96 beats per minute and a low-grade fever of 100.4°F, while her blood pressure remains stable at 110/70 mmHg.

Given these new symptoms, the healthcare team is concerned about the possibility of a delayed infection or abscess formation as a complication following the uterine artery embolization. A repeat complete blood count (CBC) reveals leukocytosis, with a white blood cell count of 14,500/µL, suggesting an inflammatory or infectious process. C-reactive protein (CRP) levels are also elevated, further indicating inflammation. To investigate these findings, an urgent pelvic ultrasound is ordered, which reveals an area of increased echogenicity near the site of the embolized fibroids, suggestive of a possible abscess.

The team initiates a course of broad-spectrum antibiotics to address the potential infection and closely monitors the patient for any signs of systemic involvement. This development emphasizes the need for ongoing vigilance and adaptive management in post-procedural care. The patient is advised to remain in close contact with the healthcare team and to report any worsening symptoms immediately. This phase underscores the critical role of clinical reasoning in identifying and managing unexpected complications, ensuring that the patient's recovery trajectory is maintained.