A patient with confirmed microcytic anemia due to iron deficiency is not responding to oral ferrous sulfate despite adherence to the regimen. Which nursing intervention is most appropriate to enhance the effectiveness of her iron supplementation?

B) Suggest the patient take the ferrous sulfate on an empty stomach with vitamin C to enhance absorption.

A) Advise the patient to take the ferrous sulfate with a glass of milk to increase absorption.

B) Suggest the patient take the ferrous sulfate on an empty stomach with vitamin C to enhance absorption.

C) Encourage the patient to take ferrous sulfate along with her oral contraceptive to reduce side effects.

D) Recommend increasing dietary fiber intake to prevent constipation from iron supplements.

A patient with a diagnosis of microcytic anemia is found to have low serum ferritin and elevated total iron-binding capacity (TIBC). Despite taking ferrous sulfate supplements, her hemoglobin and hematocrit levels remain low. Which action should the nurse prioritize to address the potential cause of her persistent anemia?

C) Discuss with the healthcare provider the potential for intravenous iron therapy to improve iron status.

A) Encourage the patient to increase dietary intake of iron-rich foods.

B) Monitor the patient for signs of gastrointestinal bleeding and re-evaluate the need for an occult blood test.

C) Discuss with the healthcare provider the potential for intravenous iron therapy to improve iron status.

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

A patient who has been undergoing intravenous iron therapy presents with improved hemoglobin and hematocrit levels but continues to exhibit microcytic anemia. Given the healthcare team's concerns about potential malabsorption issues, which of the following nursing interventions is most appropriate to address her ongoing fatigue and support her recovery?

B) Educate the patient on consuming a diet high in vitamin C to enhance iron absorption.

A) Encourage the patient to increase her intake of calcium-rich foods to support bone health.

B) Educate the patient on consuming a diet high in vitamin C to enhance iron absorption.

C) Advise the patient to increase her physical activity to improve cardiovascular function.

D) Recommend the patient to limit fluid intake to reduce potential gastrointestinal irritation.

A patient with iron deficiency anemia has been receiving intravenous iron therapy and reports improvement in energy levels and a reduction in dizziness. However, she still experiences significant fatigue, and her MCV remains low. Which nursing intervention is most appropriate to address the underlying cause of her anemia while awaiting further specialist evaluation?

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

B) Advise the patient to reduce physical activity to conserve energy until her hemoglobin levels normalize.

C) Suggest the patient take oral iron supplements in addition to intravenous therapy to boost iron levels.

D) Recommend the patient start a gluten-free diet to address potential celiac disease.

A patient diagnosed with celiac disease and iron deficiency anemia is starting a gluten-free diet and continuing intravenous iron therapy. Which nursing intervention is most important to evaluate the effectiveness of the treatment plan?

D) Evaluate the patient's hemoglobin and hematocrit levels.

A) Monitor the patient’s weight for any changes.

B) Assess the patient's adherence to a gluten-free diet.

C) Check the patient's blood pressure regularly.

D) Evaluate the patient's hemoglobin and hematocrit levels.

A patient with confirmed celiac disease and iron deficiency anemia is on a gluten-free diet and receiving intravenous iron supplementation. During her follow-up, she continues to experience fatigue and palpitations. Which nursing intervention is most appropriate to prioritize at this time?

A) Educate the patient on the importance of strict adherence to a gluten-free diet.

B) Recommend increasing oral iron supplement intake to enhance hemoglobin levels.

C) Initiate a referral to a cardiologist for evaluation of palpitations.

D) Monitor her blood glucose levels to rule out diabetes as a cause of fatigue.

A patient with celiac disease has been on a gluten-free diet and intravenous iron supplementation for four weeks. The patient reports decreased gastrointestinal symptoms, but still experiences fatigue. Her hemoglobin level has improved modestly. Considering her current condition, which nursing intervention is most appropriate to prioritize in her care plan?

C) Reinforce the importance of adhering strictly to the gluten-free diet to prevent symptom recurrence

A) Encourage increased fluid intake to address potential dehydration

B) Educate the patient on incorporating high-fiber gluten-free foods to enhance energy levels

C) Reinforce the importance of adhering strictly to the gluten-free diet to prevent symptom recurrence

D) Recommend a daily low-impact exercise routine to help improve fatigue and energy levels

A patient with celiac disease has shown improvement in gastrointestinal symptoms and anemia after starting a gluten-free diet and intravenous iron therapy. However, she continues to experience fatigue and mild anemia. Which nursing intervention is most appropriate to further address her fatigue and support her recovery?

B) Educate the patient about the importance of a balanced diet including vitamin C-rich foods to enhance iron absorption.

A) Encourage the patient to increase daily physical activity to improve energy levels.

B) Educate the patient about the importance of a balanced diet including vitamin C-rich foods to enhance iron absorption.

C) Suggest the patient take oral iron supplements in addition to intravenous therapy for faster improvement.

D) Recommend the patient to drink caffeine-containing beverages to combat fatigue during the day.

A patient with a history of celiac disease and borderline low vitamin B12 levels presents with persistent fatigue, pallor, and new-onset tingling in the extremities. Which nursing intervention is most appropriate to address the suspected vitamin B12 deficiency and its neurological implications?

C) Administer vitamin B12 injections as prescribed and monitor neurological status.

A) Encourage the patient to increase dietary intake of iron-rich foods.

B) Educate the patient on the importance of adhering to a gluten-free diet.

C) Administer vitamin B12 injections as prescribed and monitor neurological status.

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

A patient with a history of celiac disease presents with persistent fatigue, mild shortness of breath on exertion, and new neurological symptoms despite adherence to a gluten-free diet and iron supplementation. Laboratory results show a borderline low vitamin B12 level and low mean corpuscular volume (MCV). Which nursing intervention is most appropriate to address the patient's current symptoms and underlying condition?

B) Administer vitamin B12 injections and monitor for improvement in neurological symptoms.

A) Educate the patient on increasing dietary intake of vitamin B12-rich foods such as red meat and dairy products.

B) Administer vitamin B12 injections and monitor for improvement in neurological symptoms.

C) Reinforce the importance of strict gluten-free dietary adherence to prevent further complications.

D) Suggest the patient take oral vitamin B12 supplements and reassess in one month.

iron deficiency anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Iron deficiency anemia primarily occurs due to inadequate iron availability, which is essential for hemoglobin synthesis. This leads to reduced hemoglobin levels and, consequently, impaired oxygen transport capacity of red blood cells.

• Secondary mechanism: The body's iron storage in the liver, spleen, and bone marrow diminishes over time due to chronic blood loss, poor dietary intake, or malabsorption, further exacerbating anemia by limiting erythropoiesis (production of red blood cells).

• Key complication: As a result of decreased oxygen delivery to tissues, patients may experience symptoms such as fatigue, pallor, and dyspnea. In the long term, this can lead to compensatory mechanisms like tachycardia and eventual cardiac strain if untreated.

Patient Profile

Demographics:

34-year-old female, office manager

History:

• Past medical history: History of heavy menstrual bleeding, previous diagnosis of mild iron deficiency anemia

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

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Increased fatigue and dizziness over the past month

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

• Vital signs: Blood pressure 100/60 mmHg, heart rate 98 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F

Section 1

As the case progresses, the patient returns for a follow-up appointment after her initial presentation with increased fatigue and dizziness. Despite adherence to her current treatment regimen of ferrous sulfate and oral contraceptives, her symptoms have not improved, prompting the healthcare provider to order a comprehensive set of laboratory tests to evaluate her iron status and overall hematologic health. The results reveal a hemoglobin level of 9.5 g/dL, hematocrit of 30%, and mean corpuscular volume (MCV) of 70 fL, all indicative of microcytic anemia. Her serum ferritin is markedly low at 10 ng/mL, confirming depleted iron stores, while her total iron-binding capacity (TIBC) is elevated at 450 mcg/dL, suggesting an increased capacity for iron binding due to deficiency.

Further investigation into her gastrointestinal system is warranted to rule out additional causes of iron loss or malabsorption, given the persistence of her anemia despite supplementation. An occult blood test is negative, and there are no signs of gastrointestinal bleeding, which shifts the focus to potential absorption issues or increased menstrual losses. The healthcare provider considers the possibility of inadequate absorption of oral iron, possibly due to poor gastrointestinal absorption or issues related to the formulation of the supplement. A trial of intravenous iron therapy is proposed to bypass gastrointestinal absorption and directly replenish iron stores, with close monitoring of her response and potential side effects.

Clinically, the patient is exhibiting mild compensatory tachycardia with a heart rate of 110 bpm at rest, a sign that her cardiovascular system is under strain due to the chronic anemia. This reinforces the need for a more aggressive approach to treatment to prevent further cardiac complications. The healthcare team discusses with the patient the importance of follow-up and monitoring, including regular laboratory tests to track her hemoglobin and iron levels, as well as adjustments to her treatment plan. This will ensure timely intervention and prevent the progression of her condition, while also exploring lifestyle modifications to support her recovery.

Section 2

Following the initiation of intravenous iron therapy, the patient returns for a follow-up appointment two weeks later. Clinically, she reports a slight improvement in energy levels and a reduction in dizziness, though she still experiences significant fatigue. Her heart rate has decreased to 95 bpm at rest, indicating a mild improvement in her cardiovascular strain. New laboratory results are promising; her hemoglobin has increased to 10.5 g/dL, and her hematocrit has risen to 32%. However, her mean corpuscular volume (MCV) remains low at 72 fL, suggesting that while her iron levels are improving, the microcytic anemia has not yet fully resolved. Serum ferritin levels have increased to 30 ng/mL, providing evidence that her iron stores are beginning to replenish.

Despite these improvements, the healthcare team remains concerned about the underlying cause of her iron deficiency. Given the negative occult blood test and the absence of gastrointestinal bleeding, further evaluation of potential malabsorption issues is warranted. A referral to a gastroenterologist is made for further assessment, including the possibility of celiac disease or other malabsorption syndromes that could be interfering with oral iron absorption. Additionally, a pelvic ultrasound is scheduled to assess for potential uterine abnormalities, such as fibroids, which could contribute to increased menstrual losses.

The healthcare provider discusses with the patient the importance of continuing her current treatment plan and attending all scheduled specialist appointments. They emphasize the need for ongoing monitoring of her iron levels and symptoms to ensure that any new complications are promptly identified and managed. The patient is advised to maintain a diet rich in iron, vitamin C, and other essential nutrients to support her recovery. As she leaves the clinic, the plan is set for another follow-up in four weeks to reassess her progress and make any necessary adjustments to her treatment regimen based on the outcomes of the specialist evaluations.

Section 3

At her follow-up appointment four weeks later, the patient presents with new symptoms of intermittent abdominal discomfort and frequent diarrhea. Despite a continued slight improvement in energy levels, she reports experiencing more pronounced fatigue and occasional palpitations. Her vital signs reveal a resting heart rate of 105 bpm and a blood pressure of 110/70 mmHg. Physical examination shows mild pallor and conjunctival paleness, indicative of persistent anemia. Her laboratory results indicate a hemoglobin level of 10.2 g/dL and a hematocrit of 31%, reflecting a slight regression compared to her previous labs. The mean corpuscular volume (MCV) remains low at 70 fL, and her serum ferritin is stable at 28 ng/mL, suggesting that while iron stores are not depleting rapidly, her body is struggling to maintain adequate hemoglobin synthesis.

The gastroenterologist's evaluation reveals positive serology for celiac disease, indicating that malabsorption is a likely contributor to her iron deficiency anemia. The pelvic ultrasound results return normal, ruling out uterine abnormalities as a source of significant blood loss. With these findings, the healthcare team hypothesizes that the patient's iron deficiency anemia is primarily due to malabsorption secondary to celiac disease, complicating her recovery despite intravenous iron therapy.

In response to these developments, the care team initiates a gluten-free diet to address the underlying malabsorption issue. They emphasize the importance of dietary adherence and close monitoring of her symptoms and lab values. Additionally, they plan to continue intravenous iron supplementation, adjusting the dosage as needed to support her iron levels while her gastrointestinal health improves. The patient is scheduled for another follow-up in four weeks, at which time her response to the dietary changes and the stability of her anemia will be reassessed. This plan aims to stabilize her condition and address both the symptomatic anemia and its root cause, guiding her towards a more sustainable recovery.

Section 4

At the next follow-up appointment four weeks later, the patient reports a noticeable improvement in her gastrointestinal symptoms since starting the gluten-free diet. She mentions that her diarrhea has significantly reduced, and she experiences less frequent abdominal discomfort. However, she still feels fatigued, although the severity of her palpitations has decreased. Her energy levels have shown a modest improvement, allowing her to resume some of her daily activities with less difficulty.

Upon examination, her vital signs indicate a slight improvement: her resting heart rate has decreased to 95 bpm, and her blood pressure is stable at 112/72 mmHg. Physical examination still reveals mild pallor, but her conjunctival paleness appears slightly less pronounced. Laboratory results show a modest improvement in her hemoglobin level, now at 10.8 g/dL, and her hematocrit is 33%. Her mean corpuscular volume (MCV) remains low at 71 fL, but her serum ferritin has increased to 32 ng/mL, suggesting a positive response to the continued intravenous iron therapy and dietary changes.

Despite these improvements, the care team remains vigilant, as her anemia persists, albeit with slight progress. They decide to continue with the current regimen of intravenous iron supplementation and strict adherence to the gluten-free diet. The team discusses the potential for long-term dietary management and the need for ongoing monitoring of her iron levels and overall health. They plan to reassess her condition in another four weeks, aiming to further stabilize her anemia and evaluate any additional intervention needs. This follow-up will be crucial for determining the success of the treatment plan and addressing any lingering issues that might arise as her body adjusts to the dietary changes.

Section 5

Four weeks later, the patient returns for her scheduled follow-up appointment. She reports that her energy levels have plateaued despite adhering strictly to her gluten-free diet and completing her course of intravenous iron therapy. While she no longer experiences palpitations, her fatigue persists, and she has developed mild shortness of breath on exertion. She also mentions a new sensation of tingling in her fingertips and toes, raising concerns about potential neurological involvement.

Upon examination, her vital signs are stable with a resting heart rate of 90 bpm and blood pressure of 110/70 mmHg. However, her physical assessment reveals some concerning changes: her pallor has not improved, and her conjunctiva remains pale. Neurological examination highlights diminished sensation in her extremities, suggesting possible peripheral neuropathy. A review of her laboratory results indicates that her hemoglobin level has slightly increased to 11.2 g/dL, but her mean corpuscular volume (MCV) remains low at 70 fL. Notably, her serum vitamin B12 level is now borderline low at 230 pg/mL, raising suspicion of concurrent vitamin B12 deficiency contributing to her anemia and new neurological symptoms.

Given these findings, the care team decides to expand their diagnostic evaluation to include additional tests to assess vitamin B12 absorption and potential malabsorption issues beyond gluten sensitivity. They plan to initiate vitamin B12 supplementation while continuing to monitor her iron levels and dietary adherence. The team acknowledges the complexity of her case, emphasizing the need for a multifaceted approach to address both her hematologic and neurological symptoms. This new development prompts them to consider the broader implications of her nutritional deficiencies, setting the stage for a comprehensive reassessment of her treatment plan in the coming weeks.