A patient with confirmed iron deficiency anemia is experiencing escalated shortness of breath, chest discomfort on exertion, a heart rate of 115 bpm, and a blood pressure drop to 95/60 mmHg. Which nursing intervention is most appropriate to prioritize at this time?

B) Notify the healthcare provider and prepare for intravenous iron therapy.

A) Administer oral iron supplements and monitor the patient's response.

B) Notify the healthcare provider and prepare for intravenous iron therapy.

C) Encourage the patient to engage in light exercise to improve circulation.

D) Increase dietary iron intake by providing iron-rich foods.

A patient with diagnosed iron deficiency anemia is experiencing increased shortness of breath and chest discomfort. Vital signs indicate a heart rate of 115 bpm and blood pressure of 95/60 mmHg. Given these symptoms, what is the priority nursing intervention?

C) Initiate oxygen therapy and notify the healthcare provider for further cardiac evaluation.

A) Administer prescribed oral iron supplements and encourage rest.

B) Prepare the patient for immediate blood transfusion to address anemia.

C) Initiate oxygen therapy and notify the healthcare provider for further cardiac evaluation.

D) Increase the dosage of levothyroxine to improve thyroid function and assess anemia impact.

A patient with severe anemia is experiencing symptoms of high-output heart failure. The healthcare team has initiated intravenous iron therapy and adjusted her levothyroxine dosage. What should the nurse prioritize in monitoring to ensure effective management of this patient's condition?

A) Monitor for signs of fluid overload, such as peripheral edema and shortness of breath.

B) Assess for signs of infection, such as fever and elevated white blood cell count.

C) Monitor for neurovascular changes, such as numbness and tingling in the extremities.

D) Evaluate for gastrointestinal symptoms, such as nausea and vomiting.

A nurse is reviewing the care plan for a patient diagnosed with severe anemia and early signs of high-output heart failure. Which intervention should the nurse prioritize to address the patient's current condition?

B) Administer intravenous iron therapy as prescribed.

A) Initiate oxygen therapy to improve tissue oxygenation.

B) Administer intravenous iron therapy as prescribed.

C) Encourage ambulation to prevent deep vein thrombosis.

D) Increase oral fluid intake to support circulatory volume.

A patient receiving intravenous iron therapy for anemia shows positive initial responses, with improved hemoglobin levels and reduced heart rate. However, a fecal occult blood test indicates gastrointestinal bleeding. Which nursing intervention is most critical at this time?

D) Coordinate with the gastroenterology team to expedite diagnostic endoscopy.

A) Increase the patient's iron dosage to accelerate anemia correction.

B) Prepare the patient for an immediate blood transfusion to stabilize hemoglobin levels.

C) Educate the patient on avoiding NSAIDs to reduce the risk of gastrointestinal bleeding.

D) Coordinate with the gastroenterology team to expedite diagnostic endoscopy.

A patient with chronic anemia is receiving intravenous iron therapy and shows improvement in hemoglobin levels and cardiovascular response. However, a positive fecal occult blood test suggests gastrointestinal bleeding. What is the priority nursing intervention while awaiting endoscopic evaluation?

C) Monitor vital signs closely and assess for signs of hypovolemia or worsening anemia.

A) Administer prescribed proton pump inhibitors to reduce gastrointestinal bleeding risk.

B) Educate the patient on avoiding iron-rich foods to prevent exacerbation of symptoms.

C) Monitor vital signs closely and assess for signs of hypovolemia or worsening anemia.

D) Encourage increased oral fluid intake to enhance hydration and support recovery.

A patient with a bleeding gastric ulcer has undergone an upper gastrointestinal endoscopy with hemostatic intervention and is prescribed proton pump inhibitor therapy. As a nurse, which action is most important to ensure the effectiveness of the patient's treatment plan?

B) Educate the patient on the importance of taking the proton pump inhibitor before meals.

A) Monitor the patient’s hemoglobin levels daily.

B) Educate the patient on the importance of taking the proton pump inhibitor before meals.

C) Advise the patient to avoid all solid foods until the ulcer heals completely.

D) Schedule daily follow-up endoscopies to assess ulcer healing.

A patient is recovering from an upper gastrointestinal endoscopy where a bleeding gastric ulcer was identified and treated. The nurse is responsible for post-procedure care. Which intervention should the nurse prioritize to prevent further complications in this patient?

B) Administer prescribed proton pump inhibitors (PPIs) promptly to reduce gastric acid secretion.

A) Encourage the patient to ambulate frequently to improve circulation.

B) Administer prescribed proton pump inhibitors (PPIs) promptly to reduce gastric acid secretion.

C) Provide a high-fiber diet to promote bowel movements and prevent constipation.

D) Monitor the patient’s blood pressure every 4 hours to detect hypertension early.

A patient with iron deficiency anemia presents with orthostatic hypotension and fatigue. The nursing team is considering interventions to manage her condition. Which nursing intervention should be prioritized to address her orthostatic hypotension?

D) Instruct the patient to rise slowly from a seated or lying position to prevent dizziness.

A) Encourage the patient to increase her fluid intake and monitor her electrolyte balance.

B) Advise the patient to take her iron supplements with meals to enhance absorption.

C) Implement a regular exercise program to improve her cardiovascular health.

D) Instruct the patient to rise slowly from a seated or lying position to prevent dizziness.

A patient with iron deficiency anemia exhibits signs of orthostatic hypotension and fatigue. The nursing team is considering initiating intravenous iron supplementation. Which of the following nursing interventions is most critical to prioritize to ensure patient safety and optimize treatment outcomes?

B) Monitor the patient's blood pressure and heart rate before and after changing positions to assess for orthostatic changes.

A) Encourage the patient to consume a high-fiber diet to prevent constipation associated with iron supplementation.

B) Monitor the patient's blood pressure and heart rate before and after changing positions to assess for orthostatic changes.

C) Educate the patient on the importance of adhering to a low-sodium diet to prevent fluid retention.

D) Schedule the patient's activities and rest periods to minimize fatigue and promote recovery.

Anaemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Reduced red blood cell (RBC) production often due to deficiencies in essential components like iron, vitamin B12, or folate, leading to decreased hemoglobin synthesis and impaired oxygen transport capacity, which are critical for cellular metabolism and energy production.

• Secondary mechanism: Increased RBC destruction, as seen in hemolytic anemias, where premature RBC breakdown occurs due to intrinsic defects or external factors, resulting in a decreased lifespan of RBCs and insufficient numbers to meet physiological demands.

• Key complication: Tissue hypoxia, stemming from inadequate oxygen delivery, can lead to fatigue, pallor, and shortness of breath, with chronic hypoxia causing compensatory mechanisms like increased cardiac output and potential cardiac strain.

Patient Profile

Demographics:

45-year-old female, office worker

History:

• Key past medical history: Iron deficiency anemia diagnosed 3 years ago, hypothyroidism

• Current medications: Levothyroxine, ferrous sulfate

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Fatigue and shortness of breath

• Key symptoms: Dizziness, pallor, heart palpitations, mild chest discomfort

• Vital signs: Blood pressure 100/65 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 98.6°F

Section 1

As the patient's condition is further evaluated, new diagnostic results provide additional insights into her anemia. Laboratory tests reveal a hemoglobin level of 8.5 g/dL, which is significantly lower than the normal range, indicating moderate anemia. Her mean corpuscular volume (MCV) is 75 fL, which confirms microcytic anemia, typically associated with iron deficiency. Serum ferritin levels are critically low at 10 ng/mL, reinforcing the diagnosis of iron deficiency anemia. Furthermore, her thyroid function tests show that her TSH level is slightly elevated, suggesting a possible need for adjustment in her levothyroxine dosage. Despite supplementation, her iron stores have not improved significantly, prompting consideration of alternative causes such as malabsorption or chronic blood loss.

As the team discusses these findings, the patient's condition begins to show signs of possible complications. Her shortness of breath escalates, and she reports increased chest discomfort, particularly during exertion. Repeat vital signs indicate a heart rate of 115 bpm and a blood pressure drop to 95/60 mmHg, suggesting a compensatory response to worsening anemia and possible cardiac strain. This raises concerns about the potential development of high-output heart failure due to chronic tissue hypoxia and increased cardiac workload. The healthcare team must now consider more aggressive interventions such as intravenous iron therapy and further cardiac evaluation to prevent further deterioration and optimize her treatment plan.

Section 2

As the healthcare team initiates a more detailed cardiac evaluation, they promptly order an echocardiogram and electrocardiogram (ECG) to assess the patient's cardiac function given her escalating symptoms. The echocardiogram reveals mild left ventricular hypertrophy and an ejection fraction of 55%, indicating that while the heart's pumping ability remains within normal limits, there is some evidence of cardiac remodeling likely due to the chronic anemia and increased cardiac workload. The ECG shows sinus tachycardia with a rate of 115 bpm, consistent with her compensatory tachycardia observed in the vital signs. These findings suggest the early stages of high-output heart failure, driven by the body's need to deliver more oxygen to tissues under the stress of severe anemia.

In light of these results, the healthcare team decides to initiate intravenous iron therapy to rapidly replenish iron stores and address the underlying cause of her anemia more effectively. They also consider the need for closer monitoring of her cardiac status, given the signs of strain, and discuss the potential need for a cardiology consult. The patient's oral iron supplementation is reviewed, and the team decides to assess her gastrointestinal function for any signs of malabsorption by scheduling a gastroenterology referral and considering tests such as a fecal occult blood test or an endoscopy to rule out chronic blood loss.

Simultaneously, the team revisits her thyroid function management. Given the slightly elevated TSH level, they decide to adjust her levothyroxine dosage, considering that optimal thyroid function can play a crucial role in her overall energy levels and cardiovascular health. As they implement these changes, the team remains vigilant for any signs of further cardiac compromise or complications from her anemia, ensuring that the patient receives comprehensive and timely care to stabilize her condition and prevent further deterioration. This integrated and proactive approach aims to improve her clinical outcomes and address both the immediate and underlying issues contributing to her current health challenges.

Section 3

As the healthcare team continues to monitor the patient, her initial response to the intravenous iron therapy appears promising. Within 48 hours, there is a modest but encouraging improvement in her hemoglobin levels, rising from 7.5 g/dL to 9 g/dL. This change is accompanied by a slight reduction in her heart rate, now recorded at 100 bpm, indicating a positive cardiovascular response to the increased oxygen-carrying capacity. Her blood pressure remains stable at 118/76 mmHg, and she reports feeling somewhat less fatigued. However, the team remains cautious, aware that her cardiac status still requires close observation.

Despite these improvements, new diagnostic results reveal an unexpected complication. The fecal occult blood test returns positive, suggesting potential gastrointestinal bleeding as a source of her chronic anemia. This finding correlates with the patient's history of intermittent abdominal discomfort and occasional episodes of melena, which she had previously attributed to dietary changes. The healthcare team decides to expedite the gastroenterology referral for an endoscopy to identify and address any underlying lesions or sources of bleeding.

These developments necessitate a careful reassessment of the patient's treatment plan. The team prioritizes the need to balance the ongoing correction of anemia with the investigation and management of the newly identified gastrointestinal issue. They emphasize the importance of maintaining adequate hydration and nutrition to support her recovery while preparing for possible endoscopic intervention. This evolving scenario challenges the team to integrate their clinical reasoning skills, ensuring that they address both the symptomatic relief and root cause of the patient's anemia to prevent further complications and promote optimal healing.

Section 4

As the patient undergoes further evaluation, a gastroenterology consultation is swiftly arranged, and an upper gastrointestinal endoscopy is performed. The endoscopic findings reveal the presence of a small bleeding gastric ulcer in the antrum, which appears to be the source of her chronic blood loss. Biopsies are taken to rule out malignancy and test for Helicobacter pylori infection, a common etiological factor in peptic ulcer disease. The endoscopic intervention includes the application of a hemostatic agent to control the bleeding, alongside recommendations for proton pump inhibitor therapy to promote ulcer healing and reduce gastric acid secretion.

In the interim, the patient's clinical status is closely monitored. Her hemoglobin levels are checked daily to ensure stability, and her heart rate has decreased further to 92 bpm, suggesting a gradual improvement in her cardiac workload. However, her blood pressure has slightly increased to 126/82 mmHg, which may be attributed to the physiological stress of the endoscopic procedure and the body's compensatory mechanisms in response to ongoing anemia. The nursing team notes that the patient experiences mild epigastric discomfort post-procedure, which is addressed with dietary modifications and analgesics as needed.

These developments highlight the need for a comprehensive, multidisciplinary approach to her care, integrating gastroenterological management with ongoing hematologic support. The team emphasizes the importance of patient education, particularly regarding adherence to the prescribed medication regimen and dietary recommendations to prevent ulcer recurrence. As the patient's treatment plan evolves, the healthcare team remains vigilant, recognizing the potential for further complications and the necessity for continuous reassessment to ensure a holistic approach to her recovery.

Section 5

As the patient's care progresses, a notable change in her status begins to emerge. Despite the initial improvements in heart rate and the stabilization of her hemoglobin levels, she starts to exhibit signs of fatigue and occasional dizziness, particularly upon standing. The nursing team conducts a thorough assessment, revealing orthostatic hypotension with blood pressure readings dropping to 98/68 mmHg upon standing. This suggests that her body is struggling to maintain adequate perfusion, possibly due to the underlying anemia and recent procedural stress. Her skin appears pallid, and capillary refill is slightly prolonged, further indicating compromised peripheral circulation.

Concurrently, the latest lab results provide additional insight into her condition. While her hemoglobin has stabilized at 9.2 g/dL, her serum ferritin levels remain low at 15 ng/mL, confirming iron deficiency anemia. Additionally, her lactate dehydrogenase (LDH) levels are slightly elevated, suggesting increased red blood cell turnover, which may be contributing to her fatigue. Given these findings, the healthcare team deliberates on the need to initiate intravenous iron supplementation to expedite the correction of her iron stores, alongside her oral supplementation, to optimize her recovery.

The patient's response to these interventions is closely monitored. The team focuses on her hydration status and adjusts her fluid intake to mitigate the effects of orthostatic hypotension while maintaining her electrolyte balance. As part of the multidisciplinary approach, the nursing team reinforces education on safety measures to prevent falls, such as rising slowly from seated or lying positions. Continuous evaluation of her response to treatment is crucial, as the team remains alert to the possibility of further complications, such as potential re-bleeding or delayed ulcer healing, which would necessitate a reevaluation of her management plan.