A patient with iron deficiency anemia is experiencing increased fatigue, shortness of breath, and palpitations. Laboratory tests confirm a hemoglobin level of 9.0 g/dL and low ferritin levels. Which nursing intervention should be prioritized to address the patient's current symptoms?

D) Prepare the patient for possible intravenous iron supplementation as ordered.

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

B) Administer oxygen therapy at 2 L/min via nasal cannula.

C) Educate the patient on the importance of adhering to oral iron supplements.

D) Prepare the patient for possible intravenous iron supplementation as ordered.

A patient with worsening iron deficiency anemia presents with increased fatigue, shortness of breath, and palpitations. Laboratory results confirm microcytic, hypochromic anemia with low ferritin levels. Which nursing intervention is the most appropriate to address the immediate needs of this patient?

A) Encourage the patient to increase oral iron supplement intake to improve absorption.

B) Initiate a referral for a gastrointestinal evaluation to identify potential sources of bleeding.

D) Educate the patient on dietary sources of iron to support long-term management.

A patient with a history of hypertension and chronic NSAID use is found to have multiple gastric ulcers contributing to iron deficiency anemia. Which nursing intervention is most appropriate to prevent further gastrointestinal complications?

C) Educate the patient on the importance of taking a proton pump inhibitor (PPI) as prescribed.

A) Encourage the patient to take NSAIDs with milk to reduce gastric irritation.

B) Advise the patient to take NSAIDs on an empty stomach to enhance absorption.

C) Educate the patient on the importance of taking a proton pump inhibitor (PPI) as prescribed.

D) Instruct the patient to use acetaminophen instead of NSAIDs for pain management.

A patient with iron deficiency anemia secondary to gastrointestinal bleeding is being treated with proton pump inhibitors (PPIs) and intravenous iron supplementation. The patient is also taking a non-steroidal anti-inflammatory drug (NSAID) for hypertension. Which nursing intervention is most appropriate to prevent further gastrointestinal complications in this patient?

C) Educate the patient on the importance of adhering to the PPI regimen

A) Encourage the patient to take the NSAID with meals

B) Increase the patient's dietary intake of vitamin C-rich foods

C) Educate the patient on the importance of adhering to the PPI regimen

D) Advise the patient to stop taking the NSAID immediately

A patient undergoing treatment for gastric ulcers with a history of hypertension presents with new symptoms of dizziness, shortness of breath, and dark tarry stools. Despite initial improvement, her hemoglobin levels have dropped. Which nursing intervention is most appropriate to address the potential underlying cause of her current condition?

B) Suggest switching from NSAIDs to acetaminophen for pain management to reduce GI irritation.

A) Administer antiemetics to manage potential side effects of iron supplementation.

B) Suggest switching from NSAIDs to acetaminophen for pain management to reduce GI irritation.

C) Increase the dose of proton pump inhibitors to further reduce gastric acid secretion.

D) Encourage the patient to increase dietary iron intake to address anemia.

A patient undergoing treatment for gastric ulcers with intravenous iron therapy and proton pump inhibitors reports new symptoms, including dizziness and shortness of breath, along with a decrease in hemoglobin levels and the presence of dark, tarry stools. Considering these symptoms and the current treatment plan, what should be the nurse's priority action?

C) Notify the healthcare provider for further evaluation and possible repeat endoscopy.

A) Continue current treatment and schedule a follow-up in one month.

B) Administer oxygen therapy and prepare for a possible blood transfusion.

C) Notify the healthcare provider for further evaluation and possible repeat endoscopy.

D) Increase the dose of proton pump inhibitors to manage gastrointestinal symptoms.

A patient with multiple gastric ulcers and confirmed Helicobacter pylori infection is experiencing palpitations and tachycardia. Her hemoglobin levels are low, and she is being considered for a blood transfusion. Which nursing intervention is most appropriate to address the patient's current symptoms and underlying condition?

A) Administer oxygen therapy to improve oxygen delivery and reduce cardiac workload.

B) Encourage the patient to increase physical activity to improve circulation.

C) Provide reassurance and monitor vital signs while waiting for the transfusion.

D) Educate the patient on dietary modifications to increase iron intake.

A patient with multiple gastric ulcers and a confirmed H. pylori infection is experiencing increased palpitations and tachycardia. The healthcare team suspects anemia-induced cardiac strain. Which of the following nursing interventions should be prioritized to help stabilize the patient's condition?

C) Prepare the patient for a blood transfusion as ordered to address anemia

A) Administer a proton pump inhibitor as prescribed to promote ulcer healing

B) Monitor the patient's vital signs closely and report any further increase in heart rate or palpitations

C) Prepare the patient for a blood transfusion as ordered to address anemia

D) Provide patient education on dietary modifications to support gastrointestinal health

A patient with diagnosed iron deficiency anemia secondary to chronic blood loss from gastric ulcers is receiving intravenous iron supplementation. Which nursing intervention is most important to prioritize to ensure the effectiveness of the treatment and prevent complications?

B) Monitor the patient for signs of an allergic reaction during iron infusion.

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

B) Monitor the patient for signs of an allergic reaction during iron infusion.

C) Educate the patient about the importance of medication adherence to ulcer treatment.

D) Assess the patient's stool for occult blood to evaluate ongoing blood loss.

A patient with a history of chronic gastric ulcers and newly diagnosed iron deficiency anemia is receiving intravenous iron supplementation. Which nursing intervention is most critical to ensure the effectiveness of the treatment plan?

B) Monitoring the patient for signs of hypersensitivity during iron infusion.

A) Encouraging the patient to increase dietary iron intake.

B) Monitoring the patient for signs of hypersensitivity during iron infusion.

C) Advising the patient to take antacids to prevent gastric irritation.

D) Educating the patient about the importance of rest to reduce cardiac workload.

Moderate anemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Reduced erythropoiesis—decreased production of red blood cells (RBCs) often due to nutritional deficiencies (e.g., iron, vitamin B12) or bone marrow disorders, leading to insufficient hemoglobin levels and impaired oxygen transport.

• Secondary mechanism: Increased RBC destruction or loss—conditions such as hemolysis or chronic bleeding result in a decreased lifespan of RBCs, exacerbating anemia by reducing the overall RBC count.

• Key complication: Tissue hypoxia—insufficient oxygen delivery to tissues can cause fatigue, weakness, and pallor, significantly impacting daily functioning and quality of life.

Patient Profile

Demographics:

38-year-old female, office manager

History:

• Key past medical history: Iron deficiency anemia diagnosed 2 years ago, mild hypertension

• Current medications: Ferrous sulfate 325 mg daily, Lisinopril 10 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increased fatigue and shortness of breath

• Key symptoms: Palpitations, dizziness, pale skin, occasional headaches

• Vital signs: Blood pressure 132/88 mmHg, heart rate 104 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F, oxygen saturation 94% on room air

Section 1

The initial assessment findings reveal that the patient's condition has progressed beyond her previous baseline of iron deficiency anemia. Upon physical examination, her pallor is more pronounced, and she exhibits mild tachycardia with a heart rate of 104 bpm. Auscultation of her lungs reveals clear breath sounds, but her respiratory rate is elevated at 20 breaths per minute. The patient's oxygen saturation is slightly reduced at 94% on room air, indicating potential early signs of compromised oxygen delivery to tissues. Her blood pressure remains mildly elevated at 132/88 mmHg, consistent with her history of hypertension.

Laboratory tests are ordered to further evaluate the extent of her anemia and identify any underlying causes. The complete blood count (CBC) shows a hemoglobin level of 9.0 g/dL, a decrease from her previous readings, confirming moderate anemia. The mean corpuscular volume (MCV) is low at 75 fL, consistent with microcytic anemia typically seen in iron deficiency. Ferritin levels are notably low at 8 ng/mL, reinforcing the likelihood of iron deficiency as a primary factor, while vitamin B12 and folate levels remain within normal limits, ruling out concurrent deficiencies. A peripheral blood smear reveals hypochromic microcytic red blood cells, with no evidence of hemolysis or other abnormalities.

The patient's clinical picture suggests a worsening of her iron deficiency anemia, potentially due to inadequate absorption or increased loss. Given her symptoms and lab results, the healthcare team considers the need for further investigations to determine any underlying causes, such as gastrointestinal bleeding or malabsorption syndromes. The patient's increased fatigue, shortness of breath, and palpitations indicate that her anemia is now significantly impacting her daily life, prompting an immediate review of her current treatment regimen and consideration of additional interventions, such as intravenous iron supplementation, to rapidly improve her hemoglobin levels and alleviate symptoms.

Section 2

New Diagnostic Results:

Following the initial assessment and laboratory findings, the healthcare team decides to pursue further diagnostic evaluations to uncover any underlying causes contributing to the patient's worsening anemia. A fecal occult blood test is ordered to check for hidden gastrointestinal bleeding, given the possibility of chronic blood loss as a contributing factor. The test returns positive, suggesting the presence of bleeding in the gastrointestinal tract. To further investigate, an upper endoscopy and colonoscopy are scheduled, aiming to identify potential sources of bleeding such as peptic ulcers or colorectal lesions.

The endoscopic evaluations reveal the presence of multiple small gastric ulcers in the patient's stomach, along with mild inflammation of the gastric mucosa, consistent with gastritis. These findings suggest that chronic blood loss from these ulcers is likely exacerbating her iron deficiency anemia. The discovery of these ulcers prompts the healthcare team to consider the role of her hypertension medication, which includes a non-steroidal anti-inflammatory drug (NSAID) that could contribute to gastric irritation and ulcer formation.

With these results, the healthcare team embarks on a multifaceted approach to manage the patient's condition. In addition to initiating a course of proton pump inhibitors (PPIs) to promote ulcer healing and reduce gastric acid secretion, they also plan to review and adjust her medication regimen to prevent further gastrointestinal complications. Coupled with the introduction of intravenous iron supplementation, these interventions aim to address both the acute and chronic aspects of her anemia, setting the stage for her recovery and stabilization. The team emphasizes the importance of close monitoring and follow-up to evaluate the effectiveness of the treatment plan and adjust as necessary.

Section 3

As the treatment plan is implemented, the patient initially shows signs of improvement. Her hemoglobin levels begin to stabilize, slowly rising from 9.0 g/dL to 10.2 g/dL after a week of intravenous iron therapy. The introduction of proton pump inhibitors seems to effectively reduce her gastric symptoms, including epigastric pain and discomfort, suggesting a positive response to ulcer management. Vital signs are stable, with blood pressure controlled at 128/78 mmHg and heart rate at 78 bpm. The patient reports increased energy levels and a reduction in fatigue, allowing her to engage more in daily activities.

However, during a routine follow-up appointment two weeks into the treatment, the patient presents with a new set of symptoms, raising concerns about potential complications. She experiences episodes of dizziness and shortness of breath, particularly when climbing stairs or exerting herself. A repeat complete blood count (CBC) reveals that, despite an initial improvement, her hemoglobin has unexpectedly dropped to 8.5 g/dL. This decline suggests ongoing blood loss or another underlying issue that has not been fully addressed. Additionally, she reports dark, tarry stools, indicative of melena, which heightens the suspicion of persistent gastrointestinal bleeding.

The healthcare team is prompted to reassess the situation, considering the possible need for further diagnostic investigation. A repeat endoscopy is considered to evaluate the current status of the gastric ulcers and to check for any new lesions that might have developed. The team also deliberates on the potential need to switch her hypertension management from NSAIDs to an alternative medication that poses less risk of gastrointestinal irritation. This strategic adjustment, coupled with continued iron supplementation and monitoring, aims to mitigate the bleeding risk while addressing her hypertensive condition, thereby facilitating a comprehensive and targeted approach to her recovery.

Section 4

The healthcare team proceeds with a repeat endoscopy to investigate the cause of the patient's ongoing symptoms and decline in hemoglobin levels. The procedure reveals the presence of multiple small gastric ulcers, some of which show signs of recent bleeding, confirming the suspicion of continued gastrointestinal blood loss. Additionally, a biopsy is taken to rule out Helicobacter pylori infection, a common contributor to ulcer formation and persistence. The biopsy results return positive for H. pylori, indicating that this bacterial infection is likely exacerbating the patient's ulcer condition and contributing to the recurrent bleeding.

In light of these findings, the treatment plan is adjusted to include a course of antibiotics specifically targeting H. pylori, alongside continued proton pump inhibitor therapy to promote ulcer healing. The patient's hypertension management is also revised; the team decides to discontinue NSAIDs, replacing them with an antihypertensive medication that has a lower risk of causing gastrointestinal irritation, such as a calcium channel blocker. These adjustments are aimed at reducing the potential for further gastrointestinal bleeding while managing her blood pressure effectively.

Despite these interventions, the patient experiences a new complication. She begins to report increased palpitations and tachycardia, with her heart rate rising to 102 bpm at rest. This change prompts the healthcare team to consider the possibility of anemia-induced cardiac strain, given her reduced hemoglobin levels and the body's effort to compensate for decreased oxygen-carrying capacity. The team initiates a more aggressive approach to anemia management, including consideration of a blood transfusion to quickly elevate her hemoglobin levels and alleviate cardiac stress. This comprehensive approach is designed to stabilize her condition, address the underlying causes of her symptoms, and prevent further complications as she continues her recovery journey.

Section 5

New Diagnostic Results:

Following the patient's report of increased palpitations and tachycardia, the healthcare team conducted additional diagnostic tests to assess the patient's cardiovascular and hematological status. A complete blood count (CBC) was repeated, revealing a hemoglobin level of 8.2 g/dL, indicating a further decline from previous measures. This confirmed the suspicion of exacerbated anemia, likely contributing to the patient's reported symptoms of cardiac strain. Additionally, an electrocardiogram (ECG) was performed to evaluate the electrical activity of the heart, which showed sinus tachycardia but no signs of ischemia or arrhythmias, reassuring the team that while cardiac demand was increased, there was no immediate evidence of structural heart disease.

Further laboratory tests included an iron panel, which revealed low serum ferritin and transferrin saturation, consistent with iron deficiency anemia secondary to chronic blood loss from the gastric ulcers. In light of these findings, the healthcare team emphasized the importance of addressing the iron deficiency as a priority alongside managing the H. pylori infection and ulcers. They initiated intravenous iron supplementation to rapidly replenish the patient's iron stores, given her inability to adequately absorb oral iron due to ongoing gastric issues.

These diagnostic results necessitate close monitoring of the patient's cardiovascular status as they continue to manage her anemia and gastrointestinal bleeding. The team anticipates that with the combined therapy targeting the underlying causes, her hemoglobin levels will stabilize, reducing cardiac workload and alleviating her symptoms. This phase of the patient's treatment plan is critical, requiring vigilant observation and iterative reassessment to ensure a comprehensive recovery and prevent further complications.