What nursing interventions are used in the management and treatment of iron deficiency anemia?

Table of Contents Show

Lecture on Iron-Deficiency Anemia
Iron-Deficiency Review Notes
Pathophysiology of Iron Deficiency Anemia
Causes of Iron-Deficiency Anemia
Signs and Symptoms of Iron-Deficiency Anemia
Nursing Interventions for Iron-Deficiency Anemia
Learning Outcome
Nursing Diagnosis
Nursing Management
When To Seek Help
Outcome Identification
Discharge Planning
Pearls and Other issues
Review Questions

This is an NCLEX review for iron-deficiency anemia. Patients who have iron-deficiency anemia are suffering from low red blood cells and/or hemoglobin levels. This leads to the patient experiencing low levels of oxyen throughout the body.

In the previous review, I covered other hematology disorders. So, if you are studying for NCLEX or your nursing lecture exams be sure to check out that section.

When taking care of a patient with iron-deficiency anemia it is very important the nurse knows how to recognize the typical signs and symptoms seen in this condition, how it is diagnosed, nursing interventions, and patient education.

Don’t forget to take the iron-deficiency anemia quiz.

In this NCLEX review for iron-deficiency anemia, you will learn the following:

Definition of iron-deficiency anemia Pathophysiology of iron-deficiency anemia Causes Treatment Signs and Symptoms

Nursing Interventions

Lecture on Iron-Deficiency Anemia

Iron-Deficiency Review Notes

Definition: a type of anemia that is caused by low IRON levels.

What is Anemia? Anemia is a decreased amount of red blood cells or hemoglobin in the body. These components play a huge role in carrying oxygen throughout the body. If you are low in RBCs or hemoglobin, your body won’t receive enough oxygen to function properly.

Key Points about Iron-Deficiency Anemia:

Most common type of anemia (there are various types)
Body uses IRON to make hemoglobin
Low levels of iron lead the body to produce fewer red blood cells which leads to less hemoglobin in the body. Hence, your body receives less amounts of oxygen.
Signs and symptoms are vague at first and as it progresses the signs and symptoms become more noticeable
A blood test such as a CBC (complete blood count) or iron level will help the doctor detect anemia.
Women who are childbearing age may be plagued with this due to heavy menstruation or pregnancy and people with poor digestion (intestinal issue) or poor intake of iron.
Treatment includes: incorporating more iron in the diet, taking iron supplements, and prevention.

Pathophysiology of Iron Deficiency Anemia

The red blood cells transport oxygen throughout the body and remove carbon dioxide (a waste product from metabolism) with the help of hemoglobin.

Hemoglobin is an “ingredient” found in the RBC that is a protein that contains IRON.

IRON helps make hemoglobin.
Around 70% of the body’s iron is found in the hemoglobin.
Function of hemoglobin is to facilitate the transfer of the oxygen and carbon dioxide throughout the body. It does this with the help of the RBCs.

Remember low IRON levels: mean less production of hemoglobin which means less oxygen to the body.

Causes of Iron-Deficiency Anemia

Poor intake of iron through diet (pregnancy…increased demand of iron for fetus, vegetarians)
Absorption problem: intestinal surgery…gastric bypass, celiac disease, small intestine removal (most iron is absorbed by the small intestine)
Losing iron from blood loss (menstruation, GI bleeding…ulcers, hemorrhoids)

Signs and Symptoms of Iron-Deficiency Anemia

Remember the Mnemonic: “Low Iron”

Lethargic

Overexerted easily (may be short of breath)

Weird food cravings (ice, dirt, clay), White-faced (pale)

Inflammation of tongue…will become smooth and turn various colors of red (due to lack of oxygen it receives), Increased Heart rate (trying to compensate for the low oxygen)

Reduced Hemoglobin level

Observe changes in RBCs with a blood smear test…will appear hypochromic (pale) and microcytic (small)

Nail changes (Koilonychias….spoon-shaped nails), neuro change (confused, moody)

Diagnosed?

CBC (to assess red blood cells, hemoglobin levels)…may order a blood smear to assess color and size of RBCs
Iron levels

Nursing Interventions for Iron-Deficiency Anemia

Monitoring, education, and administering medications
Monitor patient for bleeding and hemoglobin levels and other major signs and symptoms…assessing diet, menstrual cycles etc.
Educating how to take IRON supplements:
- Take iron on an empty stomach (increases absorption…may take with small amounts of food due to stomach upset)
- Take with Vitamin C…glass of orange juice (helps increase absorption)
- Don’t take with any milk products, calcium, or antacids (decreases absorption) and wait 2 hours in between
- Stools will turn black which is normal while taking iron supplements (tarry stools or having stools with blood..not normal)
- For liquid preparations: mix in a drink, drink with straw, and brush teeth afterwards (can stain teeth)
Side effects: constipation (drink plenty of fluids and take over the counter stool softener if needed)
May give IV iron or blood transfusion if severe per md order
Eat Food High in Iron: Remember the mnemonic “Eat Lots of Iron”

Egg yolks

Apricots

Tofu

Legumes, Leafy green vegetables

Oysters

Tuna

Sardines, Seeds

pOtatoes

Fish (halibut, haddock, salmon)

Iron-fortified cereal and breads

Raisins, Red meats (beef)

pOultry (turkey, chicken)

Nuts

More NCLEX Reviews

References

What Is Iron-Deficiency Anemia? – NHLBI, NIH. (2014). Nhlbi.nih.gov. Retrieved 19 November 2016, from https://www.nhlbi.nih.gov/health-topics/topics/ida

Learning Outcome

Describes the types of anemia
List the causes of anemia
Summarize the treatment of anemia

The word anemia derives from an ancient Greek word anaimia, meaning “lack of blood.”

Anemia, like a fever, is not a diagnosis but a presentation of an underlying disease. Multiple diseases can present as anemia due to various mechanisms.

Anemia affects a significant number of people worldwide (more so in the developing world), resulting in a considerable increase in the cost of medical care.

Anemia can be defined as a reduction in hemoglobin (less than 13.5 g/dL in men; less than 12.0 g/dL in women) or hematocrit (less than 41.0% in men; less than 36.0% in women) or red blood cell (RBC) count. The terms hemoglobin and hematocrit are more commonly used than RBC count in day-to-day clinical practice. There are different lower limits of normal range based on ethnicity, gender, and age.

Anemia causes decreased oxygen-carrying capacity of the blood leading to tissue hypoxia.

Grading of Anemia, according to the National Cancer Institute, is as follows:

Mild: Hemoglobin 10.0 g/dL to lower limit of normal
Moderate: Hemoglobin 8.0 to 10.0 g/dL
Severe: Hemoglobin 6.5 to 7.9 g/dL[1]
Life-threatening: Hemoglobin less than 6.5 g/dL

Anemia classified into acute anemia and chronic anemia. Acute anemia is predominantly due to acute blood loss or acute hemolysis. Chronic anemia is more common and is secondary to multiple causes.

Nursing Diagnosis

Etiology of chronic anemia based on mean corpuscular volume (MCV is the average size of RBC).

Microcytic Anemia (MCV less than 80 femtoliters [fL])

Iron deficiency anemia: Most common cause of anemia
Thalassemia
Anemia of chronic disease
Sideroblastic anemia

Macrocytic Anemia (MCV greater than 100 fL)

Vitamin B12 and folic acid deficiency
Alcoholism and liver disease
Myelodysplastic syndromes
Drug-induced
Hypothyroidism

Normocytic Anemia (MCV 80 to 100 fL)

Bone marrow suppression (aplastic anemia and myelophthisic anemia)
Anemia of chronic disease

Some conditions can present in more than 1 classification. For example, early iron deficiency can be normocytic. Anemia of chronic disease is mostly normocytic but can be microcytic too. Hemolytic anemia[2] can cause either macrocytic or normocytic anemia.

Iron deficiency anemia is the most common type of anemia, affecting approximately 8% to 9% of the world’s population.

Anemia is more prevalent in:

Developing countries from malnutrition and lack of proper medical care
Women due to pregnancy and menstrual bleeding [3]
African Americans due to sickle cell disease and G6PD deficiency
Older adults due to multiple comorbidities like chronic kidney disease (CKD), malignancy, medications, among others[4]

Symptoms and signs of chronic anemia are mostly due to decreased tissue oxygenation from the reduction of the oxygen-carrying capacity of the blood. Symptoms are worse when anemia is severe, with a rapid decrease in hemoglobin/HCT and with increased oxygen demands states like exercise.

Common presenting symptoms include:

Weakness, fatigue
Dizziness, Near syncope, Syncope
Exertional dyspnea (exercise intolerance)
Chest pain and palpitations
Anorexia
Cognitive impairment in elderly

A detailed history should include medical history, home medications, alcohol use, and family history. Ethnicity and country of origin are also helpful.

Important examination findings include:

Pallor
Jaundice
Tachycardia
Tachypnea
Orthostatic hypotension and
Other findings relevant to underlying etiology

Initial Work-Up

Complete blood count: Hemoglobin, HCT, MCV, reticulocyte count index
Comprehensive metabolic panel: Renal and liver function tests
Iron studies which include serum iron, TIBC (total iron binding capacity) and ferritin
Serum vitamin B12, folic acid, and thyroid-stimulating hormone (TSH)
Stool for occult blood

Differentiation of Microcytic Anemias Based on Iron Studies

Iron deficiency anemia: Low serum iron, high TIBC, and low ferritin.
Anemia of chronic disease: Low serum iron, low TIBC, and high ferritin.
Sideroblastic anemia: High serum iron, normal TIBC, and high ferritin.
Thalassemia: Normal serum iron, normal TIBC and normal ferritin.

Peripheral smear, hemoglobin electrophoresis, and bone marrow examination if needed. Further testing would include esophagogastroduodenoscopy (EGD) and colonoscopy if gastrointestinal (GI) bleeding is suspected and imaging studies if malignancy suspected.

Chronic anemia is managed predominantly in outpatient settings. They need hospitalization if:

Patient is symptomatic
Significant drop in hemoglobin/HCT
Transfusion needed
Extensive investigations needed

If hemoglobin is less than 7 g/dL or if a patent is symptomatic, transfusion of packed red blood cells (PRBC) is indicated.

Transfusions should be done with caution in patients with volume overload status like end-stage renal disease (on hemodialysis) and congestive heart failure (CHF).

Other treatments include treating underlying conditions as below.

Iron deficiency anemia: Intravenous (IV) iron versus oral iron
Vitamin B12 and folic acid deficiency with B12 and folic acid supplementation
Treating underlying bone marrow disorders
EPO injections in chronic kidney disease patients
Synthroid in patients with hypothyroidism
Avoiding any culprit medications
Treatment of GI causes of blood loss (PPI for gastritis and PUD)
Regulation of menstrual cycles in patients with menorrhagia

Nursing Management

Signs of external bleeding
Check stools for occult blood
Administer medications as prescribed (Vitamin B12, iron or folate)
Educate patient on nutrition (fruits and vegetables to obtain folate and iron)

When To Seek Help

Signs of external bleeding

Outcome Identification

No signs of external bleeding

Monitoring

Signs of external bleeding
Check stools for occult blood
Administer medications as prescribed (Vitamin B12, iron or folate)
Educate patient on nutrition

Chronic anemia is a very common condition seen in day-to-day clinical practice and managed in outpatient settings. Anemia management can range from simple to complex based on the underlying condition causing it. Most of the time patient's primary care physician needs help with a specialist based on underlying condition either a gastroenterologist or a hematologist or a nephrologist or a gynecologist. It is very important to have good interprofessional communication and care coordination for the management of anemia appropriately and promptly. This would help both in correcting anemia and treating underlying conditions.

Anemia is a condition with decreased oxygen-carrying capacity of the blood. Anemia is very common and caused by different conditions ranging from simple nutritional deficiencies (iron, vitamin B12, and folic acid) to blood loss to other complicated causes.

Anemia is a common medical condition and easily diagnosed with a simple blood work CBC. Treatment can be simple like nutritional supplements (iron, vitamin B12, and folic acid) to blood transfusion to treating complex underlying conditions.

It is very important to follow up with the doctor and sometimes with a specialist to treat anemia because untreated anemia can be life-threatening and may even cause death.

Discharge Planning

Encouraging patients to eat a healthy and balanced diet is important to prevent anemia from nutritional deficiencies.
Follow up with a clinician

Pearls and Other issues

Anemia is the most common hematological disease and is one of the most common conditions seen in the clinical practice.
Iron deficiency anemia is the most common cause of anemia while anemia of chronic disease is most common anemia in hospitalized patients.
Anemia is not a diagnosis but a presentation of underlying diseases. Work up for the cause of anemia can unmask many of the underlying diseases thereby helping to treat patients early and appropriately.
Most of the anemias are easy to treat and thereby improve a person's productivity.
Comprehensive history taking and physical examination are very important in diagnosing anemia.
If early workup is unrevealing, appropriate consultation by a specialist is important for further workup and treatment.
Encouraging patients to eat a healthy and balanced diet is important to prevent anemia from nutritional deficiencies.
Women of childbearing age are at increased risk of anemia due to pregnancies and menstrual bleeding and need close monitoring.

Review Questions

Reticulocytes, Polychromatic, polychromatophilic, red blood cell, Romanowsky, Stain, peripheral blood, hemolytic anemia. Contributed by Ed Uthman (CC by 2.0) https://creativecommons.org/licenses/by/2.0/

Macrocytic anemia. Contributed by Ruozhi Xiao via SlideShare, “Anemia Overview,”

Iron deficiency anemia. Image courtesy S Bhimji MD

Sideroblastic anemia. Image courtesy S Bhimji MD

Hypochromic microcytic anemia. Image courtesy S Bhimji MD

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