“NEVER LET ME DOWN”

1. “NEVER LET ME DOWN” A CASE PRESENTATION ON IRON DEFICIENCY ANEMIA JENNIE ROSE V. ANONUEVO, BSN, RN DEPARTMENT OF OB-GYNE DR. AHMAD ABANAMY HOSPITAL JANUARY 2013

2. 1. DEMOGRAPHIC DATA • Case number: 190*** • Age: 30 Years Old • Sex: Female • Diagnosis: G4 P2 A1, 37 1/7 wks AOG, Iron Deficiency Anemia

3. 2. PHYSICAL ASSESSMENT I. GENERAL APPERANCE: • Well groom • Cooperative • Weak looking

4. II. SKIN • Pale • Warm to touch • Dry course noted in elbows and knees • No edema • Hair is generally black, well distributed over the scalp • No infestation noted • No clubbing but upon blanch test of fingernails shows sluggish capillary refill ≥ 3 secs.

5. III. HEAD - NECK • Facial symmetry • No scalp tenderness • No lesion nor masses noted • Iris are black, pupils equal, round, reactive to light and accommodation • White clear sclera noted • Conjunctiva are pale • Patient’s pinna is the same color as her facial skin, smooth and aligned with the eye level • Able to hear sound clearly as claimed • No pain, inflammation or drainages noted • She has both patent and equal nostrils • No nasal flaring, congestion or drainages noted

6. Lips and mucous membranes are pale • Tongue is centrally positioned, uvula is in the midline • Lingual tonsils noted at the posterior portion of the tongue • Have good oral hygiene, no presence of bad smell. • Jugular vein not distended • No swollen lymph nodes palpated • With good ROM.

7. IV. THORAX: • Symmetrical chest wall upon movement and breathing on room air • Breath sound equal • Respiratory rate range = 18-24 cpm

8. V. CARDIOVASCULAR: • Absence of chest pain • Peripheral pulse noted. • BP range (eg. 130-110/80-60), pulse rate range (95-135 bpm), O2 saturation range (94-98%)

9. VI. GENITOURINARY: • Positive gross watery vaginal discharges • No active bleeding noted • No discharges or foul smelling odor • Able to void freely to adequate clear urine • No sensation of pain during urination.

10. VII. GASTROINTESTINAL: • Abdomen is soft, with mild to moderate uterine contraction at time of assessment • No abdominal tenderness • (+) bowel sound

11. VIII. MUSCULOSKELETAL: • No physical deformities, contractors nor paralysis noted • With active range of movement • Joints can move freely without resistance or pain.

12. IX. NEUROLOGIC: • Awake, alert and oriented to time, place and person. • Understand written and spoken language and responds appropriately • Able to follow commands and instructions.

13. 3. PATIENT HISTORY • PAST MEDICAL HISTORY • (+) History of Anemia as claimed • (+) History of Abortion • (-) Surgical history

14. PRESENT MEDICAL HISTORY • Patient 190*** is a referral patient from Security Forces Hospital with chief complaint of labor pain and watery vaginal discharges since 10:00 pm (1-12-12). • She is G4P2A1 37 1/7 wks AOG, with Iron Deficiency Anemia. • LMP: 16-3-12 • EDC: 22-12-12

15. P/V done : 3 cm dilated cervix, 50% effaced, station -3, cephalic in presentation • (+) adherent membrane, watery vaginal leaking noted, (+) Amnicator • Not able to tolerate intake of iron due to vomiting. • No allergies to food or drugs. • No relevant family medical history.

16. ANEMIA

17. 4. TOPIC PRESENTATION ANEMIA • Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal

18. PREVALENCE RATE • 25% world’s population • 56% developing countries(pregnant) • 18% industrialized countries(pregnant)

19. CRITERIA: • <12 g/dL in nonpregnant women • <10 g/dL during pregnancy or the puerperium.

20. ANEMIA IN PREGNANCY

21. IRON DEFICIENCY ANEMIA (IDA) in PREGNANCY • Is defined as decreased total iron body content. • Occurs when iron deficiency is severe enough to diminish erythropoiesis and cause the development of anemia. • Most common form of anemia among pregnant women.

23. IMPORTANCE OF IRON IN PREGNANCY • OXYGENATION • NUTRITION • DEVELOPMENT • BRAIN DEVELOPMENT • IMMUNE FUNCTION

24. 5. ANATOMY AND PHYSIOLOGY

26. 6. ETIOLOGY OF IDA • Nutritional/ dietary deficiencies • Inadequate intake of iron supplement • Inability to absorb iron • Blood loss

28. 7. SIGNS AND SYMPTOMS • Feel weak and tire out more easily. • Look very pale. • Feel short of breath. • Weakness or fatigue • Dizziness. • Develop palpitations (feeling of heart racing) on exertion.

29. Have headaches. • Have trouble concentrating. • Irritability. • Craving substances that are not food (pica). In particular, a craving for ice can be a sign of iron deficiency anemia. • Cracked lips. • Smooth, sore tongue.

30. Muscle pain during exercise. • Trouble swallowing. • Hair loss • Malaise (general sense of feeling unwell) • Worsening of heart problems • Brittle fingernails and toenails.

31. PATHOPHYSIOLOGY FEMALE POOR DIETARY INTAKE (-) IRON TABLET (+) HX OF ABORTION (+) HX OF ANEMIA MENSTRATION PREGNANT SUPPLY OF IRON SUPPLEMENT (+) HX OF BLOOD LOSS (+) HX OF IRON LOSS IRON LOSS IRON DEMAND INABILITY TO COMPENSATE THE DEMAND AND SUPPLY NEEDS OF IRON

32. INABILITY TO COMPENSATE THE DEMAND AND SUPPLY NEEDS OF IRON USAGE OF IRON IN THE BONE MARROW HGB SYNTHESIS IS IMPAIRED MICROCYTIC HYPOCHROMIC ERYTHROCYTES OXYGEN AND ENERGY DELIVERY

34. OXYGEN AND ENERGY DELIVERY • SIGNS AND SYMPTOMS • PALE SKIN / PALE LOOKING • PALE CONJUNCTIVA • WEAKNESS/ FATIGUE • DIZZINESS • SHORTNESS OF BREATH ON EXERTION • PALPITATION ON EXERTION • TREATMENT • REST • POSITIONING • O2 SUPPORT(PRN) • BLOOD TRANSFUSION

35. BLOOD TRANSFUSION OF 2 UNIT PRBC 1ST POST BT: HGB 7.3 g/dl 2nd POST BT: HGB 8.3 g/dl Delivered NSVD to alive Baby boy 2.99 kg

36. PATIENT WAS DISCHARGE 24 HRS POST DELIVERY STILL WITH LOW RBC AND HGB CONCLUDING OF STILL (+) FOR ANEMIA, HOME MEDICATION FERROUS SULFATE BID WAS PRESCRIBE, FOR FOLLOW –UP AFTER 4 WKS TO SFH.SHE WAS DISCHARGE IN GOOD CONDITION.

37. 8. INTERVENTION • Dietary Improvement- advises iron-rich diet. • Compliance to prescribe ante natal supplement such as ferrous tablet.

38. Undergo laboratory examination like routine CBC during prenatal check-up. • Emphasize the need for follow-up checkup.

39. 9. TREATMENT 1. Oral supplements of iron (Ferrous Sulphate) 2. Parenteral Iron 3. Blood Transfusion 4. Identify and treat the underlying cause.

40. 9. COMPLICATION • Diminishes work performance. • Heart problems. • Worsen the pulmonary status of patients with chronic pulmonary disease.

41. Severe anemia with maternal Hgb ≤ 6 g/ dl may result to prematurity, spontaneous abortion, low birth weight and fetal death. • Increased risk of postpartum depression; with poor results in mental and psychomotor performance of offspring. • Increases susceptibility to infections.

42. 10. PRIORITIZATION OF NURSING PROBLEM 1. Activity intolerance due to insufficient physiological and psychological energy to endure or complete required and desired daily activities as related to imbalance between oxygen supply and demand.

43. 2. Imbalance nutrition less than body requirement related to lack of appetite and increasing needs of growing fetus. .3. Fatigue related to lack of energy in the body.

44. 4.Impaired social interaction related to ineffective quality to social exchange. 5. Risk for infection related to decreasing immune system.

45. 11. NURSING CARE PLAN ASSESSMENT CUES/ EVIDENCE A. SUBJECTIVE: • “I easily get tired even I’m just walking or doing simple task, I also experience shortness of breath and palpitation on exertion.” B. OBJECTIVE: • Cardiac rate: 125bpm • Respiratory rate: 24cpm

46. ASSESSMENT 2. NURSING DIAGNOSIS Activity intolerance due to insufficient physiologic and psychological energy to endure or complete required or desired daily activities as related to imbalance between oxygen supply and demand.

47. PLANNING GOALS AND DESIRED OUTCOME Within 6-12 hours of nursing intervention the patient will be able to do or maintains activity level with capabilities as evidenced by: • 80-120 heart rate • 16-20 respiratory rate, • Reduction of fatigue as claimed by the patient.

48. IMPLEMENTATION

49. IMPLEMENTATION

50. IMPLEMENTATION