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Case Study 89
Transcript of Case Study 89
Over the past few years, G.C. has eaten less and less meat because of her financial situation and the trouble
of preparing a meal “just for me.” She struggles financially to buy medicines for the treatment of hypertension
and arthritis. Over the past 2 to 3 months, she has felt increasingly tired, despite sleeping well at
night. When she goes to the senior clinic, the nurse practitioner orders blood work. G.C.'s chemistry panel
is all within normal limits and a stool guaiac test is negative.
Case Study 89
Her other results include the following:
Laboratory Test Results
WBC 7600 /mm 3 (5000-10000)
Hct 27.3% decreased
Hgb 8.3 mg/dL decreased
Platelets 151,000 /mm 3 normal
Mean corpuscular volume (MCV) 65 mm 3
Mean corpuscular hemoglobin (MCH) 31.6 pg
MCH concentration (MCHC) 35.1%
Red cell distribution width (RDW) 15.6%
Iron (Fe) 30 mcg/dL
Total iron-binding capacity (TIBC) 422 mcg/dL
Ferritin 8 mg/dL
Vitamin B 12 414 pg/mL
Folate 188 ng/mL
WBC 7600 /mm 3 (5000-10000)--WNL
Hct 27.3% decreased (38-47)
Hgb 8.3 mg/dL decreased (12-16)
Platelets 151,000 /mm 3 WNL-lower
Mean corpuscular volume (MCV) 65 mm 3 (90-95)
Mean corpuscular hemoglobin (MCH) 31.6 pg (27-31)
MCH concentration (MCHC) 35.1% (27-31)
Red cell distribution width (RDW) 15.6% (11-14.5%)
Iron (Fe) 30 mcg/dL (34.9-44.5) women
Ferritin 8 mg/dL (12-150)
Total iron-binding capacity (TIBC) 422 mcg/d
L (increased r/t insufficient circulating iron levels)
Vitamin B 12 414 pg/mL(200-900)
Folate 188 ng/mL
1. Which lab values are normal, and which are abnormal?
Hct 27.3% decreased (38-47)--packed cell volume indicates that out of a 100 ml sample 27ml makes the sample
Hgb 8.3 mg/dL decreased (12-16)--this molecule carries oxygen to the tissues and carbon dioxide away
Mean corpuscular volume (MCV) 65 mm 3 (90-95)--determined by dividing the hematocrit by the total RBC count and is helpful in classifying anemias
Mean corpuscular hemoglobin (MCH) 31.6 pg (27-31)-- determined by dividing the total hemoglobin concentration by the RBC count.
MCH concentration (MCHC) 35.1% (27-31)-- determined by dividing the total hemoglobin concentration by the RBC count.
Red cell distribution width (RDW) 15.6% (11-14.5%)--is a measurement of cell size distribution over the entire RBC population measured.
Iron (Fe) 30 mcg/dL (34.9-44.5) women--circulating iron in the blood stream that is related to dietary intake of iron and oxygen binding molecles
Ferritin 8 mg/dL (12-150)-- diagnosing and monitoring various forms of anemia related to ferritin levels such as iron-deficiency anemia
Total iron-binding capacity (TIBC) 422 mcg/dL--assess blood iron levels to assist in diagnosing types of anemia such as iron deficiency.
2. Explain the significance of each abnormal result.
Iron Deficiency Anemia
According to Mauk (2014) it is a common disorder among older adults, especially those in nursing homes
According to Mauk (2014) 40% of adults 60 and older have iron deficiency anemia
3. What type of anemia does G.C. have?
A slight decrease in Hgb occurs with aging (Mauk, 2014)But more often the disorder is attributed to an iron deficiency or illness
G.C. has not been eating much meat, which is a good source of iron.
An inability to absorb iron
More seriously, it can occur because of blood loss
Therefore, nurses should assess and ask about blood in the stools
4. What are some causative factors for the type of anemia G.C. has?
-People at risk for Iron Deficiency Anemia:
Women. Because women lose blood during menstruation, women in general are at greater risk of iron deficiency anemia.
Infants and children. Infants, especially those who were low birth weight or born prematurely, who don't get enough iron from breast milk or formula may be at risk of iron deficiency. Children need extra iron during growth spurts. If your child isn't eating a healthy, varied diet, he or she may be at risk of anemia.
Vegetarians. People who don't eat meat may have a greater risk of iron deficiency anemia if they don't eat other iron-rich foods.
Frequent blood donors. People who routinely donate blood may have an increased risk of iron deficiency anemia since blood donation can deplete iron stores. Low hemoglobin related to blood donation may be a temporary problem remedied by eating more iron-rich foods
5. Which individuals are at risk?
-Shortness of breath
-Dizziness or light headedness
-Cold hands and feet
-Inflammation or soreness of your tongue
-Unusual cravings for non-nutritive substances, such as ice, dirt or starch
-Poor appetite, especially in infants and children with iron deficiency anemia
-An uncomfortable tingling or crawling feeling in your legs (restless legs syndrome
6. Describe the signs and symptoms of this type of anemia.
7. Discuss some of the treatment options for her disease.
Treatment for iron-deficiency anemia will depend on its cause and severity. Treatments may include dietary changes and supplements (Iron and Vitamin C), medicines, and surgery. Severe iron-deficiency anemia may require a blood transfusion, iron injections, or intravenous (IV) iron therapy. Treatment may need to be done in a hospital. The goals of treating iron-deficiency anemia are to treat its underlying cause and restore normal levels of red blood cells, hemoglobin, and iron.
8. The physician starts G.C. on ferrous sulfate (Feosol) 325 mg orally per day. What teaching needs to be done regarding this medication?
* Explain purpose of iron therapy to patient.
* Encourage patient to comply with medication regimen. Take missed doses as soon as remembered within 12 hr; otherwise, return to regular dosing schedule. Do not double doses.
* Advise patient that stools may become dark green or black.
* Seek emergency medical attention if you think you have used too much of this medicine, or if anyone has accidentally swallowed it. An overdose of iron can be fatal, especially in a young child.
* Overdose symptoms may include nausea, severe stomach pain, bloody diarrhea, coughing up blood or vomit that looks like coffee grounds, shallow breathing, weak and rapid pulse, pale skin, blue lips, and seizure (convulsions).
* Take ferrous sulfate on an empty stomach, at least 1 hour before or 2 hours after a meal. Avoid taking antacids or antibiotics within 2 hours before or after taking ferrous sulfate.
* Ferrous sulfate is only part of a complete program of treatment that may also include a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat to make sure you get enough iron from both your diet and your medication.
9. Discuss some ideas that might help her with her meal planning.
10. You teach G.C. about foods she should include in her diet. You determine that she understands your teaching if she states she will increase her intake of which of the following foods?
a. Whole wheat pastas and skim milk
b. Lean cuts of poultry, pork, and fish
c. Cooked cereals, such as oats, and bananas
d. Beans and dark green, leafy vegetables
-One idea to discuss with G.C.’s meal planning may include meal prepping. Because G.C. has a hard time cooking for one, it would be a good idea for her to make a larger portion to save and eat throughout the week. Suggesting that G.C. visit a local senior center for lunch may be helpful because they are very inexpensive and would also provide G.C. with some social interaction.
11. What evaluative parameters could you use to determine whether G.C.'s nutritional needs are
Mauk, K. L. (2014). Gerontological Nursing: Competencies for Care (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Morton. P.G. & Fontaine, D.K. (2012). Critical Care Nursing: A Hollistic Approach (10th. ed). Philadelphia, PA: W.B. Saunders
Nursing Central (2012)
Labs, weight (BMI), nutritional assessment