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Fatigue Case Study
Transcript of Fatigue Case Study
M.B. is a generally healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup she is noted to have the following vital signs: heart rate 118 beats/min, blood pressure 128/60, oral temperature 37º C, and respiratory rate 26 breaths/min. Her skin and nail beds are pale. Laboratory results demonstrate hematocrit (Hct) 31%; hemoglobin (Hb) 10 g/dl; mean corpuscular hemoglobin concentration 27; mean corpuscular volume 70; total iron binding capacity 600 mg/dl.
RR: 26 breaths/min
Hb: 10g/dl; normal for women is 12-16g/dl
Hct: 31%; normal for women is 36-48%
MCHC: 27; normal is 32-36g/dl
MCV:70; normal is 80-99fL
TIBC: 600mcg/dl (measures the blood's capacity to bind with transferrin [iron binding proteins])
Pale skin and nail beds
2. What other questions to ask M.B.?
-Do you have heavy periods?
-Do you take any medicines that cause GI bleeding?
-What foods do you eat that have iron in them?
-Are you a vegetarian?
-Do you have pica?
-increased BP and HR
Blood oxygen level
If M.B. has normal blood oxygen level of PaO2=100, then the oxygen content of her blood would be normal because the average range of PaO2 is 75-100mmHg. The body is attempting to compensate for the decreased oxygen carrying capacity so the PaO2 is within normal limits.
5. What foods are recommended?
Heme Iron Foods (better absorption)
-Meat and eggs
Non-Heme Iron Foods (not as good absorption, but still good to eat)
-Green Leafy Vegetables
6. Pharmacologic intervention
M.B. is given a prescription of ferrous sulfate 300mg t.i.d. How long do you anticipate this will continue?
- This dose should be given until iron levels return to normal limits and then M.B. should be given a maintenance dose of ferrous sulfate to prevent this from happening again
1. What's the problem?
Iron deficiency anemia
-it is a type of microcytic-hypochromic anemia->abnormally small RBC that contain abnormally small amounts of Hb.
-The most common type of anemia
-Who's at risk? Poverty-stricken, pregnant women, and children
-Most common causes: Pregnancy and continuous blood loss
3. Compensating for decreased oxygen carrying capacity
Bruso, J. (2013, ). Are there foods that reduce iron in your blood? SFGate. Retrieved from http://healthyeating.sfgate.com/there-foods-reduce-iron-blood-5708.html
Huether, S. E., & McCance, K. L. (2012). Chapters 19 and 20. In Understanding pathophysiology (pp. 494-497, 504-505). St. Louis, MO: Elsevier.