Ch. 34 Iron Deficiency Anemia and Vit B12 Deficiency

Question 1

Hematology

Answer 1

is the study of the blood and the lymphatic system.

Question 2

Anemia

Answer 2

occurs when there is a reduction in the oxygen-carrying capacity through either fewer RBCs or a reduction in hemoglobin.

Question 3

Which anemia is the most prevalent nutritional deficiency in the world?

Answer 3

Iron deficiency anemia

Question 4

Which group of people does IDA affect the most?

Answer 4

African American’s or those in low social status

Question 5

Risk Factors for IDA

Answer 5

Inadequate iron in the diet
Hemorrhage
Chronic blood loss
Gastrointestinal problems (ulcers, esophageal varices)
Colon cancer 
Meds (PPI, NSAIDs)
Pregnancy
Premenopausal women 
Celiac or Chron's disease 
Gastrointestinal surgeries such as gastric bypass surgery and partial and total gastrectomy can lead to poor absorption of iron and IDA

Question 6

Patho of IDA

Answer 6

With an iron deficiency, the body has insufficient hemoglobin to carry adequate oxygen to meet body requirements

Question 7

What is the late manifestation of iron deficiency?

Answer 7

Anemia

Question 8

Where does the body store iron?

Answer 8

in the liver as ferritin

Question 9

Clinical Manifestations of IDA

Answer 9

Hypoxia
Fatigue
Pallor
Tachycardia
Tachypnea 
Spoon-shaped fingernails, or koilonychias
Glossitis

Question 10

diagnosis of IDA?

Answer 10

A complete blood count (CBC) demonstrates decreased hemoglobin and hematocrit levels. Low serum ferritin levels, which reflect the body’s iron stores, are a confirmation of IDA

Question 11

Diet for medical management of IDA?

Answer 11

Good dietary sources of iron include meat (especially red meat), dark green leafy vegetables (spinach, broccoli, peas), beets, dried beans, iron-fortified breakfast cereals and breads, and Cream of Wheat

Question 12

What is diet alone does not work for IDA and what is the first line of therapy?

Answer 12

iron supplementation is needed, and this can be done through iron preparations administered orally, intramuscularly, or intravenously. Oral supplementation is the first line of therapy

Question 13

Pts on iron therapy should be monitored for?

Answer 13

monitored for nausea, abdominal discomfort, constipation, and/or diarrhea

Question 14

Iron supplementation by parenteral means is indicated only in cases of

Answer 14

severe gastrointestinal distress secondary to oral administration, malabsorption disorders, or in acute cases of IDA in which levels need to be increased more rapidly.

Question 15

How are parenteral iron given and why?

Answer 15

Because parenteral iron formulas stain the skin, the Z-track method is used when administering iron intramuscularly. The Z-track prevents leakage of irritating and discoloring medications, such as iron dextran

Question 16

Complications of IDA and why

Answer 16

• Heart failure- b/c w/o iron do not have the O2 carrying ability to meet demand
• Renal failure- all blood flows through renal system b/c kidneys filter the waste products and will not produce more RBCs due to lack of erythropoietin
• Impaired thermoregulation- w/o enough O2 carrying RBCs, blood is shunted to core leading to shivering
• Impaired immune function -Its deficiency affects the capacity to have an adequate immune response. The role of iron in immunity is necessary for immune cell proliferation
• Psychomotor and cognitive impairment- b/c in puts body into a inflammatory state and causes tissue damage

Question 17

Signs/symptoms related to decreased oxygenation

Answer 17

• Decreased hematocrit and hemoglobin levels
• Decreased serum ferritin levels
• Tachypnea
• Shortness of breath
• Tachycardia
• Pallor
• Fatigue
• Blood loss
• Changes in level of consciousness
• Cognitive impairment
• Glossitis
• Physical abnormalities such as spoon-shaped fingernails

Question 18

IDA nursing diagnosis

Answer 18

• Inadequate tissue perfusion related to decreased oxygen delivery as a result of decreased iron stores
• Fatigue related to inadequate oxygenation to body tissues
• Activity intolerance related to impaired oxygen-carrying capacity secondary to IDA

Question 19

Nursing Interventions for IDA: Assessment

What are you looking for and why?

Answer 19

Vital signs Tachycardia and tachypnea are secondary to the heart and lungs compensating for decreased oxygenation of body tissues caused by decreased iron levels, which leads to decreased hemoglobin levels.
• Serum hemoglobin and ferritin levels With an iron deficiency, reflected by low ferritin levels, there is insufficient hemoglobin to deliver oxygen to the body tissues. Decreased hemoglobin and serum ferritin levels indicate IDA.
• Fatigue, pallor, and shortness of breath Fatigue, pallor, and shortness of breath worsen with increasingly decreased levels of iron, resulting in inadequate oxygen-carrying capacity.
• Level of consciousness Alterations in level of consciousness occur as a result of decreased iron levels that cause decreased oxygenation to the brain. If prolonged IDA is present in a child’s developing brain, cognitive impairment could be permanent.
• Blood loss, if present The greater the blood loss, the worse the clinical manifestations are as a result of decreasing iron stores and decreased hemoglobin levels leading to inadequate tissue perfusion.

Question 20

How to see if there is blood loss?

Answer 20

Bruising, H&H, and urine

Question 21

Nursing actions to increase iron for IDA

Answer 21

Increase dietary iron. Increasing iron intake through dietary sources increases the body’s iron stores and results in increased hemoglobin levels, thus increasing tissue perfusion.
• Increase intake of vitamin C. Increasing vitamin C intake may increase iron absorption.
• Administer iron-supplement therapy. Iron-supplement therapy is necessary if iron stores need to be increased quickly or if malabsorption disorders are present, which interfere with the body’s ability to incorporate iron from dietary sources.
• Minimize blood loss. Any obvious hemorrhaging needs to be controlled immediately to minimize blood loss. Excessive bleeding with menstruation may be controlled by various hormonal medications.

Question 22

Nursing pt teaching for IDA

Answer 22

Dietary sources of iron Good dietary sources include meat (especially red), dark green leafy vegetables (spinach, broccoli, peas), beets, dried beans, iron-fortified breakfast cereals and breads, and Cream of Wheat. Many Web sites are available for nutritional information
• Immediately report any signs of bleeding, increasing fatigue, or shortness of breath. Most cases of IDA occur over a prolonged period of time. Therefore, clinical manifestations usually present when iron stores have already been significantly decreased.
• Daily iron supplements must be taken as prescribed. Iron supplements replace the body’s iron stores and increase the production of hemoglobin molecules, leading to improved tissue perfusion. Oral supplements can cause constipation, diarrhea, nausea, or abdominal discomfort. Patients need to be instructed to report these side effects to the healthcare provider. If side effects are too severe, then supplementation via parenteral routes is available.
• Dangers of lead exposure In lower-socioeconomic environments, lead paint is still present in many buildings. Exposure to lead can lead to cognitive impairment and developmental abnormalities in children.
• Prenatal teaching about iron intake Inadequate iron intake by pregnant women has been linked to lower birth weight, preterm labor, and increased mortality of mother and child.

Question 23

Pica

Answer 23

When iron levels are low people start to crave non food items

Question 24

Vitamin B12, also called

Answer 24

cobalamin

Question 25

Vitamin B12 Deficiency

Answer 25

deficiency occurs either when the body has inadequate sources of vitamin B12 or because of malabsorption disorders that make dietary vitamin B12 unavailable for body use

Question 26

Does the body store iron and Vit B12?

Answer 26

Body stores iron but not Vit B12 - have to consume daily

Question 27

Risk factors for Vit B12 deficiency

Answer 27

``` Older adults G I resections Autoimmune disorders (AIDS) Crohn’s disease Celiac disease Long-term use of medications that decrease gastric acid (PPI and H2) ```

Question 28

Vit B12 is needed for

Answer 28

- coenzyme required for normal function of the central nervous system, formation of red blood cells, and synthesis and regulation of DNA - vitamin B12 because it is essential to the synthesis of fatty acids and energy production

Question 29

What foods have Vit B12?

Answer 29

dietary sources of animal proteins, including meat, seafood, eggs, and dairy products

Question 30

Clinical Manifestations of Vit B12 deficiency

Answer 30

``` Spinal cord degeneration Peripheral neuropathy Altered mental status Depression Visual changes Tachycardia Shortness of breath Dizziness Fatigue ```

Question 31

Diagnosis of Vit B12

Answer 31

CBC Serum Vitamin B12 Schilling’s test

Question 32

What is the Schilling’s test

Answer 32

a radionuclide 24-hour urine test that indirectly measures intrinsic factor.

Question 33

What is intrinsic factor? | and where is it made?

Answer 33

Intrinsic factor - protein that helps with absorption of vit b 12 and does it small intestine intrinsic factor made by partial cells in the stomach

Question 34

Medical management of Vit B12 deficiency

Answer 34

- Prevention is key - Oral B12 but if severe need weekly injections - Diet-meat, seafood, eggs, and dairy products * **B12 only made by animal protein

Question 35

Complications of Vit B12 deficiency

Answer 35

- impairs DNA synthesis and the body’s ability to produce RBCs - Orthostatic hypotension - causes dizziness - impacts on the functional ability of the individual and quality of life

Question 36

Nursing assessment for Vit B12 deficiency

Answer 36

Monitor VS for: • Shortness of breath • Tachypnea • Tachycardia • Pallor • Fatigue • Dizziness Neuro exam: • Numbness, tingling, or burning in hands or feet • Altered mental status (confusion, dementia) • Depression • Mood swings • Coordination and balance • Impaired taste, stinging sensation on the tongue (can cause glossitis) • Visual disturbances

Question 37

Nursing diagnosis for Vit B12 Deficiency

Answer 37

* Inadequate tissue perfusion related to decreased oxygenation as a result of decreased hemoglobin and hematocrit * Activity intolerance related to impaired oxygen-carrying capacity secondary to vitamin B12 deficiency * Chronic pain related to inadequate vitamin B12 levels as evidenced by peripheral neuropathy

Question 38

Nursing interventions: assessment for Vit B12

Answer 38

• Vital signs Vitamin B12 deficiency impairs RBC production, with a resulting decrease in tissue perfusion. Tachycardia and tachypnea occur as the heart attempts to compensate for the decrease in tissue perfusion. • Fatigue, pallor, and shortness of breath Fatigue, pallor, and shortness of breath worsen with increasingly decreased levels of RBCs, causing inadequate tissue perfusion. • Numbness, tingling, or burning of the hands or feet; confusion; mood swings Neurological clinical manifestations occur because of the impairment of DNA synthesis of myelin sheath and neurotransmitters. • Decreased hemoglobin/hematocrit levels, decreased vitamin B12 levels, elevated serum and urine MMA levels A CBC shows decreased hemoglobin and hematocrit levels. The serum vitamin B12 assay is decreased due to the lack of vitamin B12 needed for synthesis. • Fall risk (safety) Confusion, dementia, coordination and balance impairment, and visual disturbances make these patients at risk for falls. Paresthesia and tingling (peripheral neuropathy) can affect ambulation, gait, and stability. Severe neuropathy may take time to recover. • Intake and output Constipation, diarrhea, and/or anorexia affect the absorption of vitamin B12 and may worsen the problem.

Question 39

Nursing Interventions: Actions for Vit B12

Answer 39

• Ensure adequate vitamin B12 intake. Ensuring that the patient has an adequate intake of vitamin B12 prevents clinical manifestations of anemia and degenerative neurological changes (see Table 34.3). • Administer vitamin B12 therapy. Oral supplementation in mild cases of vitamin B12 deficiency may be helpful. In more severe cases, supplementation with parenteral therapy is required. Parenteral supplementation may be necessary for patients who lack intrinsic factor and cannot absorb oral supplementation. Vegetarians can prevent or treat this deficiency with oral supplements, vitamins, or fortified soy milk. When the deficiency is due to pernicious anemia or the absence of intrinsic factor, the replacement of vitamin B12 involves I-mg IM injections of cyanocobalamin vitamin B12. • Monitor use of folic acid. Before starting a patient on folic acid, confirm that the patient does not have a vitamin B12 deficiency. Folic acid resolves the anemia by escaping the methylfolate trap, but neurological degeneration due to vitamin B12 deficiency continues. • Monitor use of nitrous oxide. Nitrous oxide inactivates vitamin B12 in the body. Prior to using for anesthesia, confirm that the patient is not vitamin B12 deficient. • Assess pain and activity levels due to peripheral neuropathy. Peripheral neuropathy may develop because of vitamin B12 deficiency. Increasing pain may interfere with functional abilities. Because position sense, coordination, and balance are affected, physical therapy and occupational therapy should be considered along with the use of assistive devices.

Question 40

Nursing interventions: pt teaching Vit B12

Answer 40

* Dietary sources of vitamin B12 Dietary sources of vitamin B12 include meat, seafood, eggs, and dairy products. * Need for vitamin B12 supplementation Because of the lack of vitamin B12 in plants, vegans/vegetarians may need daily oral supplementation. Patients may have a sore tongue and need bland, soft food frequently, along with mouth care. * Immediately report any clinical manifestations of fatigue, shortness of breath, paresthesias, and confusion. Clinical manifestations usually present after prolonged vitamin B12 deficiency. Resolution of the anemia does not stop neurological degeneration unless the deficiency is resolved. * Prenatal teaching Pregnancy may increase the demand for vitamin B12. Prophylactic oral supplementation is recommended. * Radiation for advanced cancers Radiation therapy may increase the need for vitamin B12 supplementation. Patients with anemia do not respond as well to radiotherapy because of impairment of oxygen transport to cancer cells. * Actions of acid-reducing medications Patients using these medications may develop vitamin B12 deficiency because of a decrease in the function of the parietal cells of the stomach, which produce intrinsic factor.