Iron-Deficiency Anemia

Question 1

Pathophysiology

Answer 1

1. Occurs when the body does not have enough iron to produce hemoglobin
2. When not enough iron is available to the bone marrow, hemoglobin production is reduced
3. As hemoglobin levels decrease, the oxygen carrying capacity of the blood is decreased resulting in weakness and fatigue
   > In addition to delayed growth, iron-deficiency has been associated with cognitive and behavioral changes

Question 2

Risk Factors for Iron-Deficiency Anemia

Answer 2

1. Maternal anemia during pregnancy
2. Poorly controlled diabetes during pregnancy
3. Prematurity, low birth weight, or multiple birth
4. Cow’s milk consumption before 12 months of age
5. Excessive Cow’s milk consumption (greater than 24oz a day)
6. Infant consumption of low-iron formula
7. Lack of iron supplementation after age 6 months in breast fed infants
8. Excessive weight gain
9. Chronic infection or inflammation
10. Chronic or acute blood loss
11. Restricted diets
12. Medication interfering with iron absorption (antacids)
13. Low socioeconomic status
14. Recent immigration from a developing country

Question 3

Signs and Symptoms of Iron-Deficiency Anemia

Answer 3

1. Irritability
2. Headache
3. Dizziness
4. Weakness
5. Shortness of Breath
6. Pallor
7. Fatigue

Other symptoms may be subtle and difficult to identify
1. Difficulty feeding
2. Pica
3. Muscle weakness
4. Unsteady gait

Question 4

Complications of Iron-Deficiency Anemia

Question 5

Nursing Assessment: Health History

Answer 5

1. Elicit a description of the current illness and chief complaint
2. Explore for risk factors
3. Evaluate the child’s diet for adequate intake of iron-rich food

Question 6

Nursing Assessment: Physical Examination

Answer 6

1. Observe the child for fatigue and lethargy
2. Inspect the skin, conjunctivae, oral mucosa, palms, and soles for pallor
3. Note spooning of the nails
4. Obtain a pulse oximeter reading
5. Evaluate the heart for tachycardia
6. Auscultate the heart for a flow murmur
7. Palpate the abdomen for splenomegaly

Question 7

Nursing Assessment: Labs and Diagnostics

Answer 7

1. Decreased hemoglobin and hematocrit
2. Decreased reticulocyte count, microcytosis, hypochromia,
3. Decreased serum ion and ferritin levels
4. Increase in free erythrocyte protoporphyrin (FEP) levels

Question 8

Nursing Management: Promoting Safety

Answer 8

The child with anemia is at risk for changes in neurologic functioning related to the decreased oxygen supply to the brain.

1. Provide close observation of the anemic child
2. Assist older child with ambulation
3. Educate parents on how to protect the child from injury due to unsteady gait or dizziness

Question 9

Nursing Management: Providing Dietary Interventions

Answer 9

1. Ensure that iron-deficient infants are fed only formulas fortified with iron
2. Interventions for breast-fed infants include beginning iron supplementation around the age of 4-5 months
3. Encourage breastfeeding mothers to increase their dietary intake of iron or take iron supplements when breast feeding so that the iron may be passed on to the infant
4. For a child 1 years old, limit cow’s milk to 24 oz per day to decrease risk of microscopic GI bleeding and increase appetite for other foods
5. Limit-fast food consumption and encourage intake of iron-rich food (red meat, tuna, salmon, eggs, tofu, enriched grains, dried beans and peas, dried fruits, leafy green vegetables and iron-fortified cereals
6. Teach parents about dietary intake of iron
7. Encourage parents to provide a variety of food for iron support and vitamins and other minerals necessary for growth
8. Refer a parent to a developmental specialist who can assist them in their approach to diet (picky toddlers)
9. Referral to WIC, which provides for supplementation of infants’ and children’s diets

Question 10

Nursing Management: Teaching About Iron Supplement Administration

Answer 10

1. Oral supplements or multivitamin formulas that contain iron are often dark in color because the iron is pigmented
2. Teach parents to precisely measure the amount of iron to be administered
3. Parents should place the liquid behind the teeth, as iron in liquid form can stain teeth
4. Iron supplements can cause constipation
5. Reducing the amount of iron can resolve constipation, but stool softness may be necessary to control painful or difficult-to-pass stool
6. Encourage parents to increase their child’s fluid intake and include adequate dietary fiber to avoid constipation