Week 9: RBC Disorder: Iron Deficiency Anemia Flashcards
IDA is highest among what population?
most prevalent nutritional deficiency in the world and is highest among non-Caucasian Americans of lower socioeconomic status especially infants, children and pregnant women
- highly prevalent among African American and Mexican Women because of the large numbers of this population with low incomes
- it is greater in females than in males, especially premenopausal women because of the monthly blood loss with menses
What is a contributing factor to IDA?
inadequate iron in the diet
Etiology
during periods of blood loss or growth, iron intake my be inadequate to meet the increased demands of the body, resulting in a higher incidence of IDA in infants, children, and pregnant women
- in lower- socioeconomic areas where lead paint is still present in some buildings, lead poisoning, causing cognitive impairment and developmental abnormalities in children, becomes a concern
- IDA can result in pica, causing the iron-depleted individual to ingest nonnutritive substances such as paint, dirt, clay, ice, or laundry starch
Pica
IDA can result in pica, causing the iron-depleted individual to ingest nonnutritive substances such as paint, dirt, clay, ice, or laundry starch
-in lower-socioeconomic areas where lead paint is still present in some buildings, lead poisoning, causing cognitive impairment and developmental abnormalities in children, becomes a concern
Iron-deficiency Anemia often occurs as a result of what?
hemorrhage and chronic blood loss, ex: heavy menstrual bleeding, certain types of cancer (esophageal, colon, stomach), and ulcerative gastrointestinal problems such as peptic ulcer disease
Poor Absorption of Iron may be due to what?
celiac disease, Crohn’s disease, and the chronic use of medications such as H2 inhibitors, proton-pump inhibitors, antacids, aspirin, and NSAIDs
- GI surgeries such as gastric bypass surgery and partial and total gastrectomy can lead to poor absorption of iron and IDA
- in older adults with comorbidities, anemia is frequently a cause for hospitalization and exacerbates many chronic conditions such as congestive heart failure (CHF), and chronic kidney disease
Anemia (inadequate RBC) exacerbates many chronic conditions such as?
congestive heart failure (CHF) and chronic kidney disease
Pathophysiology
every living cell contains iron, and it is essential to the formation of the hemoglobin molecules on RBCs
-with an iron deficiency, the body has insufficient hemoglobin to carry adequate oxygen to meet body requirements
-Iron also plays a part in adenosine triphosphate production (ATP), necessary for glucose metabolism, and DNA synthesis, the basic gene component
-the body is able to store iron in the liver as ferritin, and it is transferred to the rest of the body in times of increased demand via the protein transferrin, manufactured in the liver
>IDA occurs when the body has exhausted its iron stores; the sequela of IDA is initiated with the release of cytokines as a response to the acute loss or inflammation that results in a diminished response from the kidneys for production of erythropoietin, increased resistance of the bone marrow to erythropoietin stimulation, and shorter RBC life span
Every living cell contains what?
iron
-it is essential to the formation of the hemoglobin molecules on RBCs
Anemia
inadequate RBCs in the body
-iron-deficiency anemia is the lack of iron-containing RBCs in the body
When does IDA occur?
when the body has exhausted its iron stores
When do greater iron demands occur?
primarily in periods of growth and development and secondary to pathologic causes
- except in the case of hemorrhage, IDA slowly progresses through several stages from a negative iron balance to iron depletion, deficient erythropoiesis, and finally IDA
- anemia is a late manifestation of iron deficiency
What is a late manifestation of iron deficiency?
anemia (lack of RBCs in the body)
IDA slowly progresses through several stages
-from a negative iron balance to iron depletion, deficient erythropoiesis (production of RBCs), and finally IDA
Erythropoiesis
the process which produces RBCs, which is the development from erythropoietic stem cell to mature red blood cell
-it is stimulated by decreased O2 in circulation, which is detected by the kidneys, which then secrete the hormone erythropoietin
What happens when the iron stores are depleted?
the decreased hemoglobin levels lead to inadequate oxygenation of the bodys tissues, or hypoxia (decreased oxygen in the tissues)
Clinical Manifestations
this oxygen deficiency manifests itself as:
-fatigue, pallor, with the onset of tachycardia and tachypnea resulting from the heart and lungs attempting to compensate for the hypoxemia (oxygen deficiency to the blood)
>as hypoxia increases, the patient may become SOB
-also cause fissures in the corners of the mouth, glossitis (painful swelling of the tongue, which appears smooth and shiny), and koilonychias (spoon-shaped fingernails)
Clinical Manifestations: Glossitis
IDA may also affect the rapidly regenerating cells of the mucous membranes and the gastrointestinal tract
-painful swelling of the tongue, which appears smooth and shiny because of the flattening of the lingual papillae on the tongue
Clinical Manifestations: koilonychias
spoon-shaped fingernails
- as a result of severe, prolonged iron deficiency, which renders the cells of the fingernail soft and malleable
- the pressure exerted by ordinary functions such as writing causes the nails to become deformed
How is the diagnosis of IDA confirmed?
by specific blood tests
- a complete blood count (CBC), demonstrates decreased hemoglobin and hematocrit levels
- Low serum ferritin levels, which reflect the bodys iron stores, as a confirmation of IDA
- additional studies: serum iron, total iron-binding capacity (TIBC), serum transferrin receptors, and mean corpuscular volume (MCV)
Ferritin Levels reflect what?
the bodys iron stores
- low levels = IDA (levels less than or equal to 100 ug/L)
- ferritin is stored in the liver
Normal RBC ranges
- Male: 4.21-5.81 million/mm3
- Females: 3.61-5.11 million/mm3
Normal Hemoglobin ranges
- Male: 14-17.3 g/dL
- females: 11.7-15.5 g/dL
Normal Hematocrit ranges
- Male: 42-52%
- females: 36-48%
What is the easiest and best way to prevent IDA?
adjusting the diet to increase iron intake
- good sources are red meat, dark green leafy vegetables (spinach, broccoli, peas), beets, dried beans, iron-fortified breakfast cereals and breads, cream of wheat
- Ingesting citrus fruits such as oranges or grapefruits increases the vitamin C intake and may improve iron absorption
What may improve iron absoprtion?
ingestion of citrus fruits such as oranges or grapefruits to increase the vitamin C intake
What to do if diet alone cannot restore iron levels?
iron supplementation is needed
-can be doe through iron preparations administered orally, intramuscularly, or intravenously
Which preparation of iron is the first line of therapy if supplementation is needed?
oral supplementation
Parenteral Supplementation of Iron
IV or IM
- indicated only in cases of severe gastrointestinal distress secondary to oral administration, malabsorption disorders, or in acute cases of IDA in which levels need to be increased more rapidly
- iron dextran was the only IV supplement but because it often causes cardiotoxic side effects, patients need to be closely monitored while infusing, but newer formulations are now available; but vital signs are always monitored
- parenteral iron formulas stain the skin; use z-track method
Parenteral Supplementation of Iron are only indicated for?
(IV or IM)
cases of severe GI distress secondary to oral administration, malabsorption disorders, or in acute cases of IDA in which levels need to be increased more rapidly
During Iron Therapy what should patients be monitored for?
nausea, abdominal discomfort, constipation, and/or diarrhea
What is important when administering Iron Intramuscularly?
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
Good Dietary Sources of Iron
-meats (red meat)
-dark green leafy vegetables (spinach, broccoli, peas)
-beets
-dried beans
-iron-fortified breakfast cereals and breads
-cream of wheat
>ingesting citrus fruits such as oranges or grapefruits increases the vitamin C intake and may improve iron absorption
Complications of IDA
- adversely affect chronic health conditions (CHF and renal failure)
- impair thermoregulation and increase immune dysfunction
- psychomotor abnormalities and cognitive impairment in children with IDA
- IDA during pregnancy increases risk for low birth weight, preterm labor, and perinatal and postpartum mortality of the infant/ or mother
- excessive iron overload (not a result of excessive oral supplementation)
What happens the longer IDA persists?
the greater clinical manifestations worsen, which impacts the function and quality of life
-can adversely affect chronic health conditions such as CHF and renal failure, as well as impair thermoregulation and increase immune dysfunction
What is the cause of iron overload?
- pica
- multiple long-term blood transfusions
Clinical Manifestations of Iron overload?
fatigue, heart palpitations, joint pain, nausea, vomiting, constipation and/or diarrhea, damage to the heart and arteries, and an increased risk of cancer
-the health care provider monitors the folate and TIBC levels when any supplementation is needed
When supplementation is needed what labs does the health care provider monitor?
the folate and the total iron-binding capacity (TIBC) levels
Folate
is one of the B vitamins and is needed to make red and white blood cells in the bone marrow, convert carbohydrates to energy, and produce DNA and RNA
Clinical Manifestations of IDA are related to?
the decreased oxygenation of body tissues
-the severity of clinical manifestations is proportional to the severity of iron-store depletion
-manifestations:
>decreased hematocrit and hemoglobin levels
>decreased serum ferritin levels
>tachypnea
>SOB
>tachycardia
>pallor
>fatigue
>blood loss
>changes in level of consciousness
>cognitive impairment
>glossitis
>physical abnormalities such as spoon-shaped fingernails (koilonychias)
Nursing Diagnosis
- inadequate tissue perfusion r/t decreased oxygen delivery as a result of decreased iron stores
- fatigue r/t inadequate oxygenation to the body tissues
- activity intolerance r/t impaired oxygen-carrying capacity secondary to IDA
Nursing Interventions: Assessment
Assess
- vital signs
- serum hemoglobin and ferritin levels
- fatigue, pallor, SOB
- level of consciousness
- blood loss if present
Assessment: Vital Signs
tachycardia and tachypnea are secondary to heart and lungs compensating for decreased oxygenation of body tissues caused by decreased iron levels, which leads to decreased hemoglobin levels
Assessment: 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 ferritin levels indicate IDA
Assessment: Fatigue, pallor, SOB
fatigue, pallor, and shortness of breath worsen with increasingly decreased levels of iron, resulting in inadequate oxygen-carrying capacity
Assessment: 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
Assessment: 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
Nursing Interventions: Actions
- increase dietary iron
- increase intake of vitamin C
- administer iron-supplement therapy
- minimize blood loss
Nursing Actions: 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
Nursing Actions: Increase intake of vitamin C
increasing vitamin C intake may increase iron absorption
Nursing Actions: 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 bodys ability to incorporate iron from dietary sources
Nursing Actions: Minimize blood loss
any obvious hemorrhage needs to be controlled immediately to minimize blood loss
-excessive bleeding with menstruation may be controlled by various hormonal medications
Teaching
- dietary sources of iron
- immediately report any signs of bleeding, increasing fatigue, or shortness of breath
- daily iron supplements must be taken as prescribed
- dangers of lead exposure
- prenatal teaching about iron intake
Teaching: Dietary sources of Iron
good dietary sources 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
Teaching: 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
Teaching: 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
Teaching: prenatal teaching about iron intake
inadequate iron intake by pregnant women has ben linked to lower birth weight, preterm labor, and increased mortality of mother and child
Evaluating Care Outcomes
iron deficiency anemia is a reversible condition that can be managed by increasing iron intake and/or through parenteral supplementation
- evaluating iron levels allows the increased production of hemoglobin, which improves the oxygenation of body tissues
- as tissue perfusion improves, so do the clinical manifestations of fatigue, pallor, and shortness of breath
- heart rate and respiratory rate return to normal as the heart and lungs no longer need to compensate for inadequate tissue perfusion
- normal levels of hemoglobin and serum ferritin confirm the resolution of anemia
- children with prolonged IDA may continue to deal with cognitive impairment and developmental abnormalities caused by insufficient oxygenation to the developing brain
A Well managed Client from IDA
- clinical manifestations of fatigue, pallor and shortness of breath improve
- normal heart rate and respiratory rate
- normal levels of hemoglobin and ferritin
