Iron-deficiency Anemia

  1. General information
    1. Chronic microcytic, hypochromic anemia caused by either inadequate absorption or excessive loss of iron
    2. Acute or chronic bleeding principal cause in adults (chiefly from trauma, excessive menses, and GI bleeding)
    3. May also be caused by inadequate intake of iron-rich foods or by inadequate absorption of iron (from chronic diarrhea, malabsorption syndromes, high cereal-product intake with low animal protein ingestion, partial or complete gastrectomy, pica)
    4. Incidence related to geographic location, economic class, age group, and sex
      1. More common in developing countries and tropical zones (blood-sucking parasites)
      2. Women between ages 15-45 and children affected more frequently, as are the poor
    5. In iron-deficiency states, iron stores are depleted first, followed by a reduction in Hgb formation.
  2. Assessment findings
    1. Mild cases usually asymptomatic
    2. Palpitations, dizziness, and cold sensitivity
    3. Brittleness of hair and nails; pallor
    4. Dysphagia, stomatitis, and atrophic glossitis
    5. Dyspnea, weakness
    6. Laboratory findings
      1. RBCs small (microcytic) and pale (hypochromic)
      2. Hgb markedly decreased
      3. Hct moderately decreased
      4. Serum iron markedly decreased
      5. Hemosiderin absent from bone marrow
      6. Serum ferritin decreased
      7. Reticulocyte count decreased
  3. Nursing interventions
    1. Monitor for signs and symptoms of bleeding through hematest of all elimination including stool, urine, and gastric contents.
    2. Provide for adequate rest: plan activities so as not to overtire.
    3. Provide a thorough explanation of all diagnostic tests used to determine sources of possible bleeding (helps allay anxiety and ensure cooperation).
    4. Administer iron preparations as ordered.
      1. Oral iron preparations: route of choice
        1. give following meals or a snack.
        2. dilute liquid preparations well and administer using a straw to prevent staining teeth.
        3. when possible administer with orange juice as vitamin C (ascorbic acid) enhances iron absorption.
        4. warn clients that iron preparations will change stool color and consistency (dark and tarry) and may cause constipation.
      2. Parenteral: used in clients intolerant to oral preparations, who are noncompliant with therapy, or who have continuing blood losses.
        1. use one needle to withdraw and another to administer iron preparations as tissue staining and irritation are a problem.
        2. use the Z-track injection technique to prevent leakage into tissues (see Intramuscular (IM) Administration)
        3. do not massage injection site but encourage ambulation as this will enhance absorption; advise against vigorous exercise and constricting garments.
        4. observe for local signs of complications: pain at the injection site, development of sterile abscesses, lymphadenitis as well as fever, headache, urticaria, hypotension, or anaphylactic shock.
    5. Provide dietary teaching regarding foods high in iron.
    6. Encourage ingestion of roughage and increase fluid intake to prevent constipation if oral iron preparations are being taken.