Iron Deficiency Anemia: 47-Year-Old Male Patient Case Study

Introduction

This paper responds to questions concerning the case study provided. It involves a 47 years old man who visited a clinic with gradual onset of dyspnea on exertion and fatigue. In addition, the patient complained of constant dyspepsia with nausea and occasional epigastric pain. The paper begins by illustrating questions which are pertinent to exploring the patient’s disease symptoms and past medical history. Moreover, it discusses the diagnostic tests carried out and shows pertinent positive and negative findings in the physical examination. This is followed by an interpretation of the findings of the diagnostic tests which in turn gives a green light to discuss the disease process related to the hemolytic system. Finally, all appropriate NANDA nursing diagnoses for anemic patients are provided.

Important questions to help explore patient’s disease symptoms

The first step in treating the patient’s condition may involve understanding his family history, history of drug use and amount of alcohol consumed per day (Springhouse, 2006). In addition, the patient should be grilled on any pre-existing mental disorder, metabolic conditions, cardiac problems and medication regimen as well as his sleep patterns. More so, it is wise to ask the patient if he ever suffered any head injury in the past and have him describe his smoking habits. Furthermore, he should be asked to explain the condition he is complaining of (dyspepsia) in relation to meals and the effects of remedies taken. Finally, the practitioner may inquire if the patient is undergoing any stress.

Important questions to help explore the patient’s medical history

The case presented may warrant a medical practitioner to ask about the patient’s critical diseases history and major hospitalizations. The caregiver should inquire about past hematologic setbacks, past surgeries and liver problems as well as breeding abnormalities (Collins, 2003).

In addition, many want to know the patient’s family history, recent medications and bleeding duration. Furthermore, it is recommended to ask if the bleeding is associated with shock and whether the patient bruises easily. Moreover, caregivers should ask about any case of petechie and renal or splenic disease. Finally, a medical officer may want to know whether the patient is allergic. This is done by considering past treatment using drugs like chloramphenicol which are known to cause allergy (Springhouse, 2006). Then, both physical and diagnostic procedures may be taken.

Abnormal and normal findings in the physical examination

Physical tests carried out on the patient revealed several abnormal conditions. General physical examination indicated that the patient had a thin pale coloration and he appeared older than the stated age even though he suffered no stress. Furthermore, the patient’s sclera was pale although it lacked icterus and his mouth’s corner had signs of cheilosis. In addition, his nails were brittle and thin in appearance. Finally, abdominal and rectal tests showed the presence of moderate epigastric tenderness and guaiac positive stool. These are the physical manifestation of anemia (Coya & Lash, 2009). Nevertheless, there were some encouraging results.

The patient had a standard body temperature (37° Celsius) and a normal pulse rate (95 beats per min). In addition, respiratory rate was normal (16 breaths per minute) while the blood pressure was typical at 120/72 mmHg (Coya & Lash, 2009). The patient’s pupils were equal, round and reactive to light and his pharynx was clear and without any postnasal drainage. More encouraging results indicated that the patient suffered no cases of thyromegaly, adenopathy, or bruits.

Moreover, the client had good bilateral lung expansion and lungs were clear to auscultation. More so, the heart rate was proved to be all right although there was a grade II/VI systolic murmur at the left sternal border. Any cases of gallops, heaves or thrills were dispelled. In addition, the patient’s abdomen was non-distended and the liver span was 8cm at the midclavicular line. His prostate was healthy and he seemed to have stamina. Finally, he had normal body strength (5/5), intact sensation, normal gait, and he had deep tendon reflexes that were 2+ and symmetric throughout. After the physical tests, diagnostic procedures were carried out and their findings are interpreted below.

Interpretation of diagnostic findings

The patient’s hemoglobin was shown to be 8 g/dl instead of 13-18g/dl for normal men (Springhouse, 2006). This means that there was less oxygen in circulation. In addition, Mean Corpuscular Volume (MCV) was normal and this condition may exist in a normocytic anemia. Additionally, the patient’s Mean Corpuscular Hemoglobin Content (MCHC) was slightly decreased. This is associated with conditions like microcytic anemia and it is attributed to factors such as iron deficiency, chronic blood loss and thalassemia (Springhouse, 2006). Moreover, the red cell distribution width was markedly increased while the MCV was normal.

This presented possible cases of early stages of iron deficiency, vitamin B deficiency, and early folate deficiency as well as initial stages of the anemic condition. The diagnostic results also showed mixed microcytic/hypochromic and macrocytic/normochromic red blood cells. The findings can be associated with folate and iron deficiencies (Springhouse, 2006). This condition may also be responsible for normal MCV. The appearance of platelets was normal hence their function in blood clotting was not jeopardized. The further result revealed that Prothrombin Time (PT), Partial Thromboplastin Time (PTT), liver function, electrolytes, and amylase were normal.

Normal PPT meant that coagulation factors such as fibrinogen and prothrombin as well as heparin were up to standard amounts. Normal PT implied that there was good interaction of prothrombin groups V, VII, X and fibrinogen which are useful in determining amounts of oral anti-coagulants. Furthermore, serum ferritin levels were decreased and this is attributed to prolonged bleeding of the digestive tract, iron deficiency or deprived iron absorption due to abnormal intestinal conditions (Springhouse, 2006). This may ultimately lead to anemia. Moreover, the patient’s transferrin saturation was decreased and this is also associated with iron deficiency.

Decreased levels of total iron-binding capacity implied that the patient also suffered from anemia of chronic ailments. Folate and cell folate levels were decreased and this shows depletion of folate storage. More so, a bone marrow biopsy showed megaloblastic changes and low iron stores giving more clues to iron deficiency anemia as well as megaloblastic anemia (Coya & Lash, 2009). Finally, an upper endoscopy revealed a 2cm duodenal ulcer with evidence of recent but no acute hemorrhage. This could be attributed to Helicobacter pylori infection and may cause bleeding. All the findings are therefore contributing to iron deficiency anemia.

The disease process for iron-deficiency anemia

Iron deficiency anemia is an abnormal body condition whereby there are not enough erythrocytes in the blood (McCance et al, 2010). The condition is brought about by low amounts of iron which then hinder the production of hemoglobin. The rate of iron absorption in the jejunum and duodenum is very low and dietary iron may fail to supply the required amounts when such foods lack heme iron. Non-heme iron has to be converted to ferrous iron before absorption (Coya & Lash, 2009).

Iron in the blood system binds to transferrin which conveys it to erythroblast receptors and also to cells in the liver and placenta. The erythroblast mitochondria then convert iron to protoporphyrin and then to heme while transferrin is recycled (McCance et al, 2010). An iron that remains after this process is transported and stored as ferritin and hemosiderin. More iron is recycled from dying erythrocytes by transferrin.

When iron absorption is low, bone marrow stores are diminished so that no red blood cell production occurs hence anemia. Nevertheless, a major cause of this disease is blood loss due to prolonged bleeding from gastrointestinal tracts and extended intravascular hemolysis in men (Springhouse, 2006). Low levels of iron intake may also result from upper small bowel malabsorption or from gastrectomy. There are odd situations when the disease is attributed to undernutrition.

Iron deficiency anemia leads to inadequate hemoglobin levels and thus the low amount of oxygen is circulated. A decreased amount makes an individual feel exhausted, feeble and have shortness of breath as well as pale skin (McCance et al, 2010). As the disease progresses, an individual may have cheilosis and brittle nails and suffer from dysphagia. The disease can be detected through conducting Complete Blood Count (CBC) (Springhouse, 2006). The test is used to ascertain hematocrit and hemoglobin levels. Low levels are a sign of anemia. The test also assesses the amount of leukocytes, erythrocytes and blood platelets.

Unusual results signify a body disorder. Finally, the CBC investigates the MCV and MCHC which give clues to possible causes of anemia. In addition to CBC, blood smears are made to observe the shape of erythrocyte (McCance et al, 2010). Furthermore, reticulocyte count test may be conducted to assess the functionality of bone marrow. Quantity of iron in the body may be determined through testing serum ferritin and iron as well as investigating the concentration of transferrin. Moreover, red blood cell protoporphyrin tests as well as stool occult blood procedures are important in establishing an anemic condition.

Clinical manifestations of this disease include fatigue, black stool, dizziness, dyspepsia and ulcers as well as hometochezia (McCance et al, 2010). Iron deficiency anemia can be cured by first treating the root causes such as hemorrhages and then taking iron supplements like ferrous sulphate (Springhouse, 2006). The supplements may come inform of non heme iron or as heme iron. Supplements can be taken orally or through an injection depending on the patient’s reaction. Other treatments may include taking iron rich foods like fish, eggs and raisins. With such treatment, iron level should normalize within two months (Mosby, 2010). There are no associated complications although the disease may reappear. Therefore, one is advised to take regular medical check ups.

Nursing Care Plan

According to Doenges (2010), interpretation of all the collected data may lead to nursing diagnoses. Conditions like exhaustion and weakness, lack of breath on exertion as well as low levels of perseverance during activity are signs of ‘activity intolerance’. As such, care plan 1 in table 1 deals with this condition by determining the desired outcome on the patient so as to achieve endurance. This is achieved through appropriate nursing interventions supported by specific scientific rationales. In addition, care plan 2 in table 2 is aimed at treating malnutrition. This plan is as a result of imbalanced diet- inadequate amount nursing diagnoses which was necessitated by conditions like exhaustion and weakness while performing minor duties.

This plan is important as it aims at ensure proper health through appropriate diet. Finally, the nursing diagnoses in care plan 3 in table 3 deals with risk of infection. This is important as the patient has a lesion on the mouth which may lead to contamination. Furthermore, anemic individuals are prone to cross infections. The care plans aims at protecting the patient from such infections and ensure stability of his immunity.

Table 1. Care Plan 1.

Table 2. Care Plan 2.

Table 3. Care Plan 3.

Conclusion

It is wise to know the patients personal, family and medical history where anemia is suspected. This should be followed by physical and diagnostic tests like CBC which help to understand the real situation of anemic condition. The disease may be brought about by loss of blood and failure of the body to make use of iron found in meals. Its various symptoms include fatigue and loss of breath among others. Treatment is through iron supplement and dietary changes. This is achieved through proper nursing diagnoses and care plan as well as medical diagnosis.

References

Collins, D. (2003). Algorithmic Diagnosis of Symptom. Web.

Coya, S., & Lash, A. (2009). Pathophysiology of anemia and nursing care implications. Web.

Doenges, M., Moorhouse, M., & Murr, A. (2010). Nursing Care Plans: Guidelines for Individualizing Client Car across the Life Span. Philadelphia: F. A. Davis Company.

McCance, K.L., Huether, S.E., Brashers, V., & Rote (2010). Pathophysiology: The biologic basis for disease in adults and children (6th Ed.). Maryland Heights, MO: Elsevier Mosby. Web.

Springhouse. (2006). Professional Guide to Signs & Symptoms. (5th Ed.). Lippincott Williams & Wilkins.