Anemia - Iron-deficiency: Nursing

Definitions & Key takeaways

Iron deficiency anemia (IDA) is a condition in which the body is unable to produce sufficient hemoglobin in the red blood cells, due to an inadequate amount of iron in the body. Hemoglobin in the red blood cells is responsible for carrying oxygen throughout the body, so without enough of it, the body doesn't get the oxygen it needs. People with IDA present with symptoms like fatigue, weakness, shortness of breath, and difficulty concentrating. It can also lead to more serious conditions like developmental delay in children, heart failure, and organ damage.

There are several reasons why someone might develop IDA. The most common cause is simply not getting enough iron in your diet. Other causes include bleeding (either internally or externally), chronic illness, and during states in which the body's iron demands are increased such as pregnancy. IDA is characterized by microcytic and hypochromic red blood cells on the peripheral blood smear.

Chapters:

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Introduction0:00–0:17

Iron deficiency anemia is a common condition that occurs when there are decreased iron stores in the body, which is essential for the production of hemoglobin in red blood cells, or RBCs for short.Now, let’s quickly discuss the physiology of RBC production, or erythropoiesis.

Physiology0:17–1:30

This process takes place in the bone marrow, where a stem cell differentiates into an erythroblast, which starts synthesizing hemoglobin, which is a protein that’s able to bind and carry oxygen.
Erythroblasts lose their nucleus and differentiate into immature RBCs, called reticulocytes. These immature cells are released from the bone marrow into the bloodstream, to ultimately become mature RBCs, called erythrocytes.
Now, RBCs have a limited lifespan of 120 days, so they require continuous replacement through erythropoiesis. To do so, the body needs important vitamins and minerals, including iron, which is an essential component of hemoglobin.
Now, iron is primarily obtained from a balanced diet that includes all types of foods. Once ingested, food passes through the gastrointestinal tract, where nutrients are slowly absorbed.
Some nutrients, such as iron, are best absorbed in acidic environments like the proximal duodenum, where gastric acid lowers the pH, in order to absorb iron into the circulation.Alright, now iron deficiency anemia can be caused by decreased dietary intake, decreased gastrointestinal absorption, increased body demand, or increased loss.

Causes & risk factors1:30–3:10

The most common cause of iron deficiency is a decreased intake of iron-rich foods, such as red meat, beans, and leafy greens; risk factors include poor nutritional status from practicing strict diets, chronic alcohol use, and experiencing homelessness, abuse, or neglect.
On the other hand, decreased gastrointestinal absorption of iron can occur due to decreased stomach acid production; risk factors include taking certain medications, such as proton pump inhibitors like omeprazole or H2 blockers like cimetidine; as well as undergoing a gastrectomy, where a part of the stomach is surgically removed.
Decreased absorption can also occur due to inflammation of the gastrointestinal tract; risk factors include conditions like inflammatory bowel disease or celiac disease.
Next, increased body demand for iron can occur in children due to rapid growth; as well as during pregnancy and lactation.
Finally, increased iron loss occurs in clients with acute hemorrhage or chronic slow bleeding; or increased hemolysis or destruction of RBCs.
Risk factors include trauma, frequent or heavy menstruation, bleeding gastric ulcers, and colorectal cancer; as well as increased autoimmune hemolytic anemia, adverse drug reactions, or even increased destruction by the spleen.Alright, so the pathology of iron deficiency anemia develops when there is a lack of sufficient iron stores needed to sustain normal hemoglobin production.

Pathology3:10–3:57

As a result, there’s not enough hemoglobin to fill a normal-sized RBC, so the bone marrow starts producing microcytic, or smaller, cells that contain less hemoglobin, in order to try to sustain erythropoiesis.
These cells also appear paler under the microscope, so they’re also called hypochromic. Some clients may also develop poikilocytes, which are abnormally shaped RBCs that appear flat, elongated, or teardrop-shaped, and may have pointy projections.
Lastly, clients may develop anisocytosis, meaning that they have unequally sized RBCs.The general clinical manifestations of iron deficiency anemia include pallor, weakness, fatigue, and reduced exercise tolerance, as well as headaches, dizziness, and tachycardia.

Clinical manifestations3:57–4:45

In severe cases, clients with iron deficiency anemia may have decreased oxygen saturation, chest pain, an irregular heartbeat, or systolic heart murmurs.
In addition, clients may also experience a sore tongue with glossitis, and angular cheilitis or fissures around the corners of the mouth, as well as koilonychia or brittle, spoon-shaped nails.
Lastly, some clients with iron deficiency anemia may experience pica, where they may crave and eat non-food substances, such as clay or dirt.
Diagnosis of iron deficiency anemia begins with the client’s history and physical assessment, followed by blood tests. These include a complete blood count or CBC, which reveals a decrease in RBC count and hemoglobin.

Diagnosis4:45–5:51

In addition, the reticulocyte count may vary depending on the cause; so it will most often decrease with iron deficiency, but in certain cases it may increase as a compensatory mechanism, such as with hemolysis, as well as in early phases after iron repletion, or when the client is recovering from a hemorrhage.
Another important blood test value is the mean corpuscular volume, or MCV, which can show the average size of the RBCs; so iron deficiency typically presents with decreased MCV, which is described as microcytic, hypochromic cells.
A peripheral smear will reveal small, pale RBCs along with irregularly shaped cells of various sizes. In addition, blood tests can show low levels of iron and ferritin, and high total iron binding capacity or TIBC.Treatment of iron deficiency anemia includes increasing dietary intake of iron, as well as oral supplements.

Treatment5:51–6:11

Clients who can’t tolerate oral iron supplements can be treated with intravenous iron, while severe cases may require blood transfusions.
Finally, the underlying cause should be addressed, when possible.Alright, now let’s look at the nursing care you’ll be providing clients with iron deficiency anemia.

Management and care6:11–7:43

The priority goals of care are centered on symptom management and promoting nutrition. Begin by asking your client if they are experiencing dizziness, weakness, or fatigue.
If needed, ensure their safety by assisting them to a seated or lying position, and allow them time to rest. Next, assess your client’s vital signs, SpO2, and monitor their rate and depth of breathing.
Report to the healthcare provider right away if your client experiences shortness of breath, tachycardia, palpitations, or if their pulse oximetry drops below 95%; and then administer supplemental oxygen as needed.Lastly, review your client’s CBC with differential.
If your client’s hemoglobin or hematocrit levels are critically low, alert the healthcare provider; and prepare to administer packed red blood cells.
Next, complete a focused nutritional assessment by asking your client about their diet history, including alcohol intake; as well as completing a physical assessment, noting skin or mucosal abnormalities that could be associated with iron deficiency, like glossitis of the tongue, fissures at the corners of the mouth, and koilonychia.
Administer the prescribed IM iron dextran using the Z-track method. Lastly, assist the healthcare provider with addressing the underlying cause of their iron deficiency.Now let’s move on to client and family teaching.

General client and family teaching7:43–8:30

Explain how iron deficiency anemia can decrease the oxygen-carrying capacity of the blood, resulting in symptoms like weakness, fatigue, reduced exercise tolerance, headaches, and dizziness; and teach your client to manage symptoms by balancing activity with rest.Then, instruct them to take their prescribed iron supplement as directed, and collaborate with them to develop an individualized diet plan to ensure there’s an adequate amount of iron in their diet.
Lastly, if your client has increased iron requirements due to an underlying disease or condition, encourage them to keep regular appointments with their healthcare provider for ongoing nutrition monitoring and support.Alright, as a quick recap… Iron deficiency anemia is a common condition characterized by decreased iron stores and impaired production of hemoglobin.

Review8:30–9:50

It can occur when there’s a decreased intake, increased loss, or increased need of iron. Clinical manifestations include pallor, fatigue, headaches, dizziness, and tachycardia, as well as decreased oxygen saturation, chest pain, and palpitations.
In addition, clients may present with pallor, glossitis, angular cheilitis, koilonychia, and pica. Diagnosis is based on history and physical assessment, followed by blood tests showing a decrease in red blood cell count and hemoglobin, decreased MCV, iron and ferritin, and high TIBC.
Cells will appear microcytic and hypochromic, and will often have unusual shapes or irregular sizes. Treatment of iron deficiency anemia includes addressing the underlying cause, as well as increasing dietary iron or taking oral iron supplements, as well as IM or IV iron administration, or blood transfusions, if needed.
Nursing care is centered on managing the client’s symptoms and promoting nutrition. Client teaching focuses on symptom management, promoting an iron-rich diet, and iron supplementation.
Anemia - Iron-deficiency: Video, Causes, Symptoms | Osmosis