Case study - Iron-deficiency anemia: Nursing

Nurse Michael works on an inpatient Medical-Surgical unit and is caring for Hannah, a 26-year-old female with a history of Crohn disease who was admitted for iron deficiency anemia. After settling Hannah in her room, Nurse Michael goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Hannah’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Michael recognizes important cues, like Hannah's laboratory results from the emergency department showing a hemoglobin of 6.5 g/dL and a hematocrit of 19 percent. Further assessments reveal pallor and a heart rate of 110 per minute with a bounding pulse. Next, Nurse Michael asks Hannah about her prescribed medications.

Nurse Michael: I see in your chart you’ve been taking infliximab for eight months. Has that helped your Crohn symptoms?

Hannah: Well, I took it for a while, but I’ve had to skip my last two infusion appointments. I don't have the money to keep going to the infusion clinic.

Nurse Michael: I understand. How has that affected your symptoms?

Hannah: The medicine really helped while I was getting it, especially since I didn’t feel as tired as I do now. I could also eat more foods that I like without pain.

Nurse Michael: That makes sense. So, what types of food are you eating now?

Hannah: Crackers and bananas, mostly. Sometimes an egg. That’s about it, because I feel like my symptoms are really flaring up. My belly really hurts after I eat.

Nurse Michael: I'm sorry to hear that. I'm glad you are here so we can help you.

Nurse Michael finishes his assessment and ensures Hannah is comfortable. He then places the call bell within her reach before leaving the room.

Next, he analyzes these cues. Nurse Michael recognizes that stopping infliximab infusions puts Hannah at risk of experiencing a Crohn disease flare-up, and that this is likely the cause of her pain after eating, as well as poor nutrient absorption and anemia.

Nurse Michael understands that Hannah’s decreased hemoglobin and hematocrit reflect her inability to consume nutrient dense foods with iron, resulting in iron deficiency anemia.

He also recognizes that for Hannah to be successfully treated, she'll need consistent access to her prescribed infliximab.

Now, using the information he's gathered, Nurse Michael chooses a priority hypothesis of compromised nutrition.

Then, he generates solutions to address Hannah's nutritional status that will include working with a multidisciplinary team including the health care provider, social worker, and dietitian.