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Severe anemia secondary to uterine fibroids

Introduction

As intrinsic as the value of the human body such as the importance of adequate blood flow and
decreased growth of muscular tumors cannot be bypassed or looked upon as its role is of major
importance to the functioning of the human body the uterus as we know is a hollow muscular
organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs
that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and
implant itself in the lining of the uterus. The main function of the uterus is to nourish the
developing fetus prior to birth.ofcourse as we know uterus may develop conditions with an
unknown cause such as the development of uterine fibroids which causes heavy bleeding.





49 yr old female patient admitted to ward with diagnosis of severe symptomatic anemia
secondary to uterine fibroids with refusal of blood due to religion and other diagnosis such as
hypovolemic shock. This woman was taken over in bed awake in supine position conscious
however not oriented with I.V fluids of 0.9 n/saline infusing, 02 therapy via nasal canula at 3L,
foley catheter on free drainage and bilateral TED stockings insitu. To lower extremities.
Here I shall focus on the condition severe anemia which was secondary to uterine fibroids with
refusal of blood and
Definition of uterine fibroids and anemia
Causes of uterine fibroids and anemia
Symptoms of uterine fibroids and anemia
Diagnostic test for uterine fibroids and anemia
Diagnosis developing due to quadriplegia
Medical and nursing management

Uterine fibroids also referred to as leiomyomas or myomas are noncancerous growths of the
uterus that often appear during childbearing year and develops from the smooth muscular tissue
of the uterus in the uterus a single cell divides repeatedly which creates a firm, rubbery mass
that differentiates from other tissues around the uterus.

Causes
The cause of growth of uterine fibroids is not exactly known however
Genetic changes may cause its growth when there are changes in genes that differ from
the normal in the uterine wall and
Hormones such as Estrogen and progesterone. These two hormones are the hormones that
stimulate development of the uterine lining during each menstrual cycle for the
preparation for pregnancy. This however may promote the growth of fibroids.
Heredity.
Race especially blacks.
Symptoms
Most women who suffer from uterine fibroids are usually asymptomatic however it may cause
symptoms such as
Prolonged menstrual periods
Pelvic pressure or pain


Frequent urination
Difficulty emptying the bladder
Constipation
Backache or leg pains
But in most cases abnormal uterine bleeding is the most common symptom of the fibroid. If the
tumors are near the uterine lining, or interfere with the blood flow to the lining, they can cause
heavy periods, painful periods, prolonged periods or spotting between menses.
Additional excessive bleeding due to fibroids may cause severe anemia.
Diagnostic test
Pelvic exam- there are irregularities in the shape of the uterus which may indicate the presence of
fibroids.
Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to
complications such as anemia from heavy blood loss.
Blood is a product providing the body with nutrition, oxygen, and waste removal. The average
person has about 5 liters of blood which is composed of plasma. Plasma contains proteins that
help blood to clot and transport substances through the blood or blood cells such as
Red blood cells, which carry oxygen to the tissuesit has hemoglobin which is a red, iron-rich
protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from
your lungs to all parts of your body and to carry carbon dioxide from other parts of the body to
your lungs so that it can be exhaled.
White blood cells, which fight infections
Platelets, smaller cells that help blood to clot.
Additional excessive bleeding due to fibroids may cause severe anemia.
Anemia occurs when the body does not have enough red blood cells to carry adequate oxygen to
tissues.
Causes
Body unable to make enough red blood cells.
excessive bleeding causes the loss of red blood cells more quickly than it can be replaced
Destruction of red blood cells
Symptoms
Fatigue


Pale skin
A fast or irregular heartbeat
Shortness of breath
Chest pain
Dizziness
Cognitive problems
Cold hands and feet
Headache
Diagnostic test
Complete blood count(CBC)
Physical examination





Blood make up



The following medical and nursing management guided us into proving the most appropriate
care of the patient
Nursing care as is known involves holistic care and such a condition deed indicates a need for
such care. Not only were nurses and doctors involved in the care of the patient but
physiotherapist were involved in some way or another to help bring back the patient as well as
the family to normal living functions.
Medical management
Diagnosis: severe symptomatic anemia secondary to uterine fibroids and hypovolemic shock.
TED stocking application to reduce incidence of thromembolism and to recuperate patient.
Patient started on IV fluids of 0.9 n/saline.
Transfuse with 3 units of PRBC when available
Patient has to commence physiotherapy
STAT Prescribed medication.
Recommend dTAH whenHb is 8.0


Nursing management
Nursing care of patient involved
Foley catheter on free drainage
Administration of medication as ordered (premarin, irondextran, trihemic.IFA, nov.70/30,
cocodamol, and erythropoietin)
Iron and protein fortified diet
Complete bed rest
Administer IV fluids of 0.9n/saline as ordered.
Assist with activities of daily living such as bathes, eating.

Physiotherapist
Assist with movement of limbs and other activities.








Present medical history

Severe anemia secondary to
uterine fibroids.
Hypovolemic shock
DM









Nursing history
Patient is unable to move lower
extremities.
DM- patient is on sliding scale.


Patients hemoglobin levels are being monitored
two to three times per week

Due to patients religion she is unable to be transfused. Her Hb is being monitored constantly. During the
past few weeks this has been her Hb levels
14/5/14-----2.81gm/Dl
16/5/14-----2.9gm/DL
18/5/14-----3.3gm/DL
22/5/14-----3.3gm/DL
25/5/14-----4.3gm/DL
02/06/14----5.2gm/DL
08/06/14----5.9gm/DL





DIAGNOSTIC TEST

WBC
Name of test: White Blood Count (WBC)
Specimen used: blood
Normal findings: 4.0-10K/ul
Patient findings: 8.6K/ul
Names of test:
hematology( white blood count)
total hemoglobin(Hgb)
Type of specimen used: the blood is used during this test. generally this white blood cell counts
the actual number of WBCs in the blood.
Description of test: WBC's are our body's first line of defense against invading bacteria and
most other harmful organisms. This test (WBC), measures the total number of all types of
WBC's. Further examination of the different types and numbers of cells present, could tell much
about the state of the body's defense system.
This test help investigate a variety of illnesses. An elevated WBC count occurs in infection,
allergy, systemic illness, inflammation, tissue injury, and leukemia. A low WBC count may
occur in some viral infections, immunodeficiency states, and bone marrow failure. The WBC
count provides clues about certain illnesses, and also would enable a physician to monitor a
patient's recovery from others. Abnormal counts which return to normal indicate that the


condition is improving, while those that become more abnormal indicate that the condition is
worsening.
Clinical problems related to each test: This test (WBC), measures the total number of all types
of WBC's. A low WBC count may occur in some viral infections, immunodeficiency states, and
bone marrow failure. White blood cells help to defend the body from foreign orgsnisms,tissues
and other substances. If however the white blood cell count is high then this can say that either
the type of white blood cell is elevated. For e.g. an increased lymphocyte count occurs in
infections such as viral hepatitis, TB ,syphilis etc.
Purpose of each test:
A white blood cell (WBC) count determines the concentration of white blood cells in the
patient's blood and if the patient has a condition known to interfere with and WBC count and
could also tell about the state of the body's defense system.
Effect of medication on test results: herbal medications pose a slight effect on the test.
Procedure for carrying out tests
Nursing implications:
Discomfort or bruising may occur at the puncture site. Pressure to the puncture site until
the bleeding stops reduces bruising; warm packs relieve discomfort.
Some people feel dizzy or faint after blood has been drawn and should be allowed to lie
down and relax until they are stable



RBC
Name of test: Red Blood Cell (RBC)
Specimen used: blood
Normal findings::
males: 4.5 to 6.0 million/cu mm blood
females: 4.0 to 5.5 million/cu mm blood
Patient findings: 5.21
Description of test: The RBC count is useful for determining such problems as anemia and
hemorrhage. In combination with other hematology tests, it can be quite useful for diagnosis.
This test can also give an indirect estimate of the hemoglobin levels in the blood.
RBC's are "Red Blood Corpuscles," (non-nucleated cells). The term corpuscle indicates that it is
a mature Red Blood Cell. Once the immature cell has matured, then, capable of carrying oxygen.
Purpose of the test: Detect a hematological disorder involving RBC destruction (e.g., hemolytic
anemia), Determine the presence of hereditary hematological abnormality, Monitor the effects of
acute or chronic blood loss, Monitor the effects of physical or emotional stress on the patient,
Monitor patients with disorders associated with elevated erythrocyte counts (e.g., polycythemia
Vera, chronic obstructive pulmonary disease [COPD]), Monitor the progression of no
hematological disorders associated with elevated erythrocyte counts, such as COPD, liver
disease,
Clinical problem related to test: hemolytic anemia, polythemiavera, chronic obstructive
pulmonary disease (COPD), liver disease, hypothyroidism, adrenal dysfunction, renal disease,
cancer, bone marrow failure, malabsorption syndromes, folic acid deficiency, vitamin B12
deficiency, iron deficiency.
Effects of medication on RBC:
Drugs that increase RBC level-. Gentamicin, Methyldopa
Drugs that decrease RBC level -Chemotherapy drugs,
Procedure for carrying out test--
observe standard precaution, the site is cleaned antiseptic, health care provider wraps an elastic
band around the arm above site to apply pressure, gently inserts a needle into the vein, blood
collects into an airtight vial or tube attached to the needle,
Nursing diagnoses:


Nutrition less than body requirement related to deficiency of iron required for RBC production
evidence by slight dizziness in client and abnormal test results.
Nursing implications:
Educate client about RBC and procedure, obtain history of allergy including to latex, tell client
that they may experience dizziness, ensure patient comfort, and reduce patient anxiety.



Fasting blood sugar
Name of test: fasting blood sugar
Specimen used: blood
Normal findings: Adult: 70 110 mg/dL , Child: 30 80 mg/dL , Elderly 70 120 mg/dL

Test type Pregnant mg/Dl Glucose
fasting 105
I hour 190
2 hours 165
3 hours 145

Patient findings:varied
Description of test:measures blood glucose level after patient has fast
Purpose of the test:, To monitor blood glucose levels during pregnancy for diabetic client
Clinical problem related to test: hyperglycemia, hypoglycemia, diabetes mellitus,
Effects of medication on fasting blood sugar:
Drugs that increase fasting blood sugar level- prednisone, dexamethasone, Thiazide diuretics,
Drugs that decrease fasting blood sugar level- insulin, beta blockers
Test procedure: NPO except for water for 12 hrs, Collect a small sample of blood, with a prick
to the finger, apply to test strip and read result
Nursing diagnosis: knowledge deficit related to therapeutic regimen during pregnancy.
Nursing implication:, Explain the purpose and procedure to the client, monitor glucose level, ,
Recognize clinical problems associated with low blood sugar level. Skipped meals and
inadequate food intake are common causes of hypoglycemia, Observe for signs and symptoms of
hypoglycemia (nervousness, weakness, confusion, cold and clammy skin, diaphoresis, and
increased pulse rate), Recognize clinical problems associated with elevated sugar level.
Ensure to inform the patient to maintain a well balanced diet during pregnancy and post
pregnancy.




Ptt
Name of test: Partial thromboplastin time
Specimen used: blood
Normal findings: 25- 35 seconds, may vary with different laboratories
Patient findings:
Description of test: Partial thromboplastin time (PTT) is a blood test identify at how long it
takes for blood to clot It can help tell if you have bleeding or clotting problems.
Purpose of the test: to determine bleeding or clotting problems,
Clinical problem related to test:Hemophilia A, Hypofibrinogenemia, Liver disease, Lupus,
Vitamin K deficiency,
Medication that affects Partial thromboplastin time: antihistamines, vitamin C (ascorbic
acid), aspirin, and chlorpromazine
Test procedure: observe standard precaution, the site is cleaned antiseptic, health care provider
wraps an elastic band around the arm above site to apply pressure, gently inserts a needle into the
vein, blood collects into an airtight vial or tube attached to the needle, the elastic band is
removed, once the blood has been collected, the needle is removed, and the puncture site is
covered with gauze and pressure is applied to stop any bleeding.
Nursing diagnosis: risk for hemorrhaging related to venipuncture
Nursing implication: obtain history of allergies including to latex, educate client on Partial
thromboplastin time and it procedure, tell client that they may experience dizziness, monitor
client vital signs, intake and output, weight and skin turgor.



Cbc
Name of test: Blood volume/ plasma volume test
Type of specimen used: 5Ml of venous blood in a blue top tube.
Normal values or reference values:

Individual

Refrence values
Total blood volume

55-80Ml/kg
Red cell volume

25-35ml/kg(male),20-30mL/kg(female)
Plasma volume

32-46mL/kg(male),30-45ml/kg(female)

Description of test:
A blood volume test (also called a plasma volume test or a red cell mass test) is a nuclear lab
procedure used to measure the volume (amount) of blood in the body. The test also measures the
volume of plasma and of red cells in the blood. This test enables one to monitor blood loss
during surgery, hypotension, determining the blood component lost for replacement therapy and
evaluating uterine bleed.

An IV (intravenous) line will be placed in a vein in your arm. The IV is used to take blood
samples for blood tests ordered by your doctor, and to inject the radioactive isotope and tagging
agent. If necessary, medications are delivered through the IV during the test.

Purpose of blood volume test
To monitor blood loss during surgery.
To evaluate for GI or uterine bleed.
To monitor blood loss during surgery.
The blood volume test results help your doctor determine the cause of symptoms, abnormal
laboratory results or certain circulation disorders.

Abnormal results:
An elevated volume may indicate dehydration which may indicate RBC volume or over
hydration.
Decreased volume: dehydration, hypovloemic shock, hemorrhaging.



Clinical problems related to the test
. Hypovolemia (low blood volume)
Hypervolemia (high blood volume)
Anemia (low red cell volume)
Polycythemia (high red cell volume
A blood volume test also helps in the evaluation and treatment of these conditions:
Orthostatic hypotension (low blood pressure while upright)
Hypertension (high blood pressure)
Heart failure (decreased pumping power of the heart)
Shock
Medical conditions associated with acute blood loss
Effect of medication on test:
Do not take diuretics or laxatives before the test.

Procedure for carrying out test:
Obtain the weight and heights of the client there after obtain a venous blood sample using a blue
top tube.
Mix the blood sample with a radioisotope. When 15-30 minutes has lapsed blood containing rthe
radioactive isotope is reinserted into the client
Another blood sample is retrieved 15 minutes later.

Nursing diagnoses
Risk for injury related to thrombolytic therapy evidence by
Altered tissue perfusion related to acute myocardial infarction

Nursing implications:
Monitor vital signs
Assess for bleeding tendencies, tachycardia and hypotension.



Platelet count
NAME OF TEST: PLATELET COUNT
TYPE OF SPCIMEN USED: collect3-5 ml of venous blood in a lavender top tube.

Normal values:
Individual Values
Adult 150,000-400,000l
Child(Premature) 100,000-300,000l
Newborn 150,000-300,00l
Infant 200,00-475,000l

Patient findings:
Description of test: Platelets are tiny cell fragments that are normally produced in the bone
marrow and circulate in the blood. When the interior wall of a blood vessel is injured, platelets
aggregate at the site and release chemicals that cause blood to clot, thus sealing off any leak.
A platelet count is used to detect a low or high number of platelets in the blood.

Purpose of test: to check the platelet count
To monitor platelet count during cancer chemotherapy

Clinical problems: decreased level: idiopathic thrombocytopenic purpura, myeloma, anemias,
liver disease,

Drug influences: aspirin, antibiotics
Elevated level: trauma, acute blood loss, pulmonary embolism.

Procedure: cleanse sight for injection and wrap elastic band around arm
Collect -t3-5 ml of venous blood in a lavender top tube.

Nursing diagnoses:
Anxiety related to hemorrhage secondary to an acute health problem like cancer

Nursing implications: explain to the client that the purpose of blood test is to determine the
platelet count
Observe for signs of bleeding and record findings on char.
Monitor platelet count.



Drug cards
Trihemic
Brand name: Trihemic
Generic name: multivitamin with iron
Drug class: multivitamin
Indications:
shigellosis
Bronchitis, chronic, acute exacerbation
Diarrhea, infectious
Infection, ear, middle
Infection, lower respiratory tract
Infection, urinary tract
Contraindications:
Drug interactions: avoid combinations of these
Simvastatin, phenytoin, erythromycin
Adverse reactions:

bright red blood in your stools; or
Pain in your chest or throat when swallowing a ferrous fumarate tablet
constipation, diarrhea;
nausea, vomiting, heartburn;
stomach pain, upset stomach;
black or dark-colored stools or urine;

Dosage: Infants 2 months of age and over- Infants and children up to 40 kg of body weight-Oral,
20 to 30 mg of sulfamethoxazol.
Adult dose: Antibacterial (systemic) - Oral, 800 mg of sulfamethoxazole
Teaching considerations:
Avoid taking any other multivitamin product within 2 hours before or after you take
multivitamin with iron.


Take your multivitamin with a full glass of water.
You may take the multivitamin with food if it upsets your stomach.
The chewable tablet must be chewed or allowed to dissolve in the mouth before swallowing.
Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole
(trihemic)

Bibliography:
http://www.drugs.com/mtm/trihemic-600.html#ewBrBxbT5yiDAqL1.99



Tylenol
Brand name: Tylenol
Generic name: acetaminophen
Drug class: non-opioid analgesic
Indications: pain reliever and fever reducer
Drug interactions:
an antibiotic, antifungal medicine, sulfa drug, or tuberculosis medicine;
birth control pills or hormone replacement therapy;
blood pressure medication;
cancer medications;
Adverse reactions:
Nausea, upper stomach pain, itching, loss of appetite;
dark urine, clay-colored stools; or
jaundice (yellowing of the skin or eyes).

Dosage:
For adults and children 12 years of age and older, the recommended dose of acetaminophen is
650 to 1000 mg every 4 to 6 hours as needed
For children under 12 years of age, the recommended dose of acetaminophen is 10 to 15 mg/kg
every 4 to 6 hours
Teaching considerations:
Do not take more Tylenol than is recommended. An overdose can damage your liver or cause
death.
The chewable tablet must be chewed thoroughly before you swallow it.
Do not use with alcohol
Notify prescriber of pain, fever lasting over three days
Bibliography:
http://www.rxlist.com/tylenol-drug.htm
Skidmore-Roth L. nursing drug reference 22
nd
edition 2009 Mosby Elsevier



0.9 % Sodium Chloride
Brand name: sodium chloride
Drug class:
Indications: used as a source of water and electrolytes and also and also indicated for use as a
priming solution in hemodialysis procedures.
replace lost body fluids and salts
dilute other medicines, which may be given by injection or drip
act as a sterile liquid for washing wounds, nasal passages, or during surgery.

Actions: used as a source of water and electrolytes in the body and capable of inducing dieresis
in a patient.
Contraindications: unknown
Drug interactions: Caution must be exercised in the administration
of Sodium Chloride Injection, USP to patients receiving corticosteroids.
Adverse reactions: febrile response, infection at site of injection, venous thrombosis or phlebitis
extending from site of injection, hypervolemia.
Dosage: As directed by a physician. Dosage is dependent upon the age, weight and clinical
condition of the patient as well as laboratory determinations.
Teaching considerations: If you feel light headed or faint when getting out of bed or standing
up, get up slowly--- Stand up slowly, especially when you get up from a bed or a chair.
Bibliography: http://www.nps.org.au/medicines/nutrition/electrolytes-oral-and-injectable/sodium-
chloride-electrolytes-oral-and-injectable/sodium-chloride.



Premarin
Brand name: PREMARIN
Generic name:
Drug class: estrogen, hormone
Indications: treatment of symptoms of menopause, abnormal uterine bleed, prevention of
osteoporosis, primary ovarian failure.
Treatment of moderate to severe symptoms of vulvar and vaginal atrophy due to menopause

Actions: needed for functioning of the female reproductive system and inhibits ovulation
Contraindications: pregnancy, thromboembolic disorders, reproductive cancer, breastfeeding,
hypersensitivity.
Drug interactions:
Adverse reactions: chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea,
sweating, general ill feeling; sudden numbness or weakness, especially on one side of the body;
sudden headache, confusion, problems with vision, speech, or balance; pain
OR signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips,
tongue, or throat.
Dosage: for menopause give0.3-1.25mg/day PO,
Prevention of osteoporosis: 0.625 mg /day.

Nursing actions: assess blood glucose if diabetic since hyperglycemia may occur.
Weigh patient daily.
Assess patients intake and output.
Assess patients mental status.
Take with food or milk to decrease GI symptoms.
Teaching considerations: avoid breastfeeding since product is excreted in milk. Avoid sunlight or wear
sunscreen since burns may occur. Weigh weekly




Novolin N
Trade names: NPG, Humulin-N, Novolin-N
Generic name; Intermediate Insulin
Classification: Antidiabetic
Action: works by lowering levels of glucose (sugar) in the blood by transporting this glucose
into cells
Indications; DM Type 1 and 2, gestational diabetes
Contraindications: Hypoglycemia, severe renal impairment and hypersensitivity
Dosages: Sliding Scale SUBCUT given within 15 mins before or 20 mins. After a meal
Availability: regular insulin soluble 100 IU/mL 10 mL vial
Adverse effects: Hypoglycemia, urticaria, itching, redness, swelling, anaphylaxis, blurred
vision, swelling and redness
Nursing. Implementation: assess blood sugar
Ensure to warm to room temperature by rotating in palms to prevent injecting cold insulin.
Choose a different place in skin area each time you inject this medication. Do not inject into the
same place two times in a row. Use each disposable needle only one time. Throw away used
needles in a puncture-proof container.
Family/ client teaching: Do not change the brand of insulin or syringe you are using without
first talking to your doctor or pharmacist. Avoid drinking alcohol. Your blood sugar may become
dangerously low if you drink alcohol while using insulin.
Blurred vision may occur
Inform patient that this product does not cure diabetes but controls its symptoms



Ifa
Classification: Ant anemic, iron
Generic name: FERROUS SULFATE
Trade names: Feosul, Fer-Gen-Sol, Fer-in-Sol, FeroSul DRIED: Feosol, Feratab, Slow FE,
Slow Release Iron, Ifa
Action: Normal daily intake males 12-20 mg; females 8-15 mg; only 10% absorbed; Iron
absorbed by from duodenum and upper jejunum by active mechanism thru mucosal cells,
combines with transferring; iron stored as hemosiderin or aggregated ferritin reticuloendothelial
cells of liver, spleen, bone marrow; 2/3 of iron in circulating RBCs
Indications: Prophylaxis, treatment of iron deficiency and iron-deficiency anemias; dietary
supplement for iron.
Contraindications: Hemosiderosis, Hemochromatosis, peptic ulcer, regional enteritis, ulcerative
colitis, hemolytic anemia, pyridoxine-responsive anemia, liver cirrhosis
INTERACTIONS : GI absorption of iron: oral antacids, calcium salts, cholestyramine,
cimetidine, histamine H-2 receptor antagonists, pancreatic extracts, proton pump inhibitors,
vitamin E, St. Johns wort; GI absorption of iron: ascorbic acid, chloramphenicol; Thyroid
hormone and trientine: DO NOT USE TOGETHER
Contraindications: Hemosiderosis, Hemochromatosis, peptic ulcer, regional enteritis, ulcerative
colitis, hemolytic anemia, pyridoxine-responsive anemia, liver cirrhosis
Availability: Drops, Elixir, Tablets, Slow-Release Tablets
Dosages: Anemia prophylaxis: Adults 300 mg/day; peds 5 mg/kg/day
Anemia: 300 mg twice a day increased to 4 times a day as needed/tolerated
Peds: 10 mg/kg/day DRIED: Anemia Prophylaxis: Adults 200 mg/day; peds 5 mg/kg/day
Anemia: 200 mg 3 times a day up to 200 mg 4 times a day as needed/tolerated10 mg/kg 3 times
daily
Slow release tablets: Adults 160 mg 1-2 times per day: NOT for children
Adverse effects: Constipation, gastric irritation, nausea, abdominal cramps, anorexia, diarrhea,
dark-colored stools
Nursing. Implementation: Substitution of one iron salt for another without proper adjustment
may result in serious over or under dosing; Eggs, milk, coffee or tea may significantly inhibit


iron absorption; Ingestion of calcium and iron supplements can decrease iron absorption by 1/3;
Iron absorption is not decreased if calcium bicarbonate used between meals. Do not crush, chew
tablets. Give liquid preparations through plastic straw to avoid discoloration of tooth enamel;
dilute thoroughly. Give at least 1 hour before bedtime because corrosion may occur in stomach
Family /client teaching: do not take with tea or milk
Take with citrus fruit juice if not contraindicated
Remind patient that poisoning may occur if increased beyond recommended level
.


Dextran
Generic name: iron dectran
Trade names: DexF, Erum, Infed
Drug class: hematinic
Action: a form of mineral iron which helps in the transport of oxygen in the blood.
Indications: Iron dextran is used to treat iron deficiencies and iron deficiency anemia.
Contraindications: hypersensitivity, all anaemias excluding iron deficiency anemia,
hepatic disease.
INTERACTIONS: increase toxicity levels when using oral iron, false elevated levels of serum
bilirubin.
Dosages: test dose for adult and child: IM 0.5ml via Z-track.
Adult <50kg: IM100mg or if adult is > 50 kg IM 250mg
Child<5-9kg: IM 50mg
Adverse effects: Anaphylactic reactions. Chest pain or tightness. Hypertension or hypotension,
tachycardia. Urticaria or pruritis, fever, sweating, chills.
Nursing. Implementation: first have test dose done and an hour after assess.
Assess bilirubin before treatment
Assess for allergic reactions to drug (anaphylaxis, rash, chills, fever, and purities.
Assess cardiac status for chest pain.
Assess for amount of iron in diet.
Family /client teaching: inform patient that iron toxicity may occur if taken in large amounts.
Stools may become dark.
Patients health issues
physical function and independence
emotional well-being
weight control and nutrition
skin and pressure issues


Aided passive range of motion exercises
Maintenance of hydration
Taking daily medication since see cannot be transfused



Aided passive range of motion exercises

Plan of care:



Demonstrate techniques that enable resumption
Of activities -independence








Maintain stimulating environment for patient such
As-engaging in positive conversation,
providing music and encouraging visits from family and friends










Instruct patient on how to perform passive range of motion
exercises-this helps to increase blood flow
to muscles and bone hence improving muscle tone











Assist with self care activities-this helps to
Improve circulation and muscle strength.






Physical function and independence

Physical function is ones own physical ability to their present level of injury. This client has
been on bed rest and has been dependent
Patient was assessed for level of immobility to lower extremties
Pain levels was assessed before initiating aided passive range of motion exercises
Assess also energy expenditure
Aiaed passive range of motion exercises were performed along with self care needs such as
bathing, oral care, and nutrition care,pressure care including.

Assist with/encourage self-care activities (e.g., bathing, this helps to improve circulation and
muscle strength.











Weight control and nutrition

This patient is for iron and protein fortified diet

Provide diet high in proteins, . Since there is reduced functioning of lower extremities,
nutrients required for healing become less which sometimes may cause weight loss. There
may also be the incidence of constipation.
Fluid increase was encouraged to help keep body well hydrated and reduce incidence of
constipation and possible urinary tract infection.
When ones activity level declines especially now that she is on bed rest, rest is unable to
move lower extremities and complains of pain. They gain wieght,this decreases the amount
of calories that is burnt
A high iron and protein fortified diet was recommended for patient


Drink adequate fluid to help prevent constipation as well.

Protein
One needs more protein to help with the tissue repair and healing process because pressure sores may
develop due to continuous bed rest.





Maintenance of hydration

Physician recommended that patient drinks at least 100ml of water daily.
Fruits and vegetables also are high in water content






Iron and protein fortified diet

Getting enough protein and iron can help you maintain lean muscle mass, prevent anemia and
symptoms of fatigue and support a healthy immune system

Patient may includes these in diet when discharged for home.




To increase iron absorption it is important to eat foods rich in vitamin c such as dark green leafy
vegetables and citrus.




Protein rich foods



Protein foods are needed to build and repair the tissues of the body.




Administration of medication as ordered

Patients diagnosis is severe anemia secondary to uterine fibroids, there has been significant
bleeding. Since patients religion does not permit her to be transfused with PRBC the following
medications has been prescribed for daily administration.

Trihemic
Oral iron tabs(IFA)
Premarin
Erythropoietin
Dextran




Bibliography

http://www.medicinet.com/medication/focus.htm
Free medical information drug in focus.com
http://.rxlist.com/drug/alpha a.htm
Otto J.H, Jillian C. J, Edward J, Nassif J.Z 1980, modern health (ED 1) city of publication:
Holt, rhinehart and Winston.
Tabers cyclopedic medical dictionary ed.21
Ackley B.J ,Ladwig G.B nursing diagnoses hand book a guide to planning care.(7) Mosby
OECS medicine formulary ed.(7)
Black J.M, Hawks J.H medical surgical nursing clinical management for positive
outcomes ed.(8) Saunders
www.mayoclinic.com
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