Question

Scenario

G.C. is a 78-year-old widow who relies on her late husband's Social Security income for all of her expenses. Over the past few years, G.C. has eaten less and less meat because of her financial situation and the trouble of preparing a meal “just for me.” She struggles financially to buy medicines for the treatment of hypertension and arthritis. Over the past 2 to 3 months, she has felt increasingly tired, despite sleeping well at night. When she goes to the senior clinic, the nurse practitioner orders blood work. G.C.'s chemistry panel is all within normal limits and a stool guaiac test is negative. Her other results include the following:

Laboratory Test Results

WBC 7600 /mm 3

Hct 27.3%

Hgb 8.3 mg/dL

Platelets 151,000 /mm 3

RBC indices

Mean corpuscular volume (MCV) 65 mm 3

Mean corpuscular hemoglobin (MCH) 31.6 pg

MCH concentration (MCHC) 35.1%

Red cell distribution width (RDW) 15.6%

Iron (Fe) 30 mcg/dL

Total iron-binding capacity (TIBC) 422 mcg/dL

Ferritin 8 mg/dL

Vitamin B 12 414 pg/mL

Folate 188 ng/mL

1. Which lab values are normal, and which are abnormal?

2. Explain the significance of each abnormal result.

3. What type of anemia does G.C. have?

4. What are some causative factors for the type of anemia G.C. has?

5. Which individuals are at risk?

6. Describe the signs and symptoms of this type of anemia.

7. Discuss some of the treatment options for her disease.

8. The physician starts G.C. on ferrous sulfate (Feosol) 325 mg orally per day. What teaching

needs to be done regarding this medication?

9. Discuss some ideas that might help her with her meal planning.

10. You teach G.C. about foods she should include in her diet. You determine that she

understands your teaching if she states she will increase her intake of which of the

following foods?

a. Whole wheat pastas and skim milk

b. Lean cuts of poultry, pork, and fish

c. Cooked cereals, such as oats, and bananas

d. Beans and dark green, leafy vegetables

11. What evaluative parameters could you use to determine whether G.C.'s nutritional needs are

being met?

Answer 1

1.

Normal value	Abnormal value
WBC	Bgb
Platelets	Hct
MCH	MCV
RDW	Fe
TIBC	Ferritin
Vitamin B12	Folate

2.

Hemoglobin is - 8.3 mg/ dL is low ( 12-15.5 gm/dL is the normal)

Hct is 27.3 % (38.3 - 48.6%) decreased

MCV is is 65mm 3 ( normal range is 80-100fL)

Fe is 30 mcg/dL ( normal range is 60 - 170 mcg/dL) is decreased

Feritin is 8 mg /dL (11-307 mg/dL is the normal range) is decreased

Folate is 188ng/mL (2.7 -17.0 ng/mL) is increased

3.

G.C have fe deficiency anemia because the main symptom of fe deficiency anemia is unusual increased tiredness and his fe and ferritin level is low as evidenced by the blood test reports.

4.

1. Decreased fe absorption
2. Decreased intake of Fe rich foods
3. Blood loss
4. Pregnancy

5.

• Peoples with intestinal disorders
• Poverty
• Lack of Fe rich foods intake
• Pregnancy
• Ecxessive bleeding during menstrual cycles

6.

1. Increased tiredness
2. Unusual tiredness
3. Pallor
4. Palpitations
5. Dry skin
6. Dry and easy britelled hair
7. Head ache
8. Breathing difficulty
9. Mouth ulcers
10. Glossitis
11. Cellulitis
12. Finger nails becoming in spoon shape
13. Cold hands and feets

7.

• Provide oral Fe supplimentation as per the doctor's order
• Provide Fe rich foods to the patient eg: Red meet
• Procvide an immediate care to stop if there is an excessive bleeding
• Administer Vitamin C which helps for Fe absorption

8.

• Explain the regarding the importance of this medication
• Tell the patiemt that melena is a symptom of Fe intake
• Advice the patient to complete the strip as prescribed and avoid skipping the medication
• Educate the patient regarding the side effects of this medicine

9.

Meal planningfor G.C

Breakfast

At 8 am - One glass orange juice and a handful of pumpkin

Lunch

At 1 pm - Sandwich with roast beef and fe enriched bread

Snacks

One glass strawberry juice with one cup of sunflower seeds

Dinner

At 9 pm Steamed barcoli 1 cup and curly kale

10.

The CORRECT Answer is Option d.beacuse bean and dark green leafy vegitables are rich in fe, which is providing Fe supplimentation for the patient

11.

Complete blood count and the total amount of Fe in the blood also reveals the nutritional needs are being met or not.