Anemia in pregnancy

casestudyquestions assessmentnote casestudy2anemia

Anemia in pregnancy

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El’alaate t&e paiient’s admittitg hislory and physical. \l-hai are the signs and,/or strryioi-.?< of patienr a.-

that supporr the di.agnosis of anemia? fiease research and provide reierences io slrpport -r-our aasrvers)

\rVhat laboratcry values Gr other tests $lppo$ this diagaosis?
a- L.isi all abr:*rmal t alues and explain the likely cause for each abaorrnai value. (Ptease r’*seasch

and provide references to suppofi your ansrvers)

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L Assess ]t4rs. h4orrls’s

9. Cireck Mrs. Marris’s prepregnancy weigh{-
a. Is hei weight gain adoquate?
b. Hor,v does her.rveight gai:r compare to the current recomrnendations?
c. Was t}rc weight gair fi’om her previous pregnaacies WNL?

{P1ease research and provide references to support your answefs}

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’10. Calculate her energy, protein. aad fluid requirements, Explain the rationaie for the msthod you used to

calc-ulate these require*reats. (Shorv calculations fqrr fuli credit;-

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1?. It{rs. h{orris was discharged oa 40 n:g of ferroi:s suiiate three tirnes daily.

a. Are there potential side effects fr*m this n:edicatioa?
b. Are there any drug**utrient interactions?
c. &’hat instructioas might you give her to maximize the benefit of her iron supplementation?

{Please. resealch a*d provide referixces to support;’our ansrvers)

Part 2 i57o of erade: lil* pointsi

i3′ Complete an #&*E r.te for this.lalrent’
uf q-i-[{* Gn 0-ssessvx-ryc# !’I o{-‘-a. R*fer to gradir:g r*bric for fiirmat. vv r r \ \

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r.nd explain four pctential risk faclo:s for &e devel*pa:eat of iro*-deflciency aneada from Mrs.

L Assess ]t4rs. h4orrls’s
9. Cireck Mrs. Marris’s prepregnancy weigh{-
a. Is hei weight gain adoquate?
b. Hor,v does her.rveight gai:r compare to the current recomrnendations?
c. Was t}rc weight gair fi’om her previous pregnaacies WNL?
{P1ease research and provide references to support your answefs}
\.-
2lFeg*
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’10. Calculate her energy, protein. aad fluid requirements, Explain the rationaie for the msthod you used to
calc-ulate these require*reats. (Shorv calculations fqrr fuli credit;-
(‘,\ L wai( itvn
1?. It{rs. h{orris was discharged oa 40 n:g of ferroi:s suiiate three tirnes daily.
a. Are there potential side effects fr*m this n:edicatioa?
b. Are there any drug**utrient interactions?
c. &’hat instructioas might you give her to maximize the benefit of her iron supplementation?
{Please. resealch a*d provide referixces to support;’our ansrvers)
Part 2 i57o of erade: lil* pointsi
i3′ Complete an #&*E r.te for this.lalrent’
uf q-i-[{* Gn 0-ssessvx-ryc# !’I o{-‘-a. R*fer to gradir:g r*bric for fiirmat. vv r r \ \
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t Sample Nutrition Assessment:
Nutrition assessment for 52 YOM admitted with CHF exacerbation and hyperglycemia. He has a
PMH significant for type 2 diabetes and hypertension.

Anthropometrics: Pt is 5′ 9″ with a current body weight of 215 pounds. His IBW is 160 pounds,
and he is currently 1,34% of his lBW. Pt reportsthat his usual bodyweight is around 220 pounds
(about l- month ago); he is at 98% of his usual body weight with a weight change of about 2%in
a L month time period. His current BMI is 31-.7 which puts him in the obese class l category.

Nutrition-related medications: Pt is currentlytaking Metformin bid. He has been placed on
sliding scale insulin during admit for glycemic control. Also noted that pt is on solu-medrol
which may contribute to hyperglycemia.

Biochemical data: Glucose at admission was elevated at 315 mg/dl. Pt’s most recent Hgb A1C
was elevated at7.7%. BS Glucose x 24 hours: 98-207 mg/dl. Pt reports that at home, his glucose
typically runs from around 90-150 mgldl.

Pt’s estimated energy needs are 1800-2100 kcals/day (25-30 kcal/kg IBW). Protein needs are
estimated to be 58-73 e/day (0.8-1 em/ke IBW). Noted that MD placed patient on a 1.5 L fluid
restriction. His current diet order is: 1800 calorie carb controlled Diet.

Food/Nutrition-related history: Patient reports that he typically eats 2 meals per day and

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snack at bedtime. He usually skips breakfast because he is too busy to eat in the mornings. He
states that he usually eats lunch at a fast food restaurant and his wife usually cooks dinner.

24 hour diet recall:
Lunch- cheeseburger and medium French fries from fast food
restaurant, large Coke
Dinner- Baked chicken breast (4 ounces), l cup macaroni and cheese
(homemade), buttered peas (7/2 cup),24 ounces sweet tea
Bedtime snack: slice of apple pie

Pt denies having any current Gl issues but does report intermittent constipation. Hetakes
Colace at home when needed for constipation.

Pt reports that he is mostly sedentary and works an office job where he sits at his desk for 8
hours per day. He does take his dog on a walk in the evening most nights, walking at a slow
pace for about 1.5 minutes. He reports that he would like to start exercising more in order to
have more energy and to improve his health. Pt is interested in losing some weight and
improving his blood glucose lab values.

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Writing out a Nutrition Assessment Note

lnclude all appropriate ond relevont dssessment inlormation. Remember ABCD inlormation.

L. Current Medical Diagnosis, PMH (Past medical history)
2. Anthropometrics (height, weight, l9w,% lBW, uBW, % uBW, % weight change, BMI) and

evaluation of these values
3. Medications, potentialfood and drug interactions
4. Lab values (are they WNL, Low, or elevated?) lnclude units on the values
5. Estimated nutrition needs: Calories, protein, fluid
5. Dietary information (24 hour recall, diet recall information, nutrition history, etc)
7. Any Gl problems? Nausea, vomiting, diarrhea, constipation
8. Physical activity information

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Ancmia is: Fregnaffic3r

*fu$e$ix*s

After cr::r:p1*ti.ng this *:s*, t}:e stud*xt rrrill’bc
*ble t*:
1. *eserib* the p’ih,:,xici*gical rlaa:rges in

Prfgna&{,y aud app”ly th*s* pri*ciples f*r th*
nutriti*n {ere process.

3, il*fine the path*physiolngv clf iron_
cleficier:ry ai:emiil.

3. fir.p.truate the signs *nd symptorns c*:rsistent
** itla i rox -cle:S cie r: c,v an emia.

4. E_valuate a presnant rto::;a*ls *i*tarT intake
fbr adeq*acy, and *iake r*c*mme*da_
tir:ns f*r enharr*ing dietarT ir*x intak* an*
abrorpticn.

5″ {d*nti$ riskx *f a::emis, {i:r rt:et*r$*l arld
$bta] ir*altl: **tcr:rl*s_

& Devel*p a nutritir:* c*r* pla**rvith *.ppra_
priat* n:easurabl* grals, ir:terve*tk:ns” ar: d
strategi*s f*r m*nitorir:g and eval*ation*
that addresses the nutritior: diagn*s*s f*r
this cxse.

Amb*r h{*rris, a 3l-vear-n}el pregnaut lv$lr:an)
is admitted thr*ugh rhe ER after fatrling or: the
ice. She is *.dmitted to n*e out prernatllre iab*r,
l:ut berause *f her l*rv- herc*gl*birr ier,,els, a
c*mpitte h*matoX*gical w*:rkup is e*n:plet*d.
She is di*gn*s*d rrttl: h1p*chrcmir, micr**..tia
anemia w

“”*trire*’ry

?42 Unit Eight ir**rriti*n ll”her*By lor ](er:rat*logi**I Oi*nEders

Marris, A.mber, Feni*i*, 31 ‘Y’c

Atl*rgies; ltllii’
Ft. L*mti*x: )iJ?

C*del FuILL
F?rysi*ian: F. Bt’.vrr*n

ls*iatlen: l*one
d

Ad*:it Sate: ii1?

Fatiext sur*:ewary: F.rrrb*i l”:}*rri* i* * 3l-YeaF*i* pt*sn*fii
wi]’lr3:]’ sla”ii a 3′ pora 2″ rvh* pr*-

s.*nt*d t* ih* *R in i:*r ?3r,J r,ri**k ,:i

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*StAti*r-i. 5he h*s *xperi*nc*d
veilin*l s**tting a** s*nt*

ahdominmr p*in, sr* i$ r,*\,.J *ri*iifi+d f*r r:bs*rva”r!*n er:d to r*1* *rir
prgillaiure 1abCIr ‘$cr*ndarY ic

ffi; mr’$ vJ p*f’,ry|qfiil*1,,
L{ist*ry: / ,

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CIns*t of dissase: lv1rs. lvl*rris is a 31-yearcid pisunani
rvon:an’i3r av’aflS’ i’i* 1 ,t:1i1t:::::lCInS*t Of diSSaSe: lvlfS. iul*ll”lg :$ A J i-yedl-Ltiu pi’,Ur i$t ‘L !vu.r I ru; r,t =,:

io the S.ft in her ?3ld r,,,,*sk *f gestati*n. Sh* ha* exparienced
r’foildtf*ttinU-ll!::::-10::l::,

nal pair:. slr* is norrn, rdn:i’ited far *bser’,’&lion and tc l”ule nut
prerr’eture labcr se*andaty io her fall

Feti**t ststes ttrat sh* is rnuch morr tir** \tuith i.hi$ $)rssn,ncy but
hes auributed it to having trvo

sr-rreii rhlidr*n. She als* descrihes heing sholi oi i:r*a”t!:.,
T,’hich si:* experienc*d wilh *rh*r preg-

nan*if;s. hurt ii }:as stsf i, ci csriier rr+lth this p{egnanc’y’^

u,,**ri*aj foisr*ry:Tl.t* pr*vious pregnanri*s d*li’.’*r*ri at 38 end
3? r””i**k*’ r*spe*ti”*lY’ l’l* oth*r

i:,i.l|il@#

{.n * i i ca t i * :t:+ a ; hon:* : I}I *:: atal’r i ta m t ns

-* * #a***cc ‘?-?sdaY
Ai**,h*l use; l’l*ne
Farrrily hisr*ry: x.4*tlrei*t-vpe 2 dlab*t**; feth*r*hi:pe rt*nsi*r:,

CA.*

D*n”x*graPhics:
Ma rii e t si*it-ts: lv’trarrrec
Years ed*rslion; i3
LartEuaEe: Errglish rnlY

SccirPaiic;:: SiaY-*i-h*il1* fii*il’i
j-isurs *f wc’rl:: l’1&
H*r.rsrft*ld rxe,t.ih*rs. l*ir:Ehanci-ag* 31; $c’ns ag*rJ

1? n”l*rths *n{i 3 v*aI$

f tfo mi*ii}’; rlau*s*ian
ft *,i,gir:us afiriietiar:; l’,il*th *’Ci : r

contribut*rY hi*t*iY
Sr-i.rgr**J i:ist*rv: sln xpp*n*e*t*{-‘1Y *g* 1’J;

A.d r*ltti rtg Fti*t*rVlF1’tysl**l:
illrief **nsplaini: ” i “t’retlt out

t8 ‘

*r::ntrlantsunl of bltsrling when
pair:. 1 call*d mY d*ctcr and the

*EFnernJ ap1a*tan**; 3 1-Yearold

Vital $Ig*sr T*mP: SS.S
BF: 11fi17?

cesareax s*et!c1-!$ m*nlIE$i*r’it:r:slY

g*t rh* n”roil and slipp*ri 0n lh* i*e. Ait*r 1 g*”i i:atk, in l tr*ti***
*

I r,ve*i tc th* *athr**m. Ov*r th* n*:

oifir* said I shculd t*me here t* bs checktci outl’
d

preililant f*x’ral*, pal*, in no *cute distre*s

Flrlne: 88
H*ight:8’*”

Hes0 rate: lv
Weight: 142 ibs

!4*art:Rftfi, h*ari **unds *ctmel

firuor*n ancy wei
t isr tbs

Y:”,1, Arnber; Femaie, 3t y.o.
Allergies; NKA
Pt. Location: ?3?

Cade: FULL
Pl’rysieian: f; Sowr*an

fase2t rbrer:riainpre*ns$qf Z4g

lsafation: lr]ane
Admit Date:1117

iry55ru7: Head:WNL
Eyes: Sclera pale,
Ears: Clear
Nose: Ciear

PEERLA, fundi without lesions

C*r,ruta.IlXil; I
n – *nx crea r with out posrna sa I dra inage

Neurolagic: Ale* and criented
Extremities; No gdema, DTfi 2+ and s,
skin: pale, *.rL *c *rv

ymmetricelthroughout

C_hest/lungs: Clear to auscultation and percussion
Feripherat vascutar: Diminished G; fi;;*ry’
Abdarnen.. nqln,,gl$sg6|L XA

rii;i,l,liii*:+:rxji::l’ii. r1:; ::1:::, ri tiiAbdorninat appearan**,;
rounded with

Stool*onsistenry

Genitourinary

cantinence
ljrine source

Integumentery

Skin color

SIir+tr{rsor{gac@

(Continued)

7,M Unit Eight lrlnhition Therapl. for ltematological Disorders

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L Monis. Ambee Female. G’i y.o.

Allergies: NKA
Pt Location:732

Code: FULL
Physicia*: E Bowman

lsolation: None
Adrnit Date: 1/17

Nursin g Ass*ssment fCo*ti*ueo?

i:lll. fSJ A 3 j$.S e$-S m e ntljrj.li:ii::.+
‘:iiiil’:;11!,i1.,1-

l]’i.i.i1.:.i?,;i.+:,:

stin i
* : ras h, w:v’reepi ng, s : siou ghi ng. D = d ryness, EX= excoriated, T:iears,
sil:pubcuian*ous emphysenla, B=blistors, v-vesicfes, N -necrosis)

intact

rvruuuus rnemDranes trntaci, LU=ecchymosi$, A:abrasions, F:petechiae,
fi:rash, W:weeping, S:sioughing, D :dr,y’ness, EX:excoriated, T:iears,
SE : su bcutaneous em p hVsenra, B : blisters. V *ves,iclpc Nt : nor.rneicl

intact

0thercornponentsofBraden$sore:specialn-ffi
ture, actirrity, friction/shear t)18:no risk, 1s-ls=low risk, 13-1A:moderete
risk, s12=high risk)

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Admission Ord*rs:
Laboratory: CBC, RpR. Chem 16
Repeat CBC, Aniyiase, Lipase in 1Z hrs
Repeat Chem ? every 6 hrs

Hadiology:
Abdominal UIS: Pregnancy ) 1st
Vital $igns: Every 4 hrs
I’donitor fetal heart tones and contr*ciions
[&OrecordedeveryShrs

Diet: NPO

Activityl Bed rest

tVFr Lft @ 100 mllhr

I\lutrition:
fl4ea/ type: NPO
F{uid requirement: 2000-2400 m Uday
flistary: Patient states appetite is good right now. she suffered a {ot of morning sickness during her firsttrimester but is better now. states that there are a lot of foods she doesn’t tike. Describes herself as apicky eeter’ Had been on vYlC during last pregnancy. Doe$ not always take prenatal vitanrins becausethey nrake her stomach hurt. States that she gained 15 lbs with her first pregnanry and almost 20 ri.rithher second.

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Morris, Amber, Fer”lalo, 31 y.o.
Allergies: Nl(A
Pt. Laeation: 732

Code: FULL
Physician: F. Eowr*an

Case2l *.aemiair Pregnancy ?45

lsolation; None
Admit ilats: 1/17

Usualdieiary infake:
Alt4: Coffee. cold cereal, cccasionally toast
Lunch: Sa*ciwich 0r soup
Dinner: Casserole such as Hamburger }*elpei, hot dogs, soup; scrfietimes sl”le cooks a f ull meal

with meat and vegetabies. Her husband v/orks nights so she doesn’t always cook except
on his days off.

24-haur-recatt (PTA):

AM: ? c Frosted Flakes, Yz c whole milk, biack coffee
Lunch: Hot dog on bun. 1/z * r*acarcni and cheese. iced tea
Dinner: 3 oz Salisbury steak, 1 c green beans, 1 c mashed potatoes with gravy, 1 ra[[with butter,

inari ta:

MD Progress Note:
1/18 0640
Subjeciive: Amber Morris previous 24 hours revielved
Vitafs: Iemp; $8,6 Fulse: 82 ft*sp rate: ZC Bp: iZOIEZ
Urine 0utput:4344 mL iS7.3 mllkg) =_

Phvsical Exam
General:23 *,eek gestetio*-no contractlons; n* furtt-rer vaginal spotiing
HgEiVT WNL
Nsck: WNt
Hurt: WNL
Lungs: Clear to auscultatian
A.bdamen:WtdL

Dx: Hypochrcmic Microcytic Anemia; 23-week gestation with narmal ultrasound. Fetal heart
sounds Wt!L.

PIan: D/C lVF, Begin 4il mg ferrsus sulfate; nuirition consult; discharge to home.

. E Bowman, MD

?;s

2,*6 UEit Xight $xtxirlon ?herapy for Xearai+Iegice} Fisori!*ro

Monis, Ambel; fumale. Bl y.o”
All*rgies: NKA
Pt. l-ocatia*: 732

Cede: fULL
Fhystcian: f Bowmen

lsolation: None
Ad*rrt ilate: tl’l?

€,r

Laboratary Hesults

136*145

2.ffi.8 r
4.S-9.0 M

3C*135 r
55-170 M,

2S-125

>55 [ >45 M

€,

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€

Case ?l Asrexriain?regn$ncy ?qZ

Morris, Amber, Female, Bl y,o,
Allergies: NKA
Pt. Lacati*n: 732

Code: FULL
Physician: f; Bawrn*n

Isslation: No*e
Admit Dats: U17

Laboratcry fiesult* {Contin u ed}

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2{8 UnitSight Nutritioa Therapy for Senaatolagica} Dieord.ers

Hlorris, Amher, Femaie, 31 y.o
Allergies: NKA
Pt. Location: ?32 lsalation: l’lone

Adnrit ilata; Il17
€

lntake/Output

1/17 *7*1 – 1/18 s7s$

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