I.

INTRODUCTION

Anemia is a medical condition characterized by low hemoglobin (Hb). It is very

important to recognize and treat this condition in pregnancy, as both mother and fetus

gets affected due to the low availability of oxygen, which is necessary for the

metabolism. Pregnant women fall under high risk as there can be loss of blood during

delivery, which compromises the health of the mother leading to morbidity and

mortality.

Types of Anemia in Pregnancy : Nutritional Anemia - deficiency of iron, folic acid,

vitamin B12 and proteins causes Anemia. Hereditary Anemia - hemoglobinopathies like

sickle-cell anemia, thalassemia and many other genetic conditions. Hemolytic Anemia -

Нese are less common and due to increase in breakdown of RBC.

Severe anemia is a serious problem in many parts of the World, being frequent in

developing countries and still being an important issue in developed countries, despite

recommended prophylactic/therapeutic recommendations by the World Health

Organization (WHO) and national health authorities and obstetric societies.

The consequences and side-effects of severe anemia all have a negative

influence on the quality of life and well-being especially of the mother, but also on her
baby and on the interactive mother-baby relationship. The physical consequences of

severe anemia on the mother are those of iron deficiency anemia in general- such as

fatigue, decreased physical working capacity, shortness of breath at exercise, increased

heart rate, dizziness, impaired function of epithelial tissues, impaired endocrine function,

impaired regulation of temperature, increased frequency of infections, restless legs and

the like.

I chose this case because anemia is common to pregnant women. It can be

Physiological or Pathological. Thus, I wanted to enhance my knowledge, improve my

skills in utilizing the nursing process, and also to enrich positive attitude in the care of

the patient with Severe anemia especially to pregnant woman. Furthermore, in order to

provide quality nursing care to patient.

II. GENERAL DATA

Patient: L.J.Q

Age: 23 years old

 Birthday: May 01, 1994

Gender: Female

Civil Status: Single

Address: Tintay talamban, Cebu city

Occupation: None

Religion: Roman Catholic

Hospital Admitted: Eversley Childs Sanitarium and

General Hospital

Hospital Number: 000000000072914

Date of Admission: February 25, 2018

Time of Admission: 8:30 pm

Admitting Diagnosis: Severe anemia

Final Diagnosis: Severe anemia

Physician: Dr. Lorenzo

L.M.P.: June 23, 2018

OB Score: G4 T3 P0 A0 L3

AOG: 35 2/7 weeks

E.D.C.: March 30, 2018

Fundal Height: 41 cm

FHT: 146 bpm

III. OBSTETRICAL GYNECOLOGICAL HISTORY

A case of L.J.Q., 23 years old, female, single, Roman Catholic, residing at Tintay

Talamban, Cebu City, was admitted due to Severe anemia. Prior to admission patient

claimed that she had fatigue and felt restless. She decided to come to Eversley Childs
Sanitarium and General hospital for check-up and was advised for a laboratory

examination, only to find out that she had Severe anemia. She was advised for

admission to OB ward under Dr. Sweirt B. Lorenzo

IV. PAST HEALTH HISTORY

Patient is non-hypertensive, she had a usual BP of 120/80 mmHg. Patient is non-

diabetic, non-smoker, non-alcoholic. Patient has no history of hospitalization except

during deliveries.

V. CLIENT’S CLINICAL COURSE IN THE UNIT

Patient L.J.Q., 23 years old, single, Filipino, a Roman Catholic, currently residing

at tintay talamban, Cebu city, was admitted last February 25, 2018, 8:30 pm at Eversley

Childs Sanitarium and General Hospital due to severe anemia under Dr. Lorenzo.

Day 1 (February 27, 2018)

I receive patient L.J.Q. laying on bed ,sleeping with on going IVF PNSS

with a drop rate of KVO 40cc/hr, right arm. CBC, Blood typing, urinalysis . Second blood

transfusion was administered with the following vital signs :Temperature 36.5°C, Pulse

Rate 64 bpm, Respiration 20 cpm, Blood Pressure 120/80 mmHg ; given furosemide

Day 2 (February 28, 2018)

Received endorsement and had nursing rounds, seen patient on bed

awake, afebrile, and coherent with an IVF of PNSS 1L @ KVO 40cc/hr, right arm.
Blood pressure of 120/80 mmHg, temperature of 36.6°C, pulse rate of 76 bpm, and

respiration of 20 cpm. Doctor ordered Diet as Tolerated (DAT) for the patient.

Assessed general status of the patient; V/S taken every hour and charted.

Conducted Physical Assessment and interviewed the patient utilizing the Gordon’s

Functional Health Pattern Guide. Time taping of IVF. Bedside care done. I and O

measured and recorded at the end of shift.

Day 3 (March 1, 2018)

Received endorsement and had nursing rounds, seen patient on bed,

awake, afebrile, and coherent, with an IVF of PNSS 1L @ KVO 40cc/hr. Assessed

general status of the patient and observed for any unusualities. V/S taken every 4 hours

and charted. IVF of PNSS was terminated. Bedside care done. Assisted patient’s need

Promote verbalization of feelings and emotions. I and O measured and recorded at the

end of the shift.

VI. GORDON’S HEALTH PATTERN

Health Perception – Health Management

 Patient’s life is good according to her. She rated her health as 7 out of 10, where

10 is the highest and 1 as the lowest, and reasoned, “7 kay tungod sa akong condition

karun” as verbalized by the patient. Patient does not have regular check up and does

not do self medication. She sees quack doctors if any unusualities occurs and is a user

of herbal medicines. She seldom practices Breast Self-Examination (BSE). She claimed

that she is completely immunized. Patient L.J.Q. is aware of her present condition and

elaborated that she was first diagnosed with anemia during her second pregnancy,

according to her, she does not take any vitamins but eats a lot of vegetables.

Nutritional Metabolic Pattern

Patient weighs 67 kg and is 5 feet and 4 inches tall. She took 3 meals a day with

snack. Her breakfast at 7 or 8 am, lunch at 12 noon, and dinner between 8 to 9 pm.

Meals usually includes: rice, vegetable and fish with soup. Patient claimes that she loves

eating banana, apple and orange. She does not have any problems in eating and does

not regularly went to the dentist . Patient L.J.Q. stated that her diet remains the same

even if she was admitted and did not notice any weight loss. When asked how much

liquid she usually takes, she verbalized, “Di ko ka estimate peru daghan jud akong

mainom”.

Elimination Pattern
 Patient usually removed her bowel in the morning and described her stool as

brown, firm in shape and has the right consistency. She does not used

any laxatives and has no problems in eliminating her bowels. When she experience

constipation, she only took lots of fluid. When asked how many times does she void, she

verbalized, “Kadaghan jud ko mangihi kay hinginom man kaayo ko ug tubig.” She

describes her urine as clear, light yellow, has normal urine flow, and normal odor.

Patient stated that she does not have any problem in voiding; when she voids, it is

painless and has no blood. Her current condition did not alter her elimination process

Activity Exercise Pattern

Patient L.J.Q. is a housewife and describes it as stressful. She is tasked to do the

household chores such as washing the dishes, cleaning the house, and doing the

laundry. She wakes up early to prepare her children for school. After breakfast, she

takes her children to school; after lunch, she usually does the laundry or takes her rest.

At night, she prepares the food for dinner, The patient watches television when she has

hard time going to sleep. Patient considered household chores as a form of exercise and

watching television as recreational activitiy.

Sleep and Rest Pattern

 Patient goes to sleep around 10 in the evening and woke up at 6 am in the

morning, she does not used any sleeping aids or any drugs or sedatives to facilitate

sleep. She does not have any problems sleeping. She usually pray before she goes to

sleep. She usually considered her sleep as not enough, patient also verbalized that her

current condition does not affect her sleep.

Cognitive Perceptual Pattern

Patient is oriented to time, place, and people. She is able to recall past events

especially those that is important to her such as her children’s birthday and her past

hospitalization.Patient is able to state her name and age. Her condition has not altered

her cognition and perception.

Self Perception and Self Concept Pattern

Patient viewed herself in a positive way. She verbalized, “ bisag daghan ug

problema mu smile gihapon ko”. She considered her children as her greatest

accomplishment in life, satisfied and happy with the life she had and what she have

done in her life. She expressed worry regarding to their financial and health status

according to her, “ mutoo ko na maayo ko”. Her current condition has not changed her

perception or the way she views herself.

Role Relationship Pattern

 Patient L.J.Q. is a mother of 3 children. She is the eldest of her 3 siblings. She is

living with her live in partner for 7 years.. She considered her role as satisfying

especially she had 3 children and another one is yet to come. Patient states that she has

a lot of friends. She stated the her current condition does not affect her relationship with

her family and friends.

Sexuality Reproductive Pattern

Patient had her menarche at the age of 13 years old . she had her first sexual

contact at the age of 16 years old with her current partner, who is her only partner. She

stated that she is choosy when it comes to choosing her partners. She does not have

any history of Sexually-Transmitted Diseases (STD). According to her that she uses oral

contraceptive pill. Patient is sexually active , she claimes that they often do the act if

they wanted to. Patient stated that her current condition does not affect her sexual

activity.

Coping Stress Tolerance Pattern

Patient defined stress as “ maka kapoy kaayo ug maka labad sa ulo”. She stated

that she is presently at stressed because of her current condition. Her partner usually

made the decisions but sometimes her partner asked for her opinion. She also asked

consultation to her family and God before in making decisions. She viewed life as good
and her major family problem is her current condition. When problems arise, She prayed

and asked for guidance from her mother and to God during times of problem.

Value Belief Pattern

Patient and her family are Roman catholic. She believed in God and verbalized, “

dako kaayo kog pag too sa ginoo”. She went to church with her family and prayed

before she sleeps and when problems arise. Her condition did not affect her religious

belief.

VII. Environmental History

Patient is currently residing at Tintay ,Talamban, Cebu City in a one-storey

house for 11 months. The lot is owned as well as the house. The health center and

church is less than one kilometer away while the barangay hall, just a few blocks away.

Their family stayed together in one room during sleeping time. Their residence is non-

congested and has easy access with the basic services.

The water supply is from Metro Cebu Water District (MCWD), electricity is

supplied by Visayan Electric Company (VECO). Their house is not near the main road but

is accessible by the barangay road, their means of transportation is through “habal-

habal”.
VIII. PHYSICAL ASSESSMENT (REVIEW OF SYSTEMS)

AREA TECHNIQUE ACTUAL FINDINGS ANALYSIS

ASSESSED USED

The hair is silky and Normal

evenly distributed;
there are no signs of
Hair Inspection infection and
infestation observed.

Skin Inspection Pallor, dry and poor Due to the result of

skin turgor a reduced amount
of oxyhaemoglobin
and is visible in skin
conjuctivae or
mucous membrane.
( Bray 2004)

Patient’s head is Normal

rounded,
normocephalic, and
symmetrical. There are
no nodules or masses
Head and Face Inspection/palpation and depressions when
palpated. Patient’s face
appeared smooth and
has uniform
consistency.

Nails is normal in Normal

Nails Inspection color.. Its surface is
slightly curved. No
clubbed finger.

Palpation Nails are smooth and Due to the result of

intact. Capillary refill a reduced amount
time more than 3 of oxyhaemoglobin
seconds. (Bray 2004)

Patient’s eyebrow is Due to the result of

evenly distributed, a reduced amount
symmetrical, aligned of oxyhaemoglobin
 and show equal (Bray 2004)
movement when raise
Eyes Inspection and lower eyebrows.
Patient’s sclera is
white, there is no
edema or tearing in the
lacrimal gland. Pupils
are black and equal in
size. Presence of
conjunctiva pallor.

Patient’s auricle is Normal

symmetrical and has
the same color with her
facial skin. The auricles
Ears Inspection are aligned with the
outer canthus of eye.

Patient’s ears are Normal

Palpation mobile, firm and not
tender upon palpation.

Patient’s nose is Normal

symmetrical, straight
Nose Inspection and uniform in color.
No presence of
discharge or flaring.

When lightly palpated, normal

no tenderness and
Palpation lesions were noted.

Patient’s lips are dry. Due to the result of

Patient’s gums are a reduced amount
Mouth Inspection pale. Patient’s tongue of oxyhaemoglobin
is centrally positioned, (Bray 2004)
pink in color and moist,
teeth are complete, no
presence of decay and
no discoloration of
enamels.

The neck muscles are Normal

equal in size, the
patient showed
coordinated, smooth
head movement with
Neck Inspection no discomfort; lymph
 nodes are not palpable,
the trachea is placed in
the middle of the neck.

Patient’s chest wall is Normal

intact with no
tenderness and
masses. The client
manifested quiet,
rhythmic and effortless
Thorax Palpation respirations. Patient’s
spine is vertically
aligned. The right and
left shoulders and hips
are of the same height.

Patient’s heart had no Normal

visible pulsations on
the aortic and pulmonic
Heart and Lungs Auscultation areas. Normal heart
and lung sounds. There
is no presence of
heaves or lifts.

Breast Inspection/palpatio Patients breast is There will be

n symmetrical in size and presence of
contour, firm, nodules engorgement due
are palpable or to the body begins
tenderness noted and to prepare milk for
has dark areola breastfeeding after
.Presence of the mother give
engorgement birth.
(Pilliteri, Adele
2014)

Abdomen Inspection/palpatio Striae noted,Contour is are caused by

n bilaterally symmetrical. tearing of the
Fundal height 41cm. dermis. This is
Fetal position cephalic often from the
with the fetal heart rapid stretching of
tone of 135 bpm. the skin associated
with rapid growth
or rapid weight
changes. Stretch
marks may also be
influenced by
 hormonal changes
associated with
pregnancy
(Pilliteri, Adele
2014)

Pelvic area Inspection Presence of Normal during

leukorrhea and is thin, pregnancy.
white, milky, and mild Leukorrhea may
smelling. occur normally
duringpregnancy.
This is caused by
increased bloodflow
to the vagina due
to increased
estrogen.
(Pilliteri, Adele
2014)

IX. DEVELOPMENTAL DATA

STAGE AGE DEVELOPMENTAL DEVELOPMENTAL PATIENT’

TASK DATA RESOLUTION

Infancy Birth to 1 Trust VS. Mistrust Infant develops Patient’s

year old trust in self, others primary care
and the giver was her
environment when mother.
caregiver is
responsive, if
needs not meet,
infant becomes
uncooperative and
aggressive and
show decreased of
interest.

Early 2-3 Autonomy VS. Toddler learns to At this age, the

Childhood years old Shame and Doubt control while patient learned
 mastering skills to play with
such as feeding, others.
toileting and
dressing when care
givers provide
reassurance, if
needs not meet,
toddler feels
ashamed which
lead to lack of self
confidence.

Preschool 3–6 Initiative VS. Guilt Child begins to Patient started

years old initiate activities in studying at the
place of just age of 5 and
imitating activities started having
uses imagination to new friends in
play and learned the form of her
what is allowed to classmates. As
develop a a child, patient
conscience. had learned to
spell short
words and
count.

School Age 6 - 11 Industry vs. Child becomes Patient studied

years old Inferiority productive by elementary at
mastering, learning the age of 7.
and obtaining Patient stated
success, child that she is a
learns to deal with fast learner
academics, group when it comes
activities and to her studies.
friends when other Patient had her
shows acceptance menarche at
of action and the age of 13.
praise success.

Adolescenc 12 – 18 Identity VS. Role Adolescent As she is

e years old Confusion searches for self- developing in
identity by making this stage, she
choices about noticed her
occupation, sexual physical
orientation, and changes such
lifestyle and relies as breast
on peer group for growth and
 support and growing of
reassurance to pubic hair.
create self-image.

Young 19 – 40 Intimacy VS. Young adult learns Patient got

Adulthood years old Isolation to make a personal pregnant 18.
commitment to She is the one
others and show who do the
life events with household
others. chores. She is a
mother of 3 at
the age of 23.

X. ANATOMY, PHYSIOLOGY AND RELATED PATHOPHYSIOLOGY

A. Anatomy and Physiology of the System Involved

Cardiovascular System and Circulation

 The Cardiovascular System is designed to deliver oxygen and nutrients to all

parts of the body and pick up waste materials and toxins for elimination. This system is

made up of the heart, the veins, the arteries and the capillaries.

Circulation is achieved by a continuous one way movement of blood throughout

the body. The network of blood vessels that flow through the body is so extensive that

blood flows within close proximity to almost every cell. (Marieb,2013)

HEART
 The heart is a muscular pump that propels blood throughout the body. The heart

is located between the lungs, slightly to the left center in the chest. The heart is broken

down into four chambers including:The right atrium which is a chamber which receives

oxygen-poor blood from the veins - The right ventricle which pumps the oxygen-poor

blood from the right atrium to the lungs - The left atrium which receives the now

oxygen-rich blood that is returning from the lungs - The left ventricle, which pumps the

oxygenated blood through the arteries to the rest of the body

BLOOD VESSELS

Blood vessels are broken down into three groups; the arteries which carry the

blood out of the heart to the capillaries, the veins which transport oxygen-poor blood

back to the heart, and the capillaries which transfer oxygen and other nutrients into the

cells and removes carbon dioxide and other metabolic waste from these body tissues.

BLOOD

is a body fluid in humans and other animals that delivers necessary substances

such as nutrients and oxygen to the cells and transports metabolic waste products away

from those same cells. it is composed of blood cells suspended in blood plasma. Plasma,

which constitutes 55% of blood fluid, is mostly water (92% by volume), and contains
dissipated proteins, glucose, mineral ions, hormones, carbon dioxide (plasma being the

main medium for excretory product transportation), and blood cells themselves. Albumin

is the main protein in plasma, and it functions to regulate the colloidal osmotic pressure

of blood. The blood cells are mainly red blood cells (also called RBCs or erythrocytes),

white blood cells (also called WBCs or leukocytes) and platelets (also called

thrombocytes).

RED BLOOD CELL (RBC)

Red blood cells (RBCs), also called erythrocytes, are the most common type of

blood cell and the vertebrate's principal means of delivering oxygen (O2) to the body

tissues—via blood flow through the circulatory system. RBCs take up oxygen in the

lungs, or gills of fish, and release it into tissues while squeezing through the body's

capillaries.

WHITE BLOOD CELL (WBC)

White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of

the immune system that are involved in protecting the body against both infectious

disease and foreign invaders. All white blood cells are produced and derived from
multipotent cells in the bone marrow known as hematopoietic stem cells. Leukocytes are

found throughout the body, including the blood and lymphatic system.

PLATELETS

Platelets, also called thrombocytes (thromb- + -cyte, "blood clot cell"), are a

component of blood whose function (along with the coagulation factors) is to stop

bleeding by clumping and clotting blood vessel injuries. Platelets have no cell nucleus:

they are fragments of cytoplasm that are derived from the megakaryocytes of the bone

marrow, and then enter the circulation. These unactivated platelets are biconvex discoid

(lens-shaped) structures, 2–3 µm in greatest diameter. Platelets are found only in

mammals, whereas in other animals thrombocytes circulate as intact mononuclear cells

B. Conceptual Framework on the Pathophysiology of Anemia

C. Discussion of Pathophysiology

Women have a lower baseline hemoglobin and hematocrit than men to

begin with. Normal values are 12-16 g/dL hemoglobin and 36-48% hematocrit for

women and 14-18 g/dL hemoglobin and 40-54% hematocrit for men. In addition to
women having a lower baseline amount of red blood cells than men, they also have

menstrual bleeding every month which serves to decrease their hemoglobin and

hematocrit even more. There are many different causes of anemia, but a surprising one

that many people don’t know about is genetics. Certain forms of anemia are genetically

passed down from one’s ancestors over generations. A reduction in the number of blood

cells in the blood causes a reduction in the consistency and volume of blood.

Hypoxemia, reduced oxygen level in the blood, further contributes to cardiovascular

dysfunction by causing dilation of arterioles, capillaries and venules thus increasing flow

through them. All of these compensatory mechanisms may cause individuals to

experience shortness of breath(dyspnea), a rapid and pounding heartbeat, dizziness and

fatigue. In mild, chronic cases, these symptoms may be present only when there is an

increased demand for oxygen but in severe cases, symptoms may be experienced even

at rest. (Porth,Carol,Essentials of Pathophysiology: Concepts of Altered Health States:

Lippincott William and Wilkins)

D. Symptomatology

CLINICAL MANIFESTATION SIGNS AND SYMPTOMS PRESENT IN

PATIENT
 ● general fatigue. ● General fatigue
● weakness. ● Weakness
● pale skin. ● Pale skin
● shortness of breath. ● Dizziness
● dizziness.
● strange cravings to eat items
that aren't food, such as dirt,
ice, or clay.
● a tingling or crawling feeling in
the legs.
● tongue swelling or soreness.

XI. MEDICAL MANAGEMENT

A. DIAGNOSTIC STUDIES

Diagnostic Studies Ordered Diagnostic Studies Rationale

Part of the regular physical

examination. A blood count
can give valuable
CBC ✓ information about the
general
state of health
(labtestonline.org.2017)

Used to screen patients for

kidney and urinary tract
Urinalysis disease and can help
detect metabolic or
systemic disease.

Blood typing ✓ To determine your ABO

blood group and Rh type

Peripheral Smear ✓ Examination of the

peripheral smear is an
important part of the
workup of patients with
anemia. Examination of the
erythrocytes shows
microcytic and
hypochromic red blood
cells in chronic iron
deficiency anemia.
(emedicine.medscape.com
)
A. Diagnostic Studies and Findings

Complete Blood Count

Test name Result Reference Range Significant Findings

Hemoglobin 3.44 10.8-14.2 Low

Hematocrit 12.9 37.7-53.7 Low

RBC 1.50 3.60-4.69 Low

WBC 8.47 3.70-10.1 Normal

Blood type 0+

Platelet count 60.1 155-366 Low

HBS Ag Non- reactive

Lymphocytes 2.41 1.09-2.99 Normal

Monocytes .208C .240-.790 Low

Eosinophils .098 .030-.440 Normal

Basophils .071 0.00-0.80 Normal

MCV 86.2 81.1-96.0 Normal

MCH 22.6 27.0-31.2 Low

Total

Urinalysis

Test Reference Value Results Implication

Macroscopic

Color Amber/straw Yellow Normal

Appearance Clear Hazy Normal

Specific Gravity 1.005-1.025 1.025 Normal

pH 4.5-7 6.0 Normal

Glucose Absent NEGATIVE Normal

Protein NEGATIVE

Microscopic

RBC 0-5/HPF 0-3 Normal

WBC 0-5/HPF 3-6 An increased

production of white
blood cells to fight
an infection
(mayoclinic.org)

Amorphous Rare FEW Amorphous material

is moderate which
are normally
present in a healthy
individual
(labtestonline.org.2
017)

Epithelial cells Rare FEW Results of

inflammatory
process associated
with an infection
(labtestonline.org.2
017)

Bacteria None FEW Bacteria in urine

can suggest
infection due to
vascular
permeability
(labtestonline.org.2
017)
B. Treatment and Procedures

Treatment and Procedures Performed to the patient Rationale

BP monitoring ✓ It must be monitored

because there is an
increased blood pressure
to ensure or notice any
sudden changes of the
blood
pressure(Pilliteri,2007)

Blood transfusion ✓ to replace blood cells or

blood products lost through
severe bleeding, during
surgery when blood loss
occurs or to increase the
blood count in an anemic
(medicinenet.com)

Hospitalization ✓ For close monitoring

(mayo.org.retrieved2017)

C. Medications

List of medication and IVF Prescribe to the patient Indications

Ferrous sulfate ✓ An essential mineral found

in hemoglobin, myoglobin,
and many enzymes. Enters
the bloodstream and is
transported to the organs
of the reticuloendothelial
system where it becomes
part of iron stores.
Therapeutic
Effects:Resolution or
prevention of iron
deficiency anemia. (nurse’s
drug guide 2006)

Multivitamins ✓ Contain fat-soluble

 vitamins (A, D, and E) and
most water-soluble
vitamins (B-complex
vitamins B1, B2, B3, B5,
B6, B12, vitamin C, biotin,
and folic acid). These
vitamins are a diverse
group of compounds
necessary for normal
growth and development.
Many act as coenzymes or
catalysts in numerous
metabolic processes.
(nurse’s drug guide 2006)

Furosemide ✓ Hypertension resistant to

thiazide therapy of blood
transfusion.(nurse’s drug
guide 2006)

PNSS ✓ Usedbecause ithas little

tono effecton thetissues
andMake theperson
feelhydratedpreventinghyp
ovolemic shock or
hypotension (nurse’s drug
guide 2006)

D. Diet

Recommended diet Ordered diet Rationale

 High iron All meat and poultry
contain heme iron. Red
meat, lamb, and venison
are the best sources.
Poultry and chicken have
lower amounts. Eating
meat or poultry with
nonheme iron foods, such
as leafy greens, can
increase iron absorption.(
healthline.com)

Vitamin C Helps absorption of iron

and It helps in building of
bodily resistance against
infections. (
healthline.com)

High in Fiber It helps prevent

constipation and also
supplies pregnant women
with vitamins and
antioxidants (
healthline.com)

XII. NURSING MANAGEMENT

A. Goal of Care

-Instruct different techniques on how to relieve fatigue

-Educate on how to manage fatigue

-Verbalize understanding of the importance of blood transfusion

ASSESSMENT

-Obtain laboratory results such as CBC, Urinalysis and Blood testing

-Thorough physical assessment

-Relating the data obtained to the results of any diagnostic procedures

DIAGNOSIS
 - Fatigue related to decreased Oxygen carrying capacity of the blood as evidenced

by patient reported lack of energy

- Risk for infection related to inadequate secondary defenses- decrease in

hemoglobin

- Activity intolerance related to imbalance between oxygen supply.

PLANNING

1. Fatigue related to Severe Anemia

- Stress the importance of frequent rest

- Educate energy conservation technique

- Anticipate the need for the transfusion of packed RBCs

2. Risk for infection

-Assess vital signs

-Assess environmental exposure

-Observe patient changes in skin color and warmth at insertion site

-Observe for changes in color and odor of secretions

-monitor the patient’s visitors and caregivers for respiratory illnesses

(nurse’s pocket guide,2016)

3. Activity intolerance related to imbalanced between oxygen supply.

- Assess client’s ability to perform normal task.

- Note changes in balance, gait disturbance and muscle weakness.

- Monitor vital signs during and after activity

 - Recommend quite atmosphere and bed rest, if indicated.

B. Actual Care Given

INTERVENTIONS

-Assessment was done to gather significant data of the condition

-Vital signs was monitored

-Provided comfort measures to promote comfortable place

-Instructed S.O not to leave the patient unattended

-Monitored patients intake and output every shift and recorded

-Gave health teachings to the patient such as the do’s and don’ts and the proper

nutrition needed

C. Problem encountered during the Implementation of Nursing Care

During the care of patient, the student was having a hard time gathering the data

during the interview because patient easily experienced fatigue, she will not maintained

eye contact and answers and only few words given

D. Restorative Measures

Patient was provided a safe, clean and comfortable environment. Advised patient to

ask assistance from significant other during ambulation and encouraged to move

carefully and advised to get up slowly from bed to avoid postural hypotension.

Encouraged verbalization of feelings and concerns. Patient was able to cope up and

answered all the questions asked.

E. Evaluation
 Throughout the care rendered to the patient, the client was able to perform minor

activities without assistance. Patient was now attentive and responsive in every question

asked. Patient felt comfortable to the environment.

F. Patient teaching

-Encouraged patient to avoid places that are stress provoking to facilitate fast recovery

-Encouraged patient to provide adequate rests to avoid stress or energy conservation

techniques.

-Advised patient to eat healthy foods such as camote tops, liver , fruits to aid in iron

deficiency anemia

-Advised patient to increase fluid intake

-Advised to avoid any strenuous activities or exercises.

XIII. CONCLUSION / RECOMMENDATION

A. Conclusion

In pregnancy, inadequate dietary intake of iron , blood loss or heavy hemorrhage

from trauma can lead to anemia. It may not be noticeable but can be detected during

routine antenatal appointment and laboratory exams. It is best to seek prenatal

checkups and consultation regularly to monitor and detect any signs of complication

during pregnancy.

B. Recommendation

With this study, the student nurse was able to gain more knowledge and wider

view about complications of pregnancy such as severe anemia. Thus the student nurse
 would like to recommend and partake some knowledge on how to deal on different

complications of pregnancy specifically Severe Anemia.

To the health care team, they should implement basic procedures and ideally

regardless of the health care facilities they’re into. They must attend the needs of

patient and to keep inline their duties towards promotion of health during pregnancy.

XIV. IMPLICATION OF THE STUDY TO

A. Nursing Education

This study will help us future nurses to fully understand pregnancy and its

complication especially severe anemia. This will help us to be a keen observer for its

signs and symptoms and help us develop our critical thinking skills in formulating and

prioritizing different intervention appropriate and need for the patient.

B. Nursing Practice

This study had a great contribution to nursing practice because it

enhances our knowledge, improve skills and enriched positive attitude.

C. Nursing Research

To all readers especially Health care providers and future researchers

who wants to gain more knowledge about the care of client with Severe Anemia, this
will provide additional information and will serve as basis for future study to improve

quality care.

Appendix C (Discharge Plan)

3. Nutritional Diet

Diet Diet as Tolerated and iron -rich foods

Height and Weight 5’4’’ and 67kg

NUTRITIONAL INTAKE AND EATING HABITS

Eat foods that are rich in iron such as camote tops,fish, shellfish and liver. Intake

of iron supplement is needed as it helps the immune system and is needed for

increase hemoglobin.

4. Sensory and Physical Impairment

Type of Impairment Complete Loss

Prosthesis /

Sight /

Hearing /

Speech /

Paralysis /

Bladder /

Incontinence
/

5. Psychological Status

The patient is conscious and well oriented to time, place and date and events that

has happened yesterday. She responds to questions being asked, expresses her feelings

and concerns regarding her hospitalization. She communicates to the health care

provider and significant others regarding her needs.

6. Special Treatment

Patient is not having any special treatment or any procedure upon discharging.

7. Dental Status
Teeth Yes No UPPER LOWER

Teeth ✓ 15 14

Dentures ✓

Decay ✓ 4 2

Condition of teeth/ gums

Patients gums are in good condition, gums are pinkish. She has no dentures and

has presence of decay in upper and lower molar.

8. Activity potential and Rehabilitation potential

Encouraged patient to walk, sit and bed side lying. Instructed patient to do deep

breathing exercise and take medications prescribed by the physician. Patient is

collaborative during the care.

9. Cognitive Status

Patient’s cognitive status is stable. She is able to understand health teachings,

instructions and answers questions being asked. She is able to ask questions for

further understanding.

10. Discharge Drug Therapy

11. Post discharge Plan of Care

-Health Teachings
M.E.T.H.O.D.S

Medications

-Instruct patient to take the medications prescribed by the physician and to take

note on the dosage, action, contraindications and its side effects.

-Proper timing and dosage of ferrous sulfate is important for the drug to be

effective. It should be taken once a day 15-30 minutes after meal.

-Take missed doses as soon as remembered within 12 hr; otherwise, return to

regular dosing schedule. Do not double doses.

-Warn the patient for side effects such as stools may be dark green or black

-Instruct the patient to report if there are any adverse effects observed

Environment and Exercise

-Tell patient to avoid doing any strenuous activities

-Instruct patient to have proper bed rest and stay in a quiet place for fast

recovery

Treatment

-Discuss the purpose of medications

 -Tell patient to submit self to diagnostic examination to make sure ones health

status and to make sure that she is not having any complication

-Instruct the patient to follow physicians orders and any health care team that

aims for the promotion of health.

Health Teaching

-Encourage patient to provide adequate rest and have 8 hours of sleep every day

-Instruct not to do any strenuous activities

-Encourage to eat healthy foods especially foods that are rich in iron

-Educate patient to perform proper hygiene

-Advise patient to have follow up check ups

-Proper timing of Ferrous Sulfate, It should be taken once a day 15-30 minutes

after meal.

Outpatient Referral

-Remind patient to have follow up check-ups to monitor patients health status

and to maintain optimum balance of wellness.

-Inform patient to report if there are any side effects or abnormalities observed

at home to avoid any further complications.

Diet

-Advised patient to healthy foods , especially those rich in iron

-Encourage to eat healthy foods such as green leafy vegetables, liver , shellfish

-Having vitamin C with iron-rich foods will help to absorb the iron more easily. -

Serve up meals with plenty of vegetables and fruit or have a glass of orange

juice with your meal.

-Drink 8-10 glasses of water everyday

Spiritual

-Advised patient to attend regular masses every Sunday

13. Aid provided to Client/ Family in Arranging Post-Discharge Plan

Client/ Patient Name Medical Record # Attending Physician

L.J.Q. 00000000072914 Dr. Lorenzo