Scenario Anemia Year Explained for Students (Easy Guide)

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Original Question

Scenario: (Anemia) G.C. is a 78-year-old widow who comes to the outpatient clinic saying that over the past 2 to 3 months she has felt increasingly tired, despite sleeping well at night. Over the past few years, she describes eating less and less meat because of her financial situation and has trouble preparing a meal “just for me.” G.C. relates how she relies on her late husband’s Social Security income for all her expenses. She struggles financially to buy medicines for the treatment of hypertension and arthritis. Her vital signs are 136/76, 16, 80. She denies any dyspnea or palpitations. The nurse practitioner orders blood work. G.C.’s chemistry panel findings are all within normal limits, and a stool fecal occult blood test result is negative. Her other results are shown in the chart. CHART VIEW Laboratory Test Results WBC 7600/ mm3 (7.6 x 109 /L) Hematocrit (Hct) 27.3% Hemoglobin (Hgb) 8.3 mg/dL (83 g/L) Platelets 151,000/ mm3 (151 x 109 /L) Red Blood Cell (RBC) Indices Mean corpuscular volume (MCV) 65 fL (65 mm3 ) Mean corpuscular hemoglobin (MCH) 31.6 pg MCH concentration (MCHC) 35.1% Iron, total 30 mcg/dL (5 mcmol/L) Iron-binding capacity 422 mcg/dL (75.5 mcmol/L) Ferritin 8mg/dL (18 pmol/L) Vitamin B12 414 pg/mL (305 pmol/L) Folate 22 ng/mL (50 nmol/L) 1. Which lab values are normal, and which are abnormal? 2. Explain the significance of each abnormal result. 3. Based on these results and her history, what condition does G.C. have? 4. Who is at risk for this condition? 5. What other signs and symptoms of this condition do you assess for in G.C.? 6. Which question would best help you determine the impact of fatigue on her activities of daily living? “Are you upset about feeling more tired?” “Do you sleep more now than you used to?” “How far can you walk until you get short of breath?” “Have you been able to do what you would like to do?” 7. Discuss the treatment options for her condition. 8. When would parenteral iron therapy be indicated? 9. The nurse practitioner starts G.C. on ferrous sulfate 325mg orally once per day. What teaching does G.C. need about this medication? 10. As you are evaluating your teaching, you determine that more instruction is needed if G.C. says: “My stools will likely turn a tarry, black color soon.” “I can take the iron and my calcium supplements at the same time.” “I will increase my fluid and fiber intake as long as I am on the iron.” “Taking the tablets when I eat my meals will help my stomach no be upset.” 11. Discuss some ideas that might help her with her meal planning. 12. You teach G.C. about foods she should include in her diet. You determine that she understands your teaching if she says she will increase her intake of which foods? Whole-wheat pastas and skim milk Lean cuts of poultry, pork, and fish Beans and dark green, leafy vegetables Cooked cereals, such as oats, and bananas 13. What community resources may benefit G.C.? 14. What parameters could you use to determine whether G.C.’s condition is improving? 15. Using a SOAP format, write a sample documentation entry for this encounter. 16. G.C. returns to the clinic in 3 months. She says she is feeling “a bit” less tired. Although her blood work shows some improvement, anemia is still present. G.C. and you discuss ways to promote better eating. She tells you she did not follow up on any suggestions about seeking community resources. She now agrees to speak with the social worker and explore available resources.

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