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 Mrs. M is a 68-year-old female who came to the clinic due to progressive lethargy, dizziness and fatigue. This started approximately three months ago. She also complains of shortness of breath, fatigue, cool lower extremities, and a beefy red tongue.  

B: She has a past medical history of type II diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), and osteoporosis.  

She is allergic to sulfa drugs with the reaction of hives when she took the medication four years ago.  

Her current medications include lisinopril/hydrochlorothiazide (Prinzide) 20/12.5mg daily, aspirin 81 mg daily, atorvastatin 20 mg daily, metformin 500 mg twice daily, ergocalciferol 800 units daily and ibandronate (Boniva) 150 mg once monthly.  

She denies ever smoked, denies alcohol and illicit drug use. She retired four years ago and was a social worker. 

She has a family history of CAD, DM and HTN her mother died at 55 years of age of heart disease and her father died of prostate cancer seven years of age both her sisters are living and diagnosed with HTN. 

A: This patient is 5’6″ tall and weighs 200 pounds her current heart rate was 100 bpm BP 130/80 respirations 20 breaths per minute with and oxygen saturation of 94% on room air. 

 Her recently drawn lab results include hemoglobin 7 g/dL, hematocrit 23%, mean corpuscular volume (MCV) 73 FL, mean corpuscular hemoglobin (MCH) 25 pictograms/cell, mean corpuscular hemoglobin concentration (MCHC) 30 g/dL, total iron binding capacity (TIBC) 550 µg/dL, serum iron 50 µg/dL, and serum ferritin 15 ng/ml. 

Questions 

1)     What is the suspected disease process in Mrs. M’s case given the results of the labs provided? 

Iron deficiency anemia 

2)     List all of the causes of this disease process with the most common cause first. 

 

3)     What questions would be important to ask Mrs. M when evaluating these abnormal labs? Your diagnosis is not only based on your lab values but also on the patient’s clinical history and presentation therefore your questions are very important. 

4)     What is the first-line pharmacological treatment for this disease process? How is this medication dosed and what are all the available routes of administration? 

5)     What side effects are often associated with this first-line pharmacological treatment and what can the nurse do to alleviate the symptoms? 

6)     At what point would you consider a blood transfusion for Mrs. M and list the risks to the patient when considering administering blood products? 

7)     When the patient is discharged home on an iron supplement what important teaching would you include regarding this medication? i.e., its administration and side effects. 

8)     What dietary recommendations would you include for this patient? Give examples.

SCIENCE
HEALTH SCIENCE
NURSING

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