uterine fibroids Case Study

Severe anemia secondary to uterine fibroids Introduction

As intrinsic as the value of the human body such as the importance of adequate blood flow and

decreased growth of muscular tumors cannot be bypassed or looked upon as its role is of major

importance to the functioning of the human body the uterus as we know is a hollow muscular

organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs

that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and

implant itself in the lining of the uterus. The main function of the uterus is to nourish the

developing fetus prior to birth.ofcourse as we know uterus may develop conditions with an

unknown cause such as the development of uterine fibroids which causes heavy bleeding.

49 yr old female patient admitted to ward with diagnosis of severe symptomatic anemia

secondary to uterine fibroids with refusal of blood due to religion and other diagnosis such as

hypovolemic shock. This woman was taken over in bed awake in supine position conscious

however not oriented with I.V fluids of 0.9 n/saline infusing, 02 therapy via nasal canula at 3L,

foley catheter on free drainage and bilateral TED stockings insitu. To lower extremities.

Here I shall focus on the condition severe anemia which was secondary to uterine fibroids with

refusal of blood and

Definition of uterine fibroids and anemia

Causes of uterine fibroids and anemia

Symptoms of uterine fibroids and anemia

Diagnostic test for uterine fibroids and anemia

Diagnosis developing due to quadriplegia

Medical and nursing management

Uterine fibroids also referred to as leiomyomas or myomas are noncancerous growths of the

uterus that often appear during childbearing year and develops from the smooth muscular tissue

of the uterus in the uterus a single cell divides repeatedly which creates a firm, rubbery mass

that differentiates from other tissues around the uterus.

Causes The cause of growth of uterine fibroids is not exactly known however

Genetic changes may cause its growth when there are changes in genes that differ from

the normal in the uterine wall and

Hormones such as Estrogen and progesterone. These two hormones are the hormones that

stimulate development of the uterine lining during each menstrual cycle for the

preparation for pregnancy. This however may promote the growth of fibroids.

Heredity.

Race especially blacks.

Symptoms

Most women who suffer from uterine fibroids are usually asymptomatic however it may cause

symptoms such as

Prolonged menstrual periods

Pelvic pressure or pain

Frequent urination

Difficulty emptying the bladder

Constipation

Backache or leg pains

But in most cases abnormal uterine bleeding is the most common symptom of the fibroid. If the

tumors are near the uterine lining, or interfere with the blood flow to the lining, they can cause

heavy periods, painful periods, prolonged periods or spotting between menses.

Additional excessive bleeding due to fibroids may cause severe anemia.

Diagnostic test

Pelvic exam- there are irregularities in the shape of the uterus which may indicate the presence of

fibroids.

Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to

complications such as anemia from heavy blood loss.

Blood is a product providing the body with nutrition, oxygen, and waste removal. The average

person has about 5 liters of blood which is composed of plasma. Plasma contains proteins that

help blood to clot and transport substances through the blood or blood cells such as

Red blood cells, which carry oxygen to the tissuesit has hemoglobin which is a red, iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from

your lungs to all parts of your body and to carry carbon dioxide from other parts of the body to

your lungs so that it can be exhaled.

White blood cells, which fight infections

Platelets, smaller cells that help blood to clot.

Additional excessive bleeding due to fibroids may cause severe anemia.

Anemia occurs when the body does not have enough red blood cells to carry adequate oxygen to

tissues.

Causes

Body unable to make enough red blood cells. excessive bleeding causes the loss of red blood cells more quickly than it can be replaced Destruction of red blood cells

Symptoms

Fatigue

Pale skin

A fast or irregular heartbeat

Shortness of breath

Chest pain

Dizziness

Cognitive problems

Cold hands and feet

Headache

Diagnostic test

Complete blood count(CBC) Physical examination

Blood make up

The following medical and nursing management guided us into proving the most appropriate

care of the patient

Nursing care as is known involves holistic care and such a condition deed indicates a need for

such care. Not only were nurses and doctors involved in the care of the patient but

physiotherapist were involved in some way or another to help bring back the patient as well as

the family to normal living functions.

Medical management Diagnosis: severe symptomatic anemia secondary to uterine fibroids and hypovolemic shock.

TED stocking application to reduce incidence of thromembolism and to recuperate patient.

Patient started on IV fluids of 0.9 n/saline.

Transfuse with 3 units of PRBC when available

Patient has to commence physiotherapy

STAT Prescribed medication.

Recommend dTAH whenHb is 8.0

Nursing management Nursing care of patient involved

Foley catheter on free drainage

Administration of medication as ordered (premarin, irondextran, trihemic.IFA, nov.70/30,

cocodamol, and erythropoietin)

Iron and protein fortified diet

Complete bed rest

Administer IV fluids of 0.9n/saline as ordered.

Assist with activities of daily living such as bathes, eating.

Physiotherapist

Assist with movement of limbs and other activities.

Present medical history

Severe anemia secondary to

uterine fibroids.

Hypovolemic shock

DM

Nursing history

Patient is unable to move lower

extremities.

DM- patient is on sliding scale.

Patients hemoglobin levels are being monitored

two to three times per week

Due to patients religion she is unable to be transfused. Her Hb is being monitored constantly. During the

past few weeks this has been her Hb levels

14/5/14-----2.81gm/Dl

16/5/14-----2.9gm/DL

18/5/14-----3.3gm/DL

22/5/14-----3.3gm/DL

25/5/14-----4.3gm/DL

02/06/14----5.2gm/DL

08/06/14----5.9gm/DL

DIAGNOSTIC TEST

WBC

Name of test: White Blood Count (WBC)

Specimen used: blood

Normal findings: 4.0-10K/ul

Patient findings: 8.6K/ul

Names of test:

hematology( white blood count)

total hemoglobin(Hgb)

Type of specimen used: the blood is used during this test. generally this white blood cell counts

the actual number of WBCs in the blood.

Description of test: WBC's are our body's first line of defense against invading bacteria and

most other harmful organisms. This test (WBC), measures the total number of all types of

WBC's. Further examination of the different types and numbers of cells present, could tell much

about the state of the body's defense system.

This test help investigate a variety of illnesses. An elevated WBC count occurs in infection,

allergy, systemic illness, inflammation, tissue injury, and leukemia. A low WBC count may

occur in some viral infections, immunodeficiency states, and bone marrow failure. The WBC

count provides clues about certain illnesses, and also would enable a physician to monitor a

patient's recovery from others. Abnormal counts which return to normal indicate that the

condition is improving, while those that become more abnormal indicate that the condition is

worsening.

Clinical problems related to each test: This test (WBC), measures the total number of all types

of WBC's. A low WBC count may occur in some viral infections, immunodeficiency states, and

bone marrow failure. White blood cells help to defend the body from foreign orgsnisms,tissues

and other substances. If however the white blood cell count is high then this can say that either

the type of white blood cell is elevated. For e.g. an increased lymphocyte count occurs in

infections such as viral hepatitis, TB ,syphilis etc.

Purpose of each test:

A white blood cell (WBC) count determines the concentration of white blood cells in the

patient's blood and if the patient has a condition known to interfere with and WBC count and

could also tell about the state of the body's defense system.

Effect of medication on test results: herbal medications pose a slight effect on the test.

Procedure for carrying out tests

Nursing implications:

Discomfort or bruising may occur at the puncture site. Pressure to the puncture site until

the bleeding stops reduces bruising; warm packs relieve discomfort.

Some people feel dizzy or faint after blood has been drawn and should be allowed to lie

down and relax until they are stable

RBC

Name of test: Red Blood Cell (RBC)


Normal findings::

males: 4.5 to 6.0 million/cu mm blood

females: 4.0 to 5.5 million/cu mm blood

Patient findings: 5.21

Description of test: The RBC count is useful for determining such problems as anemia and

hemorrhage. In combination with other hematology tests, it can be quite useful for diagnosis.

This test can also give an indirect estimate of the hemoglobin levels in the blood.

RBC's are "Red Blood Corpuscles," (non-nucleated cells). The term corpuscle indicates that it is

a mature Red Blood Cell. Once the immature cell has matured, then, capable of carrying oxygen.

Purpose of the test: Detect a hematological disorder involving RBC destruction (e.g., hemolytic

anemia), Determine the presence of hereditary hematological abnormality, Monitor the effects of

acute or chronic blood loss, Monitor the effects of physical or emotional stress on the patient,

Monitor patients with disorders associated with elevated erythrocyte counts (e.g., polycythemia

Vera, chronic obstructive pulmonary disease [COPD]), Monitor the progression of no

hematological disorders associated with elevated erythrocyte counts, such as COPD, liver

disease,

Clinical problem related to test: hemolytic anemia, polythemiavera, chronic obstructive

pulmonary disease (COPD), liver disease, hypothyroidism, adrenal dysfunction, renal disease,

cancer, bone marrow failure, malabsorption syndromes, folic acid deficiency, vitamin B12

deficiency, iron deficiency.

Effects of medication on RBC:

Drugs that increase RBC level-. Gentamicin, Methyldopa

Drugs that decrease RBC level -Chemotherapy drugs,

Procedure for carrying out test--

observe standard precaution, the site is cleaned antiseptic, health care provider wraps an elastic

band around the arm above site to apply pressure, gently inserts a needle into the vein, blood

collects into an airtight vial or tube attached to the needle,

Nursing diagnoses:

Nutrition less than body requirement related to deficiency of iron required for RBC production

evidence by slight dizziness in client and abnormal test results.


Educate client about RBC and procedure, obtain history of allergy including to latex, tell client

that they may experience dizziness, ensure patient comfort, and reduce patient anxiety.

Fasting blood sugar

Name of test: fasting blood sugar


Normal findings: Adult: 70 110 mg/dL , Child: 30 80 mg/dL , Elderly 70 120 mg/dL

Test type Pregnant mg/Dl Glucose

fasting 105

I hour 190

2 hours 165

3 hours 145

Patient findings:varied

Description of test:measures blood glucose level after patient has fast

Purpose of the test:, To monitor blood glucose levels during pregnancy for diabetic client

Clinical problem related to test: hyperglycemia, hypoglycemia, diabetes mellitus,

Effects of medication on fasting blood sugar:

Drugs that increase fasting blood sugar level- prednisone, dexamethasone, Thiazide diuretics,

Drugs that decrease fasting blood sugar level- insulin, beta blockers

Test procedure: NPO except for water for 12 hrs, Collect a small sample of blood, with a prick

to the finger, apply to test strip and read result

Nursing diagnosis: knowledge deficit related to therapeutic regimen during pregnancy.

Nursing implication:, Explain the purpose and procedure to the client, monitor glucose level, ,

Recognize clinical problems associated with low blood sugar level. Skipped meals and

inadequate food intake are common causes of hypoglycemia, Observe for signs and symptoms of

hypoglycemia (nervousness, weakness, confusion, cold and clammy skin, diaphoresis, and

increased pulse rate), Recognize clinical problems associated with elevated sugar level.

Ensure to inform the patient to maintain a well balanced diet during pregnancy and post

pregnancy.

Ptt

Name of test: Partial thromboplastin time


Normal findings: 25- 35 seconds, may vary with different laboratories

Patient findings:

Description of test: Partial thromboplastin time (PTT) is a blood test identify at how long it

takes for blood to clot It can help tell if you have bleeding or clotting problems.

Purpose of the test: to determine bleeding or clotting problems,

Clinical problem related to test:Hemophilia A, Hypofibrinogenemia, Liver disease, Lupus,

Vitamin K deficiency,

Medication that affects Partial thromboplastin time: antihistamines, vitamin C (ascorbic

acid), aspirin, and chlorpromazine

Test procedure: observe standard precaution, the site is cleaned antiseptic, health care provider

wraps an elastic band around the arm above site to apply pressure, gently inserts a needle into the

vein, blood collects into an airtight vial or tube attached to the needle, the elastic band is

removed, once the blood has been collected, the needle is removed, and the puncture site is

covered with gauze and pressure is applied to stop any bleeding.

Nursing diagnosis: risk for hemorrhaging related to venipuncture

Nursing implication: obtain history of allergies including to latex, educate client on Partial

thromboplastin time and it procedure, tell client that they may experience dizziness, monitor

client vital signs, intake and output, weight and skin turgor.

Cbc

Name of test: Blood volume/ plasma volume test

Type of specimen used: 5Ml of venous blood in a blue top tube.

Normal values or reference values:

Individual

Refrence values

Total blood volume

55-80Ml/kg

Red cell volume

25-35ml/kg(male),20-30mL/kg(female)

Plasma volume

32-46mL/kg(male),30-45ml/kg(female)

Description of test:

A blood volume test (also called a plasma volume test or a red cell mass test) is a nuclear lab

procedure used to measure the volume (amount) of blood in the body. The test also measures the

volume of plasma and of red cells in the blood. This test enables one to monitor blood loss

during surgery, hypotension, determining the blood component lost for replacement therapy and

evaluating uterine bleed.

An IV (intravenous) line will be placed in a vein in your arm. The IV is used to take blood

samples for blood tests ordered by your doctor, and to inject the radioactive isotope and tagging

agent. If necessary, medications are delivered through the IV during the test.

Purpose of blood volume test

To monitor blood loss during surgery.

To evaluate for GI or uterine bleed.

To monitor blood loss during surgery.

The blood volume test results help your doctor determine the cause of symptoms, abnormal

laboratory results or certain circulation disorders.

Abnormal results:

An elevated volume may indicate dehydration which may indicate RBC volume or over

hydration.

Decreased volume: dehydration, hypovloemic shock, hemorrhaging.

Clinical problems related to the test

. Hypovolemia (low blood volume)

Hypervolemia (high blood volume)

Anemia (low red cell volume)

Polycythemia (high red cell volume

A blood volume test also helps in the evaluation and treatment of these conditions:

Orthostatic hypotension (low blood pressure while upright)

Hypertension (high blood pressure)

Heart failure (decreased pumping power of the heart)

Shock

Medical conditions associated with acute blood loss

Effect of medication on test:

Do not take diuretics or laxatives before the test.

Procedure for carrying out test:

Obtain the weight and heights of the client there after obtain a venous blood sample using a blue

top tube.

Mix the blood sample with a radioisotope. When 15-30 minutes has lapsed blood containing rthe

radioactive isotope is reinserted into the client

Another blood sample is retrieved 15 minutes later.

Nursing diagnoses

Risk for injury related to thrombolytic therapy evidence by

Altered tissue perfusion related to acute myocardial infarction


Monitor vital signs

Assess for bleeding tendencies, tachycardia and hypotension.

Platelet count

NAME OF TEST: PLATELET COUNT

TYPE OF SPCIMEN USED: collect3-5 ml of venous blood in a lavender top tube.

Normal values:

Individual Values

Adult 150,000-400,000l

Child(Premature) 100,000-300,000l

Newborn 150,000-300,00l

Infant 200,00-475,000l

Patient findings:

Description of test: Platelets are tiny cell fragments that are normally produced in the bone

marrow and circulate in the blood. When the interior wall of a blood vessel is injured, platelets

aggregate at the site and release chemicals that cause blood to clot, thus sealing off any leak.

A platelet count is used to detect a low or high number of platelets in the blood.

Purpose of test: to check the platelet count

To monitor platelet count during cancer chemotherapy

Clinical problems: decreased level: idiopathic thrombocytopenic purpura, myeloma, anemias,

liver disease,

Drug influences: aspirin, antibiotics

Elevated level: trauma, acute blood loss, pulmonary embolism.

Procedure: cleanse sight for injection and wrap elastic band around arm

Collect -t3-5 ml of venous blood in a lavender top tube.

Nursing diagnoses:

Anxiety related to hemorrhage secondary to an acute health problem like cancer

Nursing implications: explain to the client that the purpose of blood test is to determine the

platelet count

Observe for signs of bleeding and record findings on char.

Monitor platelet count.

Drug cards

Trihemic

Brand name: Trihemic

Generic name: multivitamin with iron

Drug class: multivitamin

Indications:

shigellosis

Bronchitis, chronic, acute exacerbation

Diarrhea, infectious

Infection, ear, middle

Infection, lower respiratory tract

Infection, urinary tract

Contraindications:

Drug interactions: avoid combinations of these

Simvastatin, phenytoin, erythromycin

Adverse reactions:

bright red blood in your stools; or

Pain in your chest or throat when swallowing a ferrous fumarate tablet

constipation, diarrhea;

nausea, vomiting, heartburn;

stomach pain, upset stomach;

black or dark-colored stools or urine;

Dosage: Infants 2 months of age and over- Infants and children up to 40 kg of body weight-Oral,

20 to 30 mg of sulfamethoxazol.

Adult dose: Antibacterial (systemic) - Oral, 800 mg of sulfamethoxazole

Teaching considerations:

Avoid taking any other multivitamin product within 2 hours before or after you take

multivitamin with iron.

Take your multivitamin with a full glass of water.

You may take the multivitamin with food if it upsets your stomach.

The chewable tablet must be chewed or allowed to dissolve in the mouth before swallowing.

Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole

(trihemic)

Bibliography:

http://www.drugs.com/mtm/trihemic-600.html#ewBrBxbT5yiDAqL1.99

Tylenol

Brand name: Tylenol

Generic name: acetaminophen

Drug class: non-opioid analgesic

Indications: pain reliever and fever reducer

Drug interactions:

an antibiotic, antifungal medicine, sulfa drug, or tuberculosis medicine;

birth control pills or hormone replacement therapy;

blood pressure medication;

cancer medications;

Adverse reactions:

Nausea, upper stomach pain, itching, loss of appetite;

dark urine, clay-colored stools; or

jaundice (yellowing of the skin or eyes).

Dosage:

For adults and children 12 years of age and older, the recommended dose of acetaminophen is

650 to 1000 mg every 4 to 6 hours as needed

For children under 12 years of age, the recommended dose of acetaminophen is 10 to 15 mg/kg

every 4 to 6 hours

Teaching considerations:

Do not take more Tylenol than is recommended. An overdose can damage your liver or cause

death.

The chewable tablet must be chewed thoroughly before you swallow it.

Do not use with alcohol

Notify prescriber of pain, fever lasting over three days

Bibliography:

http://www.rxlist.com/tylenol-drug.htm

Skidmore-Roth L. nursing drug reference 22nd edition 2009 Mosby Elsevier

0.9 % Sodium Chloride

Brand name: sodium chloride

Drug class:

Indications: used as a source of water and electrolytes and also and also indicated for use as a

priming solution in hemodialysis procedures.

replace lost body fluids and salts

dilute other medicines, which may be given by injection or drip

act as a sterile liquid for washing wounds, nasal passages, or during surgery.

Actions: used as a source of water and electrolytes in the body and capable of inducing dieresis

in a patient.

Contraindications: unknown

Drug interactions: Caution must be exercised in the administration

of Sodium Chloride Injection, USP to patients receiving corticosteroids.

Adverse reactions: febrile response, infection at site of injection, venous thrombosis or phlebitis

extending from site of injection, hypervolemia.

Dosage: As directed by a physician. Dosage is dependent upon the age, weight and clinical

condition of the patient as well as laboratory determinations.

Teaching considerations: If you feel light headed or faint when getting out of bed or standing

up, get up slowly--- Stand up slowly, especially when you get up from a bed or a chair.

Bibliography: http://www.nps.org.au/medicines/nutrition/electrolytes-oral-and-injectable/sodium-

chloride-electrolytes-oral-and-injectable/sodium-chloride.

Premarin

Brand name: PREMARIN

Generic name:

Drug class: estrogen, hormone

Indications: treatment of symptoms of menopause, abnormal uterine bleed, prevention of

osteoporosis, primary ovarian failure.

Treatment of moderate to severe symptoms of vulvar and vaginal atrophy due to menopause

Actions: needed for functioning of the female reproductive system and inhibits ovulation

Contraindications: pregnancy, thromboembolic disorders, reproductive cancer, breastfeeding,

hypersensitivity.

Drug interactions:

Adverse reactions: chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea,

sweating, general ill feeling; sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance; pain

OR signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips,

tongue, or throat.

Dosage: for menopause give0.3-1.25mg/day PO,

Prevention of osteoporosis: 0.625 mg /day.

Nursing actions: assess blood glucose if diabetic since hyperglycemia may occur.

Weigh patient daily.

Assess patients intake and output. Assess patients mental status. Take with food or milk to decrease GI symptoms. Teaching considerations: avoid breastfeeding since product is excreted in milk. Avoid sunlight or wear

sunscreen since burns may occur. Weigh weekly

Novolin N

Trade names: NPG, Humulin-N, Novolin-N

Generic name; Intermediate Insulin

Classification: Antidiabetic

Action: works by lowering levels of glucose (sugar) in the blood by transporting this glucose

into cells

Indications; DM Type 1 and 2, gestational diabetes

Contraindications: Hypoglycemia, severe renal impairment and hypersensitivity

Dosages: Sliding Scale SUBCUT given within 15 mins before or 20 mins. After a meal

Availability: regular insulin soluble 100 IU/mL 10 mL vial

Adverse effects: Hypoglycemia, urticaria, itching, redness, swelling, anaphylaxis, blurred

vision, swelling and redness

Nursing. Implementation: assess blood sugar

Ensure to warm to room temperature by rotating in palms to prevent injecting cold insulin.

Choose a different place in skin area each time you inject this medication. Do not inject into the

same place two times in a row. Use each disposable needle only one time. Throw away used

needles in a puncture-proof container.

Family/ client teaching: Do not change the brand of insulin or syringe you are using without

first talking to your doctor or pharmacist. Avoid drinking alcohol. Your blood sugar may become

dangerously low if you drink alcohol while using insulin.

Blurred vision may occur

Inform patient that this product does not cure diabetes but controls its symptoms

Ifa

Classification: Ant anemic, iron

Generic name: FERROUS SULFATE

Trade names: Feosul, Fer-Gen-Sol, Fer-in-Sol, FeroSul DRIED: Feosol, Feratab, Slow FE,

Slow Release Iron, Ifa

Action: Normal daily intake males 12-20 mg; females 8-15 mg; only 10% absorbed; Iron

absorbed by from duodenum and upper jejunum by active mechanism thru mucosal cells,

combines with transferring; iron stored as hemosiderin or aggregated ferritin reticuloendothelial

cells of liver, spleen, bone marrow; 2/3 of iron in circulating RBCs

Indications: Prophylaxis, treatment of iron deficiency and iron-deficiency anemias; dietary

supplement for iron.

Contraindications: Hemosiderosis, Hemochromatosis, peptic ulcer, regional enteritis, ulcerative

colitis, hemolytic anemia, pyridoxine-responsive anemia, liver cirrhosis

INTERACTIONS : GI absorption of iron: oral antacids, calcium salts, cholestyramine,

cimetidine, histamine H-2 receptor antagonists, pancreatic extracts, proton pump inhibitors,

vitamin E, St. Johns wort; GI absorption of iron: ascorbic acid, chloramphenicol; Thyroid

hormone and trientine: DO NOT USE TOGETHER

Contraindications: Hemosiderosis, Hemochromatosis, peptic ulcer, regional enteritis, ulcerative

colitis, hemolytic anemia, pyridoxine-responsive anemia, liver cirrhosis

Availability: Drops, Elixir, Tablets, Slow-Release Tablets

Dosages: Anemia prophylaxis: Adults 300 mg/day; peds 5 mg/kg/day

Anemia: 300 mg twice a day increased to 4 times a day as needed/tolerated

Peds: 10 mg/kg/day DRIED: Anemia Prophylaxis: Adults 200 mg/day; peds 5 mg/kg/day

Anemia: 200 mg 3 times a day up to 200 mg 4 times a day as needed/tolerated10 mg/kg 3 times

daily

Slow release tablets: Adults 160 mg 1-2 times per day: NOT for children

Adverse effects: Constipation, gastric irritation, nausea, abdominal cramps, anorexia, diarrhea,

dark-colored stools

Nursing. Implementation: Substitution of one iron salt for another without proper adjustment

may result in serious over or under dosing; Eggs, milk, coffee or tea may significantly inhibit

iron absorption; Ingestion of calcium and iron supplements can decrease iron absorption by 1/3;

Iron absorption is not decreased if calcium bicarbonate used between meals. Do not crush, chew

tablets. Give liquid preparations through plastic straw to avoid discoloration of tooth enamel;

dilute thoroughly. Give at least 1 hour before bedtime because corrosion may occur in stomach

Family /client teaching: do not take with tea or milk

Take with citrus fruit juice if not contraindicated

Remind patient that poisoning may occur if increased beyond recommended level

.

Dextran

Generic name: iron dectran

Trade names: DexF, Erum, Infed

Drug class: hematinic

Action: a form of mineral iron which helps in the transport of oxygen in the blood.

Indications: Iron dextran is used to treat iron deficiencies and iron deficiency anemia.

Contraindications: hypersensitivity, all anaemias excluding iron deficiency anemia,

hepatic disease.

INTERACTIONS: increase toxicity levels when using oral iron, false elevated levels of serum

bilirubin.

Dosages: test dose for adult and child: IM 0.5ml via Z-track.

Adult 50 kg IM 250mg

Child

Aided passive range of motion exercises

Maintenance of hydration

Taking daily medication since see cannot be transfused

Aided passive range of motion exercises

Plan of care:

Demonstrate techniques that enable resumption

Of activities -independence

Maintain stimulating environment for patient such

As-engaging in positive conversation,

providing music and encouraging visits from family and friends

Instruct patient on how to perform passive range of motion

exercises-this helps to increase blood flow

to muscles and bone hence improving muscle tone

Assist with self care activities-this helps to

Improve circulation and muscle strength.

Physical function and independence

Physical function is ones own physical ability to their present level of injury. This client has

been on bed rest and has been dependent

Patient was assessed for level of immobility to lower extremties

Pain levels was assessed before initiating aided passive range of motion exercises

Assess also energy expenditure

Aiaed passive range of motion exercises were performed along with self care needs such as

bathing, oral care, and nutrition care,pressure care including.

Assist with/encourage self-care activities (e.g., bathing, this helps to improve circulation and

muscle strength.

Weight control and nutrition

This patient is for iron and protein fortified diet

Provide diet high in proteins, . Since there is reduced functioning of lower extremities,

nutrients required for healing become less which sometimes may cause weight loss. There

may also be the incidence of constipation.

Fluid increase was encouraged to help keep body well hydrated and reduce incidence of

constipation and possible urinary tract infection.

When ones activity level declines especially now that she is on bed rest, rest is unable to

move lower extremities and complains of pain. They gain wieght,this decreases the amount

of calories that is burnt

A high iron and protein fortified diet was recommended for patient

Drink adequate fluid to help prevent constipation as well.

Protein

One needs more protein to help with the tissue repair and healing process because pressure sores may develop due to continuous bed rest.

Maintenance of hydration

Physician recommended that patient drinks at least 100ml of water daily.

Fruits and vegetables also are high in water content

Iron and protein fortified diet Getting enough protein and iron can help you maintain lean muscle mass, prevent anemia and

symptoms of fatigue and support a healthy immune system

Patient may includes these in diet when discharged for home.

To increase iron absorption it is important to eat foods rich in vitamin c such as dark green leafy

vegetables and citrus.

Protein rich foods

Protein foods are needed to build and repair the tissues of the body.

Administration of medication as ordered

Patients diagnosis is severe anemia secondary to uterine fibroids, there has been significant

bleeding. Since patients religion does not permit her to be transfused with PRBC the following

medications has been prescribed for daily administration.

Trihemic

Oral iron tabs(IFA)

Premarin

Erythropoietin

Dextran

Bibliography

http://www.medicinet.com/medication/focus.htm

Free medical information drug in focus.com

http://.rxlist.com/drug/alpha a.htm

Otto J.H, Jillian C. J, Edward J, Nassif J.Z 1980, modern health (ED 1) city of publication:

Holt, rhinehart and Winston.

Tabers cyclopedic medical dictionary ed.21

Ackley B.J ,Ladwig G.B nursing diagnoses hand book a guide to planning care.(7) Mosby

OECS medicine formulary ed.(7)

Black J.M, Hawks J.H medical surgical nursing clinical management for positive

outcomes ed.(8) Saunders

www.mayoclinic.com

www.youtube.com

Documents

uterine fibroids Case Study