Anemia in pregnancy

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 6*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: / ,

i

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*:<t hout I had scms abdonri

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

{ 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)

21

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.

F Wl

(

&E

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

€,

t €

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}

I

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$

6