Medical-surgical Nursing Demystified

(^182) Medical-Surgical Nursing Demystified
HALLMARK SIGNS AND SYMPTOMS

• Weakness due to anemia and tissue hypoxia


• Pallor due to decreased amount of oxygen getting to surface tissues


• Fatigue due to anemia and hypoxemia


• Koilonychia—thin, concave nails raised at edges, also called spoon nails


• Tachycardia and tachypnea on exertion due to increased demand for oxygen

INTERPRETING TEST RESULTS

• Decrease in serum hemoglobin as fewer RBCs are made.


• Serum ferritin is low.


• Mean corpuscular volume (MCV) initially normal, then low—microcytic
  anemia.


• Mean corpuscular hemoglobin (MCH) initially normal, then low—hypo-
  chromic anemia.


• Serum iron level is low.


• Serum iron-binding capacity is increased.


• Transferrin saturation decreases.


• Peripheral blood smear shows poikilocytosis (red blood cells of different
  shapes).


• Platelet count may increase.

TREATMENT

Iron replacement therapy is continued to correct the deficiency and replace the lost

stores of iron in the body. The typical timeframe for oral therapy is to continue for

3 to 6 months after the anemia has been corrected. There have been documented

incidents of anaphylactic reactions to iron dextran. Patients new to this treatment

typically have a smaller test dose initially, prior to the initiation of treatments.

• Administer iron to replace what has been lost to return stores to normal levels:
  
  
  • Oral replacement in split doses (three times a day):
    
    
    • ferrous sulfate
    
    
    • ferrous gluconate
    
    
    • ferrous fumarate