[Solved]: 1 Case21 Anemia in Pregnancy Objectives After…

1 Case21 Anemia in Pregnancy Objectives After completing this case, the student will be able to: 6. Develop a nutrition care plan-with appro- priate measurable goals, interventions, and strategies for monitoringand evaluation- that addresses thenutrition diagnoses for this case. 1. 2. 3. 4. 5. Describe the physiological changes in pregnancy and apply those principles for the nutrition care process. Define the pathophysiology ofiron- deficiency anemia. Evaluate the signs and symptoms consistent with iron-deficiency anemia. Evaluate a pregnant woman’s dietary intake for adequacy, and make recommenda- tions for enhancing dietary iron intake and absorption. Identify risks of anemia for maternal and fetal health outcomes. Amber Morris, a31-year-old pregnant woman, is admitted through the ER after falling on the ice. She is admitted to rule out premature labor, but because of her low hemoglobin levels, a complete hematological workup is completed. She si diagnosed withhypochromic, microcytic, anemia. 241 242 Unit Eight NutritionTherapy for Hematological Disorders Morris, Amber, Female, 31 y.o. Allergies: NKA Code: FULL Pt. Location: 732 Physician: F. Bowman Isolation: None Admit Date: 1/17 Patient Summary: Amber Morris is a 31-year-old pregnant woman, gravida 3, para 2, who pre- sented to the ER in her 23rd week of gestation. She has experienced vaginal spotting and some abdominal pain. She is now admitted for observation and to rule out premature labor secondary to h e r fall. History: Onset of disease: Mrs. Morris is a 31-year-old pregnant woman, gravida 3, para 2, who presented to the ER in her 23rd week of gestation. She has experienced vaginal spotting and some abdomi- nal pain. She is now admitted for observation and to rule out premature labor secondary to her fall. Patient states that she is much more tired with this pregnancybut has attributed it to having two small children. She also describes being short of breath, which she experienced with other preg- nancies, but it has started earlier with this pregnancy. Medical history: Two previous pregnancies delivered at 38 and 37 weeks, respectively. No other contributory history Surgical history: s/p appendectomy age 12; cesarean section-18 months previously Medications at home: Prenatal vitamins – Tobacco use: Yes–but trying to cut back; 1-2 cigarettes/day Alcohol use: None Family history: Mother–type 2 diabetes; father–hypertension, CAD Demographics: Marital status: Married Years education: 13 Lanquage: English only Occupation: Stay-at-home mom Hours of work: N/A Household members: Husband– a g e 31; sons aged 12 months and 3 years Ethnicity: Caucasian Religious affiliation: Methodist Admitting History/Physical: Chief complaint: “I went out to get the mail and slipped on the ice. After Igot back in Inoticed a small amount of bleeding when Iwent to the bathroom. Over the next hour, I had some abdomi pain. Icalled my doctor and the office said Ishould come here to be checked out.” General appearance:31-year-old pregnant female, pale, in no acute distress Vital Signs: Temp: 98.6 BP: 118/72 Pulse: 88 Height: 5’5″ Beso rate: 19 Weight: 142 lbs ‘Prepregnancy wei 135 Ibs Heart: RRR, heart sounds normal ) Morris, Amber, Female, 31 y.o. Allergies: NKA Pt. Location: 732 Code: FULL Physician: F. Bowman Isolation: None Admit Date 1/17 : HEENT: Head: WNL Eyes: Sclera pale, PEERLA, fundi without lesions Ears: Clear Nose: Clear Throat: Pharynx clear without postnasal drainage Genitalia: Normal Neurologic: Alert and oriented Extremities: No edema, DTR 2+ and symmetrical throughout Skin: Pale, warm and dry Chest/lungs: Clear to auscultation and percussion Peripheral vascular: Diminished pulses bilaterally Abdomen:Bowel soundsX 4 NursingAssessment Abdominal appearance (concave, flat, rounded, obese, distended) 1/17 rounded with pregnancy Palpation of abdomen (soft, rigid, firm, masses, tense) soft Bowel function (continent, incontinent, flatulence, no stool) continent Bowel sounds (P=present, AB=absent, hypo, hyper) RUO p’ LUO RLO P LLO P Stool color none Stool consistency Tubes/ostomies NA Genitourinarv Urinary continence Urine source Appearance (clear, cloudy, yellow, amber, fluorescent, hematuria, orange, blue, tea) Integumentary Skin color Skin temperature (DI=diaphoretic, W=warm, dry, CL=cool, CLM=clammy, CD+=cold, M=moist, H=hot) Skin turgor (good, fair, poor, TENT=tenting) yes clean catch clear, yellow Case 21 Anemia inPregnancy 243 pale W good (Continued) C. Alergies: nukie, Femael, 13 yo. Pt. Location: 732 Code: FULL Physician: E. Bowman Isolation: None Admit Date: 1/17 Usualdietary intake: AM: Coffee, cold cereal, occasionally toast Lunch: Sandwich or soup Dinner: Casserole such as Hamburger Helper, hot dogs, soup; sometimes she cooks a full meal with meat and vegetables. Her husband works nights so she doesn’t always cook except on his days off. 24-hour-recall(PTA): AM: Lunch: Dinner: 2 c Frosted Flakes, 1⁄2 c whole milk, black coffee Hot dog on bun, 1