2420 Final Blueprint Iron deficiency anemia (Nursing interventions and Teaching) Therapeutic Management (1) Dietary addition of iron-rich foods is usually inadequate as the sole treatment of iron deficiency anemia because the iron is poorly absorbed and thus provides insufficient supplemental quantities of iron. If dietary sources of iron cannot replace body stores, oral iron supplements are prescribed for approximately 3 months (2) Ferrous iron, more readily absorbed than ferric iron, results in higher Hgb levels. (3) Ascorbic Acid (Vitamin C) appears to facilitate absorption of iron and may be given as vitamin C–enriched foods and juices with the iron preparation. (4) If the Hgb level fails to rise after 1 month of oral therapy, it is important to assess for persistent bleeding, iron malabsorption, noncompliance, improper iron administration, or other causes of the anemia (5) Prognosis for a child with this condition is very good Formula-Fed Infants: iron are iron-fortified commercial formula and iron-fortified infant cereal. not associated with an increased incidence of gastrointestinal (GI) symptoms, such as colic, diarrhea, or constipation Infants Younger Than 12 months : should not be given fresh cow's milk because it may increase the risk for GI blood loss occurring from exposure to a heat-labile protein in cow's milk or cow's milk–induced GI mucosal damage resulting from a lack of cytochrome iron (heme protein) If GI bleeding is suspected, the child's stool should be guaiac tested on at least four or five occasions to identify any intermittent blood loss. Parenteral (IV or intramuscular [IM]) iron administration is safe and effective but PAINFUL, expensive, and occasionally associated with regional lymphadenopathy, transient arthralgias, or serious allergic reaction Parenteral iron is reserved for children who have iron malabsorption or chronic hemoglobinuria. Transfusions for Anemia- are indicated for the most severe anemia and in cases of serious infection, cardiac dysfunction, or surgical emergency when anesthesia is required. Packed RBCs (2-3 mL/kg), not whole blood, are used to minimize the chance of circulatory overload. Supplemental oxygen is administered when tissue hypoxia is severe. Care Management of Iron Deficiency Anemia Oral iron should be given as prescribed in two divided doses between meals, when the presence of free hydrochloric acid is greatest, because more iron is absorbed in the acidic environment of the upper GI tract. A citrus fruit or juice taken with the medication aids in absorption. Oral iron turns the stools a tarry green color Absence of the greenish black stool may be a clue to poor administration of iron, either in schedule or in dosage. Vomiting or diarrhea can occur with iron therapy (The iron can be given with meals and the dosage reduced and then gradually increased until tolerated) Parenteral Iron- injected deeply into a large muscle mass using the Z-track method.
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