Iron deficiency anemia (IDA) is a medical condition wherein there is insufficient supply of iron in the patient’s blood. Iron is an essential micronutrient needed by the body in the production of red blood cells (i.e., erythrocytes).
Without enough red blood cell count, the oxygen-carrying capacity of the blood via the erythrocytes is reduced and may lead to the development of hypoxemia (i.e., low oxygen levels in the blood), even hypoxia.
Because of this, having adequate iron reserves in the body is crucial to maintain normal physiologic processes. In iron deficiency anemia, the lack of iron reserves will reduce the production of erythrocytes that will likewise affect oxygen levels in the body. Iron deficiency anemia may manifest as tiredness and having shortness of breath to the patient.
Although this type is a relatively common form of anemia, many patients will not recognize that they have the condition unless they are tested.
Signs and Symptoms of Iron Deficiency Anemia
As with other anemias, clinical manifestations of iron deficiency anemia are somewhat similar to the rest of the anemias. However, iron deficiency anemia can start mildly and will only manifest as the deficiency worsens. These are the following signs:
- Extreme fatigue
- Weakness
- Pale skin
- Cardiovascular issues (i.e., chest pain, tachycardia)
- Shortness of breath
- Headache, sometimes with associated dizziness
- Cold hands and feet
- Noted inflammation or swelling of the tongue
- Brittle nails
- Presence of pica (i.e., unusual cravings for non-food or non-nutritious substances such as ice, dirt, etc.)
- Poor appetite, particularly for infants and children
Causes of Iron Deficiency Anemia
As explained earlier, having enough iron reserves and supply is crucial for the physiologic process of the body. If the patient is experiencing any iron losses or is not consuming adequate iron, hemoglobin production is altered that will result in iron deficiency anemia.
Below are some of the causes of this kind of anemia.
- Blood loss. Blood includes numerous components, some of which are erythrocytes that contain some of the iron supply in the body. Following this, losing blood will also reduce the iron levels in the body. Some women who experience heavy menstruation episodes are typically at risk in developing iron deficiency anemia due to the associated blood loss. In the event of chronic blood loss, such as peptic ulcer disease, hiatal hernia, colorectal cancer, etc., will eventually lead to iron deficiency anemia. Over utilization of some over-the-counter drugs such as aspirin, may lead to adverse effects such as gastrointestinal bleeding.
- Lack of iron supplementation. The body primarily would need regular supply of iron, preferably and normally through iron-rich foods in the diet. If the patient will only consume small amounts of iron, naturally it will lead to iron deficiency anemia. Iron-rich foods such as meat, eggs, and green leafy vegetables are necessary to promote good iron supply for the body. Infants and children would also need adequate iron supplementation through their diet to promote proper development and growth.
- Inability to absorb iron. The iron present in food is absorbed by the body through the small intestines. Any encountered issues of the small intestine will likely lead to malabsorption of nutrients, including iron. Intestinal disorders, such as celiac disease, can affect the body’s ability to properly absorb iron that can lead to iron deficiency anemia. In instances wherein a part of the small intestines is needed to be removed (e.g., via surgery due to cancer), iron deficiency anemia is guaranteed to develop.
- Pregnancy. Iron supplementation in pregnant mothers is needed due to the growing fetus in the womb. During pregnancy, the primary supply of the fetus’s iron and nutrient supply would be from the mother. Inadequately addressing the supplementation needs may lead to iron deficiency anemia and delayed or abnormal growth and development of the fetus.
Risk Factors to Iron Deficiency Anemia
Risk factors for the development of iron deficiency anemia varies. However, certain population have elevated risks in its development. The following are listed below:
- Women. Because women experience blood loss during menstruation, they are generally more prone to develop iron deficiency anemia.
- Infants and children. Infants, especially those who were born prematurely or who had low birth weights are at risk for iron deficiency anemia due to their inability get enough iron via the breast milk or milk formula. In children, they would be at risk due to varied diet and the inability to follow through with eating the proper diet for growth and development. This is further compounded by the child’s growth spurts wherein proper nutrition is needed.
- Vegetarians. People who have restricted diets and those who don’t eat meat and meat products are at greater risk for iron deficiency anemia due to low consumption.
- Frequent blood donors. People who frequently donate blood are more prone to develop iron deficiency anemia since blood donation reduces blood and iron stores. Low hemoglobin due to blood donation maybe temporary and would only need iron supplementation through proper diet.
Complications of Iron Deficiency Anemia
Some cases of mild iron deficiency anemia would not always develop to unusual or life-threatening complications. However, untreated iron deficiency anemia may become serious that may lead to various health issues such as:
- Heart problems. Iron deficiency anemia can lead to life threatening arrhythmias. This happens when the heart is compelled to pump more blood as a form of compensatory mechanism for the deficient oxygen supply in the body. Because of this, the heart is in constant stress, consequently enlarging the heart muscles. If left untreated, it can lead to heart failure wherein the heart has already reached its optimal performance and its functions are already in decline.
- Problems during pregnancy. Cases of severe maternal iron deficiency anemia have been associated with prematurity and low birth weights of babies. However, it is preventable through the adequate iron supplementation to the mother as part of their care.
- Growth problems. Growth problems are prevalent to infants and children with severe iron deficiency anemia. There have been associated developmental delays to patients with inadequate iron supply. In addition, having depressed iron levels also predisposes a patient to various infections.
Diagnosis of Iron Deficiency Anemia
Diagnosing iron deficiency anemia would include different methods, some of which are:
- Medical and family history. A thoroughclinical assessment of the patient’s history would yield significant data that will be beneficial in formulating the patient’s care plan.
- Comprehensive physical assessment. The healthcare worker facilitating a comprehensive physical assessment is beneficial for establishing the patient’s diagnosis and treatment plan.
- Complete blood count. The CBC is a laboratory test designed to evaluate the components of the patient’s blood. Some results of the CBC are deemed necessary for evaluation to correctly diagnose the iron deficiency anemia. Listed below are the focus elements of the CBC:
- Red blood cell size and color – It is known that patients with iron deficiency anemia have smaller erythrocytes and are paler in color than usual.
- Hematocrit – Hematocrit levels is the percent concentration of erythrocytes. The normal values are 35.5 to 44.9 for women and 38.3 to 48.6 for men and will vary depending on the age group.
- Hemoglobin – The normal range for hemoglobin is 13.2 to 16.6 g/dL for men and 11.6 to 15 g/dL for women. Any results below these ranges would be suggestive of anemia.
- Ferritin – Ferritin is a specialized protein that helps with iron storage. Low ferritin levels would indicate low iron levels.
- Endoscopy. Endoscopy may be utilized by the healthcare team to assess for bleeding in the gastrointestinal tract starting from the mouth. This procedure utilizes a thin, flexible tube and is inserted first through the mouth down through the stomach and intestines.
- Colonoscopy. Colonoscopy is done to rule out bleeding in the lower intestinal regions, such as the colon and rectum. This procedure utilizes a thin, flexible tube and is inserted first through the anus until reaching the colon.
- Ultrasound. Patients with excessive menstrual bleeding may undergo this procedure to assess the pelvic structures to look for sources of bleeding.
Treatment for Iron Deficiency Anemia
Treating iron deficiency includes a variety of methods, some of which are:
- Iron supplements. The physician will prescribe over-the-counter forms of iron supplements (e.g., iron tablets) and the corresponding dosages applicable for the patient. This will ensure that iron reserves are replenished in the patient’s body. However, there are certain considerations that must be followed by the patient when taking iron supplements.
- Take on an empty stomach. It is suggested medically to take iron tablets on an empty stomach for better absorption. However, iron tablets may cause stomach upset to some patients. In this case, iron tablets may be taken with meals.
- Avoid combining iron with antacids. Certain medications, such as antacids, may interfere with the absorption of iron in the gut. If this cannot be prevented, the nurse should advise the patient to take iron tablets two hours before or four hours after the antacid dose is taken.
- Include vitamin C when taking iron. Iron absorption is improved if taken together with vitamin C. Advise the patient to take iron tablets with drinks high in vitamin C such as orange juice.
- Treating the underlying cause. If iron levels are not corrected despite supplementation, further evaluation will be done by the healthcare provider by looking for reasons of bleeding. This may involve the following instances.
- The use of oral contraceptives may be given to women to alleviate heavy menstruation episodes.
- In the case of peptic ulcers, the patient may be given antibiotics and other medications to address the condition.
- If the cause of the anemia are bleeding tumors or polyps, surgery may be done to address the condition.
- If the anemia is serious, iron supplementation via the intravenous route or blood transfusions will be ordered for the patient.
Nursing Diagnosis for Iron Deficiency Anemia
Nursing Care Plan for Iron Deficiency Anemia 1
Nursing Diagnosis: Risk for Bleeding related to abnormal RBC production and decreased hemoglobin count secondary to iron deficiency anemia.
Desired Outcomes:
- The patient will be able to reduce the risk of bleeding as evidenced by the normal and appropriate hemoglobin levels.
- The patient will be able to have normal platelet levels as evidenced by the absence of bleeding, bruises, and petechiae.
| Nursing Interventions for Iron Deficiency Anemia | Rationale |
| 1. Check the patient’s skin for bruising, petechiae, or any signs of bleeding from the nose, mouth, vaginal area, gastrointestinal or urinary tract. | Iron deficiency anemia may cause bleeding in the patient due to the decreased level of platelet count. Early diagnosis is important to plan prompt treatment that will help in decreasing the risk of iron deficiency anemia. |
| 2. Monitor and evaluate the patient’s complete blood count levels. | The nurse needs to closely monitor the patient’s blood count, especially those with critically low hemoglobin, hematocrit, and platelet levels. Monitoring the blood levels helps the nurse review the patient’s overall health. |
| 3. Consolidate the patient’s blood laboratory tests. | Consolidation of the blood tests may help in decreasing venipunctures and anemia may happen because of repeated sampling over time. |
| 4. Check the patient’s stool and urine for the presence of occult blood. | It is important to monitor for the presence of occult blood in the urine and the stool to identify the presence and site of bleeding. |
| 5. Advise the patient about the bleeding precautions and instruct him or her to report any signs of bleeding. Bleeding precautions that should be advised to the patient include: Avoid using electric shavers.Use a soft-bristled toothbrush when he or she is brushing his or her teeth. | To reduce the risk for bleeding while doing activities of daily living (ADLs). |
Nursing Care Plan for Iron Deficiency Anemia 2
Nursing Diagnosis: Risk for Infection related to the decrease in the internal defenses of the body and bone marrow malfunctioning secondary to iron deficiency anemia.
Desired Outcomes:
- The patient will be able to show a decreased risk of infection as evidenced by normal temperature, normal vital signs, and normal white blood cell count.
- The patient will verbalize and demonstrate proper handwashing to prevent infection.
| Nursing Interventions for Iron Deficiency Anemia | Rationale |
| 1. Check and monitor for the signs and symptoms of local or systemic infections including fever, chills, swelling, pain, and body malaise. | If the patient is immunocompromised, opportunistic infections may easily develop. Fever, chills, swelling, pain, and body malaise are common signs of infection that the nurse should monitor. |
| 2. Monitor and evaluate the patient’s white blood cell count regularly. | If the patient’s white blood cell decreases, it increases the patient’s risk of having infection because the white blood cells help the body to fight infection and other diseases. |
| 3. Advise the patient and the significant others to report signs and symptoms of infection as soon as possible. | The presence of fever is a sign of infection, but it is not usually a cause for concern. The underlying illness that causes fever may need medical treatment. |
| 4. Instruct the patient to avoid people with present infections. | People with present infection may be a source of infection for the immunocompromised patient. Advise the significant others to wash hands to prevent the spread of infections. |
| 5. Instruct the patient to refrain from eating raw fruits and vegetables as well as uncooked meats. | Raw fruits, raw vegetables, and uncooked meats should be avoided because these foods can harbor bacteria that may cause infection. |
| 6. Teach the patient about the importance of daily hygiene, hand hygiene, mouth care, and perineal care. | This measure will prevent skin breakdown and will help in reducing the risk of infection. |
Nursing Care Plan for Iron Deficiency Anemia 3
Nursing Diagnosis: Activity Intolerance related to the mismatch in the oxygen supply and demand secondary to iron deficiency anemia as evidenced by generalized weakness and sedentary lifestyle.
Desired Outcomes:
- The patient will be able to be knowledgeable about the factors that cause activity intolerance.
- The patient will verbalize his or her ability to do activities and tasks of daily living.
- The patient will be able to express understanding about the techniques to conserve his or her energy.
- The patient will be able to verbalize understanding about the methods to reduce activity intolerance caused by iron deficiency anemia.
| Nursing Interventions for Iron Deficiency Anemia | Rationale |
| 1. Assess the level of the patient’s activity intolerance and ask the patient the rate of perceived exertion on a scale of 0 to 10. | The patient may experience dyspnea on exertion, headaches, dizziness, palpitations, and verbalization of increased exertion level because of activity intolerance and reduced tissue oxygenation. The patient should be advised to decrease activity until the signs of increased exertion are no longer present. |
| 2. Advise the patient to do and practice deep breathing exercises regularly. | Deep breathing exercises will help with the proper oxygenation and will help in improving blood circulation. |
| 3. Monitor the patient’s pulse oximetry and inform the physician if the patient’s oxygen level decreases below the target range. | If the patient’s level of oxygen decreases below the target range, the nurse should administer supplemental oxygen. |
| 4. Advise the patient that his or her physical condition may improve over time and the activities will be increased within his or her capacity. | This will help the patient to enhance endurance and strength. Encouraging the patient will also help to improve his or her condition. |
| 5. Encourage the patient to express his or her feeling about the set limitations. | Activity intolerance due to iron deficiency anemia may be physically and emotionally difficult for the patient. Expression of his or her feelings will help the patient to cope with the condition. |
Nursing Care Plan for Iron Deficiency Anemia 4
Nursing Diagnosis: Deficient Knowledge related to lack of resources and information about the condition secondary to iron deficiency anemia as evidenced by constant inquiries and inability to follow directions.
Desired Outcomes:
- The patient will be able to express understanding about his or her condition and treatment options.
- The patient will be able to understand the importance of diagnostic procedures for his or her condition.
| Nursing Interventions for Iron Deficiency Anemia | Rationale |
| 1. Allow the patient to express his or her current knowledge and perception about the condition. | Assessing the patient’s current knowledge and perception of the condition will help the nurse in planning strategies for patient teaching. The nurse should make an effort to inform the patient about his or her condition to increase the patient’s level of awareness. |
| 2. Explain and teach the patient the importance of blood constituents including red blood cells, white blood cells, and platelets. | It is important to explain the importance of blood constituents because most patients are not familiar with the importance and function of the blood constituents. |
| 3. Teach the patient to avoid known risk factors that cause iron deficiency anemia. | The nurse should teach the patient to avoid causative factors including alcoholism, exposure to toxic chemicals, dietary deficiencies, and use of some medications because these will affect the red blood cell production that will lead due iron deficiency anemia. |
| 4. Teach the patient about proper nutrition for patients with iron deficiency anemia. | One of the effective ways to prevent iron deficiency anemia is through dietary education. The nurse should teach the patient to eat foods that are high in iron that will help in increasing hemoglobin levels such as red meat, liver, legumes, spinach, and shellfish. |
| 5. Instruct the patient about the medications that may stimulate RBC production. | Certain medications increase hemoglobin levels and reduce the need for blood transfusion. |
Nursing Care Plan for Iron Deficiency Anemia 5
Nursing Diagnosis: Fatigue related to decreased hemoglobin and decreased oxygen carrying capacity of the blood secondary to iron deficiency anemia as evidenced by dyspnea, difficulty maintaining a usual level of physical activity, and lack of energy.
Desired Outcomes:
- The patient will be able to express understanding about the use of energy conservation techniques and principles.
- The patient will verbalize decreased fatigue as evidenced by the patient’s report of ability to do desired activities.
| Nursing Interventions for Iron Deficiency Anemia | Rationale |
| 1. Review the specific cause of the patient’s fatigue. | The nurse should assess for the presence of tissue hypoxia and other medical problems such as iron deficiency anemia because this may cause compromised activity tolerance. |
| 2. Assess the patient’s ability to do activities as well as the demand of daily living. | The nurse should assess the ability of the patient to do self-care and his or her ability to perform roles in the family and society may be limited because of fatigue. |
| 3. Monitor and note for changes in the patient’s hemoglobin, hematocrit, RBC, and reticulocyte count. | Monitoring the blood levels is important to evaluate the patient’s progression or deterioration and to identify the changes to reduce the risk for life-threatening conditions. The RBC levels should be monitored because the decreased level of RBC also decreases the oxygen-carrying capacity of the blood. |
| 4. Instruct and teach the patient to do techniques to conserve his or her energy. | The patient should learn skills that would help him or her to perform the desired activities such as setting priorities and cluster care when using available energy. |
| 5. Advise the patient to seek an occupational therapist if necessary. | An occupational therapist can assist and teach the patient about the use of assistive devices. An occupational therapist can also help the patient to evaluate the need for additional energy conservation measures. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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