Anemia in Pregnancy Nursing Management

Notes

Description
  1. Hemoglobin value of less than 11 mg/dL or hematocrit value less than 33% during the second and third trimesters
  2. Mild anemia (hemoglobin value of 11 mg/dL) poses no threat but is an indication of a less than optimal nutritional state.
  3. Iron deficiency anemia is the most common anemia of pregnancy, affecting 15% to 50% of pregnant women. It is identified as physiologic anemia of pregnancy.
Etiology
Causes of anemia include: anemia in pregnancy
  1. Nutritional deficiency (e.g., iron deficiency or megaloblastic anemia, which includes folic acid deficiency and B12 deficiency). This can be a lot to get your head around, but if you do a quick search into something as simple as lactoferrin anemia, you’ll be able to further your knowledge in this field. You never know, this information may come in handy one day.
  2. Acute and chronic blood loss
  3. Hemolysis (e.g., sickle cell anemia, thalassemia, or glucose-6-phosphate dehydrogenase [G-6-PD])
Pathophysiology
  1. The hemoglobin level for nonpregnant women is usually 3.5 g/dL. However, the hemoglobin level during the second trimester of pregnancy averages 11.6 g/dL as a result of the dilution of the mother’s blood from increased plasma volume. This is called physiologic anemia and is normal during pregnancy.
  2. Iron cannot be adequately supplied in the daily diet during pregnancy. Substances in the diet, such as milk, tea, and coffee, decrease absorption of iron. During pregnancy, additional iron is required for the increase in maternal RBCs and for transfer to the fetus for storage and production of RBCs. The fetus must store enough iron to last 4 to 6 months after birth.
  3. During the third trimester, if the woman’s intake of iron is not sufficient, her hemoglobin will not rise to a value of 12.5 g/dL and nutritional anemia may occur. This will result in decreased transfer of iron to the fetus.
  4. Hemoglobinopathies, such as thalassemia, sickle cell disease, and G-6-PD, lead to anemia by causing hemolysis or increased destruction of RBCs.
Assessment Findings
  1. Associated findings. In clients with a hemoglobin level of 10.5 g/dL, expect complaints of excessive fatigue, headache, and tachycardia.
  2. Clinical manifestations:
  • Signs of iron deficiency anemia (hemoglobin level below 10.5 g/dL) include brittle fingernails, cheilosis (severely chapped lips), or a smooth, red, shiny tongue.
  • Women with sickle cell anemia experience painful crisis episodes.

Nursing Management
  1. Provide client and family teaching. Discuss using iron supplements and increasing dietary sources of iron as indicated.
  2. Prepare for blood-typing and crossmatching, and for administering packed PBCs during labor if the client has severe anemia.
  3. Provide support and management for clients with hemoglobinopathies.
    • In a client who has thalassemia or who carries the trait, provide support, especially if the woman has just learned that she is a carrier. Also assess for signs of infection throughout the pregnancy.
    • In a pregnant client with sickle cell disease, assess iron and folate stores, and reticulocyte counts; complete screening for hemolysis; provide dietary counseling and folic acid supplements; and observe for signs of infection.
    • In a pregnant client with G-6-PD, provide iron and folic acid supplementation and nutrition counseling, and explain the need to avoid oxidizing drugs.

Exam

Welcome to your Anemia in Pregnancy Practice Exam! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 10 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Think about the changes in blood volume and red blood cell mass that typically occur during pregnancy.

1 / 10

1. Nurse Leah is reviewing common conditions that occur during the second trimester of pregnancy with a group of expectant mothers. Which of the following conditions should she mention as being typical during this stage?

💡 Hint

Think about how this medication is used to prevent complications related to blood type differences between the mother and baby.

2 / 10

2. Nurse Kelly is educating a new mother who has just received Rho(D) immune globulin (RhoGAM) after delivery. How does Nurse Kelly know the patient understands the purpose of the medication when the patient states it will protect her baby from which of the following?

💡 Hint

Consider how insufficient oxygen-carrying capacity in the mother could impact fetal growth and development.

3 / 10

3. Nurse Laura is caring for a pregnant patient diagnosed with severe anemia. She is concerned about the potential effects on the fetus. What is the most likely outcome for the fetus if the mother’s anemia is severe?

💡 Hint

Consider the primary risks associated with a compromised immune system in a child with leukemia.

4 / 10

4. Nurse Rachel is caring for a child newly diagnosed with acute lymphocytic leukemia (ALL). What should be the initial priority in her care plan?

💡 Hint

Think about the complications associated with reduced oxygen-carrying capacity in the blood during pregnancy and how it may impact the body during and after delivery.

5 / 10

5. Nurse Maria is assessing a pregnant client admitted to the labor room. After noting the client's low hemoglobin and hematocrit levels, which indicate anemia, Nurse Maria determines that the client is at risk for which of the following?

💡 Hint

Focus on the physiological changes in pregnancy that demand a higher red blood cell count and iron reserves.

6 / 10

6. Nurse Jenna is discussing iron supplementation with a pregnant patient who is curious about the increased need for iron during pregnancy. What is the primary reason for this increased requirement?

💡 Hint

Consider the nature of anemia in premature infants, which typically involves a decreased production of red blood cells rather than abnormal cell shapes or sizes.

7 / 10

7. Nurse Carol is caring for an infant born at 33 weeks’ gestation who has been diagnosed with anemia of prematurity, characterized by an inadequate response to erythropoietin. The healthcare provider expects that microscopic examination of the infant's red blood cells would most likely reveal:

💡 Hint

Consider the role of vitamin K in the body and how it helps address a specific deficiency in newborns that affects clotting.

8 / 10

8. A nurse instructor is preparing to administer a vitamin K injection to a newborn, and a student nurse asks about the purpose of the injection. What is the most appropriate response?

💡 Hint

Consider how different foods and beverages impact the absorption of iron in the body, and the optimal timing for taking supplements.

9 / 10

9. Nurse Jenna is providing prenatal education to a client who has been diagnosed with iron-deficiency anemia during pregnancy. Which statement by the client indicates a correct understanding of how to manage this condition?

💡 Hint

Focus on how anemia can affect pregnancy outcomes, particularly concerning oxygen supply and fetal development.

10 / 10

10. A pregnant client at 28 weeks gestation is diagnosed with anemia. Nurse Lisa reviews the client's laboratory results, which show a hemoglobin level of 9 g/dL. Which of the following complications should the nurse monitor for as a priority?