Pharmacologic Highlights

Medication or

Drug Class Dosage

Description

Rationale

Supplemental iron

Varies with drug

Oral therapy: ferrous sulfate (Feosol); ferrous gluconate (Fergon)

Parenteral therapy: iron dextran (Imferon)

Intramuscular: iron

Increases iron stores

Oral: Oral preparations should be taken with water or a straw to avoid staining teeth. Oral iron supplements may cause gastric irritation; irritation may be reduced by administering the supplement with meals as long as eggs, dairy products, coffee, tea, and antacids are avoided. Foods containing ascorbic acid, however, aid absorption.

Parenteral therapy: Iron dextran (Imferon) is the preferred medication for intramuscular injections. Pregnant and elderly patients with severe iron deficiency anemia may be given total-dose intravenous infusions of iron dextran in a sodium chloride solution, after a small test dose is given to gauge any allergic reaction.

Independent

Nursing interventions focus on preventing infections, promoting comfort, and teaching the patient. Patients with IDA are apt to have other nutritional deficiencies that place them at risk for infection. Use good hand-washing techniques, and encourage the patient to avoid contact with people with known upper respiratory infections. If the patient experiences discomfort from oral lesions, provide mouth care. To limit activity intolerance, allow rest periods between all activities. Before the patient's discharge, arrange for home health follow-up if needed.

Teach the patient and significant others the causal relationships between bleeding tendencies and poor diet in relation to this anemia. Discuss the need to pace activities and allow for periods of rest. Emphasize to the patient the need for a well-balanced diet rich in iron; provide a list of iron-rich foods. Explain that any excess in iron stores may cause toxicity. Teach the patient that certain foods and medications—such as milk and antacids—interfere with the absorption of iron. Explain that stools normally turn greenish to black in color with iron therapy and that constipation may occur. Iron-rich foods such as fresh vegetables and red meat tend to be expensive, so that budget planning activities or assistance in attaining food stamps or other assistive programs may be essential. A social service referral or arranging of home care needs may be necessary. Parents of infants may need follow-up home visits to ensure that the growth and development of the child are progressing normally.

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