GENERAL OBJECTIVES

The general objective of this case study is to enhance the knowledge of the
researchers, students, and the reader about Anemias during pregnancy and
develop their skills in assessing a client with Anemia during pregnancy and to
apply proper nursing care to the client in order to promote health, alleviate
sufferings, and provide comfort and to impart proper health teachings not only to
the client but also to their relatives.
SPECIFIC OBJECTIVES

At the end of this study, Student Nurses will be able to:

• Define Anemia during pregnancy
• Assess the client from head to toe
• Illustrate the pathophysiology of Anemia during pregnancy
• Identify the precipitating and predisposing factors of Anemia during pregnancy.
• Explain the different medications for a client with Anemia during pregnancy
Anemia in Pregnancy
INTRODUCTION

The wonder and joy of pregnancy is matched by the

body’s ability to adapt to looking after the growing
baby. In addition to the mother’s physiologic needs,
there is the additional need to provide the building
blocks for optimal growth of the baby. All this
construction requires energy and oxygen as the fuel
that helps drive the engine.
INTRODUCTION

Oxygen in the air that we breathe is delivered to the

cells of the body by hemoglobin, a protein molecule
found in red blood cells. When the blood lacks level of
healthy red blood cells or haemoglobin it leads to a
condition called anemia. The main part of red blood
cells is haemoglobin that binds to oxygen. If red blood
cells is too few or the haemoglobin is abnormal or
low , the cells in the body will not get enough oxygen.
The body goes through significant changes when a
woman is pregnant.
 INTRODUCTION

Anemia is a common disorder in pregnancy, which affect 20

to 60% of the pregnant women. About 20 to 30% of blood
increases in the body, which increases the supply of iron
and vitamins which are required in the production of
hemoglobin. Most of the mothers lack adequate amount of
iron during the second and third trimester of pregnancy. A
mild anemia is normal during pregnancy due to increase in
the blood volume, but however a severe anemia can put the
baby at high risk of iron deficiency later in infancy.
What are the signs and symptoms?

Signs and symptoms of anemia during pregnancy

can be mild at first and often go unnoticed.
However, as it progresses, the symptoms will
worsen. Some of the common symptoms of anemia
during pregnancy are: weakness or fatigue,
dizziness, shortness of breath, rapid or irregular
heartbeat, chest pain, pale skin and lips, cold
hands and feet.
What is Anemia?

• Anemia is when your blood has too few red blood cells. Having too
few red blood cells makes it harder for your blood to carry oxygen
or iron. This can affect how cells work in nerves and
muscles. During pregnancy, your baby also needs your blood.
What is Anemia?

• During pregnancy, the volume of blood increases. This means more

iron and vitamins are needed to make more red blood cells. If you
don't have enough iron, it can cause anemia. It's not considered
abnormal unless your red blood cell count falls too low.
Types of Anemia in pregnancy

• Iron – deficiency Anemia

• Vitamin B12 deficiency Anemia
• Folate deficiency Anemia
Iron – deficiency Anemia

• Most common type of anemia

• During pregnancy, your baby uses your red blood cells for growth

and development, especially in the last 3 months of pregnancy. If
you have extra red blood cells stored in your bone marrow
before you get pregnant, your body can use those stores during
pregnancy. Women who don't have enough iron stores can get iron-
deficiency anemia.
Iron – deficiency Anemia

• Normal Count:

• Hemoglobin: 12 – 16g/dL
• Hematocrit: 35 – 45%
• Iron: 12 – 15.5g/dL
 Iron – deficiency Anemia

Predisposing Factor (NM) Precipitating Factor (M)

• Sex (menstruation) • Inadequate iron intake and faulty diet
• Genetics • Blood Loss
• Pregnancy

Decreased intake of iron rich food with blood

loss

Iron in the body is used up

Decreased iron reserves needed for hemoglobin

production

Decreased RBC production due to lack of

hemoglobin

Iron – deficiency Anemia

Decreased oxygen and hemoglobin

Birth Defects
Vitamin B12 deficiency Anemia

• Vitamin B12 is important in making red blood cells and protein.

Eating food that comes from animals, such as milk, eggs, meats,
and poultry, can prevent vitamin B12 deficiency. Women who
don't eat any foods that come from animals (vegans) are most
likely to get vitamin B12 deficiency. Strict vegans often need to
get vitamin B12 shots during pregnancy.
Vitamin B12 deficiency Anemia

• Normal Count:

• Vitamin B12: 300 pmol/L

 Vitamin B12 Deficiency Anemia

Predisposing Factor (NM) Precipitating Factor (M)

• Sex (infertility) • Inadequate intake of Vitamin B12 and
• Age Faulty diet
• Genetics • Pregnancy

Decreased intake of Vitamin B12 rich foods

Vitamin B12 in the body is used up

Diminished DNA synthesis

Failure of RBC maturation

Proliferation of erythroblast fails

Megaloblastic Anemia

Rapidly Destructed

Vitamin B12 deficiency Anemia

Decreased oxygen and hemoglobin

Birth Defects
Folate acid deficiency Anemia

• Folate (folic acid) is a B vitamin that works with iron to help with
cell growth. If you don't get enough folate during pregnancy, you
could get iron deficiency. Folic acid helps cut the risk of having a
baby with certain birth defects of the brain and spinal cord if it's
taken before getting pregnant and in early pregnancy.
Folate acid deficiency Anemia

• Normal Count:

• Vitamin B9: 400 mcg

 Folate acid deficiency Anemia

Predisposing Factor (NM) Precipitating Factor (M)

• Age • Inadequate intake of Vitamin B9 and
• Genetics faulty diet
• Pregnancy

Decreased intake of Vitamin B9 rich food and

supplements

Vitamin B9 in the body is used up

Diminished DNA synthesis

Failure of RBC maturation

Proliferation of erythroblast fails

Megaloblastic Anemia

Rapidly Destructed

Vitamin B9 deficiency Anemia

Decreased oxygen and hemoglobin

Birth Defects
 PROBLEM: SHORTNESS OF BREATH

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE

SUBJECTIVE: Ineffective breathing SHORT TERM: INDEPENDENT:

“Nahihirapan po akong pattern related to After 8 hrs. of nursing
huminga, lalo na kapag decreased lung intervention, the client - Left side lying
nakahiga ako” as expansion as will be able to have position -Promote chest
claimed by the client. manifested by normal breathing expansion
restlessness, pale skin, pattern. RR= 12-20 cpm - Encouraged deep
OBJECTIVE: eyes, nail beds, RR: 27 breathing exercises - Precipitators of
• Cold clammy skin cpm LONG TERM: allergic type of
• Restlessness After 72 hrs. of nursing - Kept environmental respiratory reactions
• Pale skin, eyes, nail intervention the client pollution to minimun. that can trigger or
beds will be able to achieve exacerbate onset of
desired activity level. - Monitor respiratory acute episode.
V/S: patterns including rate,
T: 35.6 C depth and effort - Assesses the condition
P: 110 bpm of the client.
RR: 27 cpm DEPENDENT:
BP: 100/80 mmhg
-Gave supplemental
oxygen as ordered - Helps in giving
(2LPM via nasal adequate oxygen to the
cannula) client.
PROBLEM: Fatigue
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE
SUBJECTIVE: Fatigue related to SHORT TERM: • Establish rapport to the - To identify the client’s
“Nanlalambot ako, konting physiological factor: After 4 hours of nursing client demographic data.
• Asses Vital Signs - To evaluate fluid status and
galaw ko lang e ambilis bilis anemia as evidenced by interventions, the client
cardiopulmonary response.
ko nang mapagod”, as decreased performance. will be able to identify - To identify the issues
verbalized by the client. basis of fatigue and • Note recent lifestyle pertaining to fatigue such
individual areas of control. changer, including conflicts as new parenthood.
OBJECTIVE: and developmental issues
The patient manifested the LONG TERM: • Assess psychological and - To identify presence of
personality factors that may physical and/or
following: After 1 week of nursing affect reports of fatigue psychological disease state.
• Body weakness intervention, the client will level - To identify the level of
• Lethargic be able to perform ADLs at • Determine ability to fatigue.
• Compromised level of ability. participate in activities/
concentration level of mobility - To educate the client about
• Drowsy • Discuss lifestyle changes/ fatigue and independent
limitations imposed by intervention.
fatigue state - To identify the pattern/
timing of activity.
• Note daily energy patterns - To enhance commitment to
• Establish realistic goals with promoting optimal
patient outcome.
- To maximize the
• Plan care to allow participation and to
individually adequate rest promote rest.
periods
HEALTH TEACHINGS:

-The patient should consult doctor/physician if there are complications after

discharge for immediate action.
- The patient should follow the physicians order.
- Practice good eating habits.
- Maintain a healthy lifestyle
- Maintain a safe environment by keeping any hazards such as sharp objects and
chemicals away.
- Maintain cleanliness of the environment by minimizing allergens such as pollens
and dust.
 DISCHARGE PLAN

MEDICATION: FOLIC ACID 1 mg 1 tab OD - help increase red blood cells and hemoglobin levels
FERROUS SULFATE 200 mg 1 tab OD- help increase red blood cells and hemoglobin levels.
VITAMIN B12- help boost your red blood cell and decrease your symptoms.
TREATMENT:
- Rest and sleep
- Medication
- Increase fluid intake

DIET:
Eat healthy foods rich in iron and Vitamin C
-Nuts, red meat, dark leafy green vegetables. and beans are high in iron and protein. Foods rich in Vitamin Cinclude
oranges and other citrus fruits.
Encouraged to eat a high fiber diet such as pineapple and oats