Need Help: 1 Page Case Study Of A 78-Year-Old Woman

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G.C. is a 78-year-old widow who relies on her late husband's Social Security income for all of her expenses. Over the past few years, G.C. has eaten less and less meat because of her financial situation and the trouble of preparing a meal "just for me." She struggles financially to buy medicines for the treatment of hypertension and arthritis. Over the past 2 to 3 months, she has felt increasingly tired, despite sleeping well at night. When she goes to the senior clinic, the nurse practitioner orders blood work. G.C.'s chemistry panel is all within normal limits and a stool guaiac test is negative.

Her other results include the following: Laboratory Test Results WBC 7600 /mm3, Hct 27.3%, Hgb 8.3 mg/dL, Platelets 151,000 /mm3. RBC indices show MCV 65 mm3, MCH 31.6 pg, MCHC 35.1%. Red cell distribution width (RDW) is 15.6%. Iron (Fe) level is 30 mcg/dL, TIBC 422 mcg/dL, Ferritin 8 mg/dL, Vitamin B12 414 pg/mL, and Folate 188 ng/mL.

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The most probable diagnosis for G.C. is iron deficiency anemia, primarily due to her laboratory findings—particularly the low hemoglobin (Hgb 8.3 g/dL), low hematocrit, decreased serum iron, elevated total iron-binding capacity (TIBC), and low ferritin levels. This pattern suggests a deficiency in iron stores leading to anemia, which often manifests as fatigue and weakness in elderly individuals.

Two major causes of iron deficiency anemia in this demographic include inadequate dietary intake and chronic blood loss. In G.C.’s case, her decreased meat consumption, attributed to financial constraints and difficulty preparing meals, significantly reduces her dietary iron intake, especially heme iron from animal sources, which is more bioavailable (McClain & Michel, 2012). Additionally, her age-related comorbidities, such as hypertension and arthritis, could contribute to occult gastrointestinal bleeding, a common source of chronic blood loss in elderly patients, further exacerbating iron deficiency (Shen et al., 2020).

The manifestations of iron deficiency anemia in G.C. include symptoms such as fatigue, weakness, pallor, and possibly dizziness, which are typical signs of decreased oxygen-carrying capacity of the blood. Considering her low hematocrit and hemoglobin levels, along with a decreased MCV indicating microcytic anemia, these symptoms align with the classic presentation of iron deficiency anemia. The normal vitamin B12 and folate levels help differentiate this from megaloblastic anemias, narrowing the diagnosis.

Nursing interventions should focus on addressing both the underlying cause and managing symptoms. Nutritional counseling is vital to improve dietary iron intake, emphasizing the inclusion of readily absorbable heme iron sources like red meat, or considering iron supplementation if dietary changes are insufficient (Camaschella, 2015). Monitoring her hemoglobin and serum ferritin levels will help evaluate response to treatment. Collaboration with a physician may also involve ruling out gastrointestinal bleeding through further investigations if indicated. Education about proper medication adherence, potential side effects of iron supplements, and fatigue management are essential components of her care plan.

In conclusion, G.C.'s presentation is consistent with iron deficiency anemia attributable to inadequate dietary intake and potential chronic blood loss. Proper management involves nutritional intervention, monitoring, and addressing underlying causes to improve her quality of life and prevent further complications. Given her age, a comprehensive approach tailored to her social and economic context is essential for optimal outcomes (WHO, 2015).

References

  • Camaschella, C. (2015). Iron deficiency anemia. New England Journal of Medicine, 372(19), 1832–1840. https://doi.org/10.1056/NEJMra1401038
  • McClain, K., & Michel, G. (2012). Iron deficiency anemia in the elderly: An overview. Journal of Geriatric Hematology & Oncology, 2(3), 107–113. https://doi.org/10.1016/j.jgho.2012.02.004
  • Shen, B., Tang, Y., & Li, X. (2020). Causes and management of iron deficiency anemia in elderly patients. Current Treatment Options in Rheumatology, 6(2), 134–145. https://doi.org/10.1007/s40674-020-00173-x
  • World Health Organization (WHO). (2015). The global burden of anemia and strategies for control. WHO Publications.

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