Sixteen-year-old Jessica reports a 2-month history of fatigue, pallor, and inability to “keep up” with her team mates on the school swim team. Her last menstrual period started yesterday, and her pregnancy test is negative. The lab work that you ordered reveals an iron deficiency anemia. Treat Jessica and provide her and her mother education about her condition.
Describe the clinical problem are you seeking to treat and include 2-3 clinical goals
Iron-deficiency is one of the most common nutritional deficiencies. It is a condition that builds up over time, leading to low levels of iron in the body which prevents the formation of healthy red blood cells. Potential causes may be blood loss, insufficient diet, or the failure of the body to absorb iron from food sources. Potential symptoms include fatigue, breathing problems, and chest pain which can lead to infections or problems with the heart and normal development among other conditions. One of the clinical goals would be to treat the underlying cause which caused the iron deficiency. Further, it is critical to reestablishing a healthy level of iron, hemoglobin, and amount of red blood cells (National Heart, Lung, and Blood Institute, n.d.).
Briefly explain appropriate non-pharmacological interventions, such as lifestyle modifications, to address the particular clinical problem you have identified in #1
The only lifestyle change that may be required, depending on the underlying cause, is a change in diet. A balanced diet must be maintained through the consumption of meats and other iron-rich foods.
Review and name a relevant, clinical practice guideline that supports treatment decisions for the clinical problem you have identified
The guideline states that in premenopausal women excessive menstruation is most often the cause of an identified iron-deficiency. It may be helpful to investigate erosive lesions, thyroid issues, or other conditions that may lead to iron deficiency. Oral iron supplementation is required to treat anemia and refill body stores (Short & Domagalski, 2013).
How was the clinical practice guideline developed and by whom?
The guidelines were developed by a pair of respectable doctors at the Madigan Health Care System in Tacoma Washington. The guidelines were formed by conducting academic research and synthesizing information from various meta-analyses, controlled trials, and reviews. Various medical databases and existing guidelines were also used.
Consider the strength of the evidence (clinical trials, cohort studies, consensus, etc.) upon which the recommendation is based
Direct evidence was not presented in this guideline document or any other searches. The authors state that information from clinical randomized and controlled trials was used. It was published in a leading and respectable medical journal which suggests that the information is valid and has been peer-reviewed.
Consider the population to which the clinical practice guideline applies
The guideline applies to premenopausal women who would include the patient in the case. However, this issue is rare for people under the age of 50. Therefore, the article includes recommendations mostly for postmenopausal women and anyone over 50 years old.
Using multiple sources of information, select the appropriate class of medication for the clinical problem you are seeking to address. Consider the age, sex, comorbidities (if any), and medication pharmacokinetics
Oral iron supplementation is necessary to treat the issue. It is most commonly due to its affordability and minimal risk of side-effects. Ferrous sulfate or Ferric citrate (Auryxia) are approved drug compounds for the effective treatment of iron-deficiency.
Using multiple sources of information, select a safe and appropriate dose of medication from the class of medications you selected in #4
Ferrous sulfate (Feosol) is traditionally prescribed at 325mg three times a day oral intake. However, lower doses of 15-20mg may be more appropriate for the case-patient due to her young age and minimalize any risk of side-effects. Auryxia may be taken at one tablet (210mg) three times daily with meals (Harper, 2017).
Justify your choice of medication against other possible choices
This medication has been approved by the Food and Drug Administration and is effective in clinical trials. It is simple and lowers the risk of side-effects, critical for a 16-year old patient. Other medications are often targeted at older age-groups and accompanying conditions (such as menopause) that may affect iron-deficiency.
Include the cost of the medication. Is it available at a reduced rate at a retail store such as Walmart or Target?
The Ferrous sulfate supplement is available at all retail stores at a low price of approximately $9 for 120 tablets.
How will you assess and monitor the efficacy of the medication you have prescribed?
Patients with iron-deficiency anemia should pay close attention to their condition. Follow-up laboratory tests should be done after taking medication and balancing one’s diet to monitor iron and hemoglobin levels which may take several months to normalize.
How will you address side effects?
Side effects may cause minor constipation or digestion problems. There may stool problems. However, the doctor should only be contacted in case of prolonged or severe cases (Marks, 2014).
List any major drug-drug, drug-food interactions you found during your research
The drug has major negative interactions with dolutegravir and dimercaprol. There may problems with consuming some products such as coffee and milk, interfering with absorption.
Provide 3-5 points for client teaching related to the medication
- Dosage should be taken regularly and in recommended amounts to prevent overdoes. – Medication should be taken on an empty stomach at least an hour before a meal.
- Avoid taking antacids or antibiotics within a two-hour range of Ferrous Sulfate.
Harper, J. (2017). Iron Deficiency Anemia treatment & management. Web.
Marks, L. (2014). Ferrous sulfate. Web.
National Heart, Lung, and Blood Institute. (n.d.). Iron-Deficiency Anemia. Web.
Short, M., & Domagalski, J. (2013). Iron Deficiency Anemia: Evaluation and management. American Family Physician, 87(2), 98-104. Web.