NCMAP “Anemia in Pregnancy” 

Description 
 Anemia is a condition in which you lack sufficient healthy red blood cells to carry
the tissues of your body with enough oxygen. You may develop anemia when
you're pregnant. Your blood doesn't have enough healthy red blood cells when
you have anemia to bring oxygen to your tissues and to your baby.

Lab 
 Hemoglobin Test - a test that measures the amount of hemoglobin - an iron-rich
protein blood cell that carries oxygen from lungs to tissues in the body. This test
is important to inspect for any low or high levels of RBC, and for the process of
transferring oxygen in our blood from lungs to tissues.
 NORMAL: hemoglobin level of 12-16g/DL
 BELOW 12: iron deficiency
 BELOW 10.5: anemia

 Hematocrit test is often part of a complete blood count (CBC), a routine test that
measures the percentage of red blood cells found in a certain amount of blood.
The test is important because it is used to help diagnose blood disorders such as
anemia/ anemia in pregnancy, a condition in which your blood doesn't have
enough red cells, or polycythemia vera, a rare disorder in which your blood has
too many red cells.

 NORMAL: 36-48%

 BELOW 33%: anemia

**You don't need any special preparations for hemoglobin and hematocrit tests. If
your health care provider has also ordered other blood tests, you may need to
fast (not eat or drink) for several hours before the test.

Hemoglobin is a protein in your red blood cells. It's what carries oxygen from your
lungs to the rest of your body. Hematocrit measures how much of your blood is made
up of red blood cells.

Source:

https://medlineplus.gov/lab-tests/hemoglobin-test/ 

https://medlineplus.gov/lab-tests/hematocrit-test/ 

Precipitating and predisposing factors

 All pregnant women are at risk for becoming anemic because they need more
iron and folic acid than usual. Pregnant women are most likely to be at risk if:
 Pregnant with multiples (more than one child)
During pregnancy, your body produces more blood to support the growth of your
baby. If you're not getting enough iron or certain other nutrients, your body might not be
able to produce the amount of red blood cells it needs to make this additional blood. It's
normal to have mild anemia when you are pregnant.

 Have had two pregnancies close together

 Vomit a lot because of morning sickness
 A pregnant teenager
Pregnant adolescents are at risk of anemia because of the insufficient amount of
healthy caloric intake needed during pregnancy
 Don't eat enough foods that are rich in iron
 Without enough iron, your body can't produce enough of a substance in red
blood cells that enables them to carry oxygen (hemoglobin). Thus, resulting to anemia.
 Had anemia before you became pregnant
If the client has already anemia before pregnancy, she will most likely have
anemia during pregnancy. During pregnancy, your body produces more blood to
support the growth of your baby. If you're not getting enough iron or certain other
nutrients, your body might not be able to produce the amount of red blood cells it needs
to make this additional blood. It's normal to have mild anemia when you are pregnant.

Signs and Symptoms 

 Extreme fatigue
 Since there are inadequate oxygen levels in the tissues that are not
carried by the hemoglobin, fatigue is experienced.
Without enough oxygen being delivered to your cells you aren’t able to break
down nutrients and make energy. Without energy, you continually feel tired and weak
throughout the day and it can be difficult to complete your daily tasks.

 Headache and Dizziness

 Headache and dizziness are caused by inadequate oxygen reaching the
brain. This may cause blood vessels to swell and create pressure leading
to headaches.
Headache and dizziness may occur because low levels of hemoglobin in red
blood cells mean that not enough oxygen reaches the brain. As a result, blood vessels
in the brain may swell, causing pressure and headaches. Though headaches are
considered less common symptoms in anemia.

 Pica 
 These unusual cravings are the compensatory mechanism of our body to
replenish low nutrient levels
Pica is an eating disorder wherein the pregnant woman craves nonfood items like
ice, starch, oil, cigarette butts, ashes, hair, paper, paint chips, stones, and paper clips.
One reason why pregnant women have unusual cravings is due to inadequate nutrient
intake.

One study in 286 pregnant women in Ghana noted that pregnant women most at risk
of pica may include those who have:

 poor nutrition or nutrient deficiencies

 a history of or cultural exposure to eating nonfood items, such as eating
clay as medicine in some cultures

The study also found that 47.5 percent of the women had some form of pica during
pregnancy. The most common items consumed were white clay and ice.

The researchers noted that some participants believed that the white clay and ice had
nutritional value. They also observed that many participants sought the nonfood
items because they were appealing and felt the scent or taste helped alleviate
their nausea.

 Pale skin, lips and nails

 Having a decrease of hemoglobin, the important component that is
responsible for the color of the red blood cells, results in a decrease in
pigment that explains the paleness of the skin, lips and nails.
When your heart and brain, your two most vital organs, are not getting enough
oxygen your body sends more blood there, depriving other parts of your body in the
process. When less blood flows to your skin you’re likely to lose some of your color or
skin tone.

 Cold hands and feet 

 Blood flow in the extremities is limited when a person is anemic, that
causes it to feel cold and numb at most times.

Red blood cells may not have enough hemoglobin (iron-rich protein) to transport
oxygen from your lungs to the rest of your body. The result can be cold fingers and
toes. 

 A rapid or irregular heartbeat (Tachycardia)

 As a compensation mechanism due to the decrease in oxygen, the heart
pumps more blood to be able reach the peripheral tissues of the body.
Heart palpitations, an irregular heartbeat or an increased heart rate can be signs
that your body is attempting to compensate for its lack of energy. By circulating blood
faster your body is trying to spread around the small amounts of available hemoglobin in
order to deliver more oxygen.
 This may lead to chest pain. Your heart needs oxygen to function. Without
enough hemoglobin and oxygen, the heart tissue will behave as though you have
impaired blood flow. In very severe anemia this can lead to a myocardial infarction or
what is more commonly known as a heart attack.

 Dyspnea 
 The product of decreased concentrations of oxygen in the blood leads to
difficulty of breathing.
When your organs do not get enough oxygen, your lungs may start to
overcompensate and work harder to bring in more oxygen.

ADDITIONAL:
 Dry and damaged hair and skin
Low levels of hemoglobin reduce the amount of oxygen available to cells that
cause hair growth. When the skin and hair are deprived of oxygen, they can become dry
and weak.

Source: https://nurseslabs.com/anemia/

https://www.healthline.com/nutrition/iron-deficiency-signs-symptoms

https://www.healthline.com/health/pica#causes

https://www.westchesterhealth.com/blog/10-signs-that-you-might-have-anemia/

Nursing Diagnosis 
  Fatigue R/T decreased hemoglobin and diminished oxygen-carrying capacity of
the blood as evidenced by headache and lightheadedness

 Altered nutrition, less than the body requirements, related to inadequate intake of
nutrients as evidenced by pica

 Ineffective peripheral tissue perfusion related to insufficient hemoglobin and

hematocrit as evidenced by pale skin and nails, and cold hands and feet

 Risk for activity intolerance related to imbalance between oxygen supply/demand

Nursing Interventions 
  Extreme fatigue
o Provide education about energy-conservation techniques.
o Rationale: Energy-conservation method permits the patient to utilize
available energy to complete important activities.
 Headache and Dizziness 
 o Assist the client in developing a schedule for daily activity and rest. Stress
the importance of frequent rest periods. 
o Rationale: Energy reserves may be depleted unless the client respects
the body’s need for increased rest. A plan that balances periods of activity
with periods of rest can help the client complete desired activities without
adding levels to fatigue. 
  Pica Syndrome
o Keep the area away from unnecessary things that can be eaten by the
client. 
o Rationale: To prevent substances from being eaten by the client without
any nutritional value. 
  Pale skin, lips and nails
o Provide oxygen therapy for the patient if necessary.
o Rationale: Oxygen saturation should be maintained 90% or higher
  Cold hands and Feet 
o Provide additional or extra heat source (Heat lamp, radiant warmer,
Warming pads, Blankets, etc) 
o Rationale: These measures raise the core temperature and improve
circulation.  
o Regulate the environment temperature 
o Rationale: These methods provide for a more gradual warming of the
body. Rapid warming can induce ventricular fibrillation. Moisture promotes
evaporative heat loss.
 Tachycardia
o Assess heart rate and blood pressure
o Rationale: Most patients have compensatory tachycardia and significantly
low blood pressure in response to reduced cardiac output
  Dyspnea 
o Talk calmly to your patients and instruct them to breathe slowly.
o Rationale: It will help the client to breathe deeper effectively.

 
https://nurseslabs.com/4-anemia-nursing-care-plans/  
https://nurseslabs.com/hypothermia/   
https://www.drugs.com/cg/restless-legs-syndrome-aftercare-instructions.html   
   
Medical Management 
 Extreme fatigue
o Instruct the patient to consume iron-rich foods such as organ meats,
tomatoes and eggs.
o Rationale: to help build-up hemoglobin stores

 Headache and Dizziness

o Iron supplementation
 o Rationale: Normal iron levels will enable the red blood cells to carry the
proper amount of oxygen to the brain.

  Pica 
o Iron supplementation
o Rationale: Iron deficiency anemia is one of the most common causes of
pica. Therefore, prescribing iron supplements could help treat the said
eating disorder.

 Pale skin, lips and nails

o Iron supplements
o Rationale: can help reverse low iron levels or treat iron deficiency anemia.

 Cold hands and feet 

o Iron rich foods and iron supplementation
o Rationale: Sufficient iron in the body allows the red blood cells to have
enough hemoglobin that will transport oxygen from the lungs to the rest of
the body.

 A rapid or irregular heartbeat (Tachycardia)

o Transfusion therapy: RBC
o Rationale: Transfusions are given to replace deficient red blood cells

 Dyspnea
o Oxygenation therapy. 
o Rationale: increases the amount of oxygen your lungs receive and deliver
to your blood.

Sources:

 Armon, C. (2019). How is restless leg syndrome (RLS) treated during

pregnancy?. Retrieved 20 January 2021, from
https://www.medscape.com/answers/1149405-164892/how-is-restless-leg-
syndrome-rls-treated-during-pregnancy
 Marjorie, H. (2019). What Can I Do About Cold Feet and Hands?. Retrieved 20
January 2021, from https://www.healthline.com/health/cold-feet-and-hands
 Moyer, N. (2019). What You Need to Know When Anemia and Headaches
Happen Together. Retrieved 20 January 2021, from
https://www.healthline.com/health/headache/anemia-and-headaches
 https://www.hematology.org/education/patients/anemia/iron-deficiency
 https://www.healthline.com/nutrition/iron-supplements-who-should-
take#who-benefits
  https://www.nhlbi.nih.gov/health-topics/oxygen-therapy

 WHAT TO DO WHEN TAKING IRON SUPPLEMENTS:

 Advise women to take iron supplements with orange juice or a vitamin C

supplement
 Eat a diet high in iron and vitamins (green leafy vegetables, meat, legumes,
fruits)
 Increase roughage in diet and increase fluid intake (X constipation)
 Take the pills with food
 Black stools (X internal bleeding)

IRON SUPPLEMENTATION
= ferrous sulfate / ferrous gluconate
= 27 mg as prophylactic therapy during pregnancy
= 120-200 mg / day (if with IDA)

FOOD RICH IN IRON

 poultry
 fish
 lean red meats
 beans
 nuts and seeds
 dark leafy greens
 fortified cereals
 eggs
 fruits like bananas and melons