ADAMMC28_0131756656 2/15/07 1:06 PM Page 405 Team B 107:PEQY046:phada2:ch28:

Chapter 28

Drugs for Hematopoietic Disorders

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NURSING PROCESS FOCUS Clients Receiving Ferrous Sulfate (Feosol, others)

Potential Nursing Diagnoses

Assessment
Prior to administration:
Obtain a complete health history including allergies, drug history, possible
drug reactions, history of peptic ulcer disease, or recent blood loss.
Assess reason for drug administration such as presence/history of anemia, or
prophylaxis during infancy, childhood, and pregnancy.
Assess complete blood count, specifically hematocrit and hemoglobin levels,
to establish baseline values.
Assess vital signs.

Nutrition, Risk for Imbalanced, related to inadequate iron intake

Gas Exchange, Risk for Impaired, related to low RBC count resulting in
decreased oxygenation
Injury (weakness, dizziness, syncope), Risk for, related to anemia
Knowledge Deficient, related to drug therapy

Planning: Client Goals and Expected Outcomes

The client will:
Exhibit an increase in hematocrit level and improvement in anemia-related symptoms.
Demonstrate an understanding of the drugs action by accurately describing drug side effects and precautions.
Immediately report significant side effects such as GI distress.

Implementation
Interventions and (Rationales)

Client Education/Discharge Planning

Monitor vital signs, especially pulse. (Increased pulse is an indicator of

decreased oxygen content in the blood.)

Instruct client to monitor pulse rate and report irregularities and changes in
rhythm.

Monitor complete blood count to evaluate effectiveness of treatment.

(Increases in hematocrit and hemoglobin values indicate increased RBC
production.)

Instruct client:
On the need for initial and continuing laboratory blood monitoring.
To keep all laboratory appointments.

Monitor changes in stool. (The drug may cause constipation, change stool
color, and cause false positives when stool is tested for occult blood.)

Instruct client:
That stool color may change to dark green or black, and this is not a cause for
alarm.
On measures to relieve constipation, such as including high-fiber vegetables
and grains in diet, and increasing fluid intake and exercise.

Plan activities and allow for periods of rest to help client conserve energy.
(Diminished iron levels result in decreased formation of hemoglobin, leading
to weakness and fatigue.)

Instruct client to:

Rest when feeling tired, and avoid overexertion.
Plan activities to avoid fatigue.

Administer medication on an empty stomach (if tolerated) at least 1 hour

before bedtime.( Lack of food in the stomach maximizes absorption; taking
closer to bedtime may increase the chance of GI distress.)

Instruct client:
Not to crush or chew sustained-release preparations.
That medication may cause GI upset.
To take medication with food if GI upset becomes a problem.
To take at least 1 hour before bedtime.

Administer liquid iron preparations through a straw or place on the back of

the tongue. (This drug stains the teeth.)

Instruct client to:

Dilute liquid medication before using and to use a straw to take medication.
Rinse the mouth after swallowing to decrease the chance of staining the teeth.

Monitor dietary intake. (This ensure adequate intake of foods high in iron.)
Monitor for potential for child access to medication. (Iron poisoning can be
fatal to young children.)

Instruct client to increase intake of iron-rich foods such as liver, egg yolks,
brewers yeast, wheat germ, and muscle meats.
Advise parents to store iron-containing vitamins out of reach of children and
in childproof containers.

Evaluation of Outcome Criteria

Evaluate the effectiveness of drug therapy by confirming that client goals and expected outcomes have been met (see Planning).
The client exhibits an increase in hematocrit level and improvement in anemia-related symptoms.
The client demonstrates an understanding of the drugs action by accurately describing drug side effects and precautions.
The client immediately reports significant side effects such as GI distress.