Subject- Child Health Nursing

Topic - Nursing process

On
Iron deficiency Anemia

Submitted to :
Madam A. Khatun
Senior Faculty Submitted by:
Govt. College of Nursing Riya Sarkar
N.R.S.M.C & H, Kolkata M.Sc. Nursing 1 st year
Govt. College of Nursing
N.R.S.M.C. & H, Kolkata
 Health assessment

Date & Time of assessment : 10-02-2021

Place of assessment : Paediatric Medicine Ward

Identification Data :
Name of the baby : Arman Islam
Age : 2 years
Sex : Male
Religion : Muslim
Body Weight : 10 kgs
Name of Mother : Jhuma Bibi
Name of Father : Sk. Akttar
Identification Mark : Not Significant
Education : 8 t h pass
Registration No. : 80027
Bed No. : N-26
Under Doctor : Unit-III
Name of Operation : Not significant
Date of Operation : Not significant
Diagnosis : iron deficiency Anemia

Informant :
Reliability of the informant : Reliable
Relationship with the child : The child’s mother

History of past illness :

Medical History : Nothing Significant
Surgical History : Nothing significant
History of present illness :
Time of onset : 5 days ago
Mode of onset incident : Sudden onset
Precipitatory factor : Mother have anemia during the
antenatal period
Course of illness : 2 days ago child is pale. Vomited and
unconscious.
Association of disturbance : vomiting, diarrhea failure to thrive

Chief Complains :
The child having diarrhea, vomiting, pale and lethargic and sudden
unconscious.

Prenatal History :
Age of Mother : 29 year
Previous obstetrical history : No previous obstetrical history present

Maternal history :
1 s t trimester : Anemia present, No other significant
obstetric history
2 n d trimester : Anemia persist
3 r d trimester : Anemia persist

History of drug intake : No drug intake

during pregnancy
Immunization history of :
Mother
TT 1 : Taken
TT 2 : Not Taken

History of Labour, delivery : Baby born with preterm, LBW

Post natal Mode of delivery C - section.
Birth history :
Date of birth : 25-01-2019
Place of Birth : Hospital (rural)

Nature of Birth : C section

Birth order : Primigravida mother
Birth weight : 2 kg
Gestational week : 36 week

Resuscitation Done : Not done

Blood group and Rh factor :

of baby & mother
Mother : O+ve
Baby : B+ve

Family History
Name Education Occupation
Father - Sk. Akttar 8 t h pass Daily
worker
Mother - Jhuma Bibi 8 t h pass Housewife
Type of Family Joint

Number of family 7

Head of family Grand Father

Earning member Two

Monthly income 15,000/-

 Significant family history : No significant family history

Genogram

O = Female

 = Male

 = Child
patient

Dietary History
Breast Feeding up to 6 month of age
Supplementary feeding Given
Diet habit Mixed

Socio-economic history
Types of house Kachha
Electricity Present
Water supply Govt. Water Supply
Sanitary history Moderate

Neonatal History :
Feeding problem : Anorexia
Duration of feeding : Not maintained
Jaundice : Absent
Birth asphyxia : Absent
Immunization history

Book Picture According to child

[Achieved/Not Achieved]
At birth BCG – Birth dose Achieved
OPV – o dose Achieved
Hepatitis- B – Birth dose Achieved

6 Week OPV – 1 Achieved

Pentavalent – 1 Achieved
Rotavirus - 1 Not Achieved

10 week OPV – 2 Achieved

Pentavalent – 2 Achieved
Rota Virus - 2 Not Achieved

14 weeks OPV – 3 Achieved

IPV Not Achieved
Pentavalent – 3 Achieved
Not Achieved
Rotavirus - 3
9-12 month Measels – 1 s t dose Not Achieved
9 months Vitamin-A 1 s t dose
16-24 months DPT 1 s t booster Achieved
OPV Booster Achieved
Measles – 2 n d dose Not achieved
Vitamin-A 2 n d to 9 t h dose
(every 6 months up to
year)
 Investigation History
Hematological Value

Patient Value
Date Investigation Normal Value Remark
Hb(gm%) 8% (10.5-12%) Decreased
TC 1200 1,300-230000 Cumm Decreased
Platelet 4,50000 cumm 1,50000-4,50000 Normal
MCV 86.3 80-96 g/dl Normal
MCH 26.7 27-33 pg Decreased
10-02-2021 Neutrophils 52% 32-52% Normal
Lymphocyte 40% 20-40% Normal
Monocyte 6% (4-8)% Normal
Eosinophils 3% (2-3)% Normal
Basophil 0% 0-0.5% Normal
Sodium 139 meq/kg 139-146meq/lit Normal
Potassium 3.9 meq/L 4.1-5.3meq/l Normal
Alkaline
phosphate
Glucose 65mg/dl 60-100mg/dl Normal
Bilirubin <2 <2 Normal
Bleeding Time 2 min 1-9 min Normal
Clotting Time 2 min 1.50-2.30min Normal

Patient
Date Investigation Normal Value Remark
Value
12-02-2021 Hb% 9% 10.5-12% Decreased
ABG
pH 7.25 7.35-7.45 Decreased
PCo 2 50 30-45 Increased
Po 2 78 85-110 Decreased
HC0 3 16.0 16.3-23.9 Decreased
Hematocrit 26% 33-42% Decreased
ESR 40mm/hr 20-30mm/hr Increased

T4 6.4 5.4-14.8 Normal

T3 150 100-250 Normal
TSH 2 2-10 Normal
 Protein total gm/dl 6.5 6.2-8.0 Normal

Treatment History Date : 10 -02-2021

Sl.
Name of Drug Dose Route Frequency Time
No.
1. Zincovit syrup 5 ml oral BD 12am – 12pm

2. Zenith Tablet 1 tab oral BD 10am – 10 pm

(iron + VitC (0.5mg)

3. Hemocarext 1 tab (100 oral BD 8 a.m. – 8 p.m.

mg)

4. Inj. Ampilox 550 mg Iv BD 8 a.m. – 8 p.m.

5. Iron infusion 30ml Iv OD 6 am

Treatment History Date : 11 -02-2021

Sl.
Name of Drug Dose Route Frequency Time
No.
1. Zincovit syrup 5 ml oral BD 12am – 12pm

2. Zenith Tablet 1 tab oral BD 10am – 10 pm

(0.5mg)

3. Hemocarext 1 tab (100 oral BD 8 a.m. – 8 p.m.

mg)

4. Inj. Ampilox 550 mg Iv BD 8 a.m. – 8 p.m.

5. Blood 100ml Iv OD 7 am
transfusion
(RBc)
Treatment History Date : 12 -02-2021
Sl.
Name of Drug Dose Route Frequency Time
No.
1. Zincovit syrup 5 ml oral BD 12am – 12pm

2. MVI + ½ DNS 10 + Iv 6 hr stat 9 a.m.

(10ml) 500ml

3. Hemocarext 1 tab (100 oral BD 8 a.m. – 8 p.m.

mg)

4. Inj. Ampilox 550 mg Iv BD 8 a.m. – 8 p.m.

5. Syrup ONDEM 5 ml Oral BD 12 am – 12 pm

6. Iron Infusion 30 ml Iv OD 7 a.m.

Physical Examination
[I] General examination
Posture - Normal
Activity - Less Active
Cry - Poor cry
Color - Pale
Body Build - Thin body

Vital Sign
Temperature - 101F
Pulse - 140 b/min
BP - 90/60 mm Hg

Respiration rate - 40 b/min

[II] Anthropometric Assessment

Weight - 10 kg
Length / Height - 75 cm
Head circumference - 40 cm
Chest circumference - 34 cm
Mid arm circumference- 12 cm

[III] Head to toe Examination

Skin
Colour - pale
Lesion - Lesion present in upper & lower extrimities
Jaundice - Absent
Nails - Thin, brittle and flat
Turgor - Dehydrated
Presence of birth mask - Absent
Head :
Circumference - Normal
Shape - Normal
Molding - Absent
Any injury - Absent
Dandruff - Absent

Fontanelles
Anterior - Closed
Posterior - Closed

Birth trauma - Absent

Forceps mark - Absent
Facial symmetry - Symmetrical

Neck :
Webbing of neck -Absent
Torticolis -Absent
Enlargement -Absent
Thyroid or neck swelling -Absent
Movement -Normal
Tonic neck reflex -

Face :
Asymmetry -Absent, paralysis – Absent
tenderness over sinuses - Absent
Ears :
Position -At the level of outer canther of eye
Size -symmetrical
Cartilage formation - Wel formed
 Any discharge - Absent
Hearing abilities - Normal

Eyes :
Position symmetrical, Pupillary size – Normal
and shape
Inner canthill diameter
Discharge Absent Reaction to – Normal light
Redness Absent
Sclera White Visual activity -Normal
Conjunctiva - pale
Nose :
Potency -Normal Septum – well deviated septum
Flaring -Absent
Nasolabial flood -Normal
Discharge -Absent
Other -No problem identified

Throat :
Lips -Dehydrated
Symmetrical facial movements -Present
Platelet -wel formed
Tongue -white coated
Secretions -Absent
Mouth Ulcer -Present
Voice -Normal
Cry -Poor

Throat & Mouth :

Lips -Dehydrated
Symmetrical facial movements -Present
Platelet -Welformed
Tongue -White coated
Secretions -Absent
Mouth Ulcer -Present
Tonsils -enlarged small amount of enlargement
Seer
 Voice -Normal
Cry -Poor

Chest :
Shapped -Normal
Respiratory -40b/min
Retraction/granting -present
Apnea -Absent
Breath -Normal breathing sound
Breast tissue -6 cm
Breathing difficulty -present

Cardio Vascular :
Heart rate -144 b/min
Unusual rhythm/mumurs -abnormal rhythm
Cyanosis (acrocynosis) -absent
Pulse -144 b/min

Abdomen :
Shape -Normal shape, Abdominal girth is 34 cm
Distension -Absent
Liver -Not palpable
Spleen -Not palpable

Extremities & back :

Upper extremities (digit, symmetry)-Bilaterally symmetrical
Lower extremities (digits, symmetry) – Bilaterally symmetrical
Swelling -present in lower extrimities
Polydactyl -Absent and syndactyl

Genitalia : - Clean, Desended testies

Rougosity - Present
Neurological assessment :
Mono reflex -Absent
Tonic neck reflex -Absent
Stepping -Absent
Palmer grasping -Absent
Planter grasping -Absent
Rooting reflex -Absent
Sucking -Present
Swallowing -Present
Joint mobility -Absent
Body movements -Present

Muscle tone
Posture -Normal
Passive tone -Normal
Active tone -Normal
 1 s t Day
Physical Examination
General appearance
Body build:- Fatigue, Edema in Lower extremities
Activity : - Less active.
Cry : - weak cry
Colour : - Pale
Vital Sign
Temperature 100F
Pulse 140b/min
BP 99/66 mm Hg
Respiration rate 44 b/min
Skin
pale appearance of body, lesion present in hand and leg
Nails are thin, brittle and flat
Head
Dandruff present in scalp. There is no discharge or bleeding
Anterior and posterior fontenelle is closed
Hair
Hair colour is brown and rough.
Face
Normal expression is maintained during examination. No scar mark
present
Eye
Child eye are normal in size and shape. Eyes are bilaterally symmetrical
papillary reaction and blinking reflex are present. Sign at anemia is
present.
Ear
Ears are bilaterally symmetrical, No hearing difficulty. No abnormal
sound is present
Chest
Trachycardia 160 b/min, Trachypnea 40 b/min, size & shape is normal.
No abnormal sound is present
Abdomen Normal
Lower extremities Edema present
Upper extremities Normal
Impression skin colour is pale, lesion present, nails are thin,
brittle and that, hair colour is brown & rough, sign of
anemia present in eye.
Date & Assessment Nursing Diagnosis Goal Intervention Rationale Implementation Evaluation
Time
Subjective Data Fatigue related to To minimize To observe the To early detection The child vital Increased
Child mother say decreased oxygen fatigue and to child for vital of any defer sign are checked child activity
that he is very supply to the tissue as relief signs and other condition of 2 hourly level
weak, and respiratory related features health & prompt Temperature 100F
evidence by child Hb
complain of head problem action
reeling level is 8g/dl child
having loss of Positioning the To improve
Child positioned in
appetite and Fatigue child in upright respiratory statusup right position
Objective Data position. provided client
Fatigue Promote rest and To provide client comfort to
Weakness sleep comfort improved rest
Hb% - 8g/dl and sleep advice
to
Loss of
Advice to
appetite Allowing foods To prevent iron provided child
Trachycardia containing more deficiency in iron containing
(160b/min) calories and iron body & energy food in daily diet
Trachypnea (32 improved as chicken,
b/min) lentils, beams,
Edema in Lower egg., soya sea
food
leg.
Date & Assessment Nursing Goal Intervention Rationale Implementation Evaluation
Time Diagnosis
Subjective Data Altered nutrition To provide providing diet rich in To improve child Advice mother to Improved
Child mother Less than body adequate protein and iron nutritional status provide protein and child
say that ‘she requirements nutritional according to food iron absorption in iron rich diet such dietary
intake preference and body as egg, seafood pattern
cannot want to related to
availability chicken as per child
take food’ inadequate To advice mother to To maintain child choice
dietary intake and give small amount nutritional status
chronic blood frequent food Advice mother to
Objective data loss, as evidence To encourage the child give small amount
-Pallor by child is pallor for positive attempt To improve child frequent food
-Edema in edema in lower to take food dietary pattern
Giving iron Encouraged the child
lower limp limp and sore in
supplementation in for positive attempt
-Sore in the mouth between meals with To increases iron to take food in play
mouth fruit juice as per level in body to activitis
doctor advice prevent anemia

Giving child iron

supplements as
zincovit mixed with
fruit juice as per
doctor advice
Physical Examination
Day – 2
General Appearance

Vital Sign
Temperature 101F
Pulse 144 b/min
BP 90/60 mmHg
Respiration rate 44 b/min
Anthropometric measurement
Body weight - 10 kg
Head circumference -40 cm
Chest circumference -34 cm
Mid arm circumference -12cm
height -75cm

Skin
pale appearance of body, lesion present in hand and leg
Nails are thin, brittle and flat
Head
Dandruff present in scalp. There is no discharge or bleeding
Anterior and posterior fontenelle is closed
Face
Normal expression is maintained during examination. No scar mark present
Hair
Hair colour is brown and rough
Eyes
Child eye are normal in size and shape. Eyes are bilaterally symmetrical papillary reaction
and blinking reflex are present. Sign at anemia is present.
Ear
Ears are bilaterally symmetrical, No hearing difficulty. No abnormal sound is present
Chest
Trachycardia 160 b/min, Trachypnea 40 b/min, size & shape is normal. No abnormal sound
is present
Abdomen
Bowel sound is present, There is no scar mark
Upper & Lower extremities
Upper and Lower extremities are bilaterally symmetrical
Pollydactyl and syndactyl is not present. Swelling is present in
Lower extrimities
Genetalia Genetalia is clean
Impression : The child is physically weak,
Decreased body weight
Fever is present i.e. 101F
Date & Assessment Nursing Diagnosis Goal Intervention Rationale Implementation Evaluation
Time
Subjective Data Risk for infection To prevent and Promote hygienic To prevent Promoted hygienic Child body
Child mother sayrelated to the general treat infection measures and infection measures & temperature
that “his body weakness & diseases and maintain general general is reduced
feel hot, and he child body cleantines cleanness Respiration
condition as evidence
feel irritable” temperature 36 b/min
by client body Avoid exposure to Pulse 120
temperature is avoid exposure to To prevent cold and cold by b/m
Objective Data increased 101F cold and cough providing client
Fever infection blankets
Temperature Hand washing is
maintain aseptic To prevent cross done before
101F
technique and infection started any care
Pulse-160b/min hand washing
Respiration 40 practice during
b/min care
Cough TRP recorded 4
Recording of TRP To collect the hours interval
at 4 hours baseline data of
interved child health
condition provided child
provide an To prevent antibiotic
tipyretics, infection and Meropenem
antibiotics as per reduced child 350mg Iv as per
doctor advice body temperature doctor advice
Date & Assessment Nursing Diagnosis Goal Intervention Rationale Implementation Evaluation
Time
Subjective Data Altered growth and To promote Instructing the To improve child The mother is Dietary
Child mother say development growth and mother to provide growth & instructed to intake
that ‘he is not related to decreased development of adequate protein development provide adequate increased
developed as per the child and to containing food in protein Mother is
energy level and
age’ treat daily dietary containing food concerned
poor general malnutrition intake. in daily dietary about care
condition as well as intake of the child
Objective Data diseases condition & accept
Body weight as evidence by Explaining about To improved child Explained mother the
height child body weigh is importance of dietary pattern about importance instructions
less than age improved dietary of improved
MUAC
intake especially dietary in take
Head low cost food especially low
Circumference item, iron and cost food item as
Chest protein containing egg, spinach etc.
circumferance food
To improved child
Encouraging child activity level Encouraged child
play and other play activities
recreational
activities To check child
proper growth
Instructing the as per age Instructed mother
mother to to continue care
continue care at at home and
home and regular check regular
weight check up weight gain
Day – 3
Physical Examination
General appearance
Vital sign
Temperature 99F
BP 90/60 mmHg
Pulse 136 b/min
Respiration rate 32 b/min
Skin
pale appearance of body, lesion present in hand and leg
Nails are thin, brittle and flat
Head
Dandruff present in scalp. There is no discharge or bleeding
Anterior and posterior fontenelle is closed
Face
Normal expression is maintained during examination. No scar mark present
Hair
Hair colour is brown and rough
Eyes
Child eye are normal in size and shape. Eyes are bilaterally symmetrical papillary reaction
and blinking reflex are present. Sign at anemia is present.
Ear
Ears are bilaterally symmetrical, No hearing difficulty. No abnormal sound is present

Chest
Trachycardia 136 b/min, Trachypnea 40 b/min, size & shape is normal. No abnormal sound
is present
Abdomen
Upper & Lower extremities
Genitalia
Fluid intake Fluid output
2000 ml Urine 1800 ml
Oral 1000 ml Vomiting present
Iv fluid ½ DNS – 1000 ml 24 hour Diarrhoea Present

Impression :
Child have fluid imbalance and risk for imbalance fluid volume and
deficit of fluid balance. Diarrhea and vomiting present.
Date & Assessment Nursing Goal Intervention Rationale Implementation Evaluation
Time Diagnosis
Subjective DataKnowledge To improve Explaining about To prevent infection Explained about The mother
Mother is very deficit related to knowledge importance of food importance of food listen the
much anxious child care as by health hygiene, general hygiene, general information
teaching cleanliness, cleanliness use of carefully
about child
evidence by
regarding wearing of shoe latrine prevention and ensure
health and say mother is very disease use of latrine, of infection and to follow at
mother say thatmuch anxious condition prevention of worm infestation home
is that the about child health infections and
disease is curecondition worm infestation To improved child Explained mother
able or not Explaining about nutritional status about importance of
importance of improved dietary
improved dietary intake in low cost
intake in low-cost food item like egg
Objective data food item spinach
-Anxiety Discussing about To give information Discussed about
-Illiterate support facilities about health care support facilities
mother of poor available in the facilities available in the
family community community.
Informing about the For early defection of Informed about the
signs of any deteriation of signs of
deterioration or health deterioration or any
and complication complication eg
pallor, edema
Date & Assessment Nursing Goal Intervention Rationale Implementation Evaluation
Time Diagnosis
Subjective DataRisk for fluid To improve Monitor accurate To maintain child Monitored accurate Child fluid
Child mother volume deficit child fluid fluid intake fluid balance in the fluid intake balance is
say that ‘he related to the balance in the according to oral body according to oral maintained
body & intake or parental and parental fluid
have loose
child suffering
prevent fluid administration
motion and
from diarrhea and diarrhea and administration
vomited more vomiting as vomiting Monitor accurate To early defection of Monitored accurate
than 4 times evidence by child intake and output fluid volume deficit intake and output
imbalanced and keep accurate in the body and keep accurate
intake output records and records and monitor
Objective data report monitor laboratory laboratory values
values
-Diarrhea
provide frequent To prevent provided frequent
-Vomiting mouth care and dehydration of lip mouth care
-Trachy cardia application of & creak in lip
160b/min emollient to lips
Changes position To prevent pressure Position changes
frequently to sore frequently
Prognosis
1 s t day
Temperature 100F
Respiration 44 b/m
Bp 99/66mm Hg
Pulse 160 b/m

Anthropometric measurement
Body weight 10 kg
Head circumference 40 cm
Chest circumference 34 cm
Midarm circumference 12 cm

1. Fatigue related to decreased oxygen supply to the tissue as evidence

by child Hb level is 8 g/dl & child having loss of appetite.
2. Altered Nutrition less than body requirements related to inadequate
dietary intake as evidence by child is pallor and edema in Lower
extrimities
2 n d day
Temperature 101F
Respiration 44 b/m
Bp 90/60mm Hg
Pulse rate 144 b/m

Anthropometric measurement
Height 80cm
Body Weight 10 kg
Head circumference 40 cm
Chest circumference 34 cm
Midarm circumference 12 cm

1. Risk for infection related to the general weakness and diseases

condition as evidence by client body temperature is increased
101F.

2. Altered growth and developments related to decreased energy level

and poor general condition as evidence by child body weight is less
than age.
3 r d day
Temperature 99F
Respiration 32 beat/min
Bp 90/60 mm Hg
Pulse rate 136 b/m

Anthropometric measurement
Height 80cm
Body Weight 10 kg
Head circumference 40 cm
Chest circumference 34 cm
Midarm circumference 12 cm

1. Risk for third volume deficit related to the child suffering from
diarrhea and vomiting as evidence by child intake output report.

2. Knowledge deficit related to child care as evidence by mother

anxiety.

Prognosis :
The short term prognosis for most patients is excellent. However, if
the underlying cause is not corrected, the prognosis is poor. Chronic iron
deficiency can lead to death from an underlying lung or heart disorder.

Conclusion :
Body iron status can usually be assessed by considering the Hb, red
cell indices and serum ferreting concentration, along with evidence of
inflammation, infection and liver disease.
Food containing as corbic acid like citrus food, broccoli and other
dark green vegetables improved iron absorption in body.
Bibliography

1. Dutta parul, Pediatric Nursing, The health science publisher, New

Delhi, 4 t h edition, 2018.

2. Brunner Suddarth, Textbook of Medical Surgical Nursing, eleventh

Edition 2016, New Delhi, unit-v.

3. Piyush Gupta, ‘Text book of pediatrics’, CBS publishers and

distributors 2016. Chapter-10.

4. Rimple Sharma, “Essentials of pediatric Nursing” 3 r d edition,

Jaypee Publisher New Delhi.