“NURSING CARE MANAGEMENT OF A

CLIENT WITH POSTPARTUM IRON

DEFICIENCY ANEMIA”
A Case Presentation presented to Baliuag
University’s College of Nursing and Allied Health
Sciences

In partial fulfillment for the requirements of

NCM 109 – Care of Mother and Child at Risk or

with Problems, Acute and Chronic

By:

Laurente, Patrizja Ysabel B.

Naguit, Ella Joyce

Paliza, Isabella Nicole

Placido, Agatha Louise

Rimando, Jaymie Lee

Santos, Faith Stephanie

Group 11 (BSN II)

Batch 2026

Submitted on

April 6, 2024

Copyright © Baliuag University College of Nursing and Allied Health Sciences. All rights reserved.

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 OVERVIEW OF THE CASE SCENARIO:

This case study features a patient with postpartum anemia. Ms. Juliana May Nieto, a 21-year-old Filipino female,
gravida 2, para 1, who is presented to the emergency department on March 16, 2024 with complains of onset of
watery discharge followed by intense contractions, alongside with vaginal bleeding during labor. The patient
underwent cesarean section (CS) delivery. The pateint’s laboratory examinations showed decrease in red blood
cell, hemoglobin, and hematocrit and increase in white blood cell levels.

OBJECTIVES OF THE STUDY:

The objectives of the study are to comprehensively understand the condition, proficiently assess patients, diagnose
effectively, plan and implement tailored care strategies, educate patients and families, collaborate seamlessly with
other healthcare professionals, and ethically address cultural considerations. These objectives aim to enhance
nursing practice, optimize patient outcomes, and promote maternal health and well-being.

SIGNIFICANCE OF THE STUDY:

The study aims to address the overlooked and often underestimated nature of Tinea versicolor, which is
frequently disregarded or treated as a benign condition due to its lack of severe symptoms.

For postpartum mothers, this case study is crucial as it sheds light on a common yet often overlooked
condition that can significantly impact their health and well-being. By understanding the causes, symptoms, and
management of postpartum anemia, patients can become more proactive in their healthcare, recognizing signs
early and seeking timely intervention, ultimately improving their recovery process and overall health outcomes.

For nursing students, this case study serves as a valuable learning resource, offering practical insights
into the assessment, diagnosis, and management of postpartum complications. By engaging with real-life
scenarios and applying theoretical knowledge to clinical practice, students can develop critical thinking skills,
enhance their clinical reasoning abilities, and become better equipped to provide competent and compassionate
care to postpartum women with anemia and other related conditions.

For public health perspective, understanding the implications of postpartum anemia is essential for
promoting maternal health and reducing morbidity and mortality rates associated with childbirth. By raising
awareness about the risk factors, symptoms, and consequences of postpartum anemia, public health initiatives can
focus on preventive measures, early detection strategies, and accessible healthcare services, ultimately improving
maternal outcomes and contributing to overall community health and well-being.

SCOPE AND DELIMITATION:

Scope:
The case study includes biographical data, nursing health history, focused physical assessment, and
developmental level. The overview of the disease, its signs and symptoms, etiology, and pathophysiology will
also be presented. In addition, laboratory and diagnostic tests, medical and surgical management, as well as
nursing management that are applicable to the case will be mentioned. The drug study of five of the medications:

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Co-Amoxiclav, Celecoxib, MV+Iron, Calcium Tab and Ascorbic Acid, ordered by the physician and the
formulated nursing care plans - two (2) actual and one (2) risk — will also be presented.

Delimitations:

The presentation of the anatomy and physiology is limited only to the component of the affected system, which
is the blood that is part of the circulatory system.

Nursing health history presents the client's history of present condition from March 15, 11:00 pm until March 19,
2024. The data presented in this document were collected from various sources, including the patient, significant
other/s, laboratory and diagnostic results, and chart notes. However, it is essential to clarify that the client was
only directly handled by the student nurses for one day, specifically on March 19, 2024 during the 7 AM to 3 PM
shift at Baliuag District Hospital - Station 1 (OB WARD). Despite the delimitation, the student nurses utilized all
available data above to compile this comprehensive health history for the patient's care.

There has been no follow-up assessment or check-up that occurred. Due to the specific duration of their
involvement in the patient's care and the limitation of the data collection period, the student nurses were not able
to participate in subsequent assessments or check-ups and are not able to gather latest diagnostic/laboratory test
results..

DEFINITION OF TERMS:
Anemia - a reduction in hemoglobin (Hb) or hematocrit (HCT) or RBC count.

Hematocrit – percentage by volume of red blood cells in blood.

Hemoglobin- protein in red blood cells that carries oxygen.

Intrapartum - refers to the period during childbirth when labor begins and ends with the delivery of the baby
and the placenta.

Red Blood Cells – also known as erythrocytes, deliver oxygen to the tissues in the body.

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 NURSING HEALTH HISTORY

I. BIOGRAPHIC DATA
Name: Juliana May Ipio Nieto
Address: Sapang Putik, San Ildefonso, Bulacan
Contact No: 09976215345
Birthdate: 02/22/2003
Birthplace: Sapang Putik, San Ildefonso, Bulacan
Age: 21 y/o
Occupation: Unemployed
Sex: F
Civil status: Single
Religion: Catholic
Nationality: Filipino
Educational Attainment: Senior High School Graduate
Ordinal Position among the family: 1st child
Name of Spouse: Ramil Delos Santos
Number of children: Wayne Shakira Delos Santos, Lucas Nathan Delos Santos
Date of Admission: March 16, 2024
Date of Interview: March 19, 2024
Attending Physician: Dr. Bernadette P. Mateo
Chief Complaint: Onset of watery discharge followed by increasingly intense contractions,
along with significant vaginal bleeding during labor.
Admitting Diagnosis: G2P1 (1001) PU 39 3/7 WKS PREV CS 1X CPD
Principal Diagnosis: Postpartum Iron Deficiency Anemia Secondary to Intrapartum Hemorrhage and
Cesarean Delivery.

A. History of Present Illnesses

Ms. Juliana May Nieto, a 21-year-old Filipino female, gravida 2, para 1, presented to the emergency
department on March 16, 2024, at 10:59 am, accompanied by her partner. She reports experiencing an
onset of symptoms starting on March 15 at approximately 11:00 pm.

According to the patient’s account, she initially noticed a few episodes of watery discharge leaking from
her private area and ignored it. Following this, she began experiencing continuous and progressively
intensifying contractions. The contractions persisted over the next few hours, and by 5:00 am, she
observed the presence of blood alongside the contractions.

The patient described the bleeding as significant that a considerable amount of blood had already been
expelled before they were able to reach the hospital. Notably, the hospital is located a considerable
distance from their residence, which is in San Ildefonso to Baliwag, Bulacan, and there is no available
vehicle, which contributed to the delay in seeking medical attention. Despite the increasing intensity of

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 the symptoms, she endured the journey to the hospital, which took until approximately 9:30 am to reach.
She undergone a CBC test at 11:30 am. Showing results of a decrease in RBC levels to 3.48 10^12/L (3.5-
5.00 10^12/L), hemoglobin level to 108 g/L (normal range: 110-150 g/L), hematocrit to 36.4% (normal
range: 37.0-47.0%), and an increase in white blood cell count (WBC) to 11.00 x10^9/L (normal range:
4.00-10.00 x10^9/L).

Ms. Nieto underwent cesarean section (CS) delivery at 2:34 pm that day. During the delivery, she received
two units of packed Red Blood Cells (RBC) transfusions. After the surgery, a CBC test was performed.
At 10:35 pm, the results showed a decrease in RBC levels to 3.34 10^12/L (3.5-5.00 10^12/L) hemoglobin
level to 99 g/L (normal range: 110-150 g/L), hematocrit to 30.8% (normal range: 37.0-47.0%), and an
increase in white blood cell count (WBC) to 11.48 x10^9/L (normal range: 4.00-10.00 x10^9/L).

Three days post-operation, Ms. Nieto presents with pale conjunctiva, palmar pallor, and a capillary refill
of 3 seconds. Additionally, she has a scant amount of lochia rubra in her diaper. The physician modified
her medication regimen, changing the prescription of ferrous sulfate to be taken once a day into twice a
day, two hours after meals, and ascorbic acid to be taken once daily. The physician also instructed Ms.
Nieto to request another unit of Fresh Whole Blood (FWB), although the process has been delayed due to
unavailability of blood bag. Ms. Nieto and her partner expressed a desire to be discharged and to solely
rely on additional ferrous sulfate supplementation to restore her iron levels due to financial problem, no
updates regarding the decision of the hospital was obtained. A follow-up CBC test is requested with a
referral to MROD.

B. Past Health History

a. Childhood Illness
- She stated that during her childhood, she never had any other diseases. According to her, she
simply had flu, cough, and common colds.

b. Immunization
- The patient's last vaccinations were in 2022, which included a booster shot of the Pfizer for
COVID-19 vaccine and one shot of the flu vaccine.

c. Allergies
- She stated that she doesn't have any allergies to any kinds of food and medications.

d. Accidents/Injuries
- She didn’t experience any major accidents and injuries aside from minor abrasions and cuts
acquired in her early childhood while playing.

e. Hospitalization
- She stated that the only time that she was hospitalized is because the delivery of her first child
at a hospital in Nueva Ecija.

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 f. Medications etc.
- She stated that she is currently taking medications because of her current state. She is currently
taking Co-amoxiclav, Celecoxib, MV + Iron, Calcium tablet, and Ascorbic acid. She also
added that during her pregnancy there are times that she was not able to take her vitamins on
time due to financial problem.

g. Obstetric History
- The patient’s age of menarche and thelarche was 14-year-old. She has history of heavy
menstruation. Her last menstruation was last June 14, 2023, before she found out she was
pregnant for her second child. She has been pregnant twice, both resulting in cesarean section
deliveries. At 20 y/o, during her first pregnancy, the patient underwent a CS delivery due to
cephalopelvic disproportion (CPD), a condition where the baby’s head is larger than mother’s
pelvis, making vaginal delivery difficult or impossible.

II. FAMILY HEALTH HISTORY

• Father Side
- The patient’s father, aged 41, is hypertensive, frequently smokes tobacco, and is a habitual
drinker. Her grandfather died at the age of 60 due to myocardial infarction and her grandmother
died at 45 y/o because of a motorcycle accident.

• Mother Side
- On the maternal side, her mother, aged 40 has diabetes and hypertension. Her grandfather,
aged 71, and grandmother, aged 70, are hypertensive. Her 2 uncles and aunt are all alive and
well.
• Siblings
- Her siblings are generally healthy, although her youngest sister sometimes experience
difficulty of breathing usually after playing all day with her friends outside their house.

III. ACTIVITIES OF DAILY LIVING

A. Circulation
The client has a capillary refill time of 3 seconds, there is no cyanosis present, however the patient
presents with pale conjunctiva and palmar pallor. Her last blood pressure is 100/60 mmHg and pulse rate
is 109 bpm. She is weak in appearance.

B. Respiration
The client verbalized, “Minsan parang pakiramdam ko para akong pagod.” The client’s initial
respiratory rate was 23 bpm, oxygen saturation of 97%. Use of accessory muscle is noted as shoulder
elevation is seen upon assessment. She does not have cough and colds.

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C. Food/Fluid
The client eats three meals daily, her typical breakfast consists of pandesal paired with coffee. For lunch,
she usually eats rice with canned sardines or meatloaf. For dinner she usually eats rice with egg. She
verbalized, “Ganyan madalas naming pagkain, yung sakto lang sa kita ni Ramil, eh ayoko naman ng
tuyo at kangkong.” She added that due to financial problems, she wasn’t able to maintain a healthy diet
because of the current high prices of foods in the market.

D. Elimination
The patient reports experiencing hard time to pass stool in relation with her pregnancy. She also stated
that she doesn’t have any pain or burning feeling while urinating. With her post-partum status, she notes
that she urinates more often, going about 6 to 8 times daily. She stated that on her first few hours her
urine color in her urinary bag is stained with blood, but now the client mentioned it is already pale
yellow in color. She still uses diaper and her husband verbalized, “Nagpapalit kami diaper kapag
talagang punong-puno na kahit ilang oras na pag di naman puno di ko na pinapalitan mahirap kasi
lumabas para bumili tsaka pang gamot nalang sana yung ipambibili tsaka siya din may ayaw minsan
nahihiya marami kasi tao dito sa ward.”

E. Personal Hygiene
The patient encountered challenges in maintaining her typical self-care regimen. This was primarily due
to the presence of an intravenous line in her hand on her first few days, which restricted her independence
in attending to her personal hygiene needs, including bathroom use. Throughout her hospital stay, she
made efforts to uphold hygiene standards by regularly washing her face, although a complete bath was
deferred. She verbalized, “Di ko po ganoon na tututunan pansin ung ano (genital area) ko po ngayong nasa
ospital natatakot po ako gumalaw tsaka hinahayaan ko.”When asked about what she uses to clean her
genital area, the client verbalized, “isang pirasong wipes po, pabalik balik lang po sa isang lugar, sinusulit
po naming yung isang wipes, sayang po kasi tsaka natatakot po ako gumalaw galaw.”Attending to proper
hygiene of her own private area was hindered by discomfort caused by her surgical wound, that is heighten
by movement. During her pregnancy, she verbalized when asked about how she perform perineal care,
“Nung nakakagalaw-galaw pako, binubuhusan ko ng tubig, tapos sasabunin ko ng paulit-ulit, kinukuskos
po harap palikod tas pabalik ko para malinis.”

F. Exercise
She does not have a regular exercise program but she plays volleyball with her high school friends during
her teenage days. She stated that during her pregnancy, she was not able to engage in physical activities
because she gets dizzy and gets tired easily.

G. Rest/ Sleep
The patient typically gets about 6-7 hours of sleep per night. She has some trouble falling asleep due to
discomfort from her surgical wound, but once asleep, she generally stays asleep without significant
disruptions. However, she occasionally wakes up during the night due to discomfort or to attend to her

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 newborn. She added that during pregnancy, she also experienced difficulty finding comfortable sleeping
positions due to her growing belly, which contributed to her sleep disturbances.

H. Usual Pain/Discomfort
The patient said that during her pregnancy, she occasionally experienced headaches, particularly in the
first and third trimesters. She also experienced muscle pain, especially in her lower back and pelvic area,
as her pregnancy progressed. Upon giving birth, she said that she continues to experience muscle pain,
particularly in her abdominal area and lower back, exacerbated by her prolonged positioning on the
hospital bed.

IV. COMPETENCIES
A. Physical
The patient said that as her pregnancy advanced, she felt more tired than usual, especially during the later
months. She mentioned needing more breaks for rest, particularly when standing for long periods,
walking, or lifting heavy objects. Simple tasks like bending over or getting up from a chair became harder
due to her growing belly. At home, she mainly did light chores such as washing dishes, sweeping, and
folding clothes, but found these tasks increasingly difficult as her pregnancy progressed. She verbalized,
“Madalas hinihingal ako konting galaw ko lang, kunwari tatayo, medyo hingal ako agad.”
B. Emotional
The patient said that she only experienced fear and worry when he was confined to the hospital. The client
verbalized, "Iniisip ko nalang na nakaraos na ko ng isa sa una kong anak tsaka tumitingin nalang ako sa
asawa ko tsaka nagdadasal kapag nakakaramdam ako ng takot.” Moreover, she shared that she often
experiences stress related to their financial situation, given her responsibilities as a mother to two children
at the age of 21.

C. Mental
The patient said that she is sad because she couldn't go to college after high school as she started her own
family. But she's happy to have her kids and sees them as blessings. Sometimes she worries, but her family
and praying help her feel better. She said that it is hard for her to focus or make decisions. She verbalized,
“Nung nakaraan parang ayoko muna magpaadmit talaga dahil wala pakami pambili gamot, walang wala
talaga kahit yung araw araw na vitamins ko minsan di ko naiinom dami kasi gastusin, kaya nung may
tubig na kumatas sakin pinilit ko pa na idelay pagpunta sa ospital kasi di pa kami handa.”. The client’s
husband verbalized, “minsan iniisip na rin naming kung kakayanin ba yung gamot at mga laboratory niya.”
She also added, “Naguguluhan din kami pano ba iinumin yung mga gamot na nireseta marami kasi tapos
di ko alam ano oras tsaka alin yung magkakasabay iinumin kaya basta mainom ko nalang sya sa isang
araw.”

D. Spiritual
Her religion is Roman Catholic. She stated that she prays every day to seek
guidance and to express her gratitude to God. She also added that they are not going to church every week.
They only go to church every first Friday.

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 E. Social
The patient said that she no longer socializes with her friends as much as she did when she was studying.
However, she expressed confidence in her ability to interact well and without difficulty once she
reconnects with them. Additionally, she stated that she currently does not hold any position in any
community organization.

F. Environmental
The patient mentioned that she feels safe and contented on their community, even though it's far from
town. Their house is surrounded by many trees. She said that they only have few neighbors. She mentioned
being unaware of any nearby hospital, with only knowledge of the nearest health center. Additionally, she
highlighted the difficulty in accessing public transportation in their area, often requiring hours of waiting.

PHYSICAL ASSESSMENT

General Survey:

During the interview on March 19, 2024 at 9:00 am, Ms. Nieto was awake, alert and conscious to time but appears
to be pale and weak in appearance. She has a surgical wound on the hypogastric region, supported by a binder.
She is in a semi-fowler’s position while breastfeeding her newborn baby. The client has pale conjunctiva, palmar
pallor, and a capillary refill of 3 seconds. Upon observing, usage of accessory muscle was noted as frequent
shoulder elevation is observed.

- Blood Pressure: 100/60 mmHg - Temperature: 36.4°

- Pulse Rate: 109 beats/minute - Respiratory Rate: 23 breaths/minute
- Oxygen Saturation: 97%

V. HEAD TO TOE ASSESSMENT

1. Skin, Hair, and Nails

1.1 Skin

- Upon assessment, the patient's skin exhibits paleness and is smooth in texture; a surgical wound is noted
on the hypogastric region covered by a gauze and supported by a binder. Darker skin tone is noted on the neck
and nape area. No visible rashes are observed.

1.2 Hair

- The patient’s hair is color black and medium in length. It appears dry and frizzy. No bald spots are
observed upon inspection; a slight presence of dandruff was noted; no unwanted smell; and no signs of hair loss
were observed during inspection.

1.3 Nails

- During assessment, capillary refill time is noted to be slightly prolonged at approximately 3 seconds;
fingernails are observed to be trimmed and short; nail beds appear pale; and no finger clubbing is observed.

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2. Head and Face

- The client's face appears symmetrical without any signs of drooping; facial muscles exhibit normal tone
and strength; temporomandibular joint (TMJ) function appears to be intact, with no reported crackling or popping
sound; there is no evidence of facial swelling or inflammation; no scars or moles are observed on the face.

3. Eyes

- Upon inspection, eyes are bilaterally symmetrical in terms of size and shape; no evidence of swelling or
discharge is observed; pupils are checked and appear equal, round, and responsive to light and accommodation
(PERLA); eyes are black in color; however, conjunctiva appears pale; with slightly dry eyes; no specific eye
problems are reported; and the client does not wear glasses or contact lenses.

4. Ears

- There is no evidence of swelling or inflammation observed; small amounts of cerumen are noted during
inspection of the ears; no pain is noted upon palpation of the mastoid process; and the client has 1 healed piercing
hole on each ear lobe.

5. Nose and Sinuses

- The nose is centrally positioned with no reported pain; the nasal bridge appears prominent; the nostrils are
patent and equal in size; the mucous membrane inside the nose appears pink and moist; no signs of sinus
tenderness or discomfort upon palpation of the sinuses; a minimal amount of blackheads are noted; no evidence
of swelling or inflammation; and the client denies any history of nosebleeds, allergies, or related nose problems.

6. Mouth and Throat

- The lips are symmetrical, dry and pale in color. Tongue is moist and pink in color. Gums are pink and
firm, with no signs of bleeding or inflammation. Teeth are clean and intact, with no visible cavities or decay.
Tonsils are not enlarged or inflamed. Thin mustache is noted.

7. Neck

- The neck is midline and aligned with the head; no lesions or abrasions were found during the inspection;
the neck is warm to touch; she is able to perform range of motion (ROM) with no difficulties.

8. Posterior and Anterior Thorax

- Upon inspection, the client's thorax exhibits symmetrical expansion bilaterally during respiration; no
visible deformities or abnormalities are noted on both the anterior and posterior aspects of the thorax; the chest

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wall moves symmetrically with breathing; no signs of retractions or bulging; lung sounds are clear bilaterally on
auscultation, with no wheezing, crackles, or diminished breath sounds appreciated; and the client denies chest
pain or discomfort during assessment.

9. Heart

- Upon auscultation of the heart, the rhythm was 109 bpm. There were no murmurs, gallops, or rubs
detected. S1 and S2 heart sounds were clear and audible, with no additional sounds noted.

10. Breast

- Breast are firm upon palpation, indicative of engorgement. The patient report tenderness and discomfort
upon pressure application to the breast. Nipples are erect and dark brown in color. Areolas have darker
pigmentation than the nipple. Furthermore, there was evidence of milk leakage from both nipples, indicating
active lactation. There were no signs of redness, or unusual pigmentation noted.

11. Abdomen

- Surgical wound from the cesarean section procedure is noted on the hypogastric region, supported by a
binder.

12. Extremeties (Upper and Lower)

12.1 Arms, Hands, and Fingers (Upper Extremities)

Upon inspection, arms are bilaterally symmetrical in size and shape; both palmar

surfaces appear pale; no evidence of edema or obvious venous patterns is observed.

12.2. Hips and Legs (Lower Extremities)

During assessment, the lower extremities appear without any visible swelling or

deformities; there is no evidence of edema; there is no tenderness in the ankle area upon

palpation.

13. Genitalia

- Scant amount of lochia rubra was noted. External genitalia appeared normal with no signs of swelling and
lesions. Pubic hair is shaved.

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 DEVELOPMENTAL LEVEL

Erik Erickson’s Theory of Psychosocial Development

Stage/Age Period Psychosocial Stage Nursing Implications

Early Adulthood (20 - 35 Intimacy vs. Isolation. During As Juliana May Nieto, a 21-
y/o) this stage, individuals form deep, year-old mother, enters the
meaningful relationships and early adulthood phase of
connections with others. Failure to Intimacy vs. Isolation, it
do so may lead to feelings of becomes crucial to support her
isolation and loneliness. in fostering meaningful
connections while navigating
Intimacy refers to the ability to the challenges of motherhood.
form close, meaningful By guiding Juliana in
relationships with others. It developing communication
involves sharing one's true self, skills, educating her on healthy
feelings, and experiences with relationships, and encouraging
others, fostering emotional social engagement, nursing
connections and a sense of interventions can mitigate
belonging. On the contrary, feelings of isolation and
isolation signifies a failure to enhance her social life and
establish deep connections and psychological well-being.
relationships. It involves a sense of Through tailored support,
loneliness, detachment, and a lack Juliana can establish nurturing
of meaningful engagement with connections, contributing to her
others. overall sense of fulfillment and
belonging as she embraces her
role as a mother.

Status:
Juliana May Nieto currently leans more towards the intimacy aspect
of the Intimacy vs. Isolation developmental stage. As a 21-year-old
mother, she has formed close bonds with her partner and family,
Intimacy indicating her ability to establish meaningful connections. Despite
facing challenges such as financial strain and health issues, Juliana
relies on her support system and seeks comfort through prayer,
demonstrating a willingness to engage with others during times of
difficulty. Her commitment to nurturing relationships and seeking
social support suggests that she is actively fostering intimacy rather
than experiencing isolation.

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 ANATOMY AND PHYSIOLOGY OF THE AFFECTED SYSTEM

Circulatory System

The main function of the circulatory system is to provide oxygen,

nutrients and hormones to muscles, tissues, and organs. It allows
blood to move throughout the body, which blood circulation
keeps organs, muscles, and tissues healthy and working to keep
you alive.

The circulatory system functions with the help of blood vessels

that include arteries, veins, and capillaries. These blood vessels
work with your heart and lungs to continuously circulate blood
through the body.
Here’s how:
- The left and right sides of the heart can be considered
separate pumps.
- Blood flows from the systemic vessels to the right atrium and from the right atrium to the right
ventricle. From the right ventricle, blood flows to the pulmonary trunk and from the pulmonary trunk
to the lungs. From the lungs, blood flows through the pulmonary. veins to the left atrium, and from
the left atrium, blood flows to the left ventricle.
- From the left ventricle, blood flows into the aorta and then through the systemic vessels.

Major Organs includes:

- Heart- is a muscular organ that is essential for life because it pumps blood through the body.
- Blood vessels- carry blood from the heart to all the tissues of the body and back to the heart.
- Arteries- carry blood away from the heart; usually, the blood is oxygenated (oxygen-rich).
- Veins- carry blood toward the heart; usually, the blood is deoxygenated (oxygen poor).
- Capillaries- where exchange of substances such as 02CO, nutrients, and other waste products occurs
between the blood and the tissue fluid. Capillaries have thinner walls than do arteries
- Blood- is a type of connective tissue that consists of a liquid matrix containing cells and cell
fragments.

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HEMATOPOIETIC SYSTEM
Blood is a specialized body fluid. It has four main components: plasma,
red blood cells, white blood cells, and platelets. Blood has many
different functions, including:
• transporting oxygen and nutrients to the lungs and tissues
• forming blood clots to prevent excess blood loss
• carrying cells and antibodies that fight infection
• bringing waste products to the kidneys and liver, which filter
and clean the blood
• regulating body temperature

The blood that runs through the veins, arteries, and capillaries is known
as whole blood, a mixture of about 55 percent plasma and 45 percent
blood cells. About 7 to 8 percent of your total body weight is blood. An
average-sized man has about 12 pints of blood in his body, and an
average-sized woman has about nine pints.

Red Blood Cells (also called erythrocytes or RBCs)

Known for their bright red color, red cells are the most abundant cell in the blood, accounting for about 40 to 45
percent of its volume. The shape of a red blood cell is a biconcave disk with a flattened center - in other
words, both faces of the disc have shallow bowl-like indentations (a red blood cell looks like a donut).

Production of red blood cells is controlled by erythropoietin, a hormone produced primarily by the kidneys. Red
blood cells start as immature cells in the bone marrow and after approximately seven days of maturation are
released into the bloodstream. Unlike many other cells, red blood cells have no nucleus and can easily change
shape, helping them fit through the various blood vessels in your body. However, while the lack of a nucleus
makes a red blood cell more flexible, it also limits the life of the cell as it travels through the smallest blood
vessels, damaging the cell's membranes and depleting its energy supplies. The red blood cell survives on average
only 120 days.

Red cells contain a special protein called hemoglobin, which helps carry oxygen from the lungs to the rest of
the body and then returns carbon dioxide from the body to the lungs so it can be exhaled. Blood appears red
because of the large number of red blood cells, which get their color from the hemoglobin. The percentage of
whole blood volume that is made up of red blood cells is called the hematocrit and is a common measure of red
blood cell levels.

White Blood Cells (also called leukocytes)

White blood cells protect the body from infection. They are much fewer in number than red blood cells,
accounting for about 1 percent of your blood.

The most common type of white blood cell is the neutrophil, which is the "immediate response" cell and
accounts for 55 to 70 percent of the total white blood cell count. Each neutrophil lives less than a day, so your
bone marrow must constantly make new neutrophils to maintain protection against infection. Transfusion of
neutrophils is generally not effective since they do not remain in the body for very long.

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The other major type of white blood cell is a lymphocyte. There are two main populations of these cells. T
lymphocytes help regulate the function of other immune cells and directly attack various infected cells and
tumors. B lymphocytes make antibodies, which are proteins that specifically target bacteria, viruses, and other
foreign materials.

Platelets (also called thrombocytes)

Unlike red and white blood cells, platelets are not actually cells but
rather small fragments of cells. Platelets help the blood clotting
process (or coagulation) by gathering at the site of an injury,
sticking to the lining of the injured blood vessel, and forming a
platform on which blood coagulation can occur. This results in the
formation of a fibrin clot, which covers the wound and prevents
blood from leaking out. Fibrin also forms the initial scaffolding
upon which new tissue forms, thus promoting healing.

A higher than normal number of platelets can cause unnecessary

clotting, which can lead to strokes and heart attacks; however,
thanks to advances made in antiplatelet therapies, there are treatments available to help prevent these potentially
fatal events. Conversely, lower than normal counts can lead to extensive bleeding.

Complete Blood Count (CBC)

A complete blood count (CBC) test gives your doctor important

information about the types and numbers of cells in your blood,
especially the red blood cells and their percentage (hematocrit) or
protein content (hemoglobin), white blood cells, and platelets. The
results of a CBC may diagnose conditions like anemia, infection, and
other disorders. The platelet count and plasma clotting tests
(prothombin time, partial thromboplastin time, and thrombin time) may be used to evaluate bleeding and clotting
disorders.

The physician may also perform a blood smear, which is a way of looking at your blood cells under the
microscope. In a normal blood smear, red blood cells will appear as regular, round cells with a pale center.
Variations in the size or shape of these cells may suggest a blood disorder.

Where Do Blood Cells Come From?

Blood cells develop from hematopoietic stem cells and are formed in the bone marrow through the highly
regulated process of hematopoiesis. Hematopoietic stem cells are capable of transforming into red blood cells,
white blood cells, and platelets. These stem cells can be found circulating in the blood and bone marrow in people
of all ages, as well as in the umbilical cords of newborn babies. Stem cells from all three sources may be used to
treat a variety of diseases, including leukemia, lymphoma, bone marrow failure, and various immune disorders.

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Blood components originate in the bone marrow, circulate through blood vessels, and ultimately are destroyed
by the spleen.

BLOOD FORMATION AND COMPONENTS:

Production of Formed Elements
Hematopoiesis is the process that produces formed elements. This process is continuous throughout our lives. In
the fetus, hematopoiesis occurs in several tissues, including the liver, thymus, spleen, lymph nodes, and red bone
marrow. After birth, hematopoiesis is confined primarily to red bone marrow, but some white blood cells are
produced in lymphatic tissue.
All the formed elements of blood are derived from a single population of cells called stem cells, or
hemocytoblasts. These stem cells differentiate to give rise to different cell lines, each of which ends with the
formation of a particular type of formed element. The development of each cell line is regulated by specific growth
factors. That is, growth factors determine the types of formed elements derived from the stem cells and how many
formed elements are produced
The rate of hematopoiesis depends on the body’s needs. The body continually manufactures new blood cells to
replace old ones. About 1 percent of the body’s blood cells must be replaced every day Each type of blood cell
follows a slightly different path of hematopoiesis. All begin as stem cells called multipotent hematopoietic stem
cells (HSC). From there, hematopoiesis follows two distinct pathways.
Trilineage hematopoiesis refers to the production of three types of blood cells: platelets, red blood cells, and
white blood cells. Each of these cells begins with the transformation of HSC into cells called common myeloid
progenitors (CMP). After that, the process varies slightly. At each stage of the process, the precursor cells become
more organized: Red blood cells and platelets
Red blood cells: CMP cells change five times before finally becoming red blood cells, also known as
erythrocytes.
Platelets: CMP cells transform into three different cell types before becoming platelets
White blood cells: There are several types of white blood cells, each following an individual path during
hematopoiesis. All white blood cells initially transform from CMP cells into to myeoblasts. After that, the process
is as follows:
Before becoming a neutrophil, eosinophil, or basophil, a myeoblast goes through four further stages of
development. To become a macrophage, a myeoblast has to transform three more times.
A second pathway of hematopoiesis produces T and B cells.
T cells and B cells
To produce lymphocytes, MHCs transform into cells called common lymphoid progenitors, which then become
lymphoblasts. Lymphoblasts differentiate into infection-fighting T cells and B cells. Some B cells differentiate
into plasma cells after exposure to infection.
Erythropoiesis (production of RBCs) controlled by hormone erythropoietin, which is released from the kidneys
in response to low oxygen levels
ERYTHROCYTES (RBC) The primary functions of red blood cells are
to transport oxygen from the lungs to the various tissues of the body and
to help transport carbon dioxide from the tissues to the lungs. Oxygen
transport is accomplished when oxygen enters red blood cells and binds
to hemoglobin
Hemoglobin-The component of RBCs that allows them to carry out the
transport of oxygen is hemoglobin, composed of globin, a protein, and
heme, an iron-containing pigment. It is the heme portion that combines
with oxygen and carbon dioxide for transport.
Bilirubin- After an RBC reaches its life span of approximately 120 days,
it ruptures, and its protein component is preserved by the
reticuloendothelial cells of the liver and spleen for further use. Iron is
reused by the bone marrow to construct new RBCs. As the heme portion is degraded, it is converted into proto-
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porphyrin; protoporphyrin is then further broken down into indirect bilirubin. Indirect bilirubin is fat soluble and
so cannot be excreted by the kidneys. It is converted by the liver enzyme glucuronyl transferase into direct
bilirubin, which is water soluble and excreted in bile.
Leukocytes (WBCs) are nucleated cells and are few in number compared with RBCs (there is approximately
only one WBC to every 500 RBCs). Their primary function is defense against antigen invasion; their life span
varies from approximately 6 hours to unknown intervals.
Thrombocytes are round, nonnucleated bodies formed by the bone marrow; their function is capillary hemostasis
and primary coagulation.

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18 | Page
 OVERVIEW OF THE DISEASE

DEFINITION:

Postpartum iron deficiency anemia (IDA) is a condition characterized by low levels of iron in the blood following
childbirth. It occurs when the body's iron stores are depleted, often due to the increased demands of pregnancy
and childbirth.

During pregnancy, a woman's body undergoes significant changes to support the growing fetus, including an
increase in blood volume and a higher demand for iron to produce hemoglobin, the protein in red blood cells
responsible for carrying oxygen throughout the body.

After childbirth, especially if there was significant blood loss during delivery,labor or if the mother did not have adequate
iron stores before pregnancy, the risk of developing iron deficiency anemia increases.

ETIOLOGY:
The primary cause of postpartum IDA is inadequate iron intake or absorption during pregnancy and childbirth,
leading to diminished iron reserves. Factors contributing to this condition include:

1. Increased iron demand during pregnancy to support fetal growth and development.
2. Blood loss during childbirth, particularly in cases of significant hemorrhage during labor or delivery.
3. Insufficient iron stores prior to pregnancy, predisposing women to postpartum anemia.

SIGNS AND SYMPTOMS:

1. Fatigue
2. Weakness
3. Pale skin
4. Shortness of breath
5. Dizziness
6. Headaches
7. Difficulty concentrating

STATISTICS & INCIDENCE:

Global

- According to the World Health Organization (WHO), an estimated 32 million pregnant and
postpartum women worldwide are affected by anemia, with a significant proportion experiencing
iron deficiency anemia.

Local

- Anemia, including postpartum iron deficiency anemia, remains a significant public health concern in
the Philippines, particularly among pregnant and postpartum women. According to the Philippine
Statistics Authority (PSA), the prevalence of anemia among pregnant women in the Philippines was
estimated to be around 19.6% based on the 2019 National Demographic and Health Survey (NDHS).
While this data includes anemia during pregnancy, it highlights the ongoing issue of iron deficiency
in maternal health.
- Factors contributing to the high prevalence of anemia among pregnant and postpartum women in the
Philippines include inadequate dietary intake of iron-rich foods, limited access to prenatal care and
nutritional supplements, and socioeconomic disparities.

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COMPLICATIONS:

1.Fatigue and Weakness: Iron deficiency anemia can cause severe fatigue and weakness, impacting the ability
to perform daily activities and care for the newborn.

2.Postpartum Depression: Women with postpartum IDA may be at higher risk of developing postpartum
depression, as the physical and emotional toll of anemia can exacerbate feelings of sadness and low mood.

3.Impaired Maternal-Infant Bonding: Fatigue and weakness resulting from anemia may interfere with
maternal-infant bonding and caregiving, affecting the mother's ability to engage with and care for her newborn.

4.Delayed Recovery: Anemia can prolong the recovery period after childbirth, delaying the mother's return to
optimal health and well-being.

5.Increased Risk of Infections: Iron deficiency anemia can weaken the immune system, making the mother more
susceptible to infections during the postpartum period.

6.Cardiovascular Complications: Severe or prolonged iron deficiency anemia may lead to cardiovascular
complications such as tachycardia (rapid heart rate), palpitations, and even cardiac failure in severe cases.

7.Impact on Breastfeeding: Anemia can affect milk production and quality, potentially impacting breastfeeding
success and infant nutrition.

8.Poor Cognitive Function: Iron deficiency anemia can impair cognitive function and concentration, affecting
the mother's ability to make decisions and perform tasks effectively.

9.Increased Risk of Postpartum Hemorrhage: Women with pre-existing iron deficiency anemia may be at
higher risk of postpartum hemorrhage, particularly if adequate iron levels are not restored before childbirth.

RISK FACTORS:

- Inadequate dietary intake of iron-rich foods or prenatal supplements during pregnancy.

-Multiple pregnancies or closely spaced pregnancies, which can deplete iron stores more rapidly.

-History of heavy menstrual bleeding or anemia prior to pregnancy.

-Medical conditions such as gastrointestinal disorders or uterine fibroids that interfere with iron absorption or
lead to chronic blood loss.

-Complications during childbirth, such as postpartum hemorrhage or cesarean section.

LABORATORY EXAMINATIONS AND DIAGNOSTICS TEST

Laboratory and Diagnostic Description Status

CBC A complete blood count (CBC) is a blood test ✓
used to evaluate the overall health and detect a
wide range of disorders, including anemia,
infection and leukemia.
Compatibility Testing Compatibility testing is performed to determine ✓
if a particular unit of blood can be transfused

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 safely into a certain patient. This includes
ABO-Rh blood typing (see above), antibody
screening (for unexpected red blood cell
antibodies that could cause problem in the
recipient), and cross-matching.

Urinalysis A urinalysis is a test of urine. It's used to detect ✓

SARS-CoV-2
(Causative agent of COVID-
19) Rapid Antigen Swab Test
Hepatitis B Surface Antigen
Test
and manage urine disorders. A urinalysis
involves checking the appearance, concentration
and content of urine.
The SARS-CoV-2 Rapid Antigen Swab Test is ✓
a diagnostic tool used to detect the presence of
the SARS-CoV-2 virus, which is the causative
agent of COVID-19.
The Hepatitis B Surface Antigen (HBsAg) Test ✓
is a diagnostic tool used to detect the presence
of hepatitis B surface antigen in the blood.

Complete Blood Count (03/16/24) 11:30 am

Parameter Result (March 16, 2024) Ref.Range Unit

11:30 am (BDH)
1 WBC 11. 00 4.00-10.00 10^9/L
2 Neu% 76.0 40.0-75.0 %
3 Lym% 15.4 20.0-50.0 %
4 Mon% 7.1 3.0-10.0 %
5 Eos% 4.9 0.4-8.0 %
6 Bas% 1.0 0.0-1.0 %
7 Neu# 7.60 1.80-6.30 10^9/L
8 Lym# 1.54 1.10-3.20 10^9/L
9 Mon# 0.70 0.10-0.60 10^9/L
10 Eos# 0.33 0.02-0.52 10^9/L
11 Bas# 0.09 0.00-0.06 10^9/L
12 RBC 3.48 3.50-5.00 10^12/L
13 HGB 108 110-150 g/L
14 HCT 36.4 37.0-47.0 %
15 MCV 85.4 80.0-100.0 fL
16 MCH 29.4 27.0-34.0 pg
17 MCH 340 316-354 g/L
18 RDW-CV 16.0 11.0-16.0 %
19 RDW-SD 49.2 35.0-56.0 fL
20 PLT 220 150-400 10^9/L

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21 MPV 7.9 6.5-12.0 fL
22 PDW 13.5 9.0-17.0 fL
23 PCT 0.199 0.108-0.282 %

Complete Blood Count (03/16/24) 10:35 pm

Parameter Result (March 16, 2024) Ref.Range Unit

10:35 pm (BDH)
1 WBC 11. 48 4.00-10.00 10^9/L
2 Neu% 76.6 40.0-75.0 %
3 Lym% 13.4 20.0-50.0 %
4 Mon% 6.1 3.0-10.0 %
5 Eos% 2.9 0.4-8.0 %
6 Bas% 1.0 0.0-1.0 %
7 Neu# 8.80 1.80-6.30 10^9/L
8 Lym# 1.54 1.10-3.20 10^9/L
9 Mon# 0.70 0.10-0.60 10^9/L
10 Eos# 0.33 0.02-0.52 10^9/L
11 Bas# 0.11 0.00-0.06 10^9/L
12 RBC 3.34 3.50-5.00 10^12/L
13 HGB 99 110-150 g/L
14 HCT 30.8 37.0-47.0 %
15 MCV 82.4 80.0-100.0 fL
16 MCH 27.4 27.0-34.0 pg
17 MCH 333 316-354 g/L
18 RDW-CV 15.4 11.0-16.0 %
19 RDW-SD 47.2 35.0-56.0 fL
20 PLT 244 150-400 10^9/L
21 MPV 7.9 6.5-12.0 fL
22 PDW 10.4 9.0-17.0 fL
23 PCT 0.193 0.108-0.282 %

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Compatibility testing (03/09/2024)

COMPATIBILITY TESTING
Blood Type: “B”
(RH) Typing: POSITIVE
Blood Component: WHOLE BLOOD
Blood Bank: BPBC
Serial No. Extraction Date Expiration Date
24-1255 03/09/2024 04/13/2024
REMARKS: No agglutination nor hemolysis seen
RESULTS: Compatible for Blood Transfusion

Urinalysis (March 15, 2024)

PHYSICAL CHARACTERISTICS RESULTS

Color YELLOW
Transparency HAZY
CHEMICAL CHARACTERISTICS
Glucose NEGATIVE
pH 6.5
Specific Gravity 1.025
Protein NEGATIVE
MICROSCOPIC EXAMINATIONS
Red Blood Cells 0-3/HPF
Pus Cells 10-15/HPF
Amorphous urates/phosphates RARE
Epithelial Cells MODERATE
Mucus Threads MODERATE
Bacteria FEW
OTHERS

Rapid Antigen Swab Test (March 16, 2024)

MISCELLANEOUS
TEST: RESULT:
SARS-CoV (Causative agent of Covid-19) NEGATIVE
Rapid Antigen Swab Test

Hepatitis B Surface Antigen (March 16, 2024)

SEROLOGY
TEST: RESULT:
Hepatitis B Surface Antigen NONREACTIVE

23 | Page
 MEDICAL MANAGEMENT

Medical Rationale Status

Management Done Not Done
Pharmacological Management
Co-Amoxiclav 1 tab TID This antibiotic medication is ✓
prescribed to prevent or treat
bacterial infections that may occur
postpartum, reducing the risk of
complications such as endometritis
or wound infections following
cesarean section delivery.
Celecoxib 1 tab BID Celecoxib is a nonsteroidal anti- ✓
inflammatory drug (NSAID)
prescribed to manage pain and
inflammation, which can be
particularly beneficial postpartum to
alleviate discomfort associated with
cesarean section delivery.
MV + IRON 2 tabs 2hrs after Multivitamin with iron ✓
breakfast supplementation is administered to
address postpartum anemia, a
common condition resulting from
blood loss during delivery. Iron is
essential for red blood cell
production, and supplementation
helps replenish depleted iron stores,
improving hemoglobin levels and
alleviating symptoms of fatigue and
weakness.
Calcium Carbonate 500 mg Calcium supplementation is crucial ✓
Tablet 1 tab after lunch for postpartum women, as
pregnancy and breastfeeding
increase the demand for calcium.
Adequate calcium intake supports
bone health and prevents conditions
like osteoporosis, providing
essential support for recovery and
long-term well-being.
Ascorbic Acid 500 mg 1 tab Ascorbic acid aids in iron ✓
OD absorption, enhancing the
effectiveness of iron
supplementation for treating

24 | Page
 postpartum anemia. Additionally, it
supports the immune system and
tissue repair, contributing to overall
recovery after childbirth.

NURSING MANAGEMENT

Nursing Management Rationale Status

Done Not Done
Inspect for appearance of pale Inspecting for signs of anemia such ✓
conjunctiva, palmar pallor and as pale conjunctiva, palmar pallor,
pale lips. Check capillary refill. and pale lips, along with assessing
capillary refill, aids in evaluating
Juliana May Nieto's hemodynamic
status. These visual cues indicate
reduced hemoglobin levels and
tissue oxygenation, prompting early
intervention to optimize her
recovery postpartum.
Assist patient find a Elevating the head of the bed ✓
comfortable position in bed slightly helps ease breathing,
such as using pillows or particularly for postpartum patients
positioning devices to elevate who may experience discomfort due
the head of the bed slightly to abdominal surgery. This position
to ease breathing and reduce also reduces pressure on the
pressure on the abdomen. abdomen, minimizing strain on the
incision site and promoting healing
Encourage the client to change Frequent position changes ✓
positions frequently but slowly redistribute pressure on vulnerable
and carefully, especially when areas of the body, such as bony
lying or sitting for extended prominences, reducing the risk of
periods, to prevent localized tissue ischemia and promoting
pressure and promote blood flow to capillaries in these
circulation. regions. By relieving pressure,
circulation is optimized, allowing
for efficient oxygen and nutrient
delivery to tissues.
Encourage the patient to Rest and sleep are essential for ✓
prioritize rest and sleep. recovery and healing. Adequate rest
promotes tissue
Educate the patient with proper Deep breathing exercises induce ✓
relaxation techniques, such as relaxation by activating the body's

25 | Page
deep breathing exercises to help relaxation response, reducing stress
ease tension and promote hormones, and relieving muscle
relaxation. tension. Improved relaxation and
oxygenation resulting from these
exercises help alleviate weakness
and fatigue, promoting overall well-
being.
Monitor vital signs of patient Monitoring vital signs every 4 hours ✓
every 4 hours and evaluate and assessing capillary refill time
capillary refill time regularly. help detect complications early,
guide treatment, and ensure patient
safety.
Provide information on budget- Offering budget-friendly iron ✓
friendly sources of iron, such as sources like beans, tofu, eggs, leafy
beans, tofu, eggs, leafy greens, greens, and fortified cereals ensures
and fortified cereals. the patient can maintain adequate
nutrition without straining their
finances
Educate the patient on the Promotes awareness of affordable ✓
importance of eating foods high nutritional options essential for
in iron and vitamin B12, takin maintaining health and addressing
in consideration to the patient’s deficiencies without financial strain.
economic status.
Administer medications as Administering prescribed ✓
ordered by the physician. medications ensures patient receives
necessary treatment tailored to her
postpartum needs, aiding in pain
management, infection prevention,
anemia treatment, and nutritional
support, thereby promoting
recovery and overall well-being.
Explain medication dosage, Enhances cooperation with ✓
frequency of administration, therapeutic regimen and may
expected action, and the reason prevent client from discontinuing
for long treatment period. medication before cure is truly
affected.
Provide client a list of Providing the client with a list of ✓
medications with schedule. medications along with their
schedule ensures clarity and
adherence to the prescribed
regimen. This promotes patient
autonomy, medication compliance,
and effective management of their
26 | Page
 condition, ultimately contributing to
improved health outcomes.
Discuss and reinforce concerns, Helps promote understanding of the ✓
such as treatment failure and importance of adherence to
drug resistance. medication and treatment plans,
leading to improved patient
compliance and better treatment
outcomes.
. Stay with the patient when To ensure that the patient takes the ✓
taking the medication. medication appropriately and to
ensure compliance to the treatment
regimen.
Instruct the patient and family Helps prevent the spread of ✓
on techniques of proper hygiene infection from the anal area to the
especially perineal care. urinary tract or reproductive organs.
Emphasizing the “front -back” Additionally, educating them on the
method of cleaning the genital appropriate timing for changing
area and the right time to diapers helps maintain cleanliness
change diaper and prevents skin irritation and
infection.

27 | Page
 REFERENCES:

Definition of Terms:

VanPutte, C. L., & Seeley, R. R. (2014). Seeley's anatomy & physiology. New York, NY: McGrawHill

Stedman’s Medical Dictionary. (1954). Postgraduate Medical Journal, 30(345), 383.

https://doi.org/10.1136/pgmj.30.345.383

Developmental Level:

Cherry, K. (2022). Erikson's Stages of Development. A Closer Look at the Eight Psychosocial
Stages.https://www.verywellmind.com/erik-eriksons-stages-of-psychosocial-development-2795740

Kozier & Erb’s Fundamentals of Nursing (11th ed., Vol. 1). (2022). Audrey Berman, Shirlee Snyder, Geralyn Frandsen.

Anatomy and Physiology of The Affected System:

VanPutte, C. L., & Seeley, R. R. (2014). Seeley's anatomy & physiology. New York, NY: McGrawHill

Kim, J., & Dao, H. (2023). Physiology, Circulatory. StatPearls. Treasure Island (FL): StatPearls Publishing.

Lopez-Ojeda, W., Amarendra, P., Alhajj, M., Oakley, A.M. (2022). Circulatory System, Heart (Hematopoietic). StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing

Yousef, H., Alhajj, M., & Sharma, S. (2022). Anatomy, Circulatory (Blood), Heart.

Route of blood flow through the heart. (n.d.). BrainKart. https://www.brainkart.com/article/Route-of-Blood-Flow-Through-

the-Heart_21878/

Overview of the Disease:.

VanPutte, C. L., & Seeley, R. R. (2014). Seeley's anatomy & physiology. New York, NY: McGrawHill.

Anesthesia Patient Safety Foundation. (2024, February 17). Iron deficiency Anemia during and after pregnancy: How can

we make a difference? - Anesthesia Patient Safety Foundation. https://www.apsf.org/article/iron-deficiency-

anemia-during-and-after-pregnancy-how-can-we-make-a-difference/#:~:text=Postpartum%20Anemia,-

Abu-Ouf, N.M. and Jan, M.M. (2015). National Library of Medicine: The impact of maternal iron deficiency and iron

deficiency anemia on child’s health. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375689/

28 | Page
National Institute of Health. (2022). Fact Sheet for Health Professionals: Iron. Retrieved

from: https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

Harvard School of Public Health. (n.d.) The Nutrition Source: Iron. Retrieved

from: https://www.hsph.harvard.edu/nutritionsource/iron/

Teschale, A.B., Tesema, G.A., Worku, M.G., Yeshaw, Y and Tessema, Z.T. (2020). Anemia and its associated factors

among women of reproductive age in eastern Africa: A multilevel mixed-effects generalized linear model. Retrieved

from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238957

Pathophysiology:

Corwin, Elizabeth J. (2008) Handbook of Pathophysiology.

Pathophysiology | Iron deficiency anemia. (n.d.).

https://u.osu.edu/irondeficiencyanemia/pathophysiology/#:~:text=Pathophysiology%20of%20Iron%20Deficiency

%20Anemia%20(IDA)%3A&text=Despite%20the%20cause%2C%20IDA%20occurs,an%20acute%20form%20o

f%20IDA

Nursing Care Plan:

● Kozier & Erb’s Fundamentals of Nursing (11th ed., Vol. 1). (2022). Audrey Berman, Shirlee Snyder, Geralyn
Frandsen.

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