1

NORTH VALLEY COLLEGE FOUNDATION, INC.

Lanao, Kidapawan City, Province of Cotabato
Nursing Department

ANEMIA SECONDARY TO UPPER GASTROINTESTINAL BLEEDING

An Undergraduate Case Presentation to the Faculty

of North Valley College Foundation, Inc.

In Partial Fulfillment of the Requirement for the degree

Bachelor of Science in Nursing

SAGADO, SHAINA MAGDALYN B.

SALARDA, ALKIANA C.
SALIGUMBA, MARISH P.
SALVAÑA, KEIN KAREN I.
SANCHEZ, JOHN LLOYD S.
SUWAIB, MAISA J.
TUSOY, MAXINE YOULAH P.
UDTOHAN, CRISTLE JOY L.
YSON, SHERYL L.

DECEMBER 2023
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ACKNOWLEDGMENT

The group would like to express their heartfelt gratitude, sincere appreciation

and profound regards to the following people who, in one way or another, gave guidanc

e, strength, and encouragement in making this case presentation possible.

First of all, to Almighty God the Father, who granted us the knowledge and skills,

who send forth the gift of Holy spirit that aided them in completing this study. Without

Him, none of these things would be possible.

To our family, friends, and classmates, for their consideration and unending

support, emotionally, spiritually and financially.

To the members of the group, for sharing ideas, cooperating and giving full effort

in making the case presentation successful.

Lastly, to our client and her family for their acceptance and willingness to share

time, effort and giving us the essential information needed for this case presentation
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TABLE OF CONTENT
Pages
Title Page i

Acknowledgment ii

Table of Content iii

I. INTRODUCTION

II. OBJECTIVES

General Objectives

Specific Objectives

III. PATIENT’S DATA

IV. FAMILY HISTORY

Family Health History

Effects and Expectations of Illness to Self/Family

Clients Health History

V. DEVELOPMENT DATA

VI. DEFINITION OF COMPLETE DIAGNOSIS

VII. PHYSICAL ASSESSMENT

VIII. ANATOMY AND PHYSIOLOGY

IX. ETIOLOGY AND SYMPTOMATOLOGY

X. PATHOPHYSIOLOGY

XI. DOCTOR’S ORDER

XII. DIAGNOSTIC EXAM

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XIII. DRUG STUDY

XIV. NURSING CARE PLAN

XV. PROGNOSIS

XVI. DISCHARGE PLAN

XVII. DEFINITION OF TERMS

XVIII. RECOMMENDATION

XIX. REFERENCES/BIBLIOGRAPHY
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I. INTRODUCTION

Background of the Study

Anemia is a condition that develops when your blood produces a lower than
normal amount of healthy red blood cells. If you have anemia, your body does not get
enough oxygen-rich blood. The lack of oxygen can make you feel tired or weak. There
are many types of anemia, including: Iron-deficiency anemia, Vitamin B12-deficiency
anemia, Hemolytic anemia to name a few. Mild anemia is a common and treatable
condition that can develop in anyone. It may come about suddenly or over time, and
may be caused by your diet, medicines you take, or another medical condition. Anemia
can also be chronic, meaning it lasts a long time and may never go away completely.
Some types of anemia are inherited. The most common type of anemia is iron-
deficiency anemia. Some people are at a higher risk for anemia, including women
during their menstrual periods and pregnancy. People who do not get enough iron or
certain vitamins and people who take certain medicines or treatments are also at a
higher risk. Anemia may also be a sign of a more serious condition, such as bleeding in
your stomach, inflammation from an infection, kidney disease, cancer, or autoimmune
diseases (National Heart, Lung, and Blood Institute, 2022).

Anemia is common worldwide, and is a major public health concern, mainly

affecting young children, pregnant and postpartum women, and menstruating
adolescent girls and women. Low- and lower-middle income countries bear the greatest
burden of anemia, particularly affecting populations living in rural settings, in poorer
households and who have received no formal education. Globally, it is estimated that
40% of all children aged 6–59 months, 37% of pregnant women and 30% of women 15–
49 years of age are affected by anemia. Anemia caused 50 million years of healthy life
lost due to disability in 2019. The largest causes were dietary iron deficiency,
thalassaemia and sickle cell trait, and malaria (Global Health Metrics, 2019).

In the Philippines, Iron Deficiency Anemia is considered the most common form
of anemia in the Philippine population (Detzel P et al., 2015). Hence, anemia is used as
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its proxy indicator. The highest prevalence of anemia in the country were observed in
infants aged 6–11 months (40.1%), pregnant women (24.6%), elderly males (23.0%),
elderly females (19.1%), and lactating women (16.7%) (Rohner F. et al., 2013 ). Rural
areas have higher levels of anemia than urban areas (11.7 vs. 10.7%) (Kreissl A, 2009).
Moreover, the prevalence of anemia among children aged 6 months to 1 year from low-
income families is considerably higher (16.5%) than among those from high-income
families (7.9%) and this trend persists in older children (Herrin AN., 2016). Anemia is
more common among teenage pregnant women (30.6%) than among their adult
counterparts (25.4%). More cases of pregnancy anemia were observed in urban areas
(30.3%) than in rural areas (21.8%) (Food and Nutrition Research Institute, 2013).

Patient B, 56 years old, Male admitted at the St. Peregrine Hospital last January
21, 2024. He was admitted with a chief complaint of epigastric pain. The patient
admitting diagnosis is Anemia Secondary to Upper Gastrointestinal Bleeding. Based on
the history of the patient, for the past 2 days before admission he was experiencing
vomiting approximately 4-5 times per day associated with epigastric pain. Symptoms
persist hence Physician decided for admission. Clinically, Complete Blood Count of the
patient revealed a low amount of his red blood cells count. We the students chose this
case study to better understand the manifestations and disease process of Anemia and
to be prepared with competence in dealing related situations in the future.
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II. OBJECTIVES

The purpose of this study is to increase our understanding of anemia secondary

to upper gastrointestinal bleeding as student nurses by gathering enough data that may
be used as a reference to improve our attitudes and abilities in applying nursing
procedures and managing food allergies.

These data will enable us to better care for patients who have experienced
anemia due to blood loss from lesions in the gastrointestinal tract by providing them with
the information and critical thinking abilities they need.

Specific Objectives:

At the end of this case presentation, the student nurses will be able to:

1. Present the patient’s data and family background

2. Discuss the developmental plan

3. Define the complete diagnosis of the patient.

4. Discuss the physical assessment

5. Explain the anatomy and physiology involved in a patient with anemia.

6. Discuss the etiology and symptomatology; and pathophysiology.

7. Elaborate the doctor’s order as well as the diagnostic exam of the patient.

8. Identify the drugs administered to the patient with anemia secondary to UGIB and its

surgical procedure, if there’s any.

9. Develop a nursing theory and nursing care plan related to the patient’s condition.

10. Provide the summary, findings, and recommendations for better management

about anemia secondary to UGIB that will be helpful in the patient, patient’s family,

community, and future researchers.

11. Provide the definition of medical terms and references/bibliography

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III. PATIENT’S DATA

Patient Code Name: Patient P

Age: 56 yrs. Old

Nationality: Filipino

Civil Status: Married

Occupation: Tricycle Driver

Sex: Male

Religion: Catholic

Ward and Room Number: NURSING STATION 1

Date of Admission: January 21, 2024

Vital Signs During Admission:

Blood Pressure: 90/60 mmHg Temperature: 35.5℃

Pulse Rate: 102 bpm Respiratory Rate: 20 bpm

O2Sat: 97% Weight: 62 kg

Height: 170.4 cm

Date of Discharge: UNDER OBSERVATION

Chief Complaint: EPIGASTRIC PAIN

Admitting Diagnosis: ANEMIA SECONDARY TO UGIB; S/P BT X 8 UNIT

Attending Physician(s): Dr. Vargas

IV. FAMILY BACKGROUND

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Grandfather Grandfather Grandfather Grandfather

(Mother side) (Father side) (Father side) (Mother side)
- Diagnose with - Diagnose with - Diagnose with - Diagnose with
diabetes Miletus Anemia diabetes Miletus diabetes Miletus

Patient Father Patient Mother

- Diagnose with - Diagnose with
Diabetes Miletus chronic kidney
disease

PATIENT

- ANEMIA SECONDARY TO UGIB;

S/P BT X 8 UNIT

Color red means diagnosis with Anemia

Family Health History

We collected pertinent information from the patient's and their family's health
history during our evaluation. The patient's wife shared that the patient's paternal
grandfather experienced anemia on his father's side, providing valuable insights into the
family's health background.

The patient's wife noted that on the side of patient father her grandfather
experienced anemia and passed away from the same illness she's currently diagnosed
with, highlighting a genetic connection in her family's health history. Despite a prevalent
family history of diabetes, she reported the patient's admission for Anemia Secondary to
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UGIB in November 2023, anticipating a formal anemia diagnosis. With eleven siblings in
the family, financial support from their parents has been crucial. The patient, a provider
for his own four children through secondary and tertiary education. Now, the patient has
a family member who is a teacher and another in the army, showcasing diverse
professions within their family.

The patient identified unhealthy lifestyle choices as the primary cause of their
anemia during our lifestyle assessment. Initially unaware of the severity, they later
acknowledged being a vegetarian and having a habit of drinking carbonated soda while
driving. Admitting to not checking blood pressure due to perceived normality in feeling
dizzy, the patient disclosed a liking for smoking and alcohol, though aware of a previous
anemia diagnosis.

Despite past awareness, the patient did not anticipate a recurrence after the
November 2023 diagnosis. During health education on anemia management, the
patient expressed commitment to adopting healthier practices as advised by the
physician. Recognizing the challenges of therapy, they emphasized compliance with
medical guidance to normalize blood sugar levels and achieve a full recovery from
anemia.

Effects/Expectations of Illness to self/family:

The patient was diagnosed with ANEMIA SECONDARY TO UGIB, manifesting

symptoms like weakness, dizziness, vomiting, facial drooping, weight loss, and
shortness of breath, particularly during physical activity. Managing this condition
requires ongoing medical care, involving costly and time-consuming procedures,
medication, and regular anemia checks. Beyond the physical effects, the patient
grapples with psychological and emotional challenges, experiencing distress and
anxiety about the treatability of the condition. Family members actively engage in
monitoring the patient's health, reflecting their concern and commitment to
understanding the normalcy of the patient's condition. This collaborative effort
underscores the importance of ongoing support in managing the patient's health and
well-being.
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The patient's family expresses deep concern about the patient's health,
particularly because this is the second occurrence of the same diagnosis. They perceive
the treatment of the patient's anemia as challenging but are committed to dedicating
extensive resources, both time and money, to ensure the highest level of care. Their
primary focus is on guaranteeing the patient's recovery, emphasizing the importance of
comprehensive and concentrated efforts.

In contrast, the patient remains optimistic about overcoming the illness. They
have faith in the doctor's guidance and value the unwavering support from their family.
The patient is actively participating in the treatment, including medication and blood
transfusions, and is determined to maintain a healthy lifestyle to facilitate a complete
recovery. This collaborative approach between the patient and their family reflects a
shared commitment to overcoming the challenges posed by the recurrent diagnosis of
anemia.

Family members express confidence in the patient's healing capabilities,

recognizing the patient's adherence to instructions and witnessing sincere efforts toward
a full recovery. They believe in the patient's ability to make wise decisions crucial for
healing. To fulfill the patient's needs, the family is dedicated to providing ongoing
assistance, encompassing support in daily activities, ensuring access to prescribed
medications, and facilitating communication with the doctor for necessary medical
guidance. This collaborative effort underscores the family's commitment to actively
contribute to the patient's well-being and recovery.

Client’s Health History

Past Health History

The patient received a diagnosis of ANEMIA SECONDARY TO UGIB in

November 2023, along with advice from the doctor to adopt a healthier lifestyle,
including dietary improvements. Despite being aware of these health issues, the patient
chose to dismiss the diagnosis and persist with unhealthy habits. They continued
working, seemingly unaffected by any pronounced symptoms.
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Significantly, the patient exhibited signs of dizziness, potentially aggravated by

unrestricted soda consumption, along with weakness, typical symptoms of anemia.
Furthermore, the patient failed to monitor their blood pressure and refrained from
adhering to prescribed medications. This casual attitude toward medical advice and the
continuous neglect of lifestyle adjustments could potentially worsen the ongoing health
challenges.

Present Illness/es

The patient's primary concern is epigastric pain, vomiting, weakness, and

dizziness, prompting them to seek urgent medical attention. Symptoms indicative of
anemia, such as numbness and intermittent paralysis throughout the body, have
become overwhelming. The patient requires assistance, even for basic tasks like
changing clothes, as independent movement has become challenging.

Furthermore, the patient experiences periodic episodes of weakness, prompting

vigilant monitoring by their wife, who is consistently attentive. Specifically, he dint feel
dizziness or vomiting however, the primary issue is the profound weakness affecting the
patient's overall mobility and independence.

V. DEVELOPMENTAL DATA
ERIKSON PSYCHOSOCIAL THEORY
Theory
Erikson's psychological
theory proposed the
human development that
occurs in stages from
childhood to old age.
According to him, the
idea of what is known
about how we develop,
how our circumstances
are made, especially our
families that affect our
lives, and why some
people experience
identity crisis is related to
how we build our
personalities depending
on where we started
13
Stages Justification and Result
Generativity vs The patient has supported all
stagnation four of his children through both
secondary and tertiary
The seventh stage of Erik
education. Additionally, their
Erikson’s theory of
family includes members with
psychosocial
diverse professions, such as a
development, occurring
teacher and a member of the
between the ages of
army, demonstrating a wide
middle adulthood (40
range of careers within their
years old) and late
household.
adulthood (65 years old).
During this stage,
Achieved
individuals begin to
reflect on their life
experiences and
accomplishments and
may experience a desire
to give back to society or
to make a positive impact
on future generations.
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SIGMUND FREUD’S PSYCHOSEXUAL DEVELOPMENT THEORY

Theory Stages Justification and Result
Sigmund Freud proposed Genital Stage The patient is dedicated to
that personality nurturing a strong emotional
development in childhood Puberty - Adult connection and sustaining a
takes place during five During this stage, fulfilling sexual relationship with
psychosexual stages, individuals start to his wife.
which are the oral, anal, become sexually mature
phallic, latency, and and begin to explore their
Achieved
genital stages. sexual feelings and
During each stage, desires more maturely
sexual energy (libido) is and responsibly.
expressed in different
ways and through
different body parts
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PIAGET’S DEVELOPMENT THEORY

Theory Stages Justification and Result
Piaget proposed that Formal Operational The patient identified unhealthy
cognition developed Stage lifestyle choices as the primary
through distinct stages cause of their anemia during
In the last stage of
from birth through the our lifestyle assessment.
Piaget's theory, people
end of adolescence.
get better at thinking
Piaget proposed four
logically and figuring Achieved
major stages of cognitive
things out. They can use
development, and called
deductive reasoning,
them (1) sensorimotor
which means they can
intelligence, (2)
come up with conclusions
preoperational thinking,
based on information
(3) concrete operational
they already know. They
thinking, and (4) formal
also start understanding
operational thinking.
abstract ideas, like love
Each stage is correlated
or justice, that don't have
with an age period of
a physical form. During
childhood, but only
this stage, teenagers and
approximately.
young adults can see
different ways to solve
problems, and they start
thinking more like
scientists, trying to
understand how things
work in the world.
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VI. DEFINITION OF COMPLETE DIAGNOSIS

The patient undergoes a thorough physical assessment where he is checked

from head to toe and is observed for any possible cues that might become a
contributing factor to the diagnosis. The physician then asks questions about the risk
factors, diet, medical history, and if there is any family member who is diagnosed with
the said disease as well. After this, the physician ordered a series of blood tests, like the
CBC, which measures many different parts of the blood, including red blood cells, white
blood cells, and platelets; the hemoglobin test; and the hematocrit test, whose results
are lower than the normal range and may confirm that the patient has a disease. The
result then aids in directing care, and a validated diagnosis assists the patient’s dealing
with the consequences of getting the assistance they require. Overall, it shows that the
patient is positive for anemia.

VII. PHYSICAL ASSESSMENT

Personal Data
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Patient P is a 56 years old male admitted on January 24, 2024 with a chief
complaint of Epigastric pain, vomiting, weaknesses and dizziness Nursing station 1 ST.
PEREGRINE HOSPITAL PLARIDEL STREET, KIDAPAWAN CITY.

General Survey

Received patient on bed awake and coherence with ongoing IVF PNSS 1L
80cc/hr on right metacarpal vein infusing well not in respiratory distress.

Vital signs

-Temperature: 35.5℃ -RR: 20 cpm

-B/P: 90/60 mmHg -O2Sat: 97%

-PR: 102 bpm -Weight: 62 kg -Height: 170.4 cm

Appearance of the Patient: The patient appeared weak, displaying classical

manifestations such as sudden confusion, facial drooping, weight loss, and dizziness.

Skin: Upon examination, the patient's skin presented pallor. Hematomas were observed
in the lower extremities. Palpation revealed cold skin with a temperature of 35.5 °C, yet
poor skin turgor indicated signs of dehydration. No notable variations in pigmentation
and texture were observed. The skin was intact without lesions, cuts, or surgical
incisions, and moles and warts appeared normal.

Hair: The patient's hair was black and white, thick, and evenly distributed. No signs of
infection, lice, or dandruff were noted.

Face: The patient's face was symmetrical in shape with facial drooping noted.

Eyes and Vision: The eyes demonstrated symmetry, with evenly distributed eyebrow
hair. There was no edema, and the eyes did not appear sunken. Pupils were equal,
round, and responsive to both light and accommodation.
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Ears and Hearing: Upon inspection, ears were symmetrically aligned with each other,
and were aligned with the outer canthus of each eye. The patient was cooperative when
answering questions about hearing.

Nose: Upon inspection, the nose was symmetrical with no swelling or malformation,
and no discoloration was observed. Nares were patented without a nasal septal defect,
though there was a sign of nasal congestion. Nasal mucosa appeared red with signs of
discharge or bleeding.

Mouth: The patient's lips were cyanotic, and pallor around the lips was pale and dry. No
missing teeth were noted, though the color was yellow. The tongue exhibited a deep
longitudinal fissure, a sign of dehydration, and no signs of lesions, ulcers, or nodules
were seen.

Head and Neck: The head was round and of normal size, exhibiting symmetry in
proportion to the overall body structure with a smooth skull contour. Upon palpation, the
head felt smooth with uniform consistency and showed no signs of nodules or masses.

Chest: Clear upon auscultation.

Nails: Examining the nails, they exhibited cyanosis, lacked nail polish, and displayed a
convex curve. Capillary refill occurred within 3 seconds. The nails were well-trimmed,
showing no discoloration, ridges, pitting, thickening, or separation of the edges.

Abdomen: Upon inspection, the abdomen appeared flat and symmetrical. As the client
was instructed to breathe in and hold their breath, no bumps, bulges, or muscle
separation were observed. The umbilicus was in the middle line, showing no signs of
redness or swelling, and the skin was smooth. During palpation, the abdomen was
noted to be round and distended, with no visible lesions. Stomach noises were audible
upon auscultation, and bowel sounds were present in all areas every 20 seconds. No
tenderness, masses, or rigidity were detected upon palpation. The liver was not
palpable, displaying no tenderness or enlargement. Similarly, the spleen was not
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palpable, with no tenderness or enlargement. The kidneys were non-palpable and non-
tender.

Extremities: No presence of ulcers, swelling, or edema was noted. Some areas

exhibited cyanosis and muscle weakness, affecting the strength and functionality of the
extremities

VIII. ANATOMY AND PHYSIOLOGY

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Blood is a constantly circulating fluid providing the body with nutrition, oxygen,
and waste removal. Blood is mostly liquid, with numerous cells and proteins suspended
in it, making blood "thicker" than pure water. The average person has about 5 liters
(more than a gallon) of blood. A liquid called plasma makes up about half of the content
of blood. Plasma contains proteins that help blood to clot, and transport substances
through the blood. Blood plasma also contains glucose and other dissolved nutrients.
About half of blood volume is composed of blood cells:

Erythrocytes

It is commonly known as a red blood cell (or RBC), is by far the most commonly
formed element: A single drop of blood contains millions of erythrocytes and just
thousands of leukocytes. Specifically, males have about 5.4 million erythrocytes per
microliter (µL) of blood, and females have approximately 4.8 million per µL. The primary
functions of erythrocytes are to pick up inhaled oxygen from the lungs and transport it to
the body’s tissues, and to pick up some (about 24 percent) carbon dioxide waste at the
tissues and transport it to the lungs for exhalation. Erythrocytes remain within the
vascular network. Although leukocytes typically leave the blood vessels to perform their
defensive functions, movement of erythrocytes from the blood vessels is abnormal.
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Erythrocytes are biconcave discs with

very shallow centers. This shape
optimizes the ratio of surface area to
volume, facilitating gas exchange. It also
enables them to fold up as they move
through narrow blood vessels.

Hemoglobin

Hemoglobin is a large molecule made up of proteins and iron. It consists of four folded
chains of a protein called globin, designated alpha 1 and 2, and beta 1 and 2 (Figure a).
Each of these globin molecules is bound to a red pigment molecule called heme, which
contains an ion of iron (Fe2+) (Figure b).
(a) A molecule of hemoglobin contains four globin proteins, each of which is bound
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to one molecule of the iron-containing pigment heme. (b) A single erythrocyte

can contain 300 million hemoglobin molecules, and thus more than 1 billion
oxygen molecules.
(b) Each iron ion in the heme can bind to one oxygen molecule; therefore, each
hemoglobin molecule can transport four oxygen molecules. An individual
erythrocyte may contain about 300 million hemoglobin molecules, and therefore
can bind to and transport up to 1.2 billion oxygen molecules (Figure b).
In the lungs, hemoglobin picks up oxygen, which binds to the iron ions,
forming oxyhemoglobin. The bright red, oxygenated hemoglobin travels to the body
tissues, where it releases some of the oxygen molecules, becoming darker
red deoxyhemoglobin, sometimes referred to as reduced hemoglobin. Oxygen release
depends on the need for oxygen in the surrounding tissues, so hemoglobin rarely if ever
leaves all of its oxygen behind. In the capillaries, carbon dioxide enters the bloodstream.
About 76 percent dissolves in the plasma, some of it remaining as dissolved CO 2, and
the remainder forming bicarbonate ion. About 23–24 percent of it binds to the amino
acids in hemoglobin, forming a molecule known as carbaminohemoglobin. From the
capillaries, the hemoglobin carries carbon dioxide back to the lungs, where it releases it
for exchange of oxygen.
Lifecycle of Erythrocytes
Production of erythrocytes in the marrow occurs at the staggering rate of more than 2
million cells per second. For this production to occur, a number of raw materials must be
present in adequate amounts. These include the same nutrients that are essential to the
production and maintenance of any cell, such as glucose, lipids, and amino acids.
However, erythrocyte production also requires several trace elements:

● Iron. We have said that each heme group in a hemoglobin molecule contains an
ion of the trace mineral iron. On average, less than 20 percent of the iron we
consume is absorbed. Heme iron, from animal foods such as meat, poultry, and
fish, is absorbed more efficiently than non-heme iron from plant foods. Upon
absorption, iron becomes part of the body’s total iron pool. The bone marrow,
liver, and spleen can store iron in the protein
compounds ferritin and hemosiderin. Ferroportin transports the iron across the
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intestinal cell plasma membranes and from its storage sites into tissue fluid
where it enters the blood. When EPO stimulates the production of erythrocytes,
iron is released from storage, bound to transferrin, and carried to the red marrow
where it attaches to erythrocyte precursors.

● Copper. A trace mineral, copper is a component of two plasma proteins,

hephaestin and ceruloplasmin. Without these, hemoglobin could not be
adequately produced. Located in intestinal villi, hephaestin enables iron to be
absorbed by intestinal cells. Ceruloplasmin transports copper. Both enable the
oxidation of iron from Fe2+ to Fe3+, a form in which it can be bound to its transport
protein, transferrin, for transport to body cells. In a state of copper deficiency, the
transport of iron for heme synthesis decreases, and iron can accumulate in
tissues, where it can eventually lead to organ damage.

● Zinc. The trace mineral zinc functions as a co-enzyme that facilitates the
synthesis of the heme portion of hemoglobin.

● B vitamins. The B vitamins folate and vitamin B 12 function as co-enzymes that

facilitate DNA synthesis. Thus, both are critical for the synthesis of new cells,
including erythrocytes.
Erythrocytes live up to 120 days in the circulation, after which the worn-out cells are
removed by a type of myeloid phagocytic cell called a macrophage, located primarily
within the bone marrow, liver, and spleen. The components of the degraded
erythrocytes’ hemoglobin are further processed as follows:

● Globin, the protein portion of hemoglobin, is broken down into amino acids, which
can be sent back to the bone marrow to be used in the production of new
erythrocytes. Hemoglobin that is not phagocytized is broken down in the
circulation, releasing alpha and beta chains that are removed from circulation by
the kidneys.

● The iron contained in the heme portion of hemoglobin may be stored in the liver
or spleen, primarily in the form of ferritin or hemosiderin, or carried through the
bloodstream by transferrin to the red bone marrow for recycling into new
 25

erythrocytes.

● The non-iron portion of heme is degraded into the waste product biliverdin, a
green pigment, and then into another waste product, bilirubin, a yellow pigment.
Bilirubin binds to albumin and travels in the blood to the liver, which uses it in the
manufacture of bile, a compound released into the intestines to help emulsify
dietary fats. In the large intestine, bacteria breaks the bilirubin apart from the bile
and converts it to urobilinogen and then into stercobilin. It is then eliminated from
the body in the feces. Broad-spectrum antibiotics typically eliminate these
bacteria as well and may alter the color of feces. The kidneys also remove any
circulating bilirubin and other related metabolic byproducts such as urobilins and
secrete them into the urine.
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IX. ETIOLOGY AND SYMPTOMATOLOGY

ETIOLOGY
BASIC PRESENT RATIONALE ACTUAL
ETIOLOGY /
ABSENT
PREDISPOSING
AND
PRECIPITATING
FACTORS

Family History ✓ The majority of anemia The patient's wife

of Anemia cases do not stem from informed us that his
genetic factors; grandfather experienced
however, certain types anemia and passed away
of anemia can be from the same illness he's
inherited. Typically, currently diagnosed with.
anemia linked to Furthermore, she
genetic predisposition acknowledged the
is identified either at hereditary connection in
birth or during the family's health history.
childhood due to its
potentially significant
impact on bodily
functions.
 27

Age ✓ People over age 50 - The patient’s mother

65 years old are one of mentioned the patient
the groups at high risk identified as a vegetarian
for anemia. This can be and having a habit of
related to diet or to drinking carbonated soda
chronic health while driving.
conditions. Chronic
health conditions are
another risk factor for
anemia, and most
people over 50 years
old have at least one
chronic health
condition.

Smoking ✓ Smoking reduces The patient's wife

Vitamin C levels, informed us that her
thereby increasing the husband engages in
likelihood of iron smoking habits impacting
deficiency anemia by his daily routine.
diminishing iron
absorption.

Alcohol ✓ Excessive alcohol The patient's wife

consumption can lead informed us that her
to a broad suppression husband engages in
of blood cell production drinking alcohol impacting
and the generation of his daily routine.
structurally abnormal
blood cell precursors
incapable of maturing
into functional cells.
Individuals with
alcoholism often exhibit
faulty red blood cells
that undergo premature
destruction, potentially
leading to the
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development of
anemia.

SYMPTOMATOLOGY
SYMPTOMS PRESENT/ RATIONALE ACTUAL
ABSENT

Epigastric Pain ✓ Increased heart rate The patient experienced

and changes in blood this symptom prior to his
flow, which can admission.
manifest as epigastric
discomfort or pain.

Dyspnea ✓ When anemia occurs, Our patient's significant

the body's natural other (S.O.) stated that
response is for the before admission, the
lungs to patient's initial complaint
overcompensate in an was experiencing
effort to intake more shortness of breath, which
oxygen, leading to was characterized by an
shortness of breath. w inability to breathe rapidly
or deeply enough.
 29

Vomiting ✓ In certain instances, Our patient's significant

the infection or other (S.O.) stated that the
inflammatory process patient also had been
linked to anemia with experiencing nausea and
UGIB can directly vomiting.
affect the
gastrointestinal
system.

Body weakness ✓ Insufficient The patient experienced

hemoglobin levels this symptom prior to his
result in reduced admission
oxygen delivery to
your tissues and
muscles, depriving
them of the energy
they need to function
optimally.

Dizziness ✓ The reduction of brain Our patient’s significant

oxygenation affects other (S.O.) stated that
the balance and prior to admission the
coordination, while patient experienced
anemia-induced dizziness.
fatigue and weakness
heighten feelings of
lightheadedness,
especially when they
move quickly or exert
themselves physically.
30
 31

X. PATHOPHYSIOLOGY

Predisposing Factors:
Precipitating Factors:
Male Inadequate Iron intake
Age (56 years old) Alcohol
Smoking
Genetics (Fathers side)

Decreased intake of iron rich

foods, with blood loss

Iron in the body is used up

Decreased iron reserves needed

for hemoglobin production

Decreased RBC production due to

lack of hemoglobin

Iron Deficiency

Decreased oxygen and hemoglobin

Anemia
 32

XI. DOCTOR’S ORDER

Date Ordered Doctor’s Order Rationale Remarks

01/21/24 Admit pt For proper Done
1:24 PM monitoring,
management and
evaluation
Secure consent to care Patient has the right Done
to be consented in all
procedures to
bedone
TPR with BP q4 To monitor vital signs Done
so that any
unusualities will be
referred as follows
Start venoclysis: Done

IVF:
● PNSS 1L, fluid IV: PNSS - A normal
drop 300cc now saline solution; a
then regulate to 20 mixture of salt
cc/hr (sodium chloride) and
water with a
concentration of
0.9% sodium
chloride. For fluid
replacement and
electrolyte balance

Laboratory: CBC with PC Done

CBC PC determines the
quantity of each
quantity of blood cell
in a given specimen
of blood,often
including the amount
of hemoglobin,
hematocrit, and the
proportion of various
white blood cells. To
know any deviations
or abnormalities in
the blood
Urinalysis To screen patient's Done
urine for renal/urinary
detect substance
 33

Random Blood Sugar To measure glucose Done

(RBS) levels in the
bloodstream at any
given time,
regardless of when
the individual last ate.

Fasting Blood Sugar To measure the Done

(FBS) glucose
concentration in the
blood after an
overnight fast and
are commonly used
to diagnose diabetes
or monitor blood
sugar levels in
individuals with the
condition.
Blood Test: A test that examines Done
● SGPT, the cells, chemicals,
● S. Urea proteins or other
● S. Uric Acid substances in the
blood.

CXR AP Chest x-ray is done Done

for internal
visualization of the
chest to check for
any unusualities and
to see if other vital
organs has already
been affected
12-lead electrocardiogram A medical test that is Done
(ECG) recorded using leads,
or nodes, attached to
the body. To capture
the electrical activity
of the heart and
transfer it to graphed
paper.
Medication: Done
● Omeprazole 40 mg To reduce the
IVTT now amount of acid in the
stomach and to treat
indigestion and
heartburn, and acid
 34

reflux.
● Omeprazole To reduce the Done
40mg/cap, 1 cap amount of acid in the
OD PO stomach and to treat
indigestion and
heartburn, and acid
reflux.
● Rebamipide Helps in replacement Done
100mg/ tab, 1 tab of lost tissue by
TID PO increasing the
expression of
epidermal growth
factor (EGF) and
EGF receptors.
These EGF causes
angiogenesis,
increased production
of granulation tissue
and epithelialization
of ulcer healing.
● Eposis 4000IU A medicine that helps Done
inject route SQ your bone marrow to
produce more red
blood cells. It is used
to treat a type of
anemia caused by
kidney disease. It is
also used to treat
anemia caused by
cancer chemotherapy
and by taking
medicines to treat
HIV.
● Propanolol 10 It is used to treat Done
mg/tab, 1 tab OD heart problems, help
with some of the
symptoms of anxiety
and prevent
migraines.
I/O every shift To indicate the fluid Done
balance for the
patient
Done
Watch out for any unusual
s/s; Report always
 35

01/21/24 To secure 2 units of whole To treat patients who Done

4:35 PM blood need all the
components of blood,
such as those who
have sustained
significant blood loss
due to trauma or
surgery.

01/22/24 One Algina Sachet now For the treatment of Done

12:20 AM symptoms of
gastroesophageal
reflux such as acid
regurgitation,
heartburn, and
indigestion due to
reflux of stomach
contents.
01/23/24 Stat CBC PC CBC with PC Done
3:50 PM determines the
quantity of each
quantity of blood cell
in a given specimen
of blood,often
including the amount
of hemoglobin,
hematocrit, and the
proportion of various
white blood cells. To
know any deviations
or abnormalities in
the blood
Refer Done
01/23/24 Plan: to collect tissue Done
7:10 PM samples (biopsy) to
● CT Scan of whole test for diseases and
abdomen with conditions that may
contrast be causing anemia,
bleeding,
inflammation or
diarrhea.

Colonoscopy is used
to look for colon
polyps or bowel
cancer and to help
 36

diagnose symptoms
● Endoscopy, such as unexplained
Colonoscopy diarrhea, abdominal
pain or blood in the
stool

Continue meds Done

Medication: Done
● Suggest to start It helps to make
Vitamin K amp various proteins that
IVTT Q8H are needed for blood
clotting and the
building of bones.

● Tranexamic Acid To indicate the fluid Done

500 mg IVTT Q8H balance for the
patient

01/24/24 For CT Scan of whole Done

9:30 PM abdomen

XII. DIAGNOSTIC EXAM

LABORATORY RESULT

COVID-19 RAPID ANTIGEN TEST

Date Exam Result Interpretation

 37

A negative
COVID-19 test
January 21, COVID-19 ANTIGEN NEGATIVE
means the test
2024 TEST
did not detect
the virus.

CROSSMATCHING RESULT
Laboratory Report

Date Blood Pack Expiration Blood Source Result Date

Number Date Type Transfused

January 23, 24-1206- 02/22/2024 A+ CRMC COMPATIB January 23,

2024 *** LE 2024

BLOOD TYPING
Laboratory Report

DATE RESULT

December 11, 2023 “ A “ POSITIVE

URINALYSIS
Laboratory Report

Date Ordered Test Patient’s Result

January 21, 2024 URINALYSIS PHYSICAL PROPERTIES

 38

◆ Color: Yellow

◆ Transparency: Hazy

MACROSCOPIC
EXAMINATION

◆ Protein: Trace

◆ Sugar: Negative

◆ Albumin: Negative

◆ pH: 6.0

◆ Specific Gravity: 1.020

MICROSCOPIC
EXAMINATION

PUS CELLS = 2-5/HPF

RBCs: 0-2/HPF

EPITHELIAL CELLS: RARE/LPF

BACTERIA: FEW/LPF

MUCUS THREADS: RARE/LPF

CLINICAL CHEMISTRY
 39

Laboratory Report

Date Test Patient’s Normal Clinical Nursing

Ordered Result Value Significance Responsibilities

January 21, RBS 8.6 mmol/L 3.4-6.7 The patient’s

2024 mmol/L RBS level is 8.6 ◆ Administered
H mmol/L. where medication as
the normal
prescribed
value level is
within the
range of 3.4- ◆ Encourage
6.7 mmol/L. patient to
The results
shows practice healthy
abnormality. lifestlye

There is a
◆ Promote rest
presence of
Polycythaemia
or
◆ Educate patient
Erythrocytosis,
which means to eat healthy
there is a high diet
concentration
of red blood
◆ Encourage
cells in the
blood. patient to
exercise
regularly.

SERUM 251. 24 148.70 - The patient’s

URIC ACID umol/L 458.0 Serum Uric
umol/L Acid level is
251. 24 umol/L.

The results
shows a
 40

normal value.

COMPLETE BLOOD COUNT

Laboratory Report

Test Time Test Patient’s Normal Clinical Nursing

Result Value Responsibilities
Significance

January WBC 12.5 5.00-10.00 The patient’s

◆ Monitor Vital
21, 2024 10^9/L WBC count is 12.5
10^9/L Signs
10^9/L where the
2:00 PM
(H) normal value level ◆ Promote bed
is within the
rest
range of 5.00-
10.00 10^9/L. The ◆ Administer
results shows
medications
abnormality. as prescribed
High WBC means
presence of ◆ Monitor labs
infection or
inflammation of ◆ Monitor I
the body. and O
Signs and
symptoms of ◆ Encourage
fever, fatigue, the patient
pain, difficulty to increased
breathing and fluid intake
rashes.

Neu% 71.5 % 41.8-79.7 % The patient’s

Neutrophils
percentage is 71.5
%.

The results shows

a normal value.
 41

Lym% 20.9 % 11.5-44.1 % The patient’s

Lymphocytes
level is 20.9 %.

The results shows

a normal value.

Mono% 6.5 % 4.8-11.6 % The patient’s

Monocytes level
is 6.5%.

The results shows

a normal value.

Eos% 0.8 0.3-7.5 % The patient’s

Eosinophils level
is 0.8 %.

The results shows

a normal value.

Bas% 0.3 % 0.1-0.4 % The patient’s

Basophils
percentage is 0.3
%.

The results shows

a normal value.

RBC 2.56 4.20-6.30 The patient’s RBC

◆ Administer
10^12/L 10^12/L level is 2.56
10^12/L where medications
(L) the normal value as needed.
level is within the
 42

range of 4.20-6.30
◆ Encourage
10^12/L. The
results shows the patient
abnormality. to practice
healthy
Presence of lifestyle
anemia. This
means the blood ◆ Encourage
has lower than the patient
normal to eat iron-
hemoglobin (Hgb) rich foods
levels.

Signs and ◆ Advise the

symptoms of patient to
fatigue, increased
headache, fluid intake
problem
concentrating, ◆ Advise
irritability, loss of
patient to
appetite and
take iron
numbness and
supplements
tingling of hands
as prescribed
and feet.
before meals

◆ Educate the
patient about
foods high in
iron

HGB 71 g/L 140-180 g/L The patient’s

◆ Encourage
HGB level is 71
(L) g/L where the the patient
normal value level to eat iron-
is within the rich foods
range of 140-180
g/L. The results ◆ Advise the
shows patient to
abnormality. increased
fluid intake
Low hemoglobin
means body’s
◆ Educate the
isn’t getting
enough oxygen, patient about
making feel very foods high in
tired and weak.
 43

Signs and iron

symptoms of
tiredness, ◆ Encourage
weakness,
the patient
shortness of
to practice
breath, pale skin,
healthy
irregular
lifestyle
heartbeat,
dizziness, chest
pain and colds
hands/feet.

HCT 0.240 0.400 - The patient’s HCT

◆ Administer
0.540 percentage is
L/L 0.240 L/L where medications
L/L the normal value as needed.
(L)
level is within the
range of 0.400- ◆ Educate the
0.540 L/L. The patient about
results shows foods high in
abnormality. iron

Low hematocrit
◆ Encourage
indicate Anemia.
The blood has too the patient
few healthy red to practice
blood cells. healthy
lifestyle
Signs and
symptoms of pale ◆ Advise the
complexion,
patient to
weakness,
increased
fatigue, trouble
fluid intake
breathing and
irregular
heartbeat.

MCV 93.8 fL 80.0-97.0 fL The patient’s

MCV level is 93.8
fL.

The results shows

 44

a normal value.

MCH 30.1 pg 26.0-32.0 The patient’s

pg MCH level is 30.1
pg.

The results shows

a normal value.

MCHC 321 g/L 310-360 g/L The patient’s

MCHC level is 321
g/L where the
normal value level
is within the
range of 310-360
g/L.

The results shows

a normal value.

RDW 16.1% 11.5-14.5 % The patient’s

◆ Encourage
RDW percentage
(H) level is 16.1% the patient
where the normal to eat
value level is balance diet
within the range
of 11.5-14.5 %. ◆ Advise
The results shows patient to
abnormality. take iron
supplements
A high RDW as prescribed
means that
there’s variation
◆ Advise the
in the size of your
red blood cells patient to
beyond what’s increased
considered fluid intake
normal.
 45

◆ Promote rest

◆ Encourage
the patient
to eat iron-
rich foods

PLT 474 150-450 The patient’s

◆ Administer
Platelets count
(H) x 10^9/L level is 474 medications
10^9/L where the as prescribed
normal value level by Physician
is within the
range of 150-450 ◆ Promote rest
x 10^9/L. The
results shows ◆ Advise
abnormality.
patient to
High PLT count practice
means presence healthy
of lifestyle
Thrombocythemi
a, refers to a high ◆ Teach patient
platelet count to avoid
that is not caused smoking
by another health
condition. ◆ Encourage
Signs and patient to
symptoms of exercise
headache, regularly
confusion or
changes in ◆ Encourage
speech, chest patient to
pain, shortness of maintain
breath and healthy
nausea, weakness weight
and burning pain
in the hands or
feet.

RADIOLOGY
 46

X RAY REPORT

Date Exam Impression Interpretation

January 21, CHEST PA NEGATIVE CHEST Chest P.A ADULT:

2024 SAVE FOR
Heart size is within normal
METALLIC limits. Its configuration is
FOREIGN BODIES, unremarkable. Hila are not
AS DESCRIBED enlarged. Pulmonary
vascularity is normal. Both
lungs are clear. The lateral
costophrenic sinuses are sharp.
Visualized osseous structures
are normal. Metallic opacities
are seen overlying the angle of
the left 10th rib and in the left
scapula.

XV. PROGNOSIS

Anemia. The condition of having a lower-than-normal number of red blood cells

or quantity of hemoglobin. Anemia diminishes the capacity of the blood to carry oxygen.
Patients with anemia may feel tired, fatigue easily, appear pale, develop palpations, and
become short of breath. Children with chronic anemia are prone to infections and
learning problems. The main causes of anemia are bleeding, hemolysis (excessive
destruction of red blood cells), underproduction of red blood cells (as in bone
marrow diseases), and underproduction of normal hemoglobin (as in sickle cell anemia
and in iron deficiency anemia). Women are more likely than men to have anemia
because of menstrual blood loss. In children, anemia is most commonly due to
insufficient iron in the diet. Anemia is also often due to gastrointestinal bleeding caused
by medications, including such common drugs as aspirin and ibuprofen.
 47

Upper gastrointestinal bleeding (UGIB). is a common problem with an annual

incidence of approximately 80 to 150 per 100,000 population, with estimated mortality
rates between 2% to 15%. UGIB is classified as any blood loss from a gastrointestinal
source above the ligament of Treitz. It can manifest as hematemesis (bright red emesis
or coffee-ground emesis), hematochezia, or melena. Patients can also present with
symptoms secondary to blood loss, such as syncopal episodes, fatigue, and weakness.
UGIB can be acute, occult, or obscure.

Anemia presents formidable challenges, diligent medical management, and

timely interventions, can significantly improve the patient's quality of life and mitigate the
risks associated with this condition.

ACTUAL GOOD FAIR POOR JUSTIFICATION

DURATION √ Patient P spent

three days in the
hospital and
with the
assistance of
the health care
giver and other
staff at the
hospital, patient
condition has
improved a little.
ONSET OF √ Patient P had a
ILLNESS chief complaint
of Epigastric
pain, vomiting,
weaknesses
 48

and dizziness.

COMPLIANCE √ The family

OF follows and
MEDICATION helps the patient
to comply with
all the
medications that
were prescribed
by the
physician.

FAMILY √ The patient was

SUPPORT able to recover
through the
support and
attention given
by his family.
The patient’s
family also
cooperate with
the medication
treatment, and
practical support
involves
assisting
patients with
daily task that
may become
challenging due
to his health
 49

condition.

AGE √ Anaemia is a
serious global
public health
problem that
particularly
affects young
children,
menstruating
adolescent girls
and women, and
pregnant and
postpartum
women. WHO
estimates that
40% of children
6–59 months of
age, 37% of
pregnant
women, and
30% of women
15–49 years of
age worldwide
are anemic.

COMPUTATIO 2/5X 100 0/5 x 100 3/5 x 100

N
40% 0% 60%

Upon assessing the patient's condition, we came up with a poor prognosis of 60%.
Through the help of the patient’s family and the rest of the health care team, the patient
 50

can restore to normal health as well as maintain his well-being.

XVI. DISCHARGE PLAN (M.E.T.H.O.D)

XVII. DEFINITION OF TERMS

● UGIB- Upper gastrointestinal bleeding (UGIB) is a common medical condition

that results in substantial morbidity, mortality, and medical care cost. It commonly
presents with hematemesis (vomiting of blood or coffee ground-like material)
and/or melena (black, tarry stools).
● Anemia- is a condition in which the body does not have enough healthy red
blood cells. Red blood cells provide oxygen to body tissues. Different types of
anemia include: Anemia due to vitamin B12 deficiency.
● Bleeding time (BT) - is the oldest and simplest test for assessing the platelets
(Plts) function. BT can be affected by several factors such as race and diet,
 51

which has a wide reference range.

● S/P - Status post (S/P) is a term used in medicine to refer to a treatment (often a
surgical procedure), diagnosis or just an event, that a patient has experienced
previously, for example, “status post cholecystectomy”, “S/P vaginal delivery”,
etc.

XVIII. RECOMMENDATION

Based on the outcome of this study, the following will benefit:

Community. This study will be helpful and intended to the most appropriate kinds
of community programs to share the source of information for those interested in
gaining a greater understanding of the knowledge of Allergy, its symptoms, causes, and
treatments.

Patients. The patients must consult with a health care practitioner for complete
information about their health, medical concerns, and treatment options. They must be
fully informed on the condition to decide which treatments and interventions are most
appropriate for the patient. Additionally, this study might help the reader understand
 52

what changes they should make or what behaviors they should avoid.

Nurses. This study is important for nurses because it will serve as a guide for
them to give scientifically valid measurements of knowledge and performance
competencies through clients with varying degrees and types of educational preparation
and experiences.

Future Researcher. The study's results were used as a source of information and
a manual for future researchers who wished to carry out the same study or any study
concerning Allergy patients.

XIX. REFERENCE/BIBLIOGRAPHY

● https://www.nhlbi.nih.gov/health/anemia
● https://www.who.int/health-topics/anaemia#tab=tab_1
● Global Health Metrics. Anaemia–Level 1 impairment. Lancet. 2019; 393
https://www.healthdata.org/results/gbd_summaries/2019/anemia-level-1-
impairment
● Detzel P, Wieser S. Food fortification for addressing iron deficiency in Filipino
children: benefits and cost-effectiveness. Ann Nutr Metab. (2015) 66:35–42.
10.1159/000375144
● Rohner F, Woodruff BA, Aaron GJ, Yakes EA, Lebanan MA, Raycon-Solon P, et
al.. Infant and young child feeding practices in urban Philippines and their
 53

associations with stunting, anemia, and deficiencies of iron and vitamin A. Food
Nutr Bull. (2013) 34:S17–34. 10.1177/15648265130342S104
● Kreissl A. Malnutrition in the Philippines: perhaps a double burden? JEM. (2009)
11:24
● Food and Nutrition Research Institute. National Nutrition Survey. Manila: FNRI.
(2013).