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Drug Study: Ferrous SulfateClassification: Hematinics

Action: Provides and replaces elemental iron, an essential component in formation of hemoglobin in red blood cell development. Ferrous fumarate contains 33% elemental iron, ferrous gluconate-12%, ferrous sulfate-20%, ferrous sulfate dessicated-30%.

Indication: Prevention and treatment of iron-deficiency anemia.

Adverse Reactions: GI irritation, anorexia, nausea, vomiting, diarrhea, constipation, dark stool. Teeth staining with liquid formulation.

Nursing Consideration

Assessment

  • Obtain baseline assessment of iron deficiency before starting therapy
  • Evaluate hemoglobin, hematocrit, and reticulocyte count during therapy.
  • Monitor for adverse reaction: nausea, epigastric pain, constipation, diarrhea, black stools, anorexia, temporary teeth staining
  • Assess bowel elimination, increase water, bulk, and activity if constipation occurs
  • Assess diet and nutrition: amount of iron in diet (meat, dark green leafy vegetables, dried beans, dried fruits, eggs)
  • Identify cause of iron loss or anemia, (salicylates, sulfonamides, antimalarials, quinidine)
  • Assess patient’s and family’s knowledge of drug therapy.

Nursing Diagnoses

  • Nutritional Imbalance: less than body requirements related to underlying condition
  • Fatigue related to iron deficiency
  • Constipation related to adverse effect
  • Knowledge-deficit of drug therapy

Planning

  • Give between meals for best absorption; may give with juice; do not give with antacids or milk, delay at least 1 ┬áhour; if GI symptoms occur give after meals even if absorption is decreased; eggs, milk products, chocolate, caffeine interfere with absorption; ferrous gluconate is less GI irritating than ferrous sulfate
  • Do not crush, chew tablets
  • Give liquid preparations through plastic straw to avoid discoloration of tooth enamel; dilute thoroughly
  • Give at least 1 hour before bedtime because corrosion may occur in stomach
  • Give for < 6 months for anemia
  • Store in airtight, light-resistant container

Implementation

  • Instruct patient not to substitute one iron salt for another because they have different elemental iron content. Swallow the whole tablet, do not crush or chew, do not double dose if missed, but take it as soon as remembered and avoid taking the drug with certain foods that may impair oral iron absorption like yogurt, cheese, eggs, milk, cereals tea and coffee.
  • Remind patient that poisoning may occur if increased beyond recommended level, as few as three tablets can cause poisoning in children. Be sure to keep the drugs out of reach of children.
  • Caution patient to avoid reclining position for 15-30 minutes after taking drug to avoid esophageal corrosion. Inform patient that iron may turn stools black; this could mask the presence of melena.

Evaluation

  • Decreased feeling of fatigue and weakness
  • Constipation is relieved or prevented by appropriate measures by the patient
  • Improvement in results of Hct, Hgb and reticulocytes on follow up examination
  • Patient and family state of understanding of drug therapy.