C H A P T E R 4 9
Drugs used to treat anaemias
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solution, can be done in a medical facility. This procedure is
safe for about the first hour after ingestion. After that time,
there is an increased risk of gastric erosion caused by the
corrosive iron, making the lavage very dangerous. Because
this toddler is well beyond the first hour, other measures
will be needed. Supportive measures to deal with shock,
dehydration and gastrointestinal damage will be necessary.
In addition, an iron-chelating agent such as desferrioxamine
mesylate may be tried.
During this crisis, L.L. will need a great deal of support,
including a responsible relative or friend or other person
who can stay with her. She also will need reassurance and
a place to rest. After the situation is stabilised, L.L. will need
teaching and additional support. For example, she should
be reassured that most people do not take OTC drugs
seriously and many do not even read the labels. However,
the healthcare professional can use this opportunity to
stress the importance of reading all of the labels and
following the directions that come with OTC drugs. L.L.
also should be commended for calling the paediatrician
and getting medical care for the toddler quickly. Finally, she
should receive a review of the iron teaching information
and be encouraged to ask questions.
This case is a good example for a staff in-service
program, stressing not only the dangers of iron toxicity,
but also the vital importance of providing good education
before sending the person home with a new drug. Simply
giving the person written information is often not enough.
The care guide and teaching guidelines for L.L. when she
was given the iron supplement should have included the
following.
CARE GUIDE FOR L.L.: IRON PREPARATIONS
Assessment: History and examination
Assess L.L.’s health history for allergies to any iron preparation,
colitis, enteritis, hepatic dysfunction or peptic ulcer.
Then focus the physical examination on the following areas:
Cardiovascular: blood pressure, pulse, perfusion
Neurological (CNS): orientation, affect, reflexes, vision
Skin: colour, lesions, gums, teeth
Respiratory system: respiratory rate and character,
adventitious sounds
GI: abdominal examination, bowel sounds
Laboratory tests: full blood count, haemoglobin,
haematocrit, serum ferritin assays
Implementation
Confirm iron-deficiency anaemia before administering drug.
Provide comfort and safety measures; for example, give
small meals; ensure access to bathroom facilities; give the
drug with food if GI upset occurs; and institute bowel
program as needed.
Arrange for the treatment of the underlying cause of
anaemia.
Provide support and reassurance to deal with drug effects.
Provide teaching regarding drug, dosage, adverse effects,
what to report and safety precautions.
Evaluation
Evaluate drug effects (relief of signs and symptoms of
anaemia, haematocrit within normal limits).
Monitor for adverse effects: GI upset, CNS toxicity, coma.
Monitor haematocrit and haemoglobin periodically.
Monitor for drug–drug interactions as indicated for each drug.
Evaluate the effectiveness of the teaching program and
comfort and safety measures.
TEACHING FOR L.L.
• Iron is a naturally occurring mineral found in many foods.
It is used by the body to make red blood cells, which carry
oxygen to all parts of the body. Supplemental iron needs
to be taken when the body does not have enough iron
available to make healthy red blood cells, a condition
called anaemia.
• Iron is a toxic substance if too much is taken. You must
avoid self-medicating with over-the-counter preparations
containing iron while you are taking this drug.
• You will need to return for regular medical checkups while
taking this drug to determine its effectiveness.
• Take your medication as follows, depending on the
specific iron preparation that has been prescribed:
• Dissolve
ferrous salts
in orange juice to improve the taste.
• Take
liquid iron preparations
with a straw to prevent the
iron from staining teeth.
• Place iron drops on the back of the tongue to prevent
staining of the teeth.
• Some of the following adverse effects may occur:
•
Dark, tarry or green stools
: The iron preparations stain the
stools; the colour remains as long as you are taking the
drug and should not cause concern.
•
Constipation
: This is a common problem; if it becomes
too uncomfortable, consult with your healthcare
provider for an appropriate remedy.
•
Nausea, indigestion, vomiting
: These problems can often
be solved by taking the drug with food, making sure to
avoid eggs, milk, coffee and tea.
• Report any of the following to your healthcare provider:
severe diarrhoea, severe abdominal pain or cramping,
unusual tiredness or weakness, or bluish tint to the lips or
fingernail beds.
• Tell any doctor, nurse or other healthcare provider that
you are taking this drug.
• Keep this drug, and all medications, out of the reach of
children. Because iron can be very toxic, seek emergency
medical help immediately if you suspect that a child has
taken this preparation unsupervised.
• Because iron can interfere with the absorption of some
drugs, do not take iron at the same time as
tetracycline
or
antacids.
These drugs must be taken during intervals
when iron is not in the stomach.
