McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 4 9 Drugs used to treat anaemias

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.