Hannah is a 14 year old who presents to the clinic with fatigue and complaints of getting really tired on her runs. She is a runner and is on the school cross country and track team. She has been previously healthy and is a vegetarian.

Advanced Practice Nurse Prescribers: Pharmacotherapeutics

Hannah is a 14 year old who presents to the clinic with fatigue and complaints of getting really tired on her runs. She is a runner and is on the school cross country and track team. She has been previously healthy and is a vegetarian. Her last menstrual period was 2 weeks prior to the visit. She states that her menses are every 4 weeks, and reports that they are heavy and last for 5 to 7 days. Hannah’s Hgb is 10.1 and her Hct is 31.2%. Her ferritin is 14.

• What is the plan of care for Hannah? Please write prescription as you would in practice.

• What education should she receive regarding her medication and lifestyle?

ANSWER

“Optimizing Energy and Performance: Managing Iron Deficiency Anemia in Adolescent Runners”

Plan of Care for Hannah

Based on Hannah’s symptoms, history, and laboratory results, it appears that she is experiencing fatigue and potential iron deficiency anemia. The plan of care for Hannah would involve addressing her anemia and optimizing her iron levels to improve her energy levels and overall well-being. The following prescription can be considered:

Prescription: Medication: Ferrous sulfate 325 mg orally, once daily with food. Dispense: #30 tablets. Refills: 1.

Instructions for Use:

1. Take one tablet of Ferrous sulfate 325 mg orally, once daily.
2. Take the medication with food to enhance absorption and reduce the risk of gastrointestinal side effects.
3. It is important to take the medication regularly and complete the full course as prescribed.
4. If any adverse effects occur or if there are any concerns, contact the healthcare provider.

Education regarding Medication and Lifestyle:

Title: “Managing Iron Deficiency Anemia: A Comprehensive Approach for Optimal Health and Performance”

Introduction

Iron deficiency anemia can significantly impact an individual’s energy levels, particularly in athletes like Hannah. This essay aims to provide comprehensive education on managing iron deficiency anemia to optimize Hannah’s overall health and athletic performance (Damian et al., 2021).

Understanding Iron Deficiency Anemia: Iron deficiency anemia occurs when the body lacks sufficient iron to produce an adequate amount of healthy red blood cells. This condition can lead to fatigue, weakness, and reduced exercise capacity. For individuals like Hannah, who are engaged in regular high-intensity activities, addressing iron deficiency is crucial.

Importance of Iron in the Body: Iron plays a vital role in transporting oxygen throughout the body, including the muscles, which is essential for optimal athletic performance. Iron is also involved in energy production, immune function, and cognitive processes.

Lifestyle Modifications

Balanced Diet: As a vegetarian, Hannah must focus on consuming iron-rich foods, including leafy green vegetables, legumes, fortified cereals, tofu, and nuts. Combining these plant-based iron sources with vitamin C-rich foods like citrus fruits or peppers can enhance iron absorption.

Timing of Meals: Encourage Hannah to consume iron-rich foods separately from calcium-rich or caffeine-containing foods, as these can inhibit iron absorption. It is advisable to wait at least two hours before or after consuming these items.

Menstrual Health: Hannah’s heavy and prolonged periods may contribute to her iron deficiency (Hennegan et al., 2021). Educate her about the importance of maintaining menstrual hygiene and suggest she consult her healthcare provider for further evaluation and management options.

Medication Usage: Hannah has been prescribed Ferrous sulfate, an oral iron supplement. Advise her on the following:

Proper Administration: Take one tablet of Ferrous sulfate 325 mg orally, once daily with food. This helps improve absorption and minimize gastrointestinal side effects.

Adherence and Completion: Stress the importance of taking the medication regularly and completing the full course as prescribed. It may take several weeks to replenish iron stores and for symptoms to improve.

Side Effects and Management: Discuss potential side effects like constipation, nausea, and darkened stools. Encourage Hannah to report any adverse effects to her healthcare provider, who can provide appropriate management strategies or consider alternative formulations if necessary.

Monitoring and Follow-up: Schedule a follow-up appointment with Hannah to assess her progress, reevaluate her iron levels, and make any necessary adjustments to the treatment plan.

Conclusion

 By addressing Hannah’s iron deficiency anemia through a combination of lifestyle modifications and medication, she can improve her energy levels and athletic performance. Emphasize the importance of ongoing communication with her healthcare provider to monitor progress and make any necessary adjustments (National Academies Press (US), 2003). With proper management, Hannah can continue to pursue her passion for running while maintaining optimal health and well-being.

References

Damian, M., Vulturar, R., Login, C., Damian, L., Chis, A., & Bojan, A. (2021). Anemia in Sports: A Narrative Review. Life, 11(9), 987. https://doi.org/10.3390/life11090987 

Hennegan, J., Winkler, I. T., Bobel, C., Keiser, D., Hampton, J., Larsson, G., Chandra-Mouli, V., Plesons, M., & Mahon, T. (2021). Menstrual health: a definition for policy, practice, and research. Sexual and Reproductive Health Matters, 29(1), 31–38. https://doi.org/10.1080/26410397.2021.1911618 

National Academies Press (US). (2003). Reducing Maternal Mortality and Morbidity. Improving Birth Outcomes – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK222105/