Nursing Guide to Iron Deficiency Anemia: Nursing Diagnosis, Interventions, & Care Plans

Iron Deficiency Anemia Definition

Hemoglobin is a protein found in the red blood cells that carries oxygen to the body’s organs and tissues and transports carbon dioxide from the organs and tissues. Iron is necessary for the production of hemoglobin. 

Iron deficiency anemia symptoms range from mild to severe and are related to the cause for the anemia. Iron deficiency anemia can be caused by inadequate iron intake, insufficient absorption, or blood loss. The following are causes of iron deficiency anemia (National Institutes of Health, 2019): 

• Deficient iron intake
• Gastrointestinal bleeding caused by prolonged use of aspirin or nonsteroidal anti- inflammatory drugs (NSAIDs)
• Gastrointestinal bleeding caused by cancer, ulcer, or surgeries (Gastric bypass and gastrectomy)
• Long term use of proton pump inhibitors that affect iron absorption (omeprazole (Zegerid®, Prilosec OTC®)
• Genetic conditions such as hemophilia, hereditary hemorrhagic telangiectasia, and Von Willebrand disease
• Frequent blood donation
• Heavy menstrual periods
• Pregnancy, delivery, and breastfeeding when iron requirements increase
• Injury or surgery that results in blood loss
• Gastrointestinal conditions that affect iron absorption such as celiac disease, ulcerative colitis, Crohn’s disease, and Helicobacter pylori infection.
• End-stage kidney failure due to blood loss during dialysis
• Inflammation from heart failure or obesity 

In the U.S., the rate of iron deficiency anemia is low with 1% of men under 50 and 10% in women of childbearing age being diagnosed annually (Warner & Kamran, 2020). In children aged 12 to 36 months, 2.7% have iron deficiency anemia (Gupta et al., 2016). Prevalence is higher in low income areas. 

Common complications of iron deficiency anemia include (Warner & Kamran, 2020): 

• Depression
• Heart problems such as arrhythmias, heart murmur, enlarged heart, and heart failure
• Increased risk for infections
• Developmental delays in children
• Pregnancy complications such as preterm delivery and low birth weight 

Iron Deficiency Anemia ICD-10 (unspecified): D50.9

Iron Deficiency Anemia Diagnosis 

The diagnosis of iron deficiency anemia is made by a thorough history intake and physical examination by the healthcare provider. Signs and symptoms of iron deficiency anemia include (National Institutes of Health, 2019): 

• Brittle nails and hair loss
• Pallor
• Tongue swelling
• Chest pain or irregular heartbeat
• Difficulty concentrating
• Dizziness, weakness, and fatigue
• Headache
• Pica or chewing ice
• Restless legs syndrome
• Shortness of breath
• Poor circulation in hands and feet 

Diagnostic tests that may be ordered include a complete blood count, fecal occult test, and urinalysis looking for blood or hemoglobin in urine. The provider may also order additional labs including iron, serum ferritin, and total iron binding capacity or transferrin levels. 

According to the American Association of Hematology (2021), in women with increased menstrual blood loss, a gynecologic evaluation with a pelvic ultrasound and uterine biopsy may be ordered. 

If a gastrointestinal cause is suspected, the provider may order: 

• Upper and lower endoscopy
• Capsule enteroscopy
• Barium enema or barium swallow
• Small bowel biopsy 

Management & Treatment of Iron Deficiency Anemia

Management and treatment of iron deficiency anemia will depend on the cause as well as the classification and severity. Treatments for iron deficiency anemia include increasing dietary intake with iron supplementation, intravenous iron therapy, red blood cell transfusions, or gastrointestinal surgery to stop internal bleeding. 

Other treatments may include the following: 

• Assess and stabilize airway, breathing, and circulation.
• Provide calm environment.
• Initiate fall precautions.
• Obtain ordered lab work.
• Monitor vital signs.
• Monitor nutritional intake.
• Monitor energy and activity level.
• Monitor for shortness of breath.
• Administer medications as ordered.
• Monitor for nausea, vomiting, and diarrhea.
• Monitor bowel pattern.
• Monitor pain.
• Monitor psychosocial wellbeing for signs of depression, fear, and anxiety.
• Observe individual continually during iron or red blood cell transfusion.
• Cease IV administration immediately if any transfusion reaction is noted or reported.
• Monitor IV site. 

Iron Deficiency Anemia Nursing Care Plan & Interventions

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for iron deficiency anemia are listed below. 

Assessment 

Assess signs and symptoms, such as: 

• Chest pain or arrythmia
• Vital signs
• Weakness and fatigue
• Pain including headache and pain at IV site
• Respiratory status, shortness of breath
• Psychosocial wellbeing
• Signs and symptoms of infection at IV site
• Fever, flushing, or chills
• Nausea and vomiting
• Prior transfusions, reactions, or complications
• Rash, hives, or pruritis
• Blood in urine or stool 

Nursing Diagnosis/Risk For 

• Fatigue related to decreased oxygen supply to the body, evidenced by:
  • Verbalization of decreased energy and tiredness
  • Shortness of breath
  • Decrease in physical activity
  • Increase in rest requirements
• Deficient knowledge related to unfamiliarity with disease condition, evidenced by:
  • Inaccurate follow-through of instructions
  • Verbalization of incorrect information
  • Reports unfamiliarity with disease condition
• Risk for infection related to decreased oxygen carrying capacity in blood, evidenced by:
  • Fever
  • High white blood cell count
  • Chills
  • Malaise
  • Redness, swelling, and pain at IV site, injury, or incision 

Nursing Interventions for Anemia 

• Verify individual’s information including blood type with a two-person verification system if transfusing red blood cells.
• Crossmatch sample label with orders and individual’s information.
• Maintain consistent direct observation of individual during transfusion.
• Monitor for signs and symptoms of transfusion reaction with red blood cell transfusion.
• Monitor for signs and symptoms of allergic reaction with IV iron therapy.
• Monitor cardiac status.
• Monitor output.
• Monitor neurological status.
• Maintain adequate ventilation and oxygenation.
• Monitor respiratory status and oxygenation.
• Provide oxygen supplementation as prescribed.
• Initiate fall precautions.
• Provide psychosocial support to individual and family.
• Monitor vitals.
• Monitor for signs and symptoms of infection.
• Involve individual in teaching plan.
• Provide a supportive and collaborative environment so individual feels comfortable asking questions.
• Encourage sufficient nutritional intake.
• Encourage individual to take necessary rests and to not overexert themselves. 

Expected Outcomes 

• Maintains adequate oxygenation
• Remains free from infection
• Maintains normal breathing pattern
• Remains afebrile
• Verbalizes understanding of condition
• Returns to baseline activity level 

Individual/Caregiver Education 

• Condition, treatment, and expected outcomes
• Nutritional sources of iron
• Side effects of iron supplements, if prescribed
• Signs and symptoms of transfusion reaction
• Signs and symptoms of IV iron therapy reaction
• Notify healthcare provider or seek immediate medical care for:
  • Redness, infection, or bleeding at the IV site
  • Fever
  • Dark colored urine
  • Chest pain or rapid heartbeat
  • Breathing difficulty
  • Headache
  • Dizziness
  • Nausea or vomiting
  • Rash or itching
  • Back pain
  • Purpura or bleeding
  • Depression
  • Constipation or no bowel movement in four days
• Recommended follow-up with healthcare provider 

Content Release Date 

4/1/2022

Content Expiration

12/31/2026

Course Contributor 

The content for this course was created by Annette Brownlee RN, BSN 

Annette Brownlee is an SME Writer for the Post-Acute Care team. She has a Bachelor of Arts in advertising from Michigan State University and a Bachelor of Science in nursing from the University of Northern Colorado. Annette has worked in skilled nursing and home health. Her most recent experience includes being a Staff Development Coordinator and Infection Preventionist. 

References 

• American Association of Hematology. (2021). Iron-deficiency anemia. https://www.hematology.org/education/patients/anemia/iron-deficiency 
• Gupta, P. M., Perrine, C. G., Mei, Z., & Scanlon, K. S. (2016). Iron, anemia, and iron deficiency anemia among young children in the United States. Nutrients, 8(6), 330. https://www.mdpi.com/2072-6643/8/6/330 
• National Institutes of Health. (2019). Iron-deficiency anemia. https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia 
• Warner, M., & Kamran, M.T. (2021). Iron deficiency anemia. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448065/#_NBK448065_pubdet_