Mrs. M is a 68-year-old African-American female who came to the clinic due to progressive lethargy, dizziness and fatigu

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Mrs. M is a 68-year-old African-American female who came
to the clinic due to progressive lethargy, dizziness and fatigue
that began approximately three months ago. She also complains of
shortness of breath, fatigue, cool lower extremities, and a beefy
red tongue. She has a past medical history of type II diabetes
mellitus (DM), hypertension (HTN), coronary artery disease (CAD),
and osteoporosis. She is allergic to sulfa drugs with the reaction
of hives when she took the medication four years ago. Her current
medications include lisinopril/hydrochlorothiazide (Prinzide)
20/12.5mg daily, aspirin 81 mg daily, atorvastatin 20 mg daily,
metformin 500 mg twice daily, ergocalciferol 800 units daily and
ibandronate (Boniva) 150 mg once monthly. She denies ever smoking,
denies alcohol and illicit drug use. She retired four years ago and
was a social worker. She has a family history of CAD, DM and HTN;
her mother died at 55 years of age of heart disease and her father
died of prostate cancer seven years ago. Both her sisters are
living and diagnosed with HTN.
This patient is 5’6” tall and weighs 200 pounds, her
current heart rate is 100 bpm, BP 130/80, respirations 20 breaths
per minute with an oxygen saturation of 94% on room air. Her
recently drawn lab results include hemoglobin 7 g/dL, hematocrit
23%, mean corpuscular volume (MCV) 73 FL, mean corpuscular
hemoglobin (MCH) 25 pictograms/cell, mean corpuscular hemoglobin
concentration (MCHC) 30 g/dL, total iron binding capacity (TIBC)
550 µg/dL, serum iron 50 µg/dL, and serum ferritin 15
ng/ml.
1. What is the most common cause of microcytic
hypochromic anemia?
2. What is the first-line pharmacological treatment
for this disease process? How is this medication dosed and what are
all the available routes of administration?
3. What side effects are often
associated with this first-line pharmacological treatment and what
can the nurse do to alleviate the symptoms?