Exhibits

The nurse has identified the priority problem for the client and now must determine proper care interventions. Based on the client history and the assessment data, which action(s) should the nurse anticipate? Select all that apply.

Decreased hemoglobin and hematocrit levels:

• Folic acid deficiency anemia: Yes, folic acid deficiency can result in low hemoglobin and hematocrit levels as folate is necessary for red blood cell (RBC) production.
• Iron deficiency anemia: Yes, iron deficiency leads to decreased hemoglobin and hematocrit levels because iron is crucial for hemoglobin synthesis.
• Vitamin B12 deficiency anemia: Yes, B12 deficiency can cause decreased hemoglobin and hematocrit levels due to impaired RBC production.
  Rationale: All three forms of anemia can result in low hemoglobin and hematocrit levels due to impaired red blood cell production.

Uptake often impeded by medications:

• Folic acid deficiency anemia: Yes, certain medications, like anticonvulsants or methotrexate, can interfere with folic acid absorption and utilization.
• Iron deficiency anemia: Yes, some medications like proton pump inhibitors (PPIs) or antacids can interfere with iron absorption.
• Vitamin B12 deficiency anemia: Yes, medications such as proton pump inhibitors, H2 blockers, and metformin can interfere with B12 absorption.
  Rationale: Medications can affect the absorption of all three nutrients—folic acid, iron, and B12—and lead to deficiencies, especially in individuals taking these medications long-term.

Result of dietary deficiency:

• Folic acid deficiency anemia: Yes, inadequate dietary intake of folate can lead to deficiency and anemia. Common in those with poor diets or increased demand (e.g., pregnancy).
• Iron deficiency anemia: Yes, iron deficiency is commonly caused by inadequate dietary intake of iron-rich foods (e.g., red meat, leafy greens).
• Vitamin B12 deficiency anemia: Yes, insufficient dietary intake, particularly in vegetarians or vegans who avoid animal products, can lead to B12 deficiency.
  Rationale: All three anemias can be caused by inadequate dietary intake of the respective nutrients.

Often associated with chronic alcoholism:

• Folic acid deficiency anemia: Yes, chronic alcohol use can impair folic acid absorption and utilization, contributing to deficiency.
• Iron deficiency anemia: Less commonly associated with alcoholism, though heavy drinking can affect iron absorption and cause gastrointestinal bleeding, leading to iron loss.
• Vitamin B12 deficiency anemia: Yes, alcohol use can interfere with vitamin B12 absorption and contribute to deficiency.
  Rationale: Chronic alcohol use is often associated with folic acid and B12 deficiencies due to impaired absorption, while its association with iron deficiency is less direct but can occur due to GI bleeding or poor nutrition.

Can be caused by malabsorption syndrome:

• Folic acid deficiency anemia: Yes, conditions like celiac disease or Crohn's disease can impair folate absorption.
• Iron deficiency anemia: Yes, malabsorption syndromes (e.g., celiac disease, Crohn's) can prevent proper iron absorption.
• Vitamin B12 deficiency anemia: Yes, malabsorption syndromes like pernicious anemia or celiac disease can impair B12 absorption in the intestines.
  Rationale: All three types of anemia can result from malabsorption syndromes due to difficulty absorbing nutrients from the digestive tract.

A. Acute pain is the most immediate and pressing problem for the client, given the reported severe flank pain. Managing pain effectively is a primary concern in nursing care, particularly for clients with renal calculi.

B. While impaired renal function is a concern with renal calculi, the acute pain takes precedence as it requires immediate intervention to enhance the client's comfort and promote better overall health.

C. The risk for aspiration is a potential issue due to nausea and vomiting; however, addressing the pain is more urgent in this scenario.

D. Nutritional deficit related to nausea is also a valid concern but is secondary to the acute pain management. The client’s immediate comfort and pain relief should be prioritized to facilitate recovery and improve overall well-being.