Acorn Squash: Aurielle, Brittni, Erin, & Ze
1.





2.

1
The signs and symptoms that support the diagnosis of anemia consist of pale skin
color and sclera, fatigue, vaginal spotting, increased respiratory rate, poor dietary
intake, and irregular use of prenatal vitamins. In addition, Mrs. Morris is pregnant
which can increase her risk of developing anemia.
Pale skin pigmentation: Pale skin pigmentation, as well as sclera pigmentation,
indicates decrease hemoglobin concentrations. Hemoglobin is the complex
molecule responsible for transporting of oxygen throughout our bodies. Its
primary protein constituent of red blood cells which can be specified as
oxygenated or deoxygenated hemoglobin. Oxygenated hemoglobin produces a
pinkish tint to lightly pigmented skin. Deoxygenated hemoglobin produces the
bluish tint to lightly pigmented skin color that is characteristic of oxygen
deprivation and suffocation. When patients suffer from reduced red blood cells or
oxygenated hemoglobin concentration, they appear to be excessively pale (1).
Fatigue: Anemia is a condition that develops specifically when your blood lacks
enough strong red bloods or hemoglobin. Hemoglobin is a central part of red
blood cells and is the part that binds to oxygen. Reduction of red blood cells or
abnormal red blood cells causes the (other) cells in the body to not obtain enough
oxygen. When cells do not obtain enough oxygen, not as much energy is not
produced, which can increase the feeling of fatigue (1).
Vaginal Spotting: Decreased iron amounts/concentrations of red blood cells can
cause anemia because of the increased demands of iron needed when pregnant.
Increased blood and iron loss can cause vaginal spotting (1).
Respiratory Rate: Increased respiratory rate is related to the blood carrying a
reduced amount of oxygen to the tissues. Lower oxygen concentrations in the
blood can stimulate the lungs to increase their respiratory rate in order to extract
more oxygen and the heart to increase its rate in order to increase the volume of
blood delivered to the tissues. In the lungs, the heme component binds to oxygen
in exchange for carbon dioxide. The oxygenated red blood cells are then
transported to the body's tissues, where the hemoglobin releases the oxygen in
exchange for carbon dioxide, and the cycle repeats. Therefore, a decreased
concentration of oxygen associated with pregnancy can cause one to have trouble
breathing (2).
Poor Dietary Intake: Nutrient needs are higher in pregnant women because the
nutrients supply both the mother and the fetus. Poor dietary intake of iron and
folic acid, compounded with irregular use of prenatal vitamins, can result in
anemia. A pregnant woman must consume an additional 700 – 800 mg of iron per
day throughout her pregnancy compounded with an additional 400 mcg per day of
folic acid from supplements or fortified foods (1).
The laboratory values that support the diagnosis of anemia are the abnormal
values of the Red Blood Cell (RBC) concentration, hemoglobin (Hgb)
concentration, hematocrit (Hct) concentration, mean cell volume (MCV), total
iron binding capacity (TIBC), ferritin concentration, and folate concentration.
Red Blood Cell: Anemia occurs when your body does not contain enough red
blood cells. Your body creates three types of blood cells within your body. The
cells include white blood cells, platelets, and red blood cells. The white blood
Acorn Squash: Aurielle, Brittni, Erin, & Ze





2
cells are used to fight off infection, platelets are used to help prevent blood
clotting, and red blood cells carry oxygen throughout your body. The decrease in
red blood cell concentration can indicate a nutritional deficit, hemorrhage,
hemolysis, genetic aberration, marrow failure, or renal disease. however the
concentration is not sensitive to iron, vitamin B12, or folate deficiencies. The
cause of a low red blood cell countcan relate to nutritional deficits associated with
poor dietary intake and/or the body not absorbing the necessary amount of
nutrients. Marrow failure related to an insufficient amount of red blood cells
being produced due to close proximity previous birth (3).
Hemoglobin: Hemoglobin is the protein molecule in red blood cells that carries
oxygen from the lungs to the body’s tissues and returns carbon dioxide from the
tissues back to the lungs. Her reported hemoglobin value of 9.1 g/dL is below the
normal range for adult women of12 to 16 g/dL. A decreased concentration of
hemoglobin can result from nutritional deficits, hemorrhage, hemolysis, genetic
aberrations, marrow failure, or renal disease; all of which are associated with
anemia. The cause of a decreased concentration of hemoglobin value can relate to
respiratory rate associated with a reduced production of oxygen to the tissues.
Nutritional deficits associated with poor dietary intake and marrow failure due to
an insufficient amount of red blood cells being produced (1).
Hematocrit: Hematocrit is the proportion of total blood volume that is composed
of red blood cells. It indicates whether you have too few or too many red blood
cells which can occur as a result of certain diseases. A lower than normal
hematocrit may can result from an insufficient supply of healthy red blood cells
(anemia) or a large number of white blood cells, which are usually a very small
portion of your blood. This can be due to long-term illness, infection, leukemia,
lymphoma, or other disorders of white blood cells; alternatively, vitamin or
mineral deficiencies and recent or long-term blood loss can cause low hematocrit
values. Thus, a lower than normal hematocrit value can be associated with a
decrease in the amount of red blood cells being produced. Vitamin or mineral
deficiencies associated with poor dietary intake or long-term blood loss (as it
relates to vaginal spotting during pregnancy) also can explain this low value (1).
Mean Cell Volume: Mean cell volume is a measure of the average volume of red
blood cells. The normal range for mean cell volume is between 80-99 fl for
adults. A value lower than 80 may be related to the presence of iron deficiency,
thalassemia trait and chronic renal failure, or anemia of chronic disease. The
patient mean cell volume value is 72, which suggests she has anemia.
Total Iron Binding Capacity: Total iron binding capacity measures the blood’s
capacity to bind iron. The normal range for total iron binding capacity is 240-450
units. If the iron concentration in the body is excessive (high), as is the patient’s
value of 465, absorbing cells would be down regulated, and less iron would be
absorbed. The latter situation occurs during iron overloads to protect the body
against toxicity (1).
Ferritin: Serum ferritin is the storage protein that stores iron within the liver,
spleen, and bone marrow. As the iron supply increases, the intracellular level of
ferritin increases to accommodate iron storage. The patient serum ferritin level is
Acorn Squash: Aurielle, Brittni, Erin, & Ze

3.


4.






5.

3
low, which indicates a low amount of iron and also that an inadequate iron is
stored (1).
Folate: Folate deficiency is the lack of folic acid in the blood, which can cause a
type of anemia known as megaloblastic anemia. Folic acid is a B vitamin that is
required for the production of normal red blood cells. Folate deficiency often
occurs during pregnancy because of the increased need of folate by the fetus. The
fetus absorbed more slowly from the mother’s digestive tract during pregnancy
(1).
The fact that Mrs. Morris’s CBC revealed a low hemoglobin count is a concern
because this result may be indicative of anemia, leading to insufficient oxygen for
her child and herself. Iron supplementation may be necessary if hemoglobin is
below 10.9 (1).
There are normal changes in hemoglobin associated with pregnancy. Blood
volume expands an average of 50% throughout pregnancy causing a decrease in
hemoglobin and other hematological components, such as serum proteins (like
albumin) and water-soluble vitamin levels (1).
Megaloblastic anemia is a type of anemia (as pernicious anemia) characterized
by the presence of megaloblasts in the circulating blood (4).
Pernicious anemia is a type of severe hyperchromic anemia marked by a
progressive decrease in the number of red blood cells and an increase in the size
and hemoglobin content of the red blood cells. Pallor, weakness, and
gastrointestinal and nervous disturbances are also associated with reduced ability
to absorb vitamin B12 due to the absence of intrinsic factor—called also
addisonian anemia (4).
Normocytic anemia is a type of anemia marked by reduced numbers of normal
red blood cells in the circulating blood (4).
Microcytic anemia is an anemia characterized by the presence of microcytes in
the blood (4).
Sickle cell anemia is a type of chronic anemia that occurs in individuals (.e.g.,
many people of African or Mediterranean descent) who are homozygous for the
gene controlling hemoglobin S. It is characterized by destruction of red blood
cells and by the episodic blocking of blood vessels. Blood vessels are blocked by
the adherence of sickle cells to the vascular endothelium, which is what causes the
serious complications of thisdisease (such as organ failure) (4).
Hemolytic anemia is a type of anemia caused by excessive destruction (as in
chemical poisoning, infection, or sickle-cell anemia) of red blood cells (4).
As a component of hemoglobin and myoglobin, which are oxygen-carrying
proteins found in red blood cells (RBC) and muscles, iron plays a crucial role in
the transfer of oxygen. The iron-containing part of hemoglobin transports oxygen
from the lungs into the tissues, where carbon dioxide is picked up and taken to the
Acorn Squash: Aurielle, Brittni, Erin, & Ze

4
lungs for removal through exhalation. The iron-containing part of myoglobin acts
as a storage site for oxygen within muscles. In addition to its involvement in RBC
and myoglobin activity, iron contributes to the function of many enzymes’
activities. Cytochromes require iron as a component to carry out cellular
respiration and energy production through the electron transport chain. Catalase is
an iron-containing enzyme that is responsible for the degradation of reactive
oxygen species ibonucleotide reductase is another iron-containing enzyme, but it
regulates the synthesis of DNA. These are just a few of the enzymes that rely on
iron. Iron also plays a critical role in the immune system through many different
mechanisms (1).
Due to the 50% expansion of blood volume during pregnancy, a decrease in the
concentration of water-soluble vitamins occurs, putting mothers at risk for
nutrient deficiencies. This expansion of blood volume dilutes the blood,
increasing the need for iron for females from 18mg per day to 27mg per day
during pregnancy. This extra consumption of iron contributes to hematopoiesis
and development of fetal and placental tissues. Without an increase in iron
consumption, many complications can occur, including inadequate delivery of
oxygen to the “uterus, placenta, and developing fetus” as well as heart
complications, slow fetal growth, low birth weight, and insufficient neonatal
health (1).
6.

In the first stage of iron insufficiency, a negative iron balance exists. This
negative balance occurs because iron absorption is reduced, causing moderate
depletion of iron stores. No laboratory values are majorly affected during this
stage. By stage two, iron stores are severely depleted and affected laboratory
values include low RE marrow Fe, low plasma ferritin (for storage), slightly
elevated transferrin (for transportation) iron binding capacity (IBC), and increased
percent absorption (due to upregulated number of receptors to maximize iron
absorption). Both stages are considered “iron depletion” stages and do not
produce any major dysfunctions. However, decreased muscle function, growth
abnormalities, epithelial disorders, reduced immune function, and fatigue are
common clinical symptoms. Stages three and four are considered “iron deficient”
stages. Stage three is characterized by damaged metabolism including gastritis as
well as iron-deficient erythropoiesis. Altered laboratory values include decreased
plasma iron levels, decreased transferrin saturation levels, decreased sideroblasts,
and elevated red blood cell (RBC) protoporphyrin levels. At stage four, iron
deficiency anemia occurs along with clinical damage, which can lead to
cardiovascular and respiratory failure. Along with the worsening levels for the
previously mentioned laboratory values, at stage four, erythrocytes are
hypochromic and microcytic with a mean corpuscular value (MCV) less than 80
and a mean corpuscular hemoglobin concentration (MCHS) value less than 31.
Additional symptoms of iron deficiency include: defects in epithelial tissue,
especially of the tongue, nails, mouth, and stomach; paleness of skin, angular
stomatitis, glossitis, koilonychia (spoon-shaped nails) may also occur (1).
Acorn Squash: Aurielle, Brittni, Erin, & Ze
7.

The patient’s laboratory values are indicative of hypochromic, microcyctic
anemia with low MCV at 72μm3, low MCHS at 28g/dL, elevated iron binding
capacity at 465μg/dL, and low ferritin levels at 10μg/dL.

She is currently pregnant, which increases her blood volume and make her more
vulnerable to iron-deficiency anemia. She also underwent 3 pregnancies with 2
being deliveries.
Her last pregnancy is very close (one of her sons is 12-months old).
Vaginal spotting related to excessive menstrual flow and internal bleeding, which
put her at higher risk for iron-deficiency anemia (7).
Her abdominal pain might be an indicator of internal bleeding, which will lead to
more iron loss and an increased risk of iron-deficiency anemia.
Being a woman automatically puts her at higher risk since her blood loss during
menstrual cycles decreases/depletes her iron stores.
There is a significant increase in maternal blood supply during pregnancy that
requires a much higher level of iron, leading to an additional 700 to 800 mg of
iron throughout pregnancy. The need for increased iron level peaks after the 20th
week of gestation, and since Mrs. Morris is at her 23rd week of gestation, the
higher demand for iron makes her even more vulnerable iron-deficiency anemia
(7).
Her cesarean section surgery during her previous delivery of her second son.
Her smoking history also puts her at higher risk for iron-deficiency anemia.
Her being a picky eater increases the chance that she is not getting enough
nutrients from a variety of food sources, including iron.








8.
5

The fetus will probably get the iron from the mother first before the mother gets
it, but maternal anemia can still affect a baby's iron stores at birth, which is more
likely to increase the newborn’s risk for anemia later. Iron-deficiency anemia
during pregnancy can also lead to premature delivery and low infant birth weight.
Moreover, iron-deficiency anemia negatively affect the mother’s hemoglobin
levels, thus the oxygen carried in the blood; this can increase the risk of newborn
death and be an important predictor of infant morbidity and mortality due to the
insufficient amount of oxygen being transferred to the infant from the mother.
One studied conducted on a group of Chinese textile workers who became
pregnant has discovered a correlation between the iron deficiency status of the
mother and the low birth weight and fetal growth restriction that infants given
birth to by iron deficient mothers. They are six times more likely to have low birth
weight and impaired fetal growth compared to infants given birth to by
nonanemic mothers. One of the underlying causes might be low pre-pregnancy
ferritin concentrations (6).

Specific nutritional requirements needed are during fetal growth demands.
Additional nutrients are defined in the DRI’s, which include RDAs and adequate
9.
Acorn Squash: Aurielle, Brittni, Erin, & Ze









6
intakes (AIs). Energy is required during pregnancy to support the metabolic
demands of pregnancy and fetal growth. The DRIs recommends a 340 to 360
kcal/day increase during the second trimester and another 112 kcal/day in the
third trimester; in the first trimester, the DRIs for energy for the pregnant woman
are as same as non-pregnant women (1).
Protein is needed for the support of the maternal and fetal tissues. It will increase
throughout gestation and peak during the third trimester. 0.8 g/kg/day is required
for women in their first half of pregnancy, which is as same as non-pregnant
women, and this number will increase to 1.1 g/kg/day during the second half of
pregnancy (1).
Recommendations for carbohydrates during pregnancy are 135 to 175 g/day for
ketosis presentation and blood glucose regulation. The DRIs for fiber during
pregnancy is 28 g/day for managing constipation that often accompanies
pregnancy. Although, they are no DRI recommendations for pregnancy, the
amount of fat in the diet depends on the energy requirements for proper weight
gain. The recommendations for omega 6 polyunsaturated fatty acids (linoleic
acid), omega 3 polyunsaturated fatty acids (alpha linolenic acid ), and
docosahexaenoic acid are 13g/day, 1.4 g/day, and 300 mg/day, respectively (1).
Folic Acid reduces the risk of having a child with neural tube defects. Women
trying to become pregnant should obtain 400 mcg of folate or folic acid per day
through supplements, compared to an a normal average of 128 mcg/ day of folic
acid being consumed through foods (with or without fortification). However,
obtaining too much folic acid by taking supplements can mask the symptoms of
vitamin B12 deficiency and delay diagnosis and treatment (1).
Vitamin B6 plays a role as a neurotransmitter, and since it is prevalent in a lot of
food sources (e.c., meat, fish, and poultry), deficiency is rare (1).
Choline is considered as an essential nutrient since it cannot be synthesized by
our bodies and has to be obtained from foods sources and supplements. The
recommendation for choline intake during pregnancy is about 450 mg/day (1).
Vitamin C is very important in collagen synthesis and also known as an
antioxidant. However, there is no recommendations specifically targeting
pregnant women (1).
Due to its risk for overdosing, vitamin A (a fat-soluble vitamin) must be
supplemented with caution, and should not exceed 10,000 IU/day in developing
countries. In order to prevent fetal anomalies, isotreinoin, a vitamin A analog, has
to be stopped before conceiving a child (1).
Low levels of Vitamin D intake during pregnancy increase the risk of PET (preeclamptic toxemia), which is a hypertensive condition. Risk factors for low
vitamin D levels prior to pregnancy includes a BMI greater than 30 and a high use
of sunscreen in addition to poor dietary intake. A vitamin D supplementation of
20 ng/ml is recommended in order to reach a desirable serum concentration, with
cautions (1).
Pregnancy demands high levels of vitamin E in order to lower the risk of
miscarriage, preterm birth, PET, and IUGR that are caused by vitamin E
deficiency (1).
Acorn Squash: Aurielle, Brittni, Erin, & Ze




7
Since diets that are low in dark leafy green vegetables will not meet the
recommended level for vitamin K, which is crucial for maintaining bone health
and coagulation homeostasis, supplementation is necessary, especially for women
who have had hyperemesis gravidarum, crohn's disease, and gastric bypass (1).
Since there is approximately 30 gram of calcium that is accumulated during
pregnancy, of which most goes to fetal skeleton, meeting the recommended
calcium level is very crucial during pregnancy. 1000 mg/day is recommended for
women before, during, and after pregnancy (1).
There is notable increase in maternal blood supply during pregnancy that
demands higher levels of iron intake, and as result, a pregnant woman need to
consume an additional 700 to 800 mg of iron throughout her pregnancy.
Supplementing iron is necessary in the third trimester and early stage in
pregnancy. 27 mg/day is generally recommended for pregnant women (1).
Restriction on dietary sodium for pregnant women with edema is not
recommended, and 2 to 3 g/day of iodized salt is recommended in order to
maintain a healthy sodium level (1).
10.

Dietary iron comes in two forms, heme iron which is derived from animal
products and nonheme iron, which is found mostly in plant products. The ironcontaining molecule found in hemoglobin, myoglobin, and some enzymes is
called heme. Heme iron is easily absorbed into the intestinal cells after the
consumption of animal foods whereas nonheme iron is harder for the body to
absorb, as it must be in a soluble, ionized form to enter the intestinal cells. The
best sources of heme iron are liver, red meat, egg yolk, shrimp, and oysters andthe
best sources of nonheme iron include legumes, whole or enriched grains, dark
green vegetables, and dark molasses (1).

The efficiency of iron absorption depends somewhat on the foods from which iron
is derived as well as the foods with which it is being consumed. It is also
important to note that iron absorption can be increased when stores are
inadequate. Intestinal cells located in the duodenum and jejunum, called
enterocytes, are responsible for iron absorption and consist of two membranes, the
brush border membrane and the basolateral membrane.
Nonheme iron must be in a “soluble, ionized form” after digestion for transfer
across the brush border. Acidic secretions enhance the solubility needed to change
nonheme iron to the ionic state for absorption. If the iron is in the preferred
reduced, ferrous state, then facilitated diffusion takes place through an iron
transporter called divalent metal transporter 1 (DMT1). Ferric iron must be
reduced by ferric reductase, a brush border enzyme, before absorption can take
place. Heme iron enters the cytosol of the enterocyte through vesicle formation.
After the iron is absorbed, the ions form protein complexes called ferritin, which
diffuse across the cell to the basolateral membrane. In the last step of absorption,
the iron ions exit into the blood through an active transport mechanism. From
11.


Acorn Squash: Aurielle, Brittni, Erin, & Ze
8
here, the iron is transported as plasma iron or bound to transferrin, a protein
carrier that transports iron through the blood (1).
12.


Her pre-pregnancy BMI= Weight (lb) x 703/ Height (in)2= 135lb x 703/ (65in)2 =
22.46, and it is within the normal, healthy BMI range.
Her %UBW= CBW/UBW x 100= 142 lbs/135 lbs x 100= 105.2%
13.
She is in her 23rd week of pregnancy. Her usual body weight is 135 pounds, her
current body weight is 142 pounds, and she has gained 7 pounds. Since she is of a
normal body weight, she should have gained between 11 and 16 pounds (Appendix 1)
by this point in her pregnancy. She gained 15 during the 38 weeks of her first
pregnancy and 20 pounds during the 37 weeks of her second pregnancy. If she was
also at a normal weight preceding her previous two pregnancies, she was below
normal limits for weight gain in them as well. For her first pregnancy (at 37th week)
she should have gained between 23.5 and 32.5 pounds and for her second (at 38th
week) she should have gained between 22.5 and 31.5 pounds (1).
14.



Her pre-pregnancy weight is 135 lbs, which is about 61.24 kg. Her REE
(Female)= 10w + 6.25H -5A – 161= 10 x 61.24kg + 6.25 x 165.1cm – 5 x 31yrs –
161= 1328 kcal. Since she is a stay-at-home mom, the activity factor would be
lightly active, which is REE x 1.375= 1826 kcal. Since she is currently in her
second trimester, her energy need will be increased by 340 to 360 kcal/day, and
her total energy need will be 1826 kcal + 340 kcal to 360 kcal = 2166 kcal to
2186 kcal per day. Once she reaches her third trimester, she will need 112 more
kcals per day, meaning that she will need to consume 2278 kcal to 2298 kcal in
the third trimester (1).
Since she is in her second half of her pregnancy, her protein needs will be 1.1
g/kg (pre-pregnancy weight)= 61.24kg x 1.1 g/kg = 67.4 g per day
Her fluid need will be 35 ml/kg for most adults= 35 ml x 61.24kg=2144 ml
15.
Her daily calorie intake according to SuperTracker is 1553. According to answer 14
she needs 2278-2298 kcal/day. The calorie deficit is 725 to 745 kcal. Her daily
protein intake according to SuperTracker is 55g. Her target protein intake, according
to question 14, is 67.4 grams per day, leading to a protein deficit of 12.4g (6).
16.
The patient’s iron intake was assessed using her 24-hour recall and Super Tracker
from choosemyplate.gov. It calculated her average iron consumption for that day to
be 28 mg (6). 27 mg is the recommendation for pregnant women so she should be
getting adequate iron if she generally eats how she did that day. However this is only
a 24-hour recall and we cannot be sure if she consumes this much iron daily.
Additionally, her greatest source of iron (69%) is cereal which contains non-heme
Acorn Squash: Aurielle, Brittni, Erin, & Ze
9
iron. Lean meat, poultry and seafood contain heme iron and that is more readily
available to the body (6).
17.



18.



Her identified pertinent problems are: low Hct, low mean cell volume,
diminished pulse, low RBC, low Hgb, shortness of breath, tired, pale, iron binding
capacity high, and low ferritin Her diagnosis would be hypochromic microcytic
and anemia, due to inadequate iron intake.
Her identified pertinent problems are: she did not reach her optimal weight gain.
Her diagnosis for this problem would be inadequate energy intake.
She also has problems with low folate intake because she has problem with
taking prenatal vitamins due to stomach pain; additionally, her inadequate folate
intake could also be caused by not adopting a nutritionally balanced diet given
that she has been a picky eater.
Inadequate iron intake (NI-5.10.1.3) related to increased iron requirement with
pregnancy as evidenced by a Hgb level of 2.9-5.9 g/dl lower than normal levels
for females.
Inadequate energy intake (NI-1.2) related to increased energy requirements during
pregnancy as evidenced by a deficit of 4 to 9 pounds of the maternal weight gain
for a normal weight pregnant woman.
Inadequate folate intake (NI-5.9.1.9) related to increased folate requirement
during pregnancy as evidenced by a folate lab result that is 3-23 ng/dL lower than
a normal level.
19.



Ferrous sulfate is a type of iron that you normally obtain from the foods you eat.
It is an essential body mineral and can treat iron deficiency anemia, which is a
lack of red blood cells caused by decreased iron status.
Common side effects associated with ferrous sulfate include, but are not limited
to, constipation, dark or green stools; diarrhea; loss of appetite, nausea, stomach
cramps, pain, or vomiting. Severe allergic reactions include, but are not limited to,
hives, itching, difficulty breathing, blood or streaks of blood in stool, fever; severe
or persistent nausea, stomach pain, or vomiting.
When taking ferrous sulfate, one should avoid taking any other multivitamin or
mineral product within two hours before or after taking ferrous sulfate. Similar
mineral products together at the same time can result in a mineral overdose or
serious side effects. This is essential if taking with antibiotics such as:
 Ciprofloxacin
 Demeclocycline
 Doxycycline
 Levofloxacin
 Minocycline
 Norfoxacin
 Ofloxacine
Acorn Squash: Aurielle, Brittni, Erin, & Ze
10


20.


Tetracycline
Take ferrous sulfate on an empty stomach, at least one hour before or two hours
after a meal. Avoid taking antacids or antibiotics within two hours before or after
taking ferrous sulfate. Take ferrous sulfate with a full glass of water. Do not
crush, chew, break, or open an extended release tablet or capsule. Ferrous sulfate
can be obtained in a liquid form as well. In that case, measure the liquid with a
special dose measuring spoon or measuring cup. Ferrous sulfate can cause teeth
staining, but this effect can be prevented. To prevent tooth staining mix the liquid
form of ferrous sulfate with water or juice and drink with mixture through straw.
Avoid mixing with milk. Certain foods can also make it harder for your body to
absorb ferrous sulfate. Avoid taking meats, liver, fish, and whole grains or
fortified breads or cereals within one hour before or two hours after eating (9).
Prenatal vitamins can help cover any nutritional gaps in the mother’s diet, and
generally includes Folic acid, Calcium, Iron, Vitamin C, Zinc, Copper, Vitamin
B6, and Vitamin D international units (10).
If her prenatal vitamin is making her sick, it is advised to take the pill with
something in your stomach. A light snack or meal can avoid irritation in the
stomach which may decrease the stomach pain that she has been experiencing. If
symptoms continue contact your practitioner and he or she may be able to
prescribe different brand (1).
21.




22.
After ensuring patient understanding of the nutrition prescription, it is important
for the RD to monitor progress after the patient leaves.
For assessment of pregnancy and nutritional status, an RD should monitor
progress made toward consumption of more calories, which is 340-360 kcal more
in the second trimester and an addition of 112 kcal in the third trimester (11).
Follow-ups should occur every 2-4 days until stable or no longer at risk and then
every 5-7 days to ensure the pregnancy is progressing at a healthy rate. It would
also be important to measure weight gain to ensure that it is sufficient for proper
growth and development of the baby, as well as maintenance of the mother’s
health. Additionally, food records would be an effective form of self-monitoring
for the patient. Telephone follow-ups would be an efficient means of monitoring
calorie intake and weight gain for both parties (12).
For assessment of mineral status, food records and telephone follow-ups would
again be important to assess effectiveness and compliance of ferrous iron and
prenatal supplementation as well as consumption of dietary sources of both iron
and folate. Inquiring about the patient’s energy level, skin color, breathing rate,
and any other epithelial disorders is also a good technique in assessing iron status.
It would also be necessary to monitor new lab values to examine any
improvements or worsening values.
Refer to the attached ADIME note (11-13).
Acorn Squash: Aurielle, Brittni, Erin, & Ze
11
References
1.
Mahan LK, Stump S, Raymond JL, & Krause MV. Krause's food & the nutrition
care process. 13th ed. St. Louis, Mo: Elsevier/Saunders; 2012:95, 107, 109, 352,
356-360, 726-729.
2.
Desforges, M.D., J. (2014, July 9). Blood Disease. Retrieved from
http://www.britannica.com/EBchecked/topic/720818/blooddisease/33526/Anemia
3.
Mayo Clinic Staff. Diseases and Conditions; Anemia. Mayo Clinic Web site.
http://www.mayoclinic.org/diseases-conditions/anemia/basics/causes/con20026209. Published August 19, 2014. Accessed October 13, 2014.
4.
Medical Dictionary. http://www.merriam-webster.com. Accessed October 3, 2014
5.
Physical Activity and Controlling Weight. Kansas State University Web site.
http://www.kstate.edu/paccats/Contents/PA/PDF/Physical%20Activity%20and%2
0Controlling%20Weight.pdf. Accessed October 9, 2014
6.
SuperTracker. USDA Web site.
https://www.supertracker.usda.gov/foodtracker.aspx. Accessed October 9, 2014.
7.
Rodriguez-Bernal CL, Rebagliato M, Ballester F. Maternal Nutrition and Fetal
Growth: the Role of Iron Status and Intake During Pregnancy. Dovepress Web
site. http://www.dovepress.com/nutrition-and-dietary-supplements-journal.
Accessed October 9, 2014.
8.
Mayo Clinic Staff. Vaginal Bleeding. Mayo Clinic Web site.
http://www.mayoclinic.org/symptoms/vaginal-bleeding/basics/definition/sym20050756. Published April 16, 2013. Accessed October 13, 2014.
9.
Ferrous Sulfate (Feosol). Everyday Health Web site.
http://www.everydayhealth.com/drugs/ferrous-sulfate#interactions. Published
May 15, 2013. Accessed October 13, 2014.
10.
Mayo Clinic Staff. Vaginal Bleeding. Mayo Clinic Web site.
http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/indepth/prenatal-vitamins/art-20046945. Published April 20, 2012. Accessed
October 13, 2014.
11.
American Dietetic Association. Nutrition Care Manual®. Normal Pregnancy.
http://su8bj7jh4j.search.serialssolutions.com.ezproxy.lib.vt.edu:8080/?sid=sersol
&SS_jc=TC_003106965&title=Nutrition%20Care%20Manual. Accessed
October 13, 2014.
Acorn Squash: Aurielle, Brittni, Erin, & Ze
12
12.
American Dietetic Association. Nutrition Care Manual®. Hyperemesis
Gravidarum/Morning Sickness.
http://su8bj7jh4j.search.serialssolutions.com.ezproxy.lib.vt.edu:8080/?sid=sersol
&SS_jc=TC_003106965&title=Nutrition%20Care%20Manual. Accessed October
13, 2014.
13.
American Dietetic Association. Nutrition Care Manual®. Iron Deficiency
Anemia.http://su8bj7jh4j.search.serialssolutions.com.ezproxy.lib.vt.edu:8080/?sid
=sersol&SS_jc=TC_003106965&title=Nutrition%20Care%20Manual. Accessed
October 13, 2014.