Ateneo de Naga University

COLLEGE OF NURSING
4400 Naga City, Philippines

SELF-INSTRUCTED MODULE
(Anemias of Pregnancy)

Submitted By:

Gabrielle Angela B. Evangelista

Submitted To:
Mr. Dennis A. Locsin, RN, MN, MAN
II. INTRODUCTION:

In the previous study sessions, you were introduced to different abnormalities a mother may

experience during pregnancy and how to manage them. In this module, you will learn about

anemias in pregnancy, its causes and effects on the mother and the baby, the risk factors and

how to manage a pregnant woman with this condition. A healthy outcome depends on your

competence and knowledge in handling patients with the said defect.

Learning Objectives:

At the end of the session, you will be able to:

1) Have a better understanding on what anemias in pregnancy is all about

2) Distinguish the two anemias and differentiate

3) Understand the pathophysiology of the condition

4) Discuss the risk factors that causes omphalocele

5) Classify nursing interventions on how to manage a woman with anemia

III. Instructions to the Users:

This self-instructional module about omphalocele will help you understand the appropriate

knowledge, skills and management needed for it. While using this module it is necessary to use

it in a systematic way. The module consists of a pretest, discussion of the topic, and some

learning activities in order for you to understand the topic well. You will also find a summary

and some visuals to guide you through. A self-check test and evaluation was also included to

assess your learning when you used the module.

IV. Pretest

1) How many anemias are there in pregnancy?

3) What do you call the anemia that has a deficiency in folic acid?

4) What do you call the anemia that is a recessively inherited hemolytic anemia?

5) What do you call the anemia that are a group of autosomal recessively inherited blood

disorders that lead to poor hemoglobin formation and severe anemia?

V. Discussion of the Topic

When you're pregnant, you may develop anemia. When you have anemia, your blood doesn't

have enough healthy red blood cells to carry oxygen to your tissues and to your baby. During

pregnancy, your body produces more blood to support the growth of your baby. If you're not

getting enough iron or certain other nutrients, your body might not be able to produce the

amount of red blood cells it needs to make this additional blood. It's normal to have mild

anemia when you are pregnant. But you may have more severe anemia from low iron or

vitamin levels or from other reasons. Anemia can leave you feeling tired and weak. If it is

severe but goes untreated, it can increase your risk of serious complications like preterm

delivery.

Anemia

 is said to be a common health problem in pregnant women.

 As it is a serious medical condition, it can cause severe complications during

pregnancy.

 is a condition that occurs when the hemoglobin level in your blood is too low.

 Is a reduced ability of the blood to carry oxygen to the cells.

In pregnancy

Hgb <11mg/dl & Hct ↓30%

1. Anemia

 Iron-Deficiency Anemia

 Most common anemia in pregnancy

 Complicates 15% to 25% of all pregnancies

 Type of anemia that can be microcytic and hypochromic

 Occurs when such an inadequate supply of iron is ingested that iron is

not available for incorporation into red blood cells

 Folic Acid-Deficiency Anemia

 Occurs most often in multiple pregnancies because of the increased fetal

demand;

 In women with a secondary hemolytic illness in which there is a rapid

destruction and production of new red blood cells;

 In women who are taking hydantoin, and anticonvulsant agent;

 And in women who have poor gastric absorption

 The anemia that develops is called megaloblastic anemia (enlarged

red blood cells)

2. Sickle Cell Disease

 A recessively inherited hemolytic anemia caused by an abnormal amino acid in

the beta chain of hemoglobin

 Majority of RBCs are irregular or sickle shaped

3. Thalassemia
  Are a group of autosomal recessively inherited blood disorders that lead to poor

hemoglobin formation and severe anemia

 Abnormal HGB form

Risk Factors

All pregnant women are at risk for becoming anemic. That's because they need more

iron and folic acid than usual. But the risk is higher if you:

 Are pregnant with multiples (more than one child)

 Have had two pregnancies close together

 Vomit a lot because of morning sickness

 Are a pregnant teenager

 Don't eat enough foods that are rich in iron

 Had anemia before you became pregnant

Causes

 Nutrition

 Hemolysis

 Blood loss

 Drugs

Pathophysiology

Iron Deficiency Anemia

 Most common hematologic disease in pregnancy affecting 20% of pregnant women.

↑ Maternal plasma volume & ↓ total RBC

c
↑ nutrient carrying capacity of the plasma but ↓ the viscosity of whole blood

(disproportionate rise in bld constituents)

Hemodilution
c

↓in Hgb concentration

Fetus requirement for Iron

Poor general nutrition

(economic status/nausea & vomiting)

Maternal depletion of iron stores

Overt Anemia

Folic Deficiency Anemia

 Folic Acid (Folate or Folacin) - Coenzyme in the synthesis of deoxyribonucleic acid (DNA)

Inadequate intake, poor absorption, or drug interaction or vit B12 deficiency

Folic acid deficiency

↓RBC production
 c

Anemia

Deficiency in folic acid

 Reduction in the rate of DNA synthesis & mitotic activity of individual cells

 Presence of large, immature erythrocytes (megaloblasts)

Signs and Symptoms

The most common symptoms of anemia during pregnancy are:

 Pale skin, lips, and nails

 Feeling tired or weak

 Dizziness

 Shortness of breath

 Rapid heartbeat

 Trouble concentrating

In the early stages of anemia, you may not have obvious symptoms. And many of the

symptoms are ones that you might have while pregnant even if you're not anemic. So be sure

to get routine blood tests to check for anemia at your prenatal appointments.

Diagnostic Tests

During your first prenatal appointment, you'll get a blood test so your doctor can check whether

you have anemia. Blood tests typically include:

 Hemoglobin test. It measures the amount of hemoglobin -- an iron-rich protein in red

blood cells that carries oxygen from the lungs to tissues in the body.

 Hematocrit test. It measures the percentage of red blood cells in a sample of blood.
If you have lower than normal levels of hemoglobin or hematocrit, you may have iron-

deficiency anemia. Your doctor may check other blood tests to determine if you have iron

deficiency or another cause for your anemia.

Even if you don't have anemia at the beginning of your pregnancy, your doctor will most likely

recommend that you get another blood test to check for anemia in your second or third

trimester.

Nursing Diagnosis

 Activity intolerance related to weakness, fatigue, and general malaise

 Imbalanced nutrition less than body requirements, related to inadequate blood volume

or hematocrit

 Noncompliance with prescribed therapy

Nursing Management

 Managing fatigue

 Focus on assisting the patient to prioritize activities

 Establish a balance between activity and rest

 Patients with chronic anemia need to maintain some physical activity and exercise to

prevent the deconditioning that result from inactivity

 Maintaining Adequate Nutrition

 Encourage a healthy diet.

 Avoid alcoholic beverages or to limit intake

 Alcohol interferes with the utilization of essential nutrients

 Provide individualized dietary teaching sessions

 Including cultural aspects related to food preferences and food preparations.

 Give dietary supplements as prescribed (vitamins, iron, folate, protein)

recommendations.

 Promoting Compliance with prescribed Therapy

 Medications or nutritional supplements.

 Explain the purpose of medication, how to take the medication and over what time

period

 Assist patients in developing ways to incorporate the therapeutic plan into their lives,

rather than giving them a list of instructions.

Medical Management

1. Administration of ferrous sulfate, 320mg 2-3x/day

2. Give iron w/ citrus drink or 500mg of ascorbic acid.

3. Parental therapy may be needed if the woman cannot take oral preparations.

4. Folic acid supplementation, 1 mg/day for folic acid deficiency.

Evaluation

 Tolerates activity at a safe and acceptable level

 Follows a progressive plan of rest, activity, and exercise

 Prioritizes activities

 Paces activities according to energy level

 Attains and maintains adequate nutrition

 Eats a healthy diet

 Develops meal plan that promotes optimal nutrition

 Maintains adequate amounts of iron, vitamins, and protein from diet or supplements

 Attains and maintains compliance on therapy

 Adheres to nutritional supplement therapy when prescribed

supplements

 Verbalizes understanding of rationale for avoiding non-recommended nutritional

supplements

VI. LEARNING ACTIVITIES

QUIZ BEE

1) What is the type of diagnostic test that measures the percentage of red blood cells in a

sample of blood?

a. Hemoglobin Test

b. Pregnancy Test

c. Pap-Smear

d. Hematocrit Test

ANSWER: D

2) Type of anemia that has an abnormal hemoglobin form.

a. Iron-deficiency Anemia

b. Folic Acid-deficiency Anemia

c. Thalassemia

d. Sickle-cell Disease

ANSWER: C

3) Type of anemia that has an irregular or abnormal shaped RBC

a. Sickle-cell Disease

b. Folic Acid-deficiency Anemia

c. Thalassemia

d. Iron-deficiency Anemia
ANSWER: A

4) All but one is a symptom of anemia in pregnancy.

a. Feeling tired or weak

b. Dizziness

c. In full concentration

d. SOB

ANSWER: C

5) How many mg of ferrous sulfate would you administer?

a. 1000mg

b. 320mg

c. 500mg

d. 450mg

ANSWER: B

VII. SUMMARY

You learned that:

1. Anemia is:

 Said to be a common health problem in pregnant women.

 As it is a serious medical condition, it can cause severe complications during pregnancy.

 is a condition that occurs when the hemoglobin level in your blood is too low.

 Is a reduced ability of the blood to carry oxygen to the cells.

2. There are 4 kinds of anemias of pregnancy, namely:

 Iron-Deficiency Anemia

 Folic Acid-Deficiency Anemia

 Sickle-Cell Disease
  Thalassemia

3. Risk Factors are:

• Are pregnant with multiples (more than one child)

• Have had two pregnancies close together

• Vomit a lot because of morning sickness

• Are a pregnant teenager

• Don't eat enough foods that are rich in iron

• Had anemia before you became pregnant

4. Signs and Symptoms

• Pale skin, lips, and nails

• Feeling tired or weak

• Dizziness

• Shortness of breath

• Rapid heartbeat

• Trouble concentrating

5. Diagnostic Tests

 Hemoglobin Test

 Hematocrit Test

6. Nursing Diagnoses

 Activity intolerance related to weakness, fatigue, and general malaise

 Imbalanced nutrition less than body requirements, related to inadequate blood

volume or hematocrit

 Noncompliance with prescribed therapy

VIII. MATERIALS/VISUAL
FOLIC ACID DEFICIENCY
IX. Self-Check Test and Evaluation

Now that you have completed this study session, you can assess how well you have achieved

its Learning Outcomes by answering the questions below. You can check your answers with the

Notes on the Self-Assessment Questions at the end of this Module.

1. Enlarged red blood cells.

a. Megaloblastic Anemia

b. Thalassemia

c. Sickle-Cell

d. Iron-Deficiency Anemia

2. The anemia that develops the answer in #1.

a. Thalassemia

b. Folic Acid-Deficiency Anemia

c. Sickle-Cell Disease

d. Iron-Deficiency Anemia

3. A test that measures the amount of hemoglobin.

a. Hematocrit Test

b. RBC Count

c. Hemoglobin Test

d. WBC Count

4. Type of anemia that is characteristically a microcytic and hypochromic.

a. Folic Acid-Deficiency Anemia

b. Thalassemia

c. Sickle-Cell Disease

d. Iron-Deficiency Anemia
 5. All but one is a medical management given in the module.

a. Administration of ferrous sulfate, 320mg 2-3x/day

b. Give iron w/ citrus drink or 500mg of ascorbic acid.

c. Parenteral therapy may be needed if the woman cannot take oral preparations.

d. Folic acid supplementation, 5 mg/day for folic acid deficiency.

X. REFERENCES

1. Pillitteri, A., & Silbert-Flagg, J. A. (2018). Maternal and Child Health Nursing (8th ed.,

Vol. 1). Philadelphia: Wolters Kluwer. P498-500

2. Pillitteri, A., & Silbert-Flagg, J. A. (2018). Maternal and Child Health Nursing (8th ed.,

Vol. 1). Philadelphia: Wolters Kluwer. P574

3. Johnson, T. C. (2018, June 2). Anemia in Pregnancy: Causes, Symptoms, and

Treatment. Retrieved from https://www.webmd.com/baby/guide/anemia-in-

pregnancy#1

4. Friel, L. A., By, Friel, L. A., & Last full review/revision Apr 2020| Content last modified

Apr 2020. (n.d.). Anemia in Pregnancy - Gynecology and Obstetrics. Retrieved from

https://www.msdmanuals.com/professional/gynecology-and-obstetrics/pregnancy-

complicated-by-disease/anemia-in-pregnancy

5. Stanford Children's Health. (n.d.). Retrieved from

https://www.stanfordchildrens.org/en/topic/default?id=anemia-in-pregnancy-90-P02428

Notes on the Self-Assessment Questions:

1. A 4. D

2. B 5. D

3. C