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nursing symposium...

nursing symposium
may 10,2010

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  • 1. Presented by: Nadia Rouchdy Bsc Charge Nurse OutPatient Clinics SFHP
  • 2.
    • WHO recommendation:
      • Hemoglobin should not fall below 11 gm/dL
    • CDC – 10.5 gm/dL (North America)
    Definition
  • 3. Objectives
    • To find the associated factors in our pregnant anaemic patients, in relation to
    • AGE
    • PARITY
    • DIET
    • COMPLIANCE with medication (Iron)
    • in order to provide relevant patient education.
  • 4. PHYSIOLOGY
    • THERE IS AN INCREASE IN PLASMA VOLUME – by 28 weeks it has increased by 50%.
    • THERE IS AN INCREASE IN BONE MARROW RED CELL PRODUCTION – but not enough to compensate for the huge plasma volume increase.
  • 5. FACTORS WHICH ARE KNOWN TO LEAD TO IRON DEFICIENCY ANAEMIA IN PREGNANCY
    • Increasing age
    • Increasing parity
    • Pregnancy interval of < 2 years (at least 2
    • years is needed to rebuild Iron Stores)
  • 6.
    • A diet low in meat/poultry
    • Taking Iron absorption - reducers (calcium/ caffeine) within 1 hour of meals or Iron tablets.
    • Caffeine reduces Iron absorption by 40-60%
    • Calcium reduces Iron absorption by 30-40%
    • Non-compliance with Iron Rx
  • 7. ANAEMIC MOTHERS HAVE A HIGH RISK OF:
    • Morbidity from OB hemorrhage
    • Transfusion risk
    • Post-partum infection
    • Thromboembolism
  • 8. THEIR BABIES HAVE A HIGH RISK OF :
    • Pre-term birth
    • Low birth weight
    • Low intelligence and behavioral problems
  • 9. MATERIALS/ METHODS
    • Type Prospective
    • Population – pregnant patients following in SFHP ante-natal clinics with a HB ≤ 10 gm/dl. (MO1 dependents)
    • Sickle Cell Anaemia /Thalassaemia patients excluded.
  • 10.
    • Sample – 180
    • Randomly selected and interviewed by the attending Physician who completed the questionnaire, between Nov.2009 and March 2010
    • Statistical analysis – SPSS – version. 17
  • 11. RESULTS
  • 12. 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 Age 1.70% 15% 22% 23% 25% 13.90%
  • 13. 0 - 1 2 - 4 5 - 8 9 + 0-1 2 - 4 5 - 8 9 + Parity 28.30% 31.10% 38.30% 2.20%
  • 14. Primagravida 1 - 2 Years 3 - 4 Years 5 + Years Pregnacy 14% 31.50% 34.30% 20.20%
  • 15. None Primary Middle Secondary University or More Educ Level 3.90% 18.30% 12.80% 30% 35%
  • 16. Late 2nd Trimester & Above # of Weeks 62.78% 37.22% Pregnant on First Visit
  • 17. Weekly 5.56% 94.44%
  • 18. Daily 68.33% 31.67%
  • 19. Weekly 21.67% 78.33%
  • 20. Yes NO 65.36% 34.64%
  • 21. 2nd Trimester 90% 10%
  • 22. Iron Rx 38.20% 39.30% 18% 4.50% Compliance Always Sometimes Occassionally As Rx Miss 1/Day Take Never Take
  • 23. Nausea/Vomiting Constipation & 20.4% 2.7% 39.8% 1.8% 0.9% 4% 0.9% 3.5% 25.7%
  • 24. Conclusions
    • Factors that DID NOT contribute to developing Anaemia are:
    • Parity
    • Education Level
    • Pregnancy Interval
    • Consumption of Animal Protein
    • Gestational stage at first visit
    • Timing of Starting Iron Therapy
  • 25. Factors that DID Contribute to Developing Anaemia Are:
    • Age
    • Diet (Not Consuming Liver & Green Vegetables)
    • Iron Absorption-Reducers (takingTea/Coffee/Dairy Products and Calcium Supplement with meals & Iron)
    • Iron Compliance
  • 26. WHAT WE FOUND OF STATISTICAL SIGNIFICANCE WAS:
    • Women with a higher education level had a lower parity (p-value <0.001)
    • Older women tended to eat more meat/ chicken (p-value = 0.018)
    • Contrary to our belief the majority of our patients came early for care and were started early on IRON Treatment (p-value=0.027)
    • Younger women (< 30 yrs) were more likely to forget to take their IRON Tablet (p-value =0.048)
  • 27. RECOMMENDATIONS
    • Educate pregnant patients regardless of age, parity, education level or gestational age regarding:
    • The dangers of anaemia in pregnancy
    • Diet - Eating a source of animal protein at least every other day
    • - Eating liver and molokia weekly
    • Avoidance of IRON Absorption -Reducers
    • - Not drinking tea/coffee/dairy products within 1 hour of meals
    • - Not taking the CALCIUM supplement together with IRON Tablet .
  • 28.
    • Taking Iron as Prescribed:
    • - Having a routine to help in remembering to take their IRON Tablet
    • - Avoiding constipation by increasing roughage containing foods & increasing fluid intake
    • - Avoiding nausea and stomach upset by taking IRON during their meals
    • Include information regarding Anaemia in Pregnancy in High School.
    • Physician should show the patient their hemoglobin result in order to increase their compliance with their Iron Rx.
  • 29.