This document summarizes a case study on anemia in pregnancy conducted at Muembe Ladu Maternity Hospital. The patient, a 22-year-old pregnant woman, presented with headaches, dizziness, weakness, and fatigue. Her hemoglobin level was initially 8.0 g/dl. She was diagnosed with anemia in pregnancy and prescribed iron supplements. Nursing assessments identified risks of nutritional imbalances, ineffective breathing, activity intolerance, and infection due to low hemoglobin. The patient received counseling and showed gradual improvement in symptoms and hemoglobin levels with treatment. The case study notes recommendations to improve care, such as ensuring adequate treatment duration and monitoring, as well as increasing health education and physician support at rural clinics.

1. BSC-NURSING 3rd YEARS
INDIVIDUALASSIGMENT
MID WIFERY AND OBSTETRICAL NURSING - NUR 312
ANEMIA IN PREGNANCY A CASE OF MUEMBE LADU MATENITY
HOSPITAL AT RCH CLINIC
BY
Abdulla Khamis Ngwali
DATE – 5th APRIL 2016.
ZU/FHS/4674/13

2. Anemia in Pregnancy
Anemia is defined as a condition in which there
is less than the normal hemoglobin (Hb) level
in the body, which decreases oxygen carrying
capacity of red blood cells to tissues. World
Health Organization (WHO) definitions for
anemia differ by age, sex and pregnancy status
as follows: children 6 months to 5year anemia
is defined as a Hb level <11g/dl, children 5–11
years Hb < 11.5 g/dl, adult males Hb < 13 g/dl;
non pregnant women Hb <12g/dl and pregnant
women Hb < 11g/dl4.Anemia could be
classified as mild, moderate and severe

3. Anemia in pregnancy remains is the one of the
most intractable public health problems in
developing countries. Globally, anemia
contributes to 20% of all maternal deaths.
Although not always shown to have a causal
link, severe anemia contributes to maternal
morbidity and mortality. Anemia in
pregnancy may also lead to premature births,
low birth weight, fetal impairment and infant
deaths

4. Literature review
 Worldwide, anemia affects over two
billion people and the World Health
Organization (WHO) has estimated that
half of these are due to iron deficiency
[5, 6]. Iron deficiency is not only the most
prevalent but also the most neglected
nutrient deficiency in the world,
particularly among pregnant women and
children in developing countries [7].
Presently, over 40 million pregnant
women suffer from iron deficiency (ID)
and its consequences in developing
countries [8].

5. The status of patient
Demographic data
 Patient initial: H . S. O.
 Address: Kilima Hewa
 Age: 22yrs
 Occupation: House wife
 Sex: Female
 M/ Status: Married
 Date of attendance: 4/03/2016
Medical history
 Previous history: The patient was pregnant women
G2, Para 1, and was well until 1 week ago when she
started to experience headache of gradual onset off and
on, heart palpitation mild to moderate intensity no
aggravating factor, relieved with sleeping,

6. Continue..................
 associated with dizziness and poor vision
sometime, no history of fever. Also
complaining general body weakness for
3days now that make her unable to do her
normal activities associated with lower
limbs numbness. She has no allergic history
no history of blood transfusion.
 LMP - 2/7/015, EED 8/4/016, Amenorrhea
for 6 months, gestational age 20weeks+ 5
days

7. Medical history
Previous history:
Gravid 2, Para 1LMP - 2/7/015, EED 8/4/016,
Amenorrhea for 6 months, gestational age
20weeks+ 5 days.
1ST Visit -V/sign. BP -120/60 mmHg , FHR was 122
b/min, Hb level was 8.0 g/dl, Respiration 14b/m,
urine albumin =Nil, weight was 52 kg, VDRL = Non
reactive, PMTCT = 2 , Blood group B, RH+ve.

8. Continue.............
 2ND Visit, V/sign. BP -120/70 mmHg ,
FHR was 123b/min, Hb level was 8.9 g/dl
last measured, Respiration 14b/m, urine
albumin =Nil, weight was 54 kg, VDRL
= Non reactive, PMTCT = 2 , Blood
group B, RH+ve.

9.  Present history:
Gestational age 31 weeks + 4 days, pale ++,
fatigue, Dysnea, palpitation.
 Medical diagnosis : Anemia in pregnancy
 Current treatment: syrup ,
Haemovit 15mls t.d.s for 7/ then
Tab FeSO4 1tab o.d for two weeks,
tab mebendazole 500 mg start,
T.T 2nd dose,

10.  V/S taken was as follows: T: 36.2 C,
P:110 b/min, R: 19 b/min, BP: 120/70
mmHg, FHR 129 b/min.

11. Nursing Assessment , Diagnosis and Investigations.
 Mental states of the patient: was good in
term of language pt able to introduce her in
good and understandable manner with
coherent speech able to identify place, time
and date
 Orientation: able to be oriented with time,
stuff, relative and recognize the services
provided
 Attention; was totally concentrated with
services and able to answer any question
requested even by try.
 Level of consciousness: full consciousness

12. NURSING
DIAGNOSIS
GOALS INTERVATION
AND RATIONALE
EVALUATION
Imbalanced nutrition
less than body
requirements related
to inadequate food
intake to utilize
nutrients so as meet
metabolic needs as
evidence by :
Loose of appetite
Muscles weakness
After 2 to 3 weeks
patient nutritional
status will be
balanced
Encourage patient
to eats balance diet
especial high iron
diet and CHO2 to
maintain body
nutrition and
energy.
Encourage patient
to eat more and
more and drinking
including fruits,
water, juice to
increase appetite.
Within 5 days
patient appetite
was increased and
muscle weakness
also decreased.

13. Cont…….
Ineffective breathing
pattern t related to failure
of nutrients absorption
necessary for formation of
red blood cells
Patient’s
breathing pattern
will be effective
Encourage
patient to eats
high iron diet
and protein diet,
like green
vegetables, soup,
beans fruits etc.
Encourage to
use iron
supplements as
prescribed.
In order to
increase Hb
level and to
correct sign of
anemia
fortunately the
sign of anemia is
reduced slowly
so and the pt
become
improved
throughout the
management

14. Activity intolerance
related to imbalance
between oxygen
supply of her
body/fetus and
demand (delivery) as
evidence by fatigue
and inability to
maintain self care
activities regularly
and dyspnea.
Short term:
After 8 hours
of nursing
interventions the
patient will:
Report an increase
in activity
tolerance including
activities of daily
living.
Long term:
After months the
patient:
Is free from
weakness and risk
for complications
has been prevented
and will deliver
safetly
Assess patient’s
ability to perform
normal task or
activities of daily
living.
Note changes in
balance/ gait
disturbance,
muscle weakness.
Recommend bed
rest if indicated.
Provide assistance
with activities or
ambulation as
necessary,
allowing patient to
do as much as
possible
After 4 days
patient was
revealed an
increase in activity
tolerance,
demonstrating a
reduction in
physiological signs
of intolerance

15. Cont……
Risk for infection
related to
inadequate
secondary defenses
due to decrease in
hemoglobin level
leucopenia.
After a month
patient will be
prevented from
infection/
complications
Encourage patient
to eats balance diet
and iron
supplements to
correct anemia and
increase body
immunity
Body immunity is
increased and
anemia slowly
slowly corrected.

16. Knowledge deficit
regarding disease
process, treatment
and individual care
need related to
unfamiliarity with
information and
misinterpretation
as evidence by :
Inadequate follow
the instruction, eg.
balance diet
A patient will be
gain knowledge
Educate the patient
on how to prepare
food.
Teach on important
of balance diet/
iron supplement .
Patient gained
knowledge and
able to correct
misperceptions
about disease and
treatment

17. Critique of the care
 She was require pronged dose especially of
ferrous sulphate at list one month
 Patent require continuous monitoring for
her Hb during whole period of pregnancy
Un usual aspect of care
 They not instruct pt as this serious
condition and need close follow up
 Patient didn’t get enough health education
on disease condition.

18. Education and lesson learned
 There must be a limit for midwifery to treat
some obstetric related condition this is because
midwife are not deep in physiology so as to
alleviate un usually suffering.
 Muembe ladu RCH must emphasize
availability of doctor such as mnazi mmoja so
as midwife and doctor make consultation on
some disease condition of the patient.
 Also midwife should provide health education
on diet and different disease in any single visit
of the pregnant mother so as to save the life and
provision of good viable health

19. Recommendation for change of the current care plan
According to the millennium goal number four (4)
which is to reduce child mortality and goal
number five (5) which is to improve maternal
health, the following are my recommendation
pertaining my case study in muembe ladu
maternity hospital.
 All nurse prescriber/midwife must follow the
standard guideline on treating different illness and
disease condition
 Government should provide doctors to every rch
so as nurse midwife could work together with

20. Pregnant women should follow the advice
given to the hospital and consult their
husband or family on its implementation
University and faculty should provide
enough time for clinical rotation if possible
practice time and case study must be
separately to ensure factual information of
case study
Students must commit them self when
performing case on behalf of the patient not
to consider the remarks of their work and left
patient with problems

21. Thank you for listening