| Course | NUR-7070 Primary Care Diagnosis, Management and Health Promotion |
|---|---|
| Module | Module 3 |
| Paper type | Diagnostic reasoning case |
| Length | About 1,071 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7070 Module 3
A Ferritin of 6 and a Cup of Ice: Choosing the Tests, Reading the Results and Deciding How Far to Look in a 38-Year-Old With Iron Deficiency Anemia
Student Name
M.S. in Nursing, Family Nurse Practitioner, Thomas Edison State University
NUR-7070: Primary Care Diagnosis, Management and Health Promotion
Mentor Name
Month Day, Year
A Ferritin of 6 and a Cup of Ice: Choosing the Tests, Reading the Results and Deciding How Far to Look in a 38-Year-Old With Iron Deficiency Anemia
Introduction
Ms. N. is an invented patient, a 38-year-old dental hygienist in Hoboken who mentions at a routine visit that she has been tired for months and gets winded on the two flights to her office. When asked about food cravings, she laughs and says she keeps a cup of ice at her station and chews it all day. For two years her first two days of bleeding have meant changing a pad roughly every two hours. She has no black stools, abdominal pain, weight loss or change in bowel habit. She eats meat twice a week. Her mother had colon cancer at 61. Her pallor and pale conjunctivae suggest anemia, and this paper explains how the diagnosis is confirmed, how far to look for a cause and how to treat it.
The First Tests
A complete blood count is the starting point, and it returns a hemoglobin of 9.8 grams per deciliter, a mean corpuscular volume of 74 femtoliters and a red cell distribution width of 17.8 percent. The anemia is microcytic, and the wide distribution suggests a mix of older normal cells and newer small ones. The main causes of microcytic anemia are iron deficiency, thalassemia trait and, less often, anemia of inflammation or sideroblastic anemia. The next test needs to separate these.
Ferritin earns the next slot because, in a person without inflammation, its level tracks how much iron is held in reserve. Camaschella (2015) explains that a low ferritin is specific for iron deficiency, while a normal or high ferritin does not exclude it in a patient with inflammation, because ferritin rises as an acute phase protein. Ms. N. has no inflammatory illness, and her ferritin is 6 nanograms per milliliter. The 2020 American Gastroenterological Association guideline uses a ferritin cutoff of 45 nanograms per milliliter to define iron deficiency in anemic patients, a level chosen to catch more cases than the traditional laboratory lower limit (Ko et al., 2020). Her value is far below either threshold.
Ruling Out Thalassemia Trait
Thalassemia trait can produce a similar blood count, and people of Mediterranean, Middle Eastern, South Asian, Southeast Asian or African ancestry are more likely to carry it. The Mentzer index offers a fast first sort: divide her MCV by her red cell count. A value above 13 favors iron deficiency, and a value below 13 favors thalassemia trait. Ms. N.'s red cell count of 3.9 million per microliter gives an index of about 19, and together with her very low ferritin, iron deficiency is clear. If her ferritin had been normal, hemoglobin electrophoresis would have been the next step.
The peripheral smear and reticulocyte count add a little more. Her smear shows small, pale cells of varying size with some pencil-shaped forms, a picture typical of iron deficiency, and her reticulocyte count is inappropriately low for the degree of anemia, which says that her marrow cannot keep up because it lacks raw material rather than because cells are being destroyed. Hemolysis would raise the reticulocyte count instead, so these two cheap tests narrow the problem further without adding cost.
| Test | Result | What it tells us |
|---|---|---|
| Hemoglobin | 9.8 g/dL | Moderate anemia |
| MCV | 74 fL | Microcytic |
| RDW | 17.8 percent | Mixed cell sizes, typical of iron deficiency |
| Ferritin | 6 ng/mL | Depleted iron stores |
| Mentzer index | About 19 | Favors iron deficiency over thalassemia trait |
How Far to Look for a Cause
Iron deficiency in an adult always needs an explanation. Ms. N.'s heavy menstrual bleeding is a likely cause, and her low dietary iron adds to it. The question is whether to look for blood loss or malabsorption in the gut as well. The AGA guideline recommends testing for celiac disease in adults with iron deficiency anemia, since celiac disease impairs iron absorption in the duodenum and may cause no gut symptoms (Ko et al., 2020). A tissue transglutaminase IgA antibody, with a total IgA level, is ordered.
For endoscopy, the guideline makes a conditional suggestion, based on low-certainty evidence, in favor of upper and lower endoscopy even in asymptomatic premenopausal women, recognizing that the yield is lower than in men and older women (Ko et al., 2020). Ms. N. has an additional reason to consider it: her mother's colon cancer at 61 means her own colorectal screening should begin at 40 rather than 45, so a colonoscopy is due within two years in any case. The decision is made together. She chooses to begin iron and see a gynecologist about her bleeding first, with gastroenterology referral if her anemia does not correct or recurs, or when she turns 40, whichever comes first. The reasoning is documented.
Treatment
Oral iron is first-line. Pasricha et al. (2021) review evidence that a single dose of oral iron raises hepcidin for about a day, reducing absorption of the next dose, so taking iron on alternate days can improve the fraction absorbed and reduce stomach upset. The order is ferrous sulfate 325 milligrams, containing 65 milligrams of elemental iron, by mouth every other day, taken in the morning on an empty stomach or with orange juice, and not with coffee, tea or calcium. She is told her stools will darken. If she cannot tolerate oral iron, does not respond or continues to lose more blood than she absorbs, intravenous iron is an option.
Follow-Up
A blood count at four weeks should show her hemoglobin up by one to two points if the iron is being absorbed. Reaching a normal hemoglobin is not the finish line; she continues the alternate-day tablets until her ferritin passes 50, which usually takes about three more months. Her celiac result is reviewed by phone. Her gynecology referral addresses the heavy bleeding, which may be from fibroids or other causes, and treatment there is what prevents the anemia from returning. Her ice chewing should fade as iron is replaced, which she can watch as a sign of progress.
Conclusion
A blood count, a ferritin and a Mentzer index established iron deficiency anemia in Ms. N. and excluded thalassemia trait. Celiac testing was ordered and the question of endoscopy was handled as a shared decision informed by the guideline and her family history. Alternate-day iron, a gynecology referral and a follow-up schedule complete a plan that treats both the anemia and its cause.
References
Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19), 1832-1843. https://doi.org/10.1056/NEJMra1401038
Ko, C. W., Siddique, S. M., Patel, A., Harris, A., Sultan, S., Altayar, O., & Falck-Ytter, Y. (2020). AGA clinical practice guidelines on the gastrointestinal evaluation of iron deficiency anemia. Gastroenterology, 159(3), 1085-1094. https://doi.org/10.1053/j.gastro.2020.06.046
Pasricha, S.-R., Tye-Din, J., Muckenthaler, M. U., & Swinkels, D. W. (2021). Iron deficiency. The Lancet, 397(10270), 233-248. https://doi.org/10.1016/S0140-6736(20)32594-0
Reading the NUR 7070 Module 3 assignment instructions
Using diagnostic tools to reach and confirm a diagnosis is part of the NUR-7070 catalog description, and since TESU posts no syllabus for the course, this third module centers on a case built around laboratory reasoning. Expect an assignment in which you choose tests in a logical order, interpret each result with its limits, decide on further evaluation and justify the plan with a guideline. Some classrooms supply the lab values; others expect you to decide which to request. Read the directions for the case and format. State reference ranges or thresholds and their sources, and explain how each result changed your thinking, not just what it was. If the case gives you a family history, decide whether it changes the workup, as a parent's cancer does here.
How this NUR 7070 Module 3 example is built
The case starts with a dental hygienist who chews ice, tires easily and has heavy periods. The first section reads her blood count and explains why ferritin is the next test and how inflammation limits it, using the AGA threshold. A Mentzer index calculation rules out thalassemia trait, and a five-row table summarizes the results. The section on causes covers celiac testing and reports the AGA endoscopy suggestion with its strength, then reaches a shared decision informed by her mother's colon cancer. Treatment explains alternate-day iron from hepcidin research, and follow-up sets a recheck, a ferritin target and a gynecology referral that addresses the source of her loss.
Reading the NUR 7070 Module 3 grading rubric
Diagnostic reasoning papers are graded on choosing appropriate tests in a logical order, interpreting them correctly with their limitations and deciding on further evaluation based on evidence. Mentors look for thresholds stated with their sources, calculations shown and alternative diagnoses excluded with specific results. Reporting a guideline recommendation with its strength and certainty shows careful reading. The plan should treat the condition and its cause, with doses, monitoring and a target. Shared decision making, when the evidence is uncertain, adds credit. Sources from the last few years, cited in APA, settle the remaining marks. A table helps when it shows what each result means rather than repeating numbers alone, and a short note on cost, ordering the cheap, informative tests first, is often credited in primary care courses.
NUR 7070 Module 3 help: mistakes that cost marks
Students often order a long list of tests at once, which makes the reasoning hard to follow. Order tests in sequence and say what each one adds. Another frequent error is treating a normal ferritin as ruling out iron deficiency without considering inflammation. Explain thresholds and their limits. Many papers stop at the diagnosis and forget the cause; in iron deficiency the cause matters as much as the anemia. When a guideline recommendation is conditional, say so and explain how you used it. Give the iron dose in elemental iron as well as the tablet strength. Use the same method for any lab-based NUR-7070 case, and the desk can write the first draft free from your directions.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 7070 and M.S. in Nursing, Family Nurse Practitioner sample papers
- NUR 7070 Module 1: Health Promotion Plan: Screening and a Statin for a Former Trucker
- NUR 7070 Module 2: Differential Diagnosis Paper: Positional Vertigo in a Church Organist
- NUR 7070 Module 4: Management Plan: Knee Osteoarthritis in a School Bus Driver
- NUR 7070 Module 5: Pediatric Primary Care Paper: Acute Otitis Media in an 18-Month-Old
- NUR 7070 Module 6: Procedures Paper: A Changing Mole, Dermoscopy and Excisional Biopsy
- NUR 7072 Module 5: Hypothyroidism Case Paper: Diagnosing Overt Disease and Starting Levothyroxine
- NUR 7071 Module 5: Type 2 Diabetes Case Paper: Adding Agents With Heart and Kidney Benefit After Metformin
- NUR 7074 Module 3: Contraception Paper: Medical Eligibility, LARC Counseling and Respecting Choice for a Teen
NUR 7070 Module 3 questions, answered
Where can I find a free NUR 7070 Module 3 sample paper?
Right on this page. It works up iron deficiency anemia in a 38-year-old woman, from ferritin and the Mentzer index to celiac testing, endoscopy and alternate-day iron.
What ferritin level indicates iron deficiency?
The 2020 AGA guideline uses a ferritin below 45 ng/mL in an anemic patient. Very low values, such as 6, are specific, but inflammation can raise ferritin and hide deficiency.
How does the Mentzer index help?
Dividing the MCV by the red cell count gives a value that favors iron deficiency above 13 and thalassemia trait below 13, guiding whether electrophoresis is needed.
Why test for celiac disease in iron deficiency anemia?
Celiac disease reduces iron absorption in the duodenum and can cause no gut symptoms, so the AGA recommends testing adults with iron deficiency anemia.
Why take oral iron every other day?
Each tablet prompts the liver to release hepcidin for roughly 24 hours, and while hepcidin is high the gut lets less of the following tablet through. Alternate-day dosing can improve absorption and reduce stomach upset.