Table of Contents

Ava Pilar iHuman Case Study

Ava Pilar is a 50-year-old female presenting to the emergency department with a chief complaint of fatigue and shortness of breath that has been progressively worsening over several months. She reports feeling “unusually tired recently and a bit short of breath” and experienced severe lightheadedness while working in her yard, describing that she “felt like I was about to pass out.” Her history reveals heavy menstrual bleeding with extended duration (7-8 days) and increased flow over the past 10 months, requiring frequent changes of both tampons and pads. She adopted a vegan diet approximately 2 years ago and reports occasional ibuprofen use for headaches.

In this comprehensive guide, we’ll walk you through how to approach her case, from initial hematologic assessment through systematic physical examination to the final nursing diagnoses of activity intolerance related to decreased oxygen-carrying capacity and risk for decreased cardiac output related to anemia. You’ll learn the key clinical reasoning steps for iron deficiency anemia care, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this essential hematologic nursing simulation involving iron deficiency anemia management and menorrhagia assessment.

Ava Pilar iHuman Case Overview (Doorway Information)

Patient Overview: Ava Pilar, a fictional patient, presents as a 50-year-old female with a several-month history of progressive fatigue, shortness of breath, and lightheadedness brought to the emergency department after experiencing near-syncope while performing yard work. She demonstrates classic signs of iron deficiency anemia with heavy menstrual bleeding as the likely underlying cause. Ava requires immediate hematologic assessment and stabilization due to her symptomatic anemia and potential cardiovascular compromise.

Key Background Information:

Age/Gender: 50-year-old female
Height/Weight: 5’6″ (168 cm), 153 lbs (69.5 kg)
Primary Condition: Iron deficiency anemia secondary to menorrhagia
Chief Concern: Fatigue, shortness of breath, and lightheadedness
Presenting Situation: Emergency department admission for near-syncope episode
Associated Conditions: Heavy menstrual bleeding lasting 7-8 days, dietary iron deficiency (vegan diet)
Significant History: Vegan diet for 2 years, increasingly heavy periods over 10 months
Current Status: Alert and oriented x4, stable vital signs, showing signs of pallor
Risk Factors: Premenopausal female, heavy menstrual bleeding, restrictive diet, middle-aged
Physical Findings: Pallor, fatigue, shortness of breath on exertion

The patient appears fatigued but hemodynamically stable, requiring comprehensive hematologic assessment and gynecologic evaluation. Her presentation with typical symptoms of iron deficiency anemia including fatigue, dyspnea, and pallor suggests need for immediate intervention with focus on iron replacement therapy, menstrual bleeding management, and cardiovascular monitoring.

Ava Pilar (50 y/o female) – Adult Hematologic Assessment

CC: Fatigue, shortness of breath, and lightheadedness
MSAP: Iron Deficiency Anemia Secondary to Menorrhagia – requiring immediate hematologic stabilization and bleeding assessment
Associated symptoms: “Unusually tired recently,” near-syncope episode, exertional dyspnea
History: Heavy menstrual bleeding for 10 months, vegan diet for 2 years, occasional headaches
High-risk factors: Middle-aged female with menorrhagia, dietary iron deficiency, progressive symptom severity

History Questions

How are you feeling right now, Ms. Pilar?
Can you tell me what brought you here today?
You mentioned feeling unusually tired – when did this start?
Can you describe your shortness of breath for me?
Tell me about the episode in your yard today – what exactly happened?
How long have you been experiencing fatigue?
Do you feel short of breath with normal activities or just with exertion?
Have you noticed any changes in your energy level over the past few months?
Can you tell me about your menstrual periods?
How long do your periods typically last?
How many tampons or pads do you use daily during your period?
Have you noticed any changes in your menstrual flow recently?
When was your last menstrual period?
Can you describe your diet – what do you typically eat?
How long have you been following a vegan diet?
Do you take any iron supplements or vitamins?
Have you been taking any medications recently?
Do you have any history of anemia or blood disorders?
Have you noticed any unusual bruising or bleeding?
How has your sleep been lately?
Do you feel dizzy when you stand up quickly?
Have you had any chest pain or heart palpitations?
Have you lost any weight recently without trying?
Do you have any family history of anemia or bleeding disorders?
What activities have become more difficult for you lately?

Physical Exam

Vitals: Temperature 98.6°F, Heart Rate 78 bpm, Blood Pressure 118/72 mmHg, Oxygen Saturation 98% – within normal limits but heart rate may be slightly elevated due to compensatory mechanisms

General appearance: Alert 50-year-old female appearing her stated age, oriented to person, place, time, and situation (A&O x4), showing mild pallor, appears fatigued but cooperative

Hematologic Assessment:

Skin and Mucous Membranes: Noticeable pallor of conjunctiva, nail beds, and oral mucosa suggesting decreased hemoglobin
Integumentary: Cool extremities, delayed capillary refill, brittle nails consistent with iron deficiency
Energy Level: Reports significant fatigue with minimal exertion, describes feeling “wiped out”
Exercise Tolerance: Dyspnea on exertion, inability to perform usual yard work without symptoms

Cardiovascular Assessment:

Regular rate and rhythm, possible compensatory tachycardia during activity
May have systolic flow murmur due to decreased blood viscosity
Peripheral pulses palpable but may be weak
Assessment for signs of high-output heart failure

Respiratory Assessment:

Clear lung sounds bilaterally
Shortness of breath on exertion related to decreased oxygen-carrying capacity
Normal respiratory effort at rest

Gynecologic Assessment:

Reports heavy menstrual bleeding with duration of 7-8 days
Uses both tampons and pads simultaneously during heavy flow days
Changes tampon every 2-4 hours during first 2-3 days
Flow heavier than previous years

Neurological Assessment:

Alert and oriented to person, place, time, and situation (A&O x4)
Reports lightheadedness, especially with position changes
No focal neurological deficits observed
Assessment for orthostatic changes

Assessment Note

A.P. is a 50-year-old female with a several-month history of progressive fatigue, shortness of breath, and lightheadedness, presenting after a near-syncope episode during physical activity. Physical examination notable for pallor of skin and mucous membranes, stable vital signs, and reports of heavy menstrual bleeding lasting 7-8 days with increased flow over 10 months. Her presentation with classic symptoms of iron deficiency anemia, combined with significant menorrhagia and dietary iron restriction, indicates need for immediate hematologic evaluation and iron replacement therapy.

Diagnostic Testing: Complete blood count with red cell indices, comprehensive metabolic panel, iron studies (serum iron, TIBC, ferritin), vitamin B12 and folate levels, thyroid function tests, pregnancy test, consideration for coagulation studies

Primary Nursing Diagnoses:

Activity Intolerance Related to Decreased Oxygen-Carrying Capacity Secondary to Iron Deficiency Anemia
Risk for Decreased Cardiac Output Related to Compensatory Mechanisms Secondary to Anemia
Deficient Knowledge Related to Iron-Rich Nutrition and Menstrual Health Management

Plan:

Initiate iron replacement therapy with monitoring for therapeutic response and side effects
Implement activity modification and energy conservation strategies
Gynecologic evaluation for menorrhagia management and ruling out structural causes
Nutritional counseling for iron-rich vegan diet planning
Patient education on iron deficiency anemia and symptom management

Ava Pilar SOAP Note

Patient: Ava Pilar

Subjective Data

CC: Fatigue, shortness of breath, and lightheadedness

HPI: 50-year-old female with a several-month history of progressive fatigue and shortness of breath who presents with an acute episode of near-syncope while performing yard work. Patient reports feeling “unusually tired recently and a bit short of breath” and describes thinking she “was about to pass out” during physical activity. Reports heavy menstrual bleeding with 7-8 day duration, using both tampons and pads simultaneously for first 2-3 days, changing tampon every 2-4 hours. Flow has been heavier than normal for approximately 10 months. Patient adopted vegan diet 2 years ago and denies iron supplementation.

Medications: Occasional ibuprofen for headaches, no regular prescription medications

Allergies: NKDA (No Known Drug Allergies)

PMH: No significant past medical history, no previous anemia diagnosis, appendectomy (surgical scar noted)

Social History: Vegan diet for 2 years for weight control, occasional alcohol use (one glass of wine daily with dinner), denies tobacco or illicit drug use. Lives independently, works outside the home.

Review of Systems: Reports progressive fatigue over several months, exertional dyspnea, lightheadedness especially with position changes, heavy menstrual bleeding lasting 7-8 days, occasional headaches managed with ibuprofen, denies chest pain, palpitations, or syncope prior to today’s episode. Loose stools occasionally over the past year.

Objective Data

General: Alert, oriented 50-year-old female in no acute distress, demonstrating mild pallor, appears fatigued but cooperative

Vital Signs: Temperature 98.6°F, Heart Rate 78 bpm, Blood Pressure 118/72 mmHg, Oxygen Saturation 98% on room air

Physical Examination:

Appearance: Pallor noted in conjunctiva, nail beds, and oral mucosa, appears tired but alert and oriented x4
Cardiovascular: Regular rate and rhythm, no murmurs appreciated at rest, assessment for tachycardia with activity
Respiratory: Clear lung sounds bilaterally, no respiratory distress at rest, reports dyspnea with exertion
Integumentary: Pallor noted, no moles, masses, rashes, erythema, or ecchymosis
Abdomen: Nondistended, scar consistent with appendectomy, bowel sounds normoactive in all four quadrants
Extremities: Cool extremities, delayed capillary refill, no edema

Assessment

Primary Nursing Diagnoses:

Activity Intolerance Related to Decreased Oxygen-Carrying Capacity Secondary to Iron Deficiency Anemia (Priority)
Risk for Decreased Cardiac Output Related to Compensatory Tachycardia Secondary to Anemia
Deficient Knowledge Related to Nutritional Management of Iron Deficiency and Menstrual Health

Secondary Concerns:

Heavy menstrual bleeding requiring gynecologic evaluation
Dietary iron deficiency from vegan diet without supplementation
Need for cardiovascular monitoring due to compensatory mechanisms
Potential for activity-related injury due to lightheadedness and fatigue

Differential Considerations

Activity Intolerance: Most appropriate priority diagnosis given the patient’s progressive fatigue, exertional dyspnea, and near-syncope episode that directly correlates with decreased oxygen-carrying capacity from iron deficiency anemia.

Risk for Decreased Cardiac Output: Highly relevant given the cardiovascular compensatory mechanisms in anemia and potential for high-output heart failure if anemia becomes severe.

Deficient Knowledge: Important consideration given the patient’s dietary choices contributing to iron deficiency and lack of awareness regarding iron supplementation needs.

Ineffective Tissue Perfusion: Potential concern related to decreased hemoglobin and oxygen-carrying capacity affecting cellular oxygenation.

Primary Focus: Hematologic stabilization with emphasis on iron replacement, activity modification, and menstrual bleeding management.

Plan

Health Promotion:

✓ Hematologic Education – Comprehensive instruction on iron deficiency anemia, dietary iron sources for vegans, and symptom recognition

✓ Nutritional Counseling – Iron-rich food education with focus on plant-based sources and absorption enhancers

✓ Activity Modification – Energy conservation techniques and gradual activity progression

✓ Menstrual Health – Education on normal vs. abnormal bleeding patterns and when to seek care

Monitoring:

✓ Hematologic Status – Regular monitoring of hemoglobin, hematocrit, and iron studies to assess treatment response

✓ Cardiovascular Function – Assessment for signs of cardiac compensation or decompensation

✓ Activity Tolerance – Monitoring of exercise capacity and symptom progression

✓ Vital Signs – Continued monitoring for orthostatic changes and tachycardia

Interventions:

✓ Iron Replacement Therapy – Initiate oral iron supplementation with vitamin C to enhance absorption

✓ Activity Restriction – Modify activities to prevent exertional symptoms and injury risk

✓ Nutritional Support – Counseling on iron-rich plant foods, absorption enhancers, and inhibitors

✓ Safety Measures – Fall precautions due to lightheadedness, gradual position changes

Long-term Management:

✓ Gynecologic Referral – Evaluation and management of heavy menstrual bleeding

✓ Hematologic Follow-up – Regular monitoring of iron studies and hemoglobin levels

✓ Nutritional Planning – Long-term dietary counseling for sustainable iron intake

✓ Lifestyle Modifications – Education on factors affecting iron absorption and optimal dietary practices

Complete Step-by-Step Guide to Writing the Ava Pilar iHuman Case Study

Completing the Ava Pilar iHuman case requires a systematic approach focused on hematologic nursing care and iron deficiency anemia management. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, review the doorway information and formulate your initial clinical approach.

Key Information to Note:

50-year-old female with progressive fatigue and dyspnea
Near-syncope episode during physical activity
History of heavy menstrual bleeding lasting 7-8 days
Vegan diet for 2 years without iron supplementation

Initial Clinical Mindset: Approach this case focusing on hematologic nursing care with emphasis on iron deficiency anemia assessment. The priority concerns include immediate cardiovascular monitoring, activity tolerance evaluation, and identification of underlying bleeding sources.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for understanding the patient’s current hematologic state and identifying contributing factors to her iron deficiency.

Key Areas to Assess:

Symptom Progression: Timeline of fatigue, dyspnea, and exercise intolerance development
Menstrual History: Detailed bleeding patterns, flow changes, and duration
Dietary Assessment: Iron intake evaluation and dietary restrictions
Cardiovascular Symptoms: Palpitations, chest pain, orthostatic symptoms

Critical Questions:

Assessment of exercise tolerance and activity limitations
Evaluation of menstrual bleeding patterns and severity
Determination of dietary iron sources and supplementation history
Assessment of cardiovascular compensation and symptoms

Step 3: Review of Systems (ROS)

Conduct a focused ROS paying attention to iron deficiency complications and related symptoms:

Hematologic:

Fatigue, weakness, pallor, cold intolerance
Easy bruising, unusual bleeding, petechiae
Pica (ice craving) or unusual food cravings

Cardiovascular:

Palpitations, chest pain, exercise intolerance
Orthostatic symptoms, syncope or near-syncope episodes
Peripheral edema or signs of heart failure

Gynecologic:

Menstrual flow characteristics, duration, and patterns
Intermenstrual bleeding, postcoital bleeding
Pelvic pain or pressure symptoms

Step 4: Nutritional and Lifestyle Assessment

Dietary History:

Detailed assessment of iron-rich food consumption
Evaluation of foods that enhance or inhibit iron absorption
Supplementation history and adherence

Functional Assessment:

Current ability to perform activities of daily living
Exercise capacity and limitations
Work and social activity impact

Step 5: Physical Examination Strategy

Perform a comprehensive hematologic assessment with focused cardiovascular evaluation:

Hematologic Examination:

Assessment of pallor in conjunctiva, nail beds, oral mucosa
Evaluation of skin temperature, capillary refill, and brittle nails
Assessment for splenomegaly or lymphadenopathy

Cardiovascular Assessment:

Heart rate, rhythm, presence of flow murmurs
Blood pressure assessment including orthostatic vital signs
Peripheral pulse evaluation and perfusion assessment

Gynecologic Assessment:

Abdominal examination for masses or tenderness
Assessment for signs of acute bleeding or hemodynamic compromise

Step 6: Developing Nursing Diagnoses

Propose appropriate nursing diagnoses with rationales:

Priority Diagnoses:

Activity Intolerance Related to Decreased Oxygen-Carrying Capacity
Risk for Decreased Cardiac Output Related to Compensatory Mechanisms
Deficient Knowledge Related to Iron-Rich Nutrition and Menstrual Health

Supporting Evidence:

Progressive fatigue and exertional dyspnea
Near-syncope episode during physical activity
Clinical signs of anemia including pallor
History of heavy menstrual bleeding
Dietary iron deficiency from vegan diet

Step 7: Hematologic Intervention and Management Plan

Acute Hematologic Management:

Iron replacement therapy initiation with monitoring for response
Activity modification and energy conservation education
Cardiovascular monitoring for signs of decompensation

Nutritional Interventions:

Iron-rich plant food education and meal planning
Vitamin C supplementation to enhance iron absorption
Avoidance of foods that inhibit iron absorption

Step 8: Discharge Planning and Follow-up Care

Hematologic Continuity of Care:

Regular monitoring of hemoglobin and iron studies
Coordination with hematology and gynecology for ongoing management
Long-term iron supplementation and dietary counseling

Patient and Family Education:

Recognition of anemia symptoms and when to seek care
Iron supplementation adherence and side effect management
Menstrual bleeding monitoring and tracking

Step 9: Interdisciplinary Collaboration

Team Coordination:

Collaboration with gynecologist for menorrhagia evaluation and management
Nutritionist consultation for specialized vegan diet planning with iron optimization
Hematology referral if anemia is severe or non-responsive to treatment

Step 10: Documentation and Submission Tips

Writing Your Summary:

Focus on systematic hematologic assessment and clinical reasoning for iron deficiency anemia nursing diagnoses
Include cardiovascular assessment rationale and activity limitation strategies
Demonstrate understanding of nutritional counseling and dietary modification interventions
Use professional hematologic nursing terminology and evidence-based practice principles

Key Documentation Elements:

Comprehensive symptom assessment and exercise tolerance evaluation
Menstrual history documentation and bleeding assessment
Nutritional assessment and iron deficiency risk factors
Discharge planning with community resource coordination

Final Submission Checklist:

✓ Complete hematologic assessment with iron deficiency evaluation
✓ Appropriate nursing diagnoses with clear rationales related to anemia
✓ Evidence-based interventions for iron replacement and activity modification
✓ Comprehensive discharge planning with follow-up coordination
✓ Professional documentation using hematologic nursing terminology

Ava Pilar iHuman Case Summary Grading Criteria

The Ava Pilar iHuman case will evaluate you across several critical domains to ensure comprehensive hematologic nursing care skills. Here’s what you need to focus on to maximize your score:

(1) Hematologic Assessment Skills (Major Points):

You must demonstrate thorough assessment of iron deficiency anemia including symptom evaluation, exercise tolerance testing, and physical signs of anemia. Essential components include: systematic evaluation of pallor, fatigue, and cardiovascular compensation, comprehensive menstrual history and bleeding assessment, nutritional assessment for iron deficiency risk factors, and cardiovascular monitoring. The rubric specifically rewards students who conduct comprehensive hematologic evaluations using evidence-based assessment techniques.

(2) Nursing Diagnosis (High Weight):

Focus on appropriate nursing diagnoses for patients with iron deficiency anemia. Must-include diagnoses: Activity Intolerance Related to Decreased Oxygen-Carrying Capacity, Risk for Decreased Cardiac Output Related to Compensatory Mechanisms, Deficient Knowledge Related to Iron-Rich Nutrition. Pro tip: The rubric awards points for accurate problem identification and appropriate prioritization based on symptom severity and cardiovascular risk.

(3) Cardiovascular Assessment and Monitoring (Critical for Scoring):

You need to demonstrate understanding of cardiovascular complications in anemia. Expected components include: assessment of compensatory tachycardia, evaluation for high-output heart failure, orthostatic vital sign assessment, and peripheral perfusion evaluation.

(4) Nutritional Assessment and Education (Heavily Weighted):

You must address dietary iron deficiency and provide appropriate education. Key components include: assessment of dietary iron sources in vegan diet, education on iron absorption enhancers and inhibitors, meal planning for optimal iron intake, and supplementation counseling.

(5) Activity and Safety Management (Heavily Weighted):

The rubric expects comprehensive understanding of activity modification in anemia including: assessment of exercise tolerance and functional capacity, energy conservation education, fall risk assessment due to lightheadedness, and gradual activity progression planning.

(6) Gynecologic Assessment and Collaboration (Essential Component):

Demonstrate appropriate assessment and referral for menorrhagia. Bonus points for: comprehensive menstrual bleeding assessment, understanding of bleeding patterns and severity markers, coordination with gynecology for evaluation, and patient education on menstrual health.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Ava Pilar

Situation: 50-year-old female with progressive fatigue, exertional dyspnea, and near-syncope episode presenting with suspected iron deficiency anemia secondary to heavy menstrual bleeding, requiring immediate hematologic stabilization and cardiovascular monitoring.

Background: Several-month history of increasing fatigue and shortness of breath, heavy menstrual bleeding lasting 7-8 days for past 10 months. Vegan diet for 2 years without iron supplementation. No significant past medical history, lives independently with normal functional capacity until recent symptom progression.

Assessment: Alert, oriented female demonstrating clinical signs of iron deficiency anemia including pallor, fatigue, and exertional limitations. Stable vital signs but requires monitoring for cardiovascular compensation. Significant menstrual bleeding history suggesting primary source of iron loss.

Primary Nursing Diagnoses:

Activity Intolerance Related to Decreased Oxygen-Carrying Capacity Secondary to Iron Deficiency Anemia
Risk for Decreased Cardiac Output Related to Compensatory Mechanisms Secondary to Anemia
Deficient Knowledge Related to Iron-Rich Nutrition and Menstrual Health Management

Recommendation:

Initiate iron replacement therapy with monitoring for therapeutic response and gastrointestinal tolerance
Implement activity modification with energy conservation strategies and fall precautions
Provide comprehensive nutritional counseling for iron-rich vegan diet planning
Coordinate gynecologic evaluation for menorrhagia assessment and management
Monitor cardiovascular status for signs of compensation or decompensation

Patient and Family Education Provided: Explained iron deficiency anemia pathophysiology and relationship to heavy menstrual bleeding, discussed importance of iron supplementation and dietary modifications, taught recognition of worsening anemia symptoms requiring immediate care, reviewed activity modification and energy conservation techniques, provided information on iron-rich plant foods and absorption optimization strategies.

Conclusion

By following this comprehensive approach to the Ava Pilar case, you’ll demonstrate the hematologic nursing care skills that iHuman evaluates. Remember, success in iron deficiency anemia cases requires understanding the underlying pathophysiology: conduct thorough hematologic assessments including cardiovascular and nutritional evaluation, develop appropriate nursing diagnoses focused on activity tolerance and cardiac function, implement evidence-based iron replacement and dietary interventions, and coordinate comprehensive care with gynecology and nutrition specialists. The key is treating each iHuman simulation as you would a real patient with iron deficiency anemia – prioritize cardiovascular monitoring, focus on iron replacement therapy, emphasize nutritional education, and always consider the underlying bleeding source. With this guide, you’re well-prepared to excel in this essential hematologic nursing care simulation.

Frequently Asked Questions

What are the priority nursing diagnoses for Ava Pilar?

The primary nursing diagnoses for Ava Pilar include Activity Intolerance Related to Decreased Oxygen-Carrying Capacity (priority), Risk for Decreased Cardiac Output Related to Compensatory Mechanisms, and Deficient Knowledge Related to Iron-Rich Nutrition and Menstrual Health. Students often struggle with prioritization, but remember that cardiovascular assessment is crucial while addressing the underlying iron deficiency that directly impacts cellular oxygenation and functional capacity.

What are the critical assessment components I need to perform?

Essential assessment elements include comprehensive evaluation of anemia symptoms including pallor, fatigue, and exercise intolerance, detailed menstrual bleeding history and pattern assessment, nutritional assessment focusing on iron intake and absorption factors, and cardiovascular monitoring for compensatory changes. Many students miss points by inadequately assessing the patient’s functional capacity or failing to evaluate dietary iron sources in vegan patients.

How do I address the iron deficiency and bleeding concerns effectively?

Focus on comprehensive iron replacement planning including oral iron supplementation with absorption enhancement strategies, coordination with gynecology for menorrhagia evaluation and management, nutritional counseling for iron-rich plant foods, and monitoring for treatment response. The key is demonstrating understanding of both immediate iron replacement needs and long-term management of the underlying bleeding source.

What nutritional interventions should I include?

The comprehensive nutritional plan should include education on iron-rich plant foods such as legumes, fortified cereals, and dark leafy greens, teaching about vitamin C as an absorption enhancer, avoidance of calcium and tannins with iron-rich meals, and meal planning strategies for optimal iron bioavailability. Students often forget to address the specific challenges of maintaining adequate iron intake on a vegan diet and the importance of combining foods for maximum absorption.