Hematology

Name: Mrs. Analyn Parker

Gender: Female
Age : 70 years old
Setting : Primary care
Ethnicity : White American

PHARMACOLOGIC
 Cyanocobalamin (oral vitamin B12)
 Cyanocobalamin crystalline (injectable vitamin B12)
 Cyanocobalamin nasal gel (Nascobal)
 hydrochloric acid (HCI)

Case # 1

Overview: This case requires the nurse to identify causes of vitamin B 12 deficiency,
define pernicious anemia, and discuss elements of treatment. Client education is provided
regarding preventing injury when experiencing parathesias or peripheral neuropathy.

Client Profile:

Mrs. Analyn Parker was diagnosed with pernicious anemia at the age of 70. She has
monthly appointments with her primary health care provider for treatment with vitamin
B12 injections.

Case Study

At the age of 70, Mrs. Analyn Parker was exhibiting weakness, fatigue, and an unexplained
weight loss. A complete blood count (CBC) was done as part of her diagnostic workup. The
CBC revealed red blood cell count (RBC) 3.20 million/mm 3, mean corpuscular volume (MCV)
130 μL, reticulocytes 0.4%, hematocrit (Hct) 25%, and hemoglobin (Hgb) 7.9 g/dL.
Suspecting pernicious anemia, the health care provider prescribed a Shilling test. Mrs.
Analyn Parker was diagnosed with pernicious anemia and started on vitamin B 12 injections.
Questions

1. Briefly describe the pathophysiology of pernicious anemia.

2. Identify possible causes of vitamin B12 deficiency.
3. Identify the possible manifestations of pernicious anemia.
4. Identify the physical assessment findings that are characteristic of pernicious
anemia.
5. What are the expected results of a complete blood count (CBC) and serum vitamin
B12 level in a female client with pernicious anemia?
6. How does Mrs. Analyn Parker ethnicity relate to pernicious anemia?
7. To help make a definitive diagnosis of pernicious anemia, a Schilling test may be
performed. Describe the Schilling test.
8. Mrs. Analyn Parker understands that including foods high in vitamin B 12 in her diet
is helpful in preventing vitamin B12 deficiency. Identify five foods rich in vitamin
B12
9. Discuss the standard dosing and desired effects of the vitamin B 12 injections for
the client with vitamin B12 deficiency.
10. When can Ms. Analyn Parker discontinue the vitamin B12 injections?
11. The nurse administers Mrs. Analyn Parker’s vitamin B 12 injections using the
z-track injection method. Discuss why the nurse used this method and the steps of
this injection technique.
12. Discuss other possible medications or supplements that may be indicated for
the treatment of pernicious anemia.
13. During a routine visit, Mrs. Analyn Parker tells the nurse that she has
noticed a decreased sensation in her fingers. “I can pick up a cup, but I can’t really
feel the cup in my hand. It is a tingling sensation of sorts.” What teaching should
the nurse initiate to promote Mrs. Analyn Parker’s safety at home?