Case Study in the Care of Older Adult

CASE STUDY

Mrs. Andersson

GENDER Female

AGE 88

SETTING ■ Primary care

ETHNICITY ■ White American

CULTURAL CONSIDERATIONS ■ Swedish; increased risk of pernicious anemia

PREEXISTING CONDITIONS ■ Small bowel obstruction (SBO) with subsequent bowel resection;
diverticuliti

COMMUNICATION■ American English

SPIRITUAL/RELIGIOUS ■ Roman Catholic

PHARMACOLOGIC ■ Cyanocobalamin (oral vitamin B12); cyanocobalamin crystalline (injectable vitamin

B12); cyanocobalamin nasal gel (Nascobal); hydrochloric acid (HCI)

Overview:

This case requires the nurse to identify causes of vitamin B12 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. Andersson 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. Andersson 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/mm3, 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. Andersson was diagnosed with pernicious anemia and started on vitamin
B12 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. Andersson’s 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. Andersson understands that including foods high in vitamin B12 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 B12 injections for the client with
vitamin B12 deficiency.

10. When can Mrs. Andersson discontinue the vitamin B12 injections?

11. The nurse administers Mrs. Andersson’s vitamin B12 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. Andersson 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. Andersson’s safety at home?