A middle-aged female is experiencing numbness and tingling in her lower extremities as well as difficulty ambulating. The patient's recent complete blood count indicates large, oval-shaped, macrocytic red blood cells with thin membranes
Which therapy would the nurse anticipate including in the discharge plan?
1. a diet high in green leafy vegetables, broccoli, wheat germ, and asparagus
2. a daily multivitamin with extra iron
3. instructions about subcutaneous injections of erythropoietin for a few weeks
4. instructions about intramuscular parenteral injections of vitamin B12 for the rest of her life
Correct Answer: 4
Because vitamin B12 is important for neurologic function, deficiency leads to paresthesias in the extremities and problems with proprioception. Treatment for vitamin B12 deficiency is oral or parenteral vitamin B12 supplements. Green leafy vegetables, broccoli, wheat germ, and asparagus are high in folic acid but not another important nutrient. Iron deficiency results in microcytic and hypochromic RBCs. Extra iron and vitamins will not correct the symptoms. Erythropoietin stimulates new RBC production by the bone marrow, but if B12 is deficient, the RBCs will not have the shape or size of normal RBCs.
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