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 red blood cells with thin membranes
Which therapy would the nurse anticipate discussing 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. Subcutaneous injections of erythropoietin for a few weeks
4. Lifelong intramuscular parenteral injections of vitamin B12
4
Rationale 1: Green, leafy vegetables, broccoli, wheat germ, and asparagus are foods high in folic acid but not high in the vitamin B12 needed by this patient.
Rationale 2: Iron deficiency results in microcytic and hypochromic RBCs. Extra iron and vitamins would not correct the symptoms.
Rationale 3: Erythropoietin stimulates new RBC production by the bone marrow, but if B12 is not present in the body to manufacture the DNA, the RBCs will not have the shape or size of normal RBCs.
Rationale 4: Larger macrocytic and oval-shaped RBCs with thin membranes, paresthesia, and proprioception are symptoms of a deficiency of B12. Because the gastrointestinal (GI) tract is permanently unable to make the intrinsic factor needed to absorb B12 from foods, an alternate absorption method that bypasses the GI tract is necessary. Intramuscular treatments are lifelong.
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