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Client Profile:Mrs. Anderson is a 70-year-old that has been married for over 40 years and has three adult children.

Case Study-NSG 315

Client Profile:

Mrs. Anderson is a 70-year-old that has been married for over 40 years and has three adult children. Mrs. Anderson worked as a librarian most of her adult life and retired from her career 15 years ago. She has a past medical history of occasional knee pain after long walks. Mrs. Anderson walks her dog every morning and enjoys having lunch with her friends Mondays and Wednesdays.

Case Study: 

At the age of 70, Mrs. Anderson started noticing generalized weakness, fatigue, and an unexplained weight loss of 10 pounds over three months. A complete blood count (CBC) was done as part of her diagnostic workup. Portions of the CBC that were abnormal were reviewed. Abnormal findings in the CBC were:

  • Red blood cell count (RBC) of 3.20 million/mm3

  • mean corpuscular volume (MCV) of 130 μL

  • reticulocytes 0.4%, 

  • hematocrit (HCT) 25%,

  • hemoglobin (Hgb) 7.9 g/dL. 

Suspecting pernicious anemia, her Primary Care Physician ordered a Shilling test. After reviewing the results of the schilling test, Mrs. Anderson was diagnosed with pernicious anemia and started on vitamin B12 injections. She currently returns to her Primary Care Physician every month for her vitamin B12 injections. 

Questions:

  1. Briefly describe the pathophysiology of pernicious anemia.

  2. Identify possible causes of vitamin B12 deficiency. 

  3. Identify the physical assessment findings that are characteristic of pernicious anemia.  

  4. To help make a definitive diagnosis of pernicious anemia, a Schilling test may be performed. Describe the Schilling test. 

  5. Patient teaching: Identify five foods rich in vitamin B12 that Mrs. Anderson should consider. 

  6. Discuss the standard dosing and desired effects of the vitamin B12 injections for the client with vitamin B12 deficiency. 

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