A client has been diagnosed with pernicious anemia. In planning care for the client, a nurse anticipates that the client will be treated with?

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

Pernicious anemia is caused by a lack of intrinsic factor, a protein needed to absorb Vitamin B12 from the gut.
Because oral Vitamin B12 cannot be absorbed without intrinsic factor, the treatment must bypass the gastrointestinal system.
The standard treatment is lifelong replacement of Vitamin B12 through parenteral routes, most commonly intramuscular injections.
This replacement therapy corrects the anemia and prevents the progression of potentially irreversible neurological damage associated with B12 deficiency.

Option A: Thiamine (Vitamin B1) is not used to treat pernicious anemia. Its deficiency leads to conditions like beriberi and Wernicke-Korsakoff syndrome, which primarily affect the nervous and cardiovascular systems.
Option B: Iron is used to treat iron-deficiency anemia, which is caused by insufficient iron for hemoglobin production. Pernicious anemia is a problem of B12 absorption, not iron levels.
Option D: Folic acid is used to treat megaloblastic anemia caused by folate deficiency. Administering folic acid to a patient with pernicious anemia is dangerous because it can correct the anemia (the hematologic signs) while masking the underlying B12 deficiency, allowing irreversible neurological damage to progress.

Clinical Relevance

Nursing practice connection: Use the key finding related to Treatment for Pernicious Anemia to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate patients with pernicious anemia that treatment with Vitamin B12 injections is lifelong. Adherence is critical to prevent relapse of anemia and progression of neurological symptoms.
A key nursing responsibility is to perform regular neurological assessments, checking for paresthesia, balance issues (ataxia), and cognitive changes, as these are hallmark signs of B12 deficiency.
What if? If a patient presents with megaloblastic anemia but the cause is unknown, the nurse should anticipate orders to test serum levels for both Vitamin B12 and folic acid before initiating any treatment. Treating with folic acid alone could have severe neurological consequences if the patient is B12 deficient.

How to Approach the Question

First, identify the key diagnosis in the question: 'pernicious anemia'.
Recall the specific pathophysiology of this condition. Pernicious anemia is not just a simple vitamin deficiency; it's an absorption problem caused by the lack of intrinsic factor.
Consider the function of intrinsic factor, which is to bind with Vitamin B12 to allow its absorption in the ileum.
Evaluate the treatment options based on this pathophysiology. Since the body cannot absorb oral B12, the treatment must provide the vitamin in a way that bypasses the GI absorption pathway.
This leads to the conclusion that parenteral (injected) Vitamin B12 is the correct treatment.
Eliminate the other options by recalling their primary uses: Thiamine for beriberi, Iron for iron-deficiency anemia, and Folic acid for folate-deficiency anemia.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 139-141

E6 Pharmacology Katzung 16e p. 935-937

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Attempt every question from this paper in a timed mock, then review the full solution for each one.