While asking about the history of a patient, the nurse finds out that the patient is on a plant-based diet only. She understands that he might develop?

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

A strictly plant-based (vegan) diet excludes all animal products, which are the primary natural sources of Vitamin B12.
Vitamin B12 is crucial for DNA synthesis and the maturation of red blood cells in the bone marrow.
A deficiency in Vitamin B12 leads to impaired red blood cell production, resulting in large, immature cells (megaloblasts) and a condition called megaloblastic anemia.
Therefore, an individual on a long-term, unsupplemented plant-based diet is at a significant risk of developing megaloblastic anemia.

Option A: Pellagra is caused by a deficiency of niacin (Vitamin B3). While severe malnutrition can cause it, many plant-based foods like whole grains, legumes, and nuts are good sources of niacin, making this deficiency less likely.
Option C: Scurvy is caused by a deficiency of Vitamin C. Plant-based diets are typically very high in Vitamin C due to the consumption of fruits and vegetables like citrus, broccoli, and peppers.
Option D: Marasmus is a form of severe malnutrition caused by a deficiency in total calories and protein, leading to extreme wasting and fat loss. The question points towards a specific micronutrient deficiency rather than overall starvation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nutritional deficiencies associated with specific dietary patterns, particularly plant-based diets to guide bedside assessment, documentation, and the next nursing action.
Nurses must conduct thorough dietary assessments to identify patients at risk for nutritional deficiencies.
Patient education is a key nursing intervention. For patients on or considering a plant-based diet, the nurse should provide information on the importance of Vitamin B12 supplementation or consumption of B12-fortified foods.
Nurses should be able to recognize the signs and symptoms of megaloblastic anemia, such as fatigue, weakness, pale skin, shortness of breath, and neurological changes (numbness, tingling), to ensure early detection and treatment.

How to Approach the Question

First, identify the key information in the question stem: the patient is on a 'plant-based diet only'.
Recognize that this implies a vegan diet, which excludes all animal products.
Consider the major nutrients and their primary dietary sources. Ask yourself, 'What essential nutrient is found almost exclusively in animal products?' The answer is Vitamin B12.
Evaluate each option based on this knowledge. Megaloblastic anemia is a classic result of B12 deficiency.
Rule out the other options: Scurvy (Vitamin C) and Pellagra (Niacin) are unlikely as their sources are plentiful in plants. Marasmus is a condition of total calorie deprivation, not a specific micronutrient deficiency.

Concept Tested & Keywords

Concept Tested: Nutritional deficiencies associated with specific dietary patterns, particularly plant-based diets.
Stem keywords: plant-based diet, history of a patient
Lead-in keywords: might develop
Clinical cues: Patient is on a plant-based diet only, which is a key indicator for potential Vitamin B12 deficiency.

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