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RNSG Theory LVL 4 > Pernicious Anemia > Flashcards

Pernicious Anemia Flashcards

1
Q

How does intrinsic factor help the body absorb vitamin b 12?

A

It attaches to the vitamin B 12 found in the food you consume and releases it into the stomach acid. Then the vitamin b 12 is absorbed by the ileum. The parietal cells in the stomach produce intrinsic factor and can become damaged from an autoimmune response in the system. Antibodies attack the parietal cells which damages them to the point where they cannot produce intrinsic factor. GI disease and stomach surgery can destroy parietal cells which decrease the production of intrinsic factor.

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2
Q

What happens to the red blood cells in the pernicious anemia?

A

If vitamin b 12 levels are too low this can lead the body to produce unhealthy red blood cells. Instead of the RBCs being normal sized and round, they become large and are shaped like an oval (also called macrocytic anemia…learn about microcytic anemia in iron-deficiency anemia).

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3
Q

How low vitamin b 12 and low RBCs affect the body?

A

Nervous System (majorly affected in pernicious anemia): low vitamin b 12 causes irreversible damage to nerve cells so the patient can experience paresthesia.
Heart: it has to work harder to pump blood to get oxygen to the organs and tissue which can eventually lead to heart failure.
Intestinal: tongue changes from decreased oxygen and the stomach lining begins to thin which can cause an upset stomach and increase risk of stomach cancer.

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4
Q

Risk Factors for Pernicious Anemia

A

Aging: older adults can experience this due to decreased production of gastric acid and intrinsic factor.
Genetic
Autoimmune disease of the endocrine system: Addison’s, Diabetes Type 1 etc.

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5
Q

How is Pernicious Anemia Diagnosed?

A

CBC: to measure RBCs, hgb, hct
Blood smear to look at RBC (will appear large and oval)
Vitamin b12 level
Intrinsic factor antibody assay
Bone marrow aspiration and biopsy

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6
Q

Signs and Symptoms of Pernicious Anemia

A

Signs and symptoms may take a while to be noticed by the patient.

*=most common in pernicious anemia

Remember the mnemonic: Pernicious

Pale

Energy gone (very fatigued)*

Red, smooth tongue*

Numbness or tingling in hands and feet*

Intestinal issues (abdominal bloating, diarrhea/constipation, indigestion)

Confusion

Increased sadness (depression)

lOss of appetite (taste changes and weight loss)

Unsteady gait (clumsy)

Shortness of breath with activity

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7
Q

Nursing Interventions for Pernicious Anemia

A

Goal replace vitamin b 12 (patient can’t receive vitamin b 12 from food…so they will need it a different route)

Administer vitamin b 12 injections (intramuscular….not orally because they aren’t absorbing it in the GI system) as ordered by doctor. Regime is usually weekly at first and then monthly for maintenance (for lifetime)….if severe anemia will need blood transfusion
Educated on safety: due to risk of injuries from unsteady gait…more clumsy from the paresthesia
Educate about importance of eating enough foods with iron, vitamin C, and folic acid because these nutrients play a role in red blood cell production as well.
Maintain good oral hygiene due to changes to tongue.

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8
Q
  1. You’re providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching?

A. “Pernicious anemia is caused by not consuming enough Vitamin B12.”

B. “Pernicious anemia causes the red blood cells to appear very large and oval.”
C. “Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12.”

D. “A red, smooth tongue can be a sign of pernicious anemia.”

A
  1. A -“Pernicious anemia is caused by consuming not enough Vitamin B12.”
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9
Q
  1. In pernicious anemia, intrinsic factor is not being secreted by the _______ cells which are found in the gastric mucosa.

A. Visceral

B. Langerhan

C. Parietal

D. Chief

A

C. Parietal

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10
Q
  1. Select the patient below who is at MOST risk for pernicious anemia:

A. A 75 year old male who recently had surgery on the ileum.

B. A 25 year old female who reports craving ice and clay.

C. A 66 year old male whose peripheral blood smear showed hypochromic red blood cells.

D. All the patients above are at risk for pernicious anemia.

A
  1. A. A 75 year old male who recently had surgery on the ileum.
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11
Q
  1. A doctor suspects pernicious anemia in a patient presenting with a beefy red tongue. The patient reports feeling extremely fatigued and numbness and tingling in the hands. The doctor orders a peripheral blood smear. From your nursing knowledge, how will the red blood cells appear in the peripheral blood smear if pernicious anemia is present?

A. Round-shaped and hypochromic

B. Oval-shaped and hyperchromic

C. Large and oval-shaped

D. Small and hyperchromic

A
  1. C. Large and oval-shaped
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12
Q
  1. Select ALL the signs and symptoms that can present in pernicious anemia:

A. Erythema

B. Paresthesia of hands and feet

C. Racing thoughts

D. Extreme hunger

E. Depression

F. Unsteady gait

G. Shortness of breath with activity

A

B. Paresthesia of hands and feet
E. Depression

F. Unsteady gait

G. Shortness of breath with activity

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13
Q
  1. A patient with pernicious anemia is ordered to receive supplementary Vitamin B12. What is the best route to administer this medication for patients with this disorder?

A. Intravenous

B. Orally

C. Through a central line

D. Intramuscular

A
  1. D- Intramuscular
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14
Q
  1. True or False: Intrinsic factor is a protein that plays a role in how the body absorbs Vitamin B12.
A
  1. True
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15
Q
  1. A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime?

A. “I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I’m done.”

B. “Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime.”

C. “I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12.”

D. “When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection.”

A

B. “Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime.”

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16
Q

Iron-Deficiency

A

a type of anemia that is caused by low IRON levels.

17
Q

What is Anemia?

A

Anemia is a decreased amount of red blood cells or hemoglobin in the body. These components play a huge role in carrying oxygen throughout the body. If you are low in RBCs or hemoglobin, your body won’t receive enough oxygen to function properly.

18
Q

Key Points about Iron-Deficiency Anemia:

A

Most common type of anemia (there are various types)
Body uses IRON to make hemoglobin
Low levels of iron lead the body to produce fewer red blood cells which leads to less hemoglobin in the body. Hence, your body receives less amounts of oxygen.
Signs and symptoms are vague at first and as it progresses the signs and symptoms become more noticeable
A blood test such as a CBC (complete blood count) or iron level will help the doctor detect anemia.
Women who are childbearing age may be plagued with this due to heavy menstruation or pregnancy and people with poor digestion (intestinal issue) or poor intake of iron.
Treatment includes: incorporating more iron in the diet, taking iron supplements, and prevention.

19
Q

The red blood cells …

A

transport oxygen throughout the body and remove carbon dioxide (a waste product from metabolism) with the help of hemoglobin.

20
Q

Hemoglobin is an “ingredient” found in

A

the RBC that is a protein that contains IRON.

IRON helps make hemoglobin.
Around 70% of the body’s iron is found in the hemoglobin.
Function of hemoglobin is to facilitate the transfer of the oxygen and carbon dioxide throughout the body. It does this with the help of the RBCs.

21
Q

Remember low IRON levels: mean

A

less production of hemoglobin which means less oxygen to the body.

22
Q

Causes of Iron-Deficiency Anemia

A

Poor intake of iron through diet (pregnancy…increased demand of iron for fetus, vegetarians)
Absorption problem: intestinal surgery…gastric bypass, celiac disease, small intestine removal (most iron is absorbed by the small intestine)
Losing iron from blood loss (menstruation, GI bleeding…ulcers, hemorrhoids)

23
Q

Signs and Symptoms of Iron-Deficiency Anemia

A

Remember the Mnemonic: “Low Iron”

Lethargic

Overexerted easily (may be short of breath)

Weird food cravings (ice, dirt, clay), White-faced (pale)

Inflammation of tongue…will become smooth and turn various colors of red (due to lack of oxygen it receives), Increased Heart rate (trying to compensate for the low oxygen)

Reduced Hemoglobin level

Observe changes in RBCs with a blood smear test…will appear hypochromic (pale) and microcytic (small)

Nail changes (Koilonychias….spoon-shaped nails), neuro change (confused, moody)

24
Q

Diagnosed?

A

CBC (to assess red blood cells, hemoglobin levels)…may order a blood smear to assess color and size of RBCs
Iron levels

25
Q

Educating how to take IRON supplements:

A

Take iron on an empty stomach (increases absorption…may take with small amounts of food due to stomach upset)
Take with Vitamin C…glass of orange juice (helps increase absorption)
Don’t take with any milk products, calcium, or antacids (decreases absorption) and wait 2 hours in between
Stools will turn black which is normal while taking iron supplements (tarry stools or having stools with blood..not normal)
For liquid preparations: mix in a drink, drink with straw, and brush teeth afterwards (can stain teeth)

26
Q

Side effects:

A

constipation (drink plenty of fluids and take over the counter stool softener if needed)

27
Q

May give IV iron or blood transfusion if

A

severe per md order

28
Q

Eat Food High in Iron:

A

Remember the mnemonic “Eat Lots of Iron” Egg yolks

Apricots

Tofu

Legumes, Leafy green vegetables

Oysters

Tuna

Sardines, Seeds

pOtatoes

Fish (halibut, haddock, salmon)

Iron-fortified cereal and breads

Raisins, Red meats (beef)

pOultry (turkey, chicken)

Nuts

29
Q
  1. True or False: The least common type of anemia is iron-deficiency anemia.
A
  1. False
30
Q
  1. Select all the patients who are at MOST risk for iron-deficiency anemia:

A. A 55 year old male who reports taking Ferrous Sulfate regularly.

B. A 25 year old female who was recently diagnosed with Celiac Disease.

C. A 35 year old female who is 36 weeks pregnant that reports craving ice.

D. A 67 year old female with a Hemoglobin level of 14.

A
  1. B. A 25 year old female who was recently diagnosed with Celiac Disease.

C. A 35 year old female who is 36 weeks pregnant that reports craving ice.

31
Q
  1. A patient with a history of gastric bypass surgery 6 months ago reports feeling very fatigued and is having food cravings for clay and dirt. On assessment, you note the patient has nail changes that look “spoon-shaped”. This spoon-shaped appearance of the nails is called?

A. Terry’s Nails

B. Onychoschizia

C. Koilonychias

D. Leukonychia

A

C. Koilonychias

32
Q
  1. The physician orders a patient with suspected iron-deficiency anemia a blood smear test to assess the quality of the red blood cells. How would the red blood cells appear if the patient had iron- deficiency anemia?

A. Hyperchromic and macrocytic

B. Hypochromic and microcytic

C. Hyperchromic and macrocytic

D. Hypochromic and macrocytic

A

A. Hyperchromic and macrocytic

33
Q
  1. You’re providing education to a patient about how to take their prescribed iron supplement. Which statement by the patient requires you to re-educate the patient on how to take this supplement?

A. “I will take this medication on an empty stomach.”

B. “I will avoid taking this medication with orange juice.”

C. “I will wait and take my calcium supplements 2 hours after I take my iron supplement.”

D. “This medication can cause constipation. So, I will drink plenty of fluids and take a stool softer as needed.”

A
34
Q
  1. A patient is admitted with iron- deficiency anemia and has been receiving iron supplementation. The patient voices concern about how their stool is dark black. As the nurse you would?

A. Notify the doctor

B. Hold the next dose of iron

C. Reassure the patient this is a normal side effect of iron supplementation

D. None of the options are correct

A

C. Reassure the patient this is a normal side effect of iron supplementation

35
Q
  1. You are providing diet teaching to a patient with low iron levels. Which foods would you encourage the patient to eat regularly?

A. herbal tea, apples, and watermelon

B. Sweet potatoes, artichokes, and packaged meat

C. Egg yolks, beef, and legumes

D. Chocolate, cornbread, and cabbage

A

C. Egg yolks, beef, and legumes

36
Q
  1. True or False: The body uses hemoglobin to make iron.
A
  1. False
37
Q
  1. True or False: High levels of iron lead to the body to producing fewer red blood cells.
A
  1. False
38
Q
  1. True or False: Early signs and symptoms of iron-deficiency anemia are vague.
    Answer Key:
  2. True
A
  1. True

RNSG Theory LVL 4 (14 decks)

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