Ward Class

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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Hematologic Disorders: Pernicious Anemia

megaloblastic cells vs normal cells
  • also called Addison's anemia, primary anemia
  • a type of megaloblastic anemia caused by the lack or deficiency of intrinsic factor (caused by gastric mucosal atrophy or as a consequence of total gastrectomy)
  • results in abnormally large erythrocytes (rbc) and hypochlorhydria
  • specifically refers to anemia resulting from vitamin B12 deficiency caused by an autoimmune metaplastic atrophic gastritis with loss of intrinsic factor
  • risk factors include age of more than 50, family history of the disease, Scandinavian or European decent, and history of autoimmune endocrine disorders such as Type 1 Diabetes Mellitus and Grave's Disease
Assessment Findings
  • anemia, weakness, pallor, shortness of breath, fatigue, rapid heart rate
  • GI symptoms: anorexia, weight loss, diarrhea, constipation, sore mouth, bleeding gum, beefy red tongue
  • neurologic symptoms: tingling fot he hands and feet, unsteady gait, paralysis, positive Babinski's reflex, personality changes such as depression and psychosis
  • diagnostic tests:
    • erythrocyte count-->decreased
    • blood smear-->oval, macrocytic eryhtrocytes
    • bone marrow-->increased megaloblasts or abnormal erythrocytes, few maturing normal erythrocytes, defective leukocyte maturation
    • indirect bilirubin-->elevated unconjugated fraction
    • serum LDH-->elevated
    • Schilling test (definitive)-->positive
    • gastric analysis-->decreased free hydrochloric acid
Medical Management
  1. monthly vitamin B12 injections
  2. iron preparations-->if hemoglobin is inadequate
  3. folic acid-->safe if given in small amounts; reverses anemia and GI symptoms but may increase neurologic symptoms
Nursing Management
  1. provide a diet high in iron (meat, milk, eggs)
  2. if patient has mouth sores, spicy or very hot foods should be avoided.
  3. provide mouth care before and after meals: soft toothbrush, no strong commercial rinses
  4. planned rest periods; bed rest if anemia is severe
  5. ensure saftey during ambulation
  6. discharge planning safety during ambulation, importance of vitamin B12 therapy, dietary teachings
Prognosis

Presently, patients who receive appropriate treatments have a normal lifespan. Perisistent neurologic defects may persist if treatment is delayed. Other complications such as gastric polyps and gastric cancer may also occur if patients do not receive treatment as needed.

Prevention

There is no known prevention for pernicious anemia.

Related Link:
Sample NCP for Pernicious Anemia



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