Author Question: A middle-aged female is experiencing numbness and tingling in her lower extremities as well as ... (Read 107 times)

joblessjake · **on:** Jun 25, 2018

A middle-aged female is experiencing numbness and tingling in her lower extremities as well as difficulty ambulating. The patient's recent complete blood count indicates large, oval-shaped, macrocytic red blood cells with thin membranes.

Which therapy would the nurse anticipate including in the discharge plan?

1. a diet high in green leafy vegetables, broccoli, wheat germ, and asparagus
2. a daily multivitamin with extra iron
3. instructions about subcutaneous injections of erythropoietin for a few weeks
4. instructions about intramuscular parenteral injections of vitamin B12 for the rest of her life

Question 2

The nurse is caring for a young female patient whose laboratory values indicate the presence of microcytic and hypochromic red blood cells. What should the nurse do to help this patient?

1. Enforce nothing by mouth in anticipation of emergency surgery.
2. Insert an intravenous access line for fluids.
3. Consult with the dietitian for a diet high in iron.
4. Assess the past history for risks of bleeding or menstrual changes.

Dunkey · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Correct Answer: 4
Because vitamin B12 is important for neurologic function, deficiency leads to paresthesias in the extremities and problems with proprioception. Treatment for vitamin B12 deficiency is oral or parenteral vitamin B12 supplements. Green leafy vegetables, broccoli, wheat germ, and asparagus are high in folic acid but not another important nutrient. Iron deficiency results in microcytic and hypochromic RBCs. Extra iron and vitamins will not correct the symptoms. Erythropoietin stimulates new RBC production by the bone marrow, but if B12 is deficient, the RBCs will not have the shape or size of normal RBCs.

Answer to Question 2

Correct Answer: 4
The nurse should do additional health history assessment to identify the source of chronic bleeding. Questions related to length and amount of menstrual flow, color of stools, and any upper gastric bleeding/conditions that might be contributing to the potential bleeding should be asked before any other actions are taken. Emergency surgery is not the first action, as microcytic and hypochromic RBCs reflect a chronic bleeding condition, not an acute one. Fluid replacement would not address the blood cells' reduced ability to carry oxygen.