A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse’s first response?
A. Assess for potential abuse.
B. Check for diminished sensations.
C. Document the findings.
D. Clean and dress the area.
Correct Answer: B. Check for diminished sensations
Macrocytic anemias can result from deficiencies in vitamin B12 or ascorbic acid. Only vitamin B12 deficiency causes diminished sensations of peripheral nerve endings. The nurse should assess for peripheral neuropathy and instruct the client in self-care activities for her diminished sensation to heat and pain. Vitamin B12 deficiency can lead to hematologic and neurological symptoms. Vitamin B12 is stored in excess in the liver, decreasing the likelihood of deficiency.
Option A: The burn could be related to abuse, but this conclusion would require more supporting data. A complete neurologic exam should evaluate for dementia, peripheral neuropathy, ataxia, and a loss of proprioception. A mental status exam may also be useful to evaluate any neuropsychiatric changes.
Option C: The findings should be documented, but the nurse would want to address the client’s sensations first. A thorough evaluation of vitamin B12 deficiency should include a complete history and physical with an increased emphasis on gastrointestinal (GI) and neurologic findings. B12 deficiency manifests as macrocytic anemia, and thus, the presenting symptoms often include signs of anemia, such as fatigue and pallor.
Option D: The decision of how to treat the burn should be determined by the physician. Treatment of vitamin B12 deficiency involves repletion with B12. However, depending on the etiology of the deficiency, the duration and route of treatment vary. In patients who are deficient due to a strict vegan diet, an oral supplement of B12 is adequate for repletion.
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