They need to assess the risk factors

Running head: CASE STUDY
Case Study
Name of the Student
Name of the University
Author Note

CASE STUDY 2
Introduction
Vitamin B12 also known as cobalamine, is an essential vitamin required to maintain normal
functioning of the nerve cells, synthesis of DNA and also helps in the production of red blood
cells, thus reducing the chance of anemia. It also boosts the energy of an individual, improves
memory and helps in preventing cardiovascular disease. Vitamin B 12 deficiency can result
in reduced production of Red blood cells, and the RBCs become enlarged and irregular in
shape, which prevents their smooth flow in the bloodstream, thus leading to megaloblastic
anemia(Chiang et al, 2020). And due to reduced concentration of RBCs in the blood, there is
less transportation of oxygen into the muscles and tissue, as a result the person feels tired and
weak.
The case of Mrs. Anderson
In the given case study, Mrs Anderson, a 70 years old lady was found to be very tired,
fatigued and also undergone a rapid weight loss. Going through her medical records, the
nurse found that she has suffered form small bowel obstruction with resection and
divertitulitis in the past. The nurses thought about performing Schilling test and started giving
Vit B 12 injections to her.
Nursing Diagnosis
The nursing diagnosis plan required for Mrs. Anderson are:
1. Maintaining activity tolerance of the patient by preventing physical inactivity and
helping the patient to live a satisfactory quality of life. Assess the patient’s ability to

CASE STUDY 2
perform ADLs and provide assistance specially when performing task that require
ambulation
2. Monitoring and evaluation of the vital signs
3. Documentation of the sleep patterns and pain, along with observation of the vital
organs, mucous membranes and skin colour
4. They need to assess the risk factors, decrease fatigue and weakness of the patient
related to decreased haemoglobin and diminished oxygen carrying capacity of the
blood(Meyer et al, 2019)
Background of the disease
The patient may be suffering from jejunal diverticulitis characterized by bacterial growth
within the diverticula, which ultimately results in vitamin B12 deficiency, as the bacteria
takes up all the nutrients and vitamins itself. This causes malabsorption due to the
deconjugation of bile salts by the bacteria followed by impaired lipid digestion. Since the
patient had undergone a previous surgery which may have removed the part of the bowel
which was responsible for absorbing vitamin B12(Haynes, 2017). Due to vitamin deficiency
the patient seemed fatigued and weak, since the body could not produce enough RBC which
helps in transporting oxygen throughout the body. Due to oxygen unavaibility, the muscles
within her body could not work properly, ultimately leading to weakness. Moreover, due to
lack of Vitamin B, there are limited production of RBC which increases the risk of
megaloblastic anemia(Rehman et al, 2019). People with deficiency of Vitamin B12 often lose
their appetite and refuse to eat, as a result, the body does not get enough nutirents to function
effectively, leading to weight loss, which exactly happened in Mrs. Anderson’s case(Gonmei
et al, 2018).

CASE STUDY 2
Literature review
Diverticulitis is an infection on the small perforation of the bowel or the diverticula. It is a
benign condition characterized by formation of pouches along the wall of the small intestine.
The thickening of the outer wall of the intestine results in narrowing of the space inside,
which makes it hard for the stool to pass(Harbi et al, 2017). The stools is usually due to low
fiber diet and and it moves through the intestinal wall, it creates pressure on it, thus forming
pockets called diverticula. Often the stool while passing through the intestinal wall may
deposit fecal materials in the diverticular, which becomes a favourable spot for bacterial
growth. When bacterial growth gets excess, it gives an inflammatory response which leads to
infection in the diverticula. The bacteria also utilizes the vitamin B12, thus leading to its
deficiency in the body(Green et al, 2017).
Assessment of the patient
The total blood count result of the patient showed, the count of erythrocytes in her blood is
3.20 million/mm3, which is lower than the normal RBC count (4.2-5.4 million/mm3), which
signifies that the person may be suffering from anemia, thus her body cannot produce the
sufficient red blood cells. The MCV (Mean Corpuscular Volume) was 130 mcg, which is
very high. MCV test is done to identify the size of the Red blood cells. A high MCV values
signifies the presence of macrocytic RBCs, which leads to macrocytic anemia due to vitamin
B12 deficiency. The reticulocyte percentage in the blood was 0.4%, which was lower than
average value. It indicates that the patient may be suffering from anemia where the body is
not being able to produce enough RBCs. The haematocrit value showed 25%, which was
ectremely low, again signifying the presence of anemia. Latly, the hemoglobin level was
found to be around 7.9g/dL, signifying the destruction of RBCs, thus leading to anemia.

CASE STUDY 2
The laboratory tests which the nurse conducts to determine Vitamin B12 deficiency in the
patient are:
1. Mean Corpuscular Volume (MCV) Test – Patient having a high value of MCV have
an increased risk of megaloblastic anemia, which in turn, implies Vitamin B12
deficiency in the serum(Karakoyun et al, 2019)
2. Peripheral Blood Smear – The patients with Vitamin B12 deficiency have
hypersegmented neutrophils, also presence of oval macrocytes suggested the presence
of megaloblastic disorder
3. Measuring the concentration of Vitamin B12 in the blood(Moll & Davis, 2017).
Nursing Interventions
The nursing interventions that are required for treating Mrs. Anderson are:
1. Assesing the specific cause of fatigue – the specific reason for fatigue can be due to
tissue hypoxia resulting from normocytic anemia, or there can be other heath issues
that can compromise activity tolerance
2. Assess the ability of the patient to perform daily activities – Weakness and fatigue can
restrict the patient from participating in daily activities
3. Monitor haemoglobin, RBC count, haematocrit level and reticulocyte count of the
patient – Decreased count of RBC is associated with decreased oxygen carrying
capacity of the blood
4. Suggest the patient to take medications which will promote RBC production in the
bone marrow – The medications consist of a haematological growth factor called
recombinant human erythropoietin, which stimulates the production of haemoglobin

CASE STUDY 2
5. Provide supplemental oxygen through oxygen therapy – to ensure proper oxygen
supply to the muscles and tissue
Conclusion
Thus in conclusion, it can be said that, deficiency in the level of Vitamin B in the blood can
lead to many health complexities in an individual, it reduces the RBC production, thus
leading to anemia. Proper diagnostic approach is taken by the nurses to address the issue of
Vitamin B12 deficiency, they conduct several laboratory tests to confirm the low level of
Vitamin B12. Once that has been confirmed, they assess and monitor the vital signs of the
patient, promote activity tolerance, provide supplemental oxygen and administer
intramascular Vitamin B12 to increase the amount of Vitamin B12 in the serum.
REFERENCE
Chiang, C. P., Wu, Y. H., Chang, J. Y. F., Wang, Y. P., Wu, Y. C., & Sun, A. (2020). Does
serum gastric parietal cell antibody titer have influence on anemia and vitamin B12
deficiency in atrophic glossitis patients?. Journal of the Formosan Medical
Association, 119(1), 377-383.

CASE STUDY 2
Gonmei, Z. A. O. Z. I. A. N. L. U. N. G. L. I. U., Dwivedi, S. U. P. R. I. Y. A., Toteja, G. S.,
Singh, K. A. R. U. N. A., Vikram, N. K., & Bansal, P. G. (2018). Anaemia and
Vitamin B12 deficiency in elderly. Asian J Pharm Clin Res, 11(1), 402-404.
Green, R., Allen, L. H., Bjørke-Monsen, A. L., Brito, A., Guéant, J. L., Miller, J. W., ... &
Ueland, P. M. (2017). Vitamin B 12 deficiency. Nature reviews Disease
primers, 3(1), 1-20.
Harbi, H., Kardoun, N., Fendri, S., Dammak, N., Toumi, N., Guirat, A., & Mzali, R. (2017).
Jejunal diverticulitis. Review and treatment algorithm. La Presse Médicale, 46(12),
1139-1143.
Haynes, S. (2017). Small Bowel Diverticulitis. In Acute Care General Surgery (pp. 125-129).
Springer, Cham.
Karakoyun, I., Duman, C., Arslan, F. D., Baysoy, A., & Basok, B. I. (2019). Vitamin B12
and folic acid associated megaloblastic anemia: Could it mislead the diagnosis of
breast cancer?. International Journal for Vitamin and Nutrition Research.
Meyer, H. E., Willett, W. C., Fung, T. T., Holvik, K., & Feskanich, D. (2019). Association of
high intakes of vitamins B6 and B12 from food and supplements with risk of hip
fracture among postmenopausal women in the Nurses’ Health Study. JAMA network
open, 2(5), e193591-e193591.
Moll, R., & Davis, B. (2017). Iron, vitamin B12 and folate. Medicine, 45(4), 198-203.
Rehman, S., Sharif, N., Rahman, S., Suleman, S., Gul, A., & Abbas, M. (2019). VITAMIN
B12 DEFICIENCY AMONG PATIENTS WITH MEGALOBLASTIC
ANEMIA. Journal Of Medical Sciences, 27(2), 103-106.

CASE STUDY 2
Toh, B. H. (2017). Pathophysiology and laboratory diagnosis of pernicious
anemia. Immunologic research, 65(1), 326-330.
ve Müdahalesi, J. D. P. D., & Gerektirir, Ö. D. (2018). Jejunoileal Diverticulosis has
Heterogeneous Pathophysiology and Requires Special Consideration During
Treatment. Turk J Colorectal Dis, 28, 140-144.
Wang, H., Li, L., Qin, L. L., Song, Y., Vidal‐Alaball, J., & Liu, T. H. (2018). Oral vitamin B
12 versus intramuscular vitamin B 12 for vitamin B 12 deficiency. Cochrane
Database of Systematic Reviews, (3).