(^184) Medical-Surgical Nursing Demystified
PROGNOSIS
Ongoing replacement of vitamin B 12 is necessary to correct the deficit and allevi-
ate symptoms that may have developed. Without treatment, the neurologic effects
will continue, ultimately leading to dementia.
HALLMARK SIGNS AND SYMPTOMS
- Pallor due to anemia
- Weakness and fatigue due to anemia
- Tingling in hands and feet—“stocking-glove paresthesia”—due to bilateral
demyelination of dorsal and lateral columns of spinal cord nerves - Diminished vibratory and position sense
- Poor balance due to effect on cerebral function
- Dementia appears later in the disease
- Atrophic glossitis—beefy red tongue
- Nausea may lead to anorexia and weight loss
- Premature graying of hair
INTERPRETING TEST RESULTS
- Decreased hemoglobin due to decreased production of RBCs.
- Increased MCV—macrocytic anemia.
- Positive Schilling test due to decrease in intrinsic factor.
- Decreased amount of hydrochloric acid in the stomach (hypochlorhydria)
due to changes within the parietal cells of the gastric mucosa. - Postitive Romberg test due to ataxia and neurologic changes.
- Diminished sensation when testing for vibration, position sense, or propio-
ception of extremities.
TREATMENT
Lifelong replacement with vitamin B 12 will correct the anemia and improve the neu-
rologic changes that have occurred. Initially the patient is given weekly injections of