A. Description 说明
1. A macrocytic anemia that results from an inadequate intake of vitamin B or lack of absorption of ingested vitamin B from the intestinal tract.
为大细胞性贫血，源于维生素B摄入不足或肠道摄入的维生素B吸收缺乏
2. Pernicious anemia results from a deficiency of intrinsic factor (normally secreted by the gastric mucosa), necessary for intestinal absorption of vitamin B12; gastric disease or surgery can result in a lack of intrinsic factor.
恶性贫血源于内因子（正常由胃粘膜分泌）缺乏，内因子是肠道吸收维生素B12所必需的；胃病或胃手术导致内因子缺乏。
B. Assessment 评估
1. Severe pallor 苍白严重
2. Fatigue 疲劳
3. Weight loss 体重减轻
4. Smooth, beefy red tongue
光滑牛肉样红舌头
5. Slight jaundice 轻微黄疸
6. Paresthesias of the hands and feet
手、脚感觉异常
7. Disturbances with gait and balance
步态、平衡失调
C. Interventions 措施
1. Increase dietary intake of foods rich in vitamin B12, such as citrus fruits, dried beans, green leafy vegetables, liver, nuts, organ meats, and brewer's yeast if the anemia is a result of a dietary deficiency.
若贫血是由饮食不足引起，则增加富含维生素B12的食物的摄入，如柑桔、成熟菜豆、绿叶蔬菜、肝、坚果、器官肉、布鲁尔酵母。
2. Administer vitamin B12 injections as prescribed, weekly initially and then monthly for maintenance (lifelong) if the anemia is the result of a deficiency of intrinsic factor or disease or surgery of the ileum.
若贫血是由内因子不足或回肠疾病或手术引起，则按处方注射维生素B12，最初每周一次，然后每月一次维持（终身）
II. Folate Deficiency Anemia 叶酸缺乏性贫血
A. Description 说明
1. A macrocytic anemia in which red blood cells are larger than normal and are oval-shaped rather than round-shaped due to the lack of inadequate intake of folate (vitamin B9).
为大细胞性贫血，此病红血细胞大于正常，为椭圆形而非圆形，原因是缺乏足够的叶酸摄入（维生素B9）。
2. Folic acid is required for DNA synthesis required for red blood cell formation and maturation.
红血细胞生成和成熟所需的DNA合成需要叶酸。
3. Common causes include dietary deficiency; malabsorption syndromes such as Celiac disease, Crohn's disease, or small bowel resection; medications (such as antiseizure medications) that decrease the absorption of folic acid, a condition (including pregnancy) that increases the requirement of folic acid; chronic alcoholism; and chronic hemodialysis.
常见原因包括饮食性缺乏；吸收不良综合征，如乳糜泻，克罗恩病、或小肠切除；减少叶酸吸收的药物（如抗癫痫药）；增加叶酸需求的情况（包括妊娠）；慢性酒精中毒；长期血液透析。
B. Assessment评估
1. Dyspepsia 消化不良
2. Smooth, beefy red tongue
平滑、牛肉样红舌头
3. Pallor, fatigue and weakness
苍白、疲劳、虚弱
4. Tinnitus 耳鸣
5. Tachycardia 心动过速
C. Interventions 措施
1. Encourage the client to eat foods rich in folic acid, such as green leafy vegetables, meat, liver, fish, legumes, peanuts, orange juice, and avocado.
鼓励患者食用富含叶酸的食物，如绿叶蔬菜、肉、肝、鱼、豆类、桔子汁、油梨
2. Administer folic acid as prescribed.
按处方使用叶酸。
★Vocabulary for Today ★
macrocytic – a. 大红细胞的
macrocytic anemia --大细胞性贫血
pernicious – a. 恶性的，致使的
pernicious anemia – 恶性贫血
intrinsic – a. 内在的，本质的，原有的
intrinsic factor – 内因子
jaundice – n. 黄疸
paresthesia – n. 感觉异常
gait – n. 步态
Brewer's yeast -- 布鲁尔酵母
folate – n. 叶酸
Celiac disease – 乳糜泻
Crohn's disease –克罗恩病
alcoholism – n. 酒精中毒
dyspepsia – n. 消化不良
tinnitus – n. 耳鸣
1. The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply.
A. Nuts
B. Corn
C. Liver
D. Apples
E. Lentils
F. Bananas
2. The nurse is instructing a client with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the client?
A. Administer the iron at mealtimes.
B. Administer the iron through a straw.
C. Mix the iron with cereal to administer.
D. Add the iron to apple juice for easy administration.
1. A, C, E Rationale: Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb vitamin B12, leading to development of pernicious anemia. Clients must increase their intake of vitamin B12 by increasing consumption of foods rich in this vitamin, such as nuts, organ meats, dried beans, citrus fruits, green leafy vegetables, and yeast. 2. B: Administer the iron through a straw. Rationale: In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth, because the iron stains the teeth. The client should be instructed to brush or wipe their teeth after administration. Iron is administered between meals, because absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not mixed with cereal or other food items.
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