Jill (not her real name) is a 24 year old female who was sexually abused from age 10 by her father and was taken into care at age 14 when her behaviour became unmanageable in the home setting. When Jill was taken into care the abuse was disclosed. Jill has two older siblings, both female, neither of which suffered abuse, both have IQ’s appropriate their age and development. Jill has been assessed as having a mild learning disability. A mild learning disability as defined by British Institute of Learning Disabilities (BILD) 2004, is a person with an IQ of between 69 and 50.

The World Health Organisation (WHO) defines learning disabilities as ‘a state of arrested or incomplete development of mind’. Somebody with a learning disability is said also to have ‘significant impairment of intellectual functioning’ and ‘significant impairment of adaptive/social functioning’. Jill was admitted to this service provider due to her challenging behaviour and is detained under section 3 of the mental health act 1983. Challenging behaviour has been defined as culturally abnormal behaviours of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities (Emerson 2001). Jill’s challenging behaviours include physical and verbal aggression towards her peers and carers, destruction of property including her own, stripping and destruction of her clothes, refusal to engage in therapeutic interventions and self injurious behaviours (SIB) mainly cutting of her arms.

Jill is 5ft 7inches tall and weighs 17st 3lb with a Body Mass Index (BMI) of 43.11 making her clinically obese, Jill’s BMI should be between 18.5 and 24.9 meaning she would need to lose 11st to bring her within the recommended BMI range. Jill has recently been diagnosed with type 2 Diabetes, currently controlled with medication, Metaphormine. Type 2 diabetes, (formerly referred to as non-insulin-dependent diabetes (NIDDM)), is due to reduced secretion of insulin or to peripheral resistance to the action of insulin or to a combination of both, British National Formulary (BNF). Jill is also asthmatic.

The nursing assessment process consists of four key elements Assessment, Planning, Implementation and Evaluation (APIE) Brooker & Nichol, 2003. A comprehensive assessment provides a basis from which to make planning decisions, as well as providing a baseline from which to measure the impact of any service provided, Gates (2008). The team used a holistic approach in the assessment of Jill, addressing her spiritual, physical, emotional, psychological and sociocultural needs. For assessment to be comprehensive, it should be undertaken in a holistic manner, Fawcett (2000), cited by Brooker, C (2007) p. 351.

In the case of Jill it was decided to focus on weight loss through diet and exercise as this would have the biggest impact on improving her health and wellbeing. “Health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, World Health Organisation (WHO)

The nursing team used the Prochaska, Norcross & Di Clemente Thranstheoretical health belief Model, 1994 (TTM). The model provides health professionals and support staff with a clear plan for working with individuals encouraging change, promote and adopt a healthy lifestyle. The TTM focuses on behaviour change, and assesses an individual’s readiness to act on a new healthier behaviour, it provides strategies, or processes of change to guide the individual through the stages of change. The TTM is comprised of six stages. Pre-contemplation, not currently considering change or unaware a problem exists. Meetings were held with Jill to address her obesity and explain the risk of not changing her life style. Jill was informed of the problems that were arising from her being overweight, diabetes, heart disease and high blood pressure and the risk of stroke, reduced mobility. This was communicated to her in a sensitive way and in a format she could easily understand. Effective communication of information is essential to ensure maximum effectiveness. Complicated health promotion images may be incomprehensible to a person who struggles with concepts. Health promotion messages that focus on giving up existing behaviours may unintentionally imply that to be healthy is to adopt a miserable and undesirable lifestyle. Care should be taken to ensure that people with learning disabilities understand health promotion messages in a balanced way Gates 2007. Jill was encouraged to re-evaluate her current unhealthy behaviour and the multiple benefits she would gain in changing her lifestyle. Jill then entered the Contemplation stage when she started to think about the changes she needed to make to become healthier. Jill was provi The nurse has a responsibility to promote health

This process is supported by a nursing model to produce a care plan, which can be evaluated and changed when necessary to suit the patient’s needs. The model used by this private care provider is the S.H.A.R.E.D Approach model (Supportive Help Achieving Realistic Effective Development). The model incorporates many other models of care, using holistic/humanistic approaches, social learning theory, behaviour profiles and other associated psychological therapies, utilising the Care Programme Approach and Person Centred Planning to best fit the service user, adapted from the La Vinga (1989) model. The service provider has developed this model and created tools in line with the requirements of the service and pursuing up to date clinical and social validity and has a bias towards addressing challenging behaviours. In assessing the patient the nurse should use a holistic approach working in partnership with the individual. Roper et al 2000, cited by Brooker & Waugh 2007, p360 states that the nurse should use the Activities of Living (ALs) approach to systematically assess the person. Roper et al 2000 suggests there are 12 activities essential for survival. Breathing, communicating, eating and drinking, eliminating, mobilizing, sleeping, personal cleansing and dressing, working and playing, controlling body temperature, expressing sexuality, maintaining a safe environment and dying.

Roper et al 2000 goes on to state there are 5 main factors that can influence ALs that need to be considered when carrying out an assessment, biological, psychological, sociocultural, environmental and politico-economic. Biological factors relate to physical and psychological issues and are usually genetic but may be the result of disease or neglect

The Planning stage based on the assessment identifies the problems and needs of the patient. Nursing diagnoses provide a focus for planning and implementing effective and evidence-based care Dougherty & Lister 2008. Goals should be incorporated into the plan to enable the nurse to measure the effectiveness or otherwise of the nursing intervention. Goals should be SMART, Specific stating clearly what is to be achieved, Measurable, Achievable, Realistic, and time oriented by which the goal can be achieved and evaluated Brooker & Waugh 2007.

The implementation stage is putting the care plan into operation and may involve referring the patient to another health care professional.

Evaluation

Abstract

TB or Tuberculosis being a bacterial disease is highly infectious but it has its cures and measures. The disease is a major point of concern in South Africa, especially in the areas of Western Cape. It is so common among them that one out of ten people develop this disease and if not treated in a timely and effective manner the infected person can affect 20 other people or more in a year. According to the World Health Organization’s (WHO’s) Global TB Report 2009, South Africa ranks fifth among the 22 high-burden tuberculosis (TB) countries. South Africa had almost 460,000 new TB cases in 2007, with a frequency rate of a projected 948 cases per 100,000 population – a major raise from 338 cases per 100,000 population in 1998. (Source, (World Health Organization Statistics, 2009).

A Synopsis of TB

Tuberculosis being a bacterial disease is caused by micro-organism, a bacilli scientifically, Mycobacterium tuberculosis which enters the body by inhaling through the lungs. From where they can spread to other parts of the body through the blood, lymphatic system via airways or by direct transfer to other body organs. It develops in the body in two stages: Tuberculosis infection in which an individual breathes in the TB bacilli and becomes infected but the infection is contained by the immune system. The other stage is when the infected individual develops the disease himself.

Out of those people who do become infected, most will never develop the disease unless their immune system is seriously damaged for instance by stress, HIV, cancer, diabetes or malnutrition. The bacteria remains dormant within the body if the patient is BCG injected. BCG immunization at the time of birth provides up to 80% protection against the progression TB infection to take form of a disease. A basic sign of TB is consistent cough of two weeks, so the earlier the patient goes to the clinic to get a check up, the more curable it is. Other severe signs are bleeding in cough, night sweating, weight-loss and short-breathing.

TB in South Africa

Africa and southern Africa

In their 1997 reports on the tuberculosis epidemic and on anti-tuberculosis drug resistance in the world, the WHO paints a bleak picture of the global failure of health service providers to deal with the burden of tuberculosis. In the 216 reporting member countries of the WHO, representing a total population of 5,72 billion, there were an estimated 7,4 million new cases of tuberculosis in 1995. This represents a rate of 130 cases among every 100 000 persons.

In Africa the case rate is 216 per 100 000. The 11 countries of the Southern Africa subregion contribute approximately 275 000 cases every year to the total case load in Africa. Almost half of these come from South Africa. In an analysis of tuberculosis trends and the impact of HIV infection on the situation in the subregion, it is estimated that by 2001 the smear positive case rate would have increased from 198 per 100 000 population for the region as a whole, to 681 per 100 000 if tuberculosis control efforts are not optimised. To aggravate the situation, 69% of these cases would be directly attributable to HIV infection.1

A serious complication of the tuberculosis problem in Southern Africa has been the emergence of multi-drug resistant (MDR) strains of the organism causing the disease. Patients infected with MDR require prolonged chemotherapy with very expensive medication which will at best cure only half of them. Such treatments cost at least 100 times as much as the cost of curing an ordinary tuberculosis patient infected with drug-sensitive bacteria. Very few countries can afford this additional burden.

In order to determine the magnitude of the MDR problem in Southern Africa, and the implication for National Tuberculosis Programmes (NTP’s), surveys are being conducted in various countries as part of the activities of the WHO/IUATLD Global Working Group on Tuberculosis Drug Resistance Surveillance. So far, information is available for four countries in southern Africa: Botswana, Lesotho, South Africa, and Swaziland.

Results confirmed that initial resistance to first-line drugs is relatively low in southern Africa compared to some other regions in Africa and Asia where the problem is up to 5 times more common. Resistance rates range between 4% and 12% for isoniazid, and between 4% and 7% for streptomycin. For rifampicin it is 1% and for ethambutol 1%; MDR is fortunately still low at 1%, indicating that resistance strains are not commonly transmitted from person to person. On the other hand, rates for acquired resistance, that is resistance which has arisen in patients previously inadequately treated for tuberculosis, are at least three times higher than in patients not previously exposed to anti-TB medications. The high rates of acquired resistance point to a failure of control programmes to effectively manage case-holding and treatment adherence.

TB Treatment

The full course treatment time can stretch up to eight months with consistency as a major factor. People who stop treatment develop a multi-drug resistance which makes the disease more complicated. TB can prove fatal if not treated.

The treatment is in two phases:

The intensive phase consists of taking four different drugs for five days a week, for two to three months.

The continuation phase consists of taking two drugs for five days a week for four to five months.

Sputum tests are regularly taken every two months for keeping a check on the progress.

DOTS

The Department of Health in South Africa has implemented the World Health Organizations’ DOTS (directly observed treatment short course) technique to make sure patients adhere to treatment. DOTS have been implemented in a good number of clinics in the Western Cape. An essential element of the strategy is the support and back-up offered to TB patients for the entire six to eight-month treatment phase, where they are directly observed taking their medication at the clinic.

The DOTS strategy is embedded in the following principles.

Government Commitment

The support of the national and provincial Heads of the Department of Health has significantly helped

South Africa to implement the DOTS strategy. This support is essential because DOTS requires

significant changes of approach and tends to challenge old practices. Although the strategy offers

the least expensive way of tackling TB, often it requires substantial redirection of funds and this

cannot happen without the political commitment and support of key decision makers.

Directly Observed Treatment Short-course as a global initiative, is a breakthrough that is increasingly

providing solutions to the control of the TB epidemic in South Africa. However, it is a new strategy

and as such may seem at first complicated and confusing. This merely shows the need to effectively

and adequately reorientate our resources and train health staff and treatment supporters to this

strategy. This means that each one of us from all sectors has a major role to play. TB is everywhere

and as such effective TB control should be practised everywhere. Good TB control is part of good

district development.

2.2 Identifying Infectious Patients

TB is a bacterial disease and bacterial tools should be used to manage it. The TB Control programme

is moving away from chest x-rays as a primary method of diagnosis. A crucial element of

DOTS is to use microscopes to ensure that infectious TB is reliably and cost -effectively diagnosed.

The first priority and the key issue in the new programme is to cure infectious patients at the very first

attempt to slow down the epidemic.

The over use of x -rays is discouraged as the primary means to confirm the diagnosis of TB because

it does not tell whether a patient is infectious, and it is difficult to distinguish between active TB and

other lung diseases or scarring. This leads to over diagnosis so that health workers could be treating

many patients that do not have active TB and are not sick with TB. More importantly, the TB epidemic

in South Africa is approaching uncontrollable levels and energies should be concentrated on curing

infectious TB patients to stop the spread of this disease. Only bacteriology identifies infectious

patients.

2.3 Direct Observation of Treatment

The implementation of DOTS ensures that every TB patient should have the support of another

person to ensure that they swallow their medication daily. The treatment supporter does not have to

be a professional health worker, but can be any responsible member of the community. Employers,

colleagues and community members can act as treatment supporters. Using family members is often

problematic but has been successful in exceptional cases. This person should know the signs and

symptoms of TB, side effects of TB drugs and the importance of taking TB medication regularly for

the patient. They should also motivate and empower patients and their families and provide them

with a better understanding of TB and the importance of cure.

Treatment supporters are best recruited as part of a community based system which is reviewed

annually and its results documented. Treatment supporters should work closely with local health

authorities.

Because of the length of time, the patient has to take treatment, completing TB treatment is a special

challenge and requires an unyielding sense of commitment. This may be easy to sustain while the

patient feels sick. However, after a few weeks of taking treatment, patients often feel better and see

no reason for continuing their treatment. It is thus essential for health workers or treatment supporters

to be supportive and use the initial period to bond with the patient. This will enable them to build

a strong relationship in which the patient believes and trusts advice given by the treatment supporter.

2.4 Standardized Drug Combinations

A daily dose of a powerful combination of medications is administered to TB patients for five days a

week. Combination tablets simplify treatment and ensure that drugs are not given separately and

therefore decrease the risk of drug resistance.

2.5 Reliable Reporting System

A reliable recording and reporting system is necessary in order to monitor progress. Sputum results

should also be recorded to document smear conversion. This gives an accurate measurement of

performance and one can identify areas which need support.

The First Step to Filling the Country with DOTS:

Setting up Demonstration and Training Districts (DTDs) in 1997 was one of the first crucial steps in

the implementation of the DOTS strategy. In South Africa at least one Demonstration and Training

area was identified in each province where all the elements of DOTS would be adopted in the management

of TB services. Initially these areas would receive the necessary resources and support to

ensure that they function well. When these districts demonstrate success in implementing DOTS

they can be used as examples and training points to expand DOTS provincially and country-wide.

Major Barriers

Everyday TB kills nearly 5000 people, which is one person every 20 seconds. (WHO, Global TB Report, 2009). There is a presence of numerous barriers while accessing TB care especially in the poor communities:

Economic Barriers – Delay in seeking health care occurs due to lack of money for transport plus the time lost working.

Socio-cultural Barriers – Lack of awareness and stigma about TB.

Geographical Barriers – Long distances from health care facilities and TB diagnosis and treatment centers.

Health System Barriers – Delays in diagnosis as a result of knowledge lapse among health care workers.

The ever existing barriers to the success of the targets involve overlooking of TB control by government, lack of monetary and human resources to provide regulation and quality control, weak and stigma health systems, poorly managed TB control health centers, poverty in majority of communities, population escalation and a significant boost in drug-resistant TB (particularly MDR-TB) and the recent, extensively drug-resistant TB (XDR-TB). Lack of new diagnostic tools has impeded progress in TB control programs. Perhaps the greatest challenge to achieving the TB targets, however, has been the ever-growing HIV outbreak and the resultant increase in HIV-associated TB.

A regional emergency was once declared in the large parts of this region due to unrestrained epidemic of HIV-associated TB. The start of such an epidemic as the TB/HIV one has seriously compromised even historically firm national TB programs working globally. TB programs are weighed down by this increasing volume of HIV-associated TB cases and by the necessity to manage cases and ensure treatment completion. in addition, TB is the leading source of death among HIV-infected persons, and HIV is the strongest forecast of progression from dormant TB infection to active disease. Thus, TB programs that were almost up to the mark by WHA-set global TB targets have seen their treatment and completion rates plummet.

The TB/HIV combination has also had a remarkable impact on human resources. In a labor force that has remained the same or shrinked, the increased overall number of TB patients has damaged TB programs’ infrastructure and amplified poor TB results such as treatment default, death and the emergence of XDR-TB. The HIV-associated TB epidemic has led to an escalating rate of smear-negative and extra pulmonary TB; these forms of TB do not add to the case-detection targets and are more difficult to identify. Moreover, smear-negative TB has a worse prediction than smear-positive TB amongst those who are also HIV-infected.

TB and HIV

The HIV outbreak has led to a massive increase in the number of fatal TB cases. TB is not accountable for a third of all deaths in HIV infected people. People with HIV are far more vulnerable to TB infection, and are not as much able to fight it off. Recent studies by Wood, (2007) in a region with an approximate HIV prevalence of about 20% in Cape Town, calculated that the pulmonary TB-warning rate among HIV-infected persons in that area amounted to 5,140 cases per 100,000; and that the rate amongst HIV-uninfected individuals in the same area was 953 cases per 100,000. Using these statistics, the determinable fraction for TB among HIV-infected individuals in that area aggregated to 82 percent.

Conclusion & Recommendations

The overall purpose of the project is to identify risk factors and make appropriate recommendations based both on the available evidence and the studies that stem from this project. As such, recommendations are structured in terms of the conceptual framework of this document. Nevertheless, the existing evidence from current data and literature reviews allows us to pinpoint areas where interventions are clearly required. On these grounds, we can make certain recommendations.

Introduce epidemiologically-led behavioural interventions

Reference has been made to the heterogeneity in HIV prevalence in the province (Shaikh et al, 2006). This unevenness is also apparent in the provincial TB profile. It is therefore important to identify the geographical focal points for interventions according to this disease distribution that has been identified by routine surveillance. Populations at high risk for infection may be identified according to geographical area, as well as according to other demographic factors such as age, sex and socio-economic status. By raising awareness in populations at high risk and targeting specific high risk behaviors, interventions will be more effective in lowering the incidence of new infections.

Target hotspots first

Once populations at risk have been identified, geographically discrete regions should be selected for resource allocation and focused interventions. An implementation of interventions based on the known and expected burden of disease will prioritise the roll out of a prevention strategy. Prevention efforts that address HIV infection should identify areas and populations where there are certain risk factors and areas of high HIV prevalence must apply concentrated intervention of TB programmes.

Identify and manage at-risk groups earlier

Behavioural and communication strategies for highest risk groups must be pro-active in their efforts, and target the false sense of security that exists regarding the risk of HIV infection. At-risk populations should include vulnerable groups such as women, and also specific groups such as prisoners, commercial sex workers, mobile persons and labour migrants. Awareness of the risk of TB among HIV infected people must be raised both in communities and within the health service.

Integrate prevention and treatment

While evaluating the effectiveness of prevention programmes within an epidemiological context, the potential future impact of treatment of both HIV/AIDS and TB needs to be examined.

Adapt relevant public services

Goal-directed partnerships between social-cluster group departments should be actively pursued. Resource allocation must be rationalised within a broader spectrum than only the health services. The high burden of TB must be taken into account in this process, and be assigned equal importance as the efforts against the spread of HIV. In addition to intersectoral collaboration towards intervention for both these infectious diseases, more effort must be made to integrate the management of HIV/AIDS with TB.

.

Omega-3 (linolenic acid) is a type of essential polyunsaturated fat. Like the omega-6 fatty acids are unsaturated because it contains in its molecule double bonds between carbon atoms and are essential (EFA) because the body can not produce it and therefore must be obtained through food. There are three omega -3 fatty acids: Alpha-linolenic, Eicosapentaenoic acid and Docosahexaenoic acid.

These essential fatty acids can be obtained from the following sources: The Blue Fish, Food Plant: The purslane, lettuce, soy, spinach, strawberries, cucumbers, Brussels sprouts, cabbages, pineapples, Almonds and Walnuts.

The body needs omega-3 fatty acid to work properly. The main functions of linolenic acid include: The formation of cell membranes, the formation of hormones, the immune system to functioning correctly, the correct formation of the retina, the functioning of neurons and chemical transmissions.

Besides the basic functions, there is evidence that ingestion of omega-3 fatty acids represents a number of benefits for the body. Beneficial effects on the circulatory system, the intake of linolenic acid-rich foods or supplements that contain this principle lowers triglycerides, lowers cholesterol, prevents blood clots in the arteries by preventing platelet aggregation and arterial pressure decreases slightly. In general thins blood and protects against heart attacks, strokes, stroke, angina pectoris, Raynaud’s disease, etc. Moreover, the cardioprotective role is further enhanced by the ability of these oils to increase the transmission power of the heart muscle as rhythm regular and prevent disease and arrhythmias. This component protects against the development of certain cancers like colon, prostate and breast cancer. They can also prevent the growth of cancer cells. In breast cancer these acids inhibit the action of estrogens that are responsible for the development of breast tumors.

There is evidence that omega-3 has anti-inflammatory joint diseases. Therefore food or supplements especially can be very appropriate to reduce swelling and relieve pain in diseases such as rheumatoid arthritis, psoriasis and lupus. The use of supplements containing omega-3 may be a natural alternative to conventional treatment for rheumatoid arthritis. It appears that this component increases the levels of PG3 prostaglandins have anti-inflammatory properties. Inflammatory properties of omega-3 can be used for the treatment of inflammatory bowel disease Crohn’s disease or ulcerative colitis.

 In the same way can help reduce the pain caused by menstruation. The intake of these acids can help maintain mental balance and avoid depression or to improve or assist in the treatment of diseases such as schizophrenia. These acids have a positive action in the maintenance of healthy skin, making them suitable for preventing or ameliorating diseases affecting this organ, such as eczema, psoriasis, etc., Intake of foods rich in omega-3 is very appropriate during pregnancy to ensure that the fetus has a right brain development. Mothers who eat foods with these components have had children with a higher learning capacity and less impaired. Similarly it has been shown that omega-3 favored the motor coordination of premature babies.

2. The client brings the results of recent cholesterol screening with him to see the nurse. The client is confused about what the results mean and asks what the total cholesterol number should be. Which of the following statements could the nurse make about interpreting the results of the cholesterol screening test?

a.

Total blood cholesterol should not exceed 150 mg/dl

c.

Total cholesterol should not exceed 150 mg/ml

b.

Total cholesterol should not exceed 200 mg/dl

d.

Total cholesterol should not exceed 200 mg/ml

Answer: b) Total cholesterol should not exceed 200 mg/dl

3. The nurse is teaching a group of clients in a cardiac rehabilitation class about food sources of proteins. In what foods will the nurse say protein is found?

a.

in foods derived from both plant and animal foods

c.

only in foods derived from plants

b.

only in foods derived from animals

d.

only in fortified foods

Answer: a) in food derived from both plant and animal foods.

4. The school nurse is making a presentation to parents of teenage students. One parent is concerned that their child is not getting adequate high quality dietary protein because the child has stopped eating meat. The nurse tells the parent that certain diets that do not contain meat can still provide adequate protein. Which of the following statements could the nurse make about vegetarian diets and protein?

a.

all vegetarian diets deliver adequate high quality dietary protein

c.

lacto-ovo vegetarian diets deliver adequate high quality dietary protein

b.

fruitarian diets deliver adequate high quality dietary protein

d.

vegan diets deliver adequate high quality dietary protein

Answer: d) Vegan diets deliver adequate high quality dietary protein.

Explain why.

Get adequate protein on a vegan diet presents no problem at all. Both nuts and seeds such as legumes, whole grains and soy products provide protein. Previously it was believed that plant proteins were of lower quality than animal proteins in which amino acid content is concerned. However, this belief has become outdated and that if you follow a diet based on balanced vegetable products, will receive all the necessary amino acids in adequate amounts. The vegan diet has several incomplete proteins to make a complete one, but that should be eaten the same day, the essential amino acids can also be found in soy products and tofu.

5. A pregnant client tells the nurse that she is taking megadoses of vitamin A in the hopes that it will keep her complexion clear throughout the pregnancy. What could the nurse say about the client’s use of this vitamin supplement?

a.

Consuming megadoses of vitamin A may cause permanent night blindness.

c.

Taking megadoses of vitamin A are a good idea during pregnancy because vitamin A supports a healthy immune system.

b.

Consuming megadoses of vitamin A may result in birth defects.

d.

Taking megadoses of vitamin A will neither help nor hurt her or the fetus during the pregnancy.

Answer: b) Consuming megadose of vitamin A may result in birth defect.

Explain your answer.

Birth defects can occur if the supplement that has high doses of retinol ingested for a while, several days or weeks and especially during the first trimester of pregnancy.

Vitamin A is an essential micronutrient for growth of the human body, the tissue tropism of epithelial organogenesis, epithelial differentiation and embryonic development. Intake, acute or chronic high amounts of vitamin A can cause various clinical manifestations such as headache, vomiting, diplopia, alopecia, dry mucous membranes, skin peeling, bone abnormalities and liver damage.

Vitamin A and retinoids are teratogens classics. Malformations that are generated depend on the doses used and timing of organogenesis in which they are provided. During early organogenesis result in abnormalities of the central nervous and cardiovascular system, while a later provision gives rise to genetic defects in the upper and lower genitourinary tract and palate. Retinoids derived from the catabolism of vitamin A mother’s diet are transferred to the embryo-fetal compartment.

6. A family member of an elderly client contacts the nurse and asks why the client is receiving B12 injections. Which of the following answers could the nurse give?

a.

The injections of B12 are given to prevent blindness.

c.

The injections of B12 are given to prevent pellagra

b.

The injections of B12 are given to prevent beriberi

d.

The injections of B12 are given to prevent pernicious anemia

Answer: d the injections of B12 are given to prevent pernicious anemia

Explain why.

Pernicious anemia is a decrease in red blood cells that occurs when the body can not properly absorb vitamin B12 from the digestive tract. This vitamin is necessary for the proper development of red blood cells. The body needs vitamin B12 to produce red blood cells. In order to provide vitamin B12 in their cells, you should eat enough foods that contain this vitamin, such as beef, poultry, seafood, eggs and dairy products (AC Antony, 2008).

To absorb vitamin B12, your body uses a special protein called intrinsic factor, secreted by cells in the stomach. The combination of vitamin B12 attached to intrinsic factor is absorbed in the latter part of the small intestine. When the stomach does not produce enough intrinsic factor, the intestine can not absorb the vitamin properly. The disease begins slowly and may take decades to fully establish. Although the congenital form occurs in children, pernicious anemia usually does not occur before age 30 in adults and the average age at diagnosis is 60 years. Monthly injections of vitamin B12 are prescribed to correct the deficiency of the vitamin. This therapy treats the anemia and may correct the neurological complications if taken soon enough. In people with a severe deficiency, injections are given more frequently at first( Medlineplus).