Assessment

Patient is a 67 year old white female who presents with weakness and pain secondary to

Squamous Cell Carcinoma. . Patient shows signs of depression and is receiving Vitamin B-12. She is on

a regular diet and weighs 166 lbs and is 5’ 5” tall

Diagnosis

Deficient Knowledge (Vitamin B12), r/t the benefits of this medication AEB vitamin deficiency.

Psychomotor Domain: Patient will begin to eat more of the foods that contain Vitamin B12, i.e.;

yogurt, breakfast cereals.

Cognitive Domain: Patient will identify reasons for receiving this medication.

Affective Domain: Patient will verbalize feelings and concerns about this medication.

Planning

1) For Deficient Knowledge (Vitamin B12): After teaching, patient will know the benefits of

taking 1000 mcg of medication.

2) I will be using information from our Nursing Fundamentals Volume One and Two, Merck

Medicus, and Davis’s Drug Guide for Nurses.

3) Patient is experiencing pain so teaching plan will be done at least 30 minutes after pain meds

have been administered.

4) Environmental factors that could be a distraction would be nurses and/or physicians coming

to speak to the patient, family and/or friends coming to visit, and people walking and talking

throughout the halls. I will close the door to minimize noises and will make modifications as

needed if healthcare personnel or visitors should arrive.

Implementation

One of the eight B vitamins, vitamin B12 is an essential water soluble vitamin for humans. Only

produced by bacteria, humans must get this vitamin from food or supplements as it cannot be naturally

produced by the body. It is involved in the metabolism of every cell. Vitamin B12 primarily functions as

a regulator for normal brain and nervous system function as well as in the formation of blood.

Vitamin B12 Deficiencies:

Vitamin B12 deficiency is characterized by anemia, fatigue, weakness, constipation, loss of

appetite, and weight loss. Neurological changes, such as numbness and tingling in the hands and feet, can

also occur. Additional symptoms of vitamin B12 deficiency include difficulty maintaining balance,

depression, confusion, dementia, poor memory, and soreness of the mouth or tongue.

Benefits of Vitamin B12:

Vitamin B12 is known to keep your red blood cells healthy. If you eat enough foods that contain

this vitamin and if your body can use it properly, you can make nice, round, healthy red blood cells every

day. If you don’t eat enough or you can’t use it properly, you can’t make enough red blood cells and the

ones you do make are too large and fragile to work.

Side Effects:

Generally, B12 side effects are quite rare, however, there are reported cases of allergic reactions

to Vitamin B12 injections, but it is not known if these reactions are due to the B12 or the preservatives

that are used to make the B12 injections.

Mild Diarrhea

Anxiety & Panic Attacks

Heart Palpitations

Insomnia

Breathing Problems

Chest Pain

Skin rash, hives, or itchy skin

Here is a list of foods that are enriched with Vitamin B12:

Mollusks, clam, mixed species, cooked 84.1

Liver, beef, braised47.9

Calves liver

Fortified breakfast cereals, (100% fortified) 6.0

Trout, rainbow, wild, cooked5.4

Salmon, sockeye, cooke4.9

Trout, rainbow, farmed 4.2

Snapper, baked

Venison

Salmon, Chinook

Beef, tenderloin

Lamb, roasted

Beef, top sirloin, lean, choice, broiled 2.4

Scallops

Fast Food, Cheeseburger, regular, double patty & bun 1.9

Shrimp, mixed species, steamed/boiled

Fast Food, Taco 1.6

Halibut, baked/broiled

Fortified breakfast cereals (25% fortified).5

Yogurt, plain, skim.4

Haddock, cooked 1.2

Cod, Pacific, fillet, baked/broiled

Clams 1.1

Tuna, white, canned in water, drained

Milk

Milk, 2%

Pork, cured, ham, lean only, canned, roasted 0.6

Egg, whole, hard boiled.6

American pasteurized cheese food3

Chicken, breast, meat only, roasted

Evaluation

At the start of my patient teaching, the door was closed and my patient was sitting up in

bed in a comfortable position. I proceeded to teach the patient about the reason why Vitamin

B12 (1000 mcg) had been prescribed, the benefits of taking B12, the deficiencies that occur, and

about the foods she could add to her diet to increase her intake of B12.

Upon finishing the patient teaching, the patient wanted to know if she would have to take

these injections for the rest of her life and if she could be taught to self-inject.

All goals were met:

The patient verbalized her feelings about this medication.

The patient began eating more of the foods that contain B12 in them.

The patient was able to identify the reasons for taking this medication.

Next time I will speak slower and try not to look at my paper as often as I did.