A nurse is assessing a patient with suspected folate-deficiency anemia. Which assessment finding is most characteristic of this condition?
1Spoon-shaped fingernails (koilonychia)
2Smooth, red tongue (glossitis)✓ 정답
3Yellowing of the sclera (jaundice)
4Petechiae and bruising
해설
Glossitis is characteristic of folate-deficiency anemia due to impaired DNA synthesis in rapidly dividing oral mucosa cells. Other options are typical of iron-deficiency anemia (koilonychia), liver disease (jaundice), or thrombocytopenia (petechiae).
Clinical Judgment
This question assesses your ability to distinguish the characteristic findings of different causes of anemia. The key is the pathophysiological understanding that folate deficiency impairs DNA synthesis, disrupting the maturation of red blood cell precursors in the bone marrow. The most characteristic finding on a peripheral blood smear is the observation of megaloblastic red blood cells. The other options are findings seen in anemias from other causes, such as iron deficiency, sickle cell disease, and hereditary spherocytosis.
Memory Tip: Both folate deficiency and vitamin B12 deficiency cause Megaloblastic anemia. "Mega" means large, so the cells appear large (Macro). In contrast, iron deficiency makes cells appear small (Micro).
KR vs US: In Korea, the focus for the main causes of folate deficiency tends to be more on alcoholism, malabsorption, and medications (like methotrexate) rather than nutritional deficiency alone. The US NCLEX emphasizes a comprehensive assessment of various risk factors, including nutritional status, pregnancy, and alcohol intake.
Folate deficiency impairs DNA synthesis, primarily affecting rapidly dividing cells. The oral mucosa and hematopoietic system are most vulnerable, making glossitis a key physical finding.
Key Physical Findings
Oral Cavity: Inspect the tongue for a smooth, erythematous, and denuded dorsal surface (glossitis). The patient may report soreness or a burning sensation.
Skin and Nails: Pallor may be present due to anemia, but koilonychia (spoon nails) is absent. Jaundice is not a primary feature unless concurrent hemolysis exists.
Neurologic: Unlike vitamin B12 deficiency, folate deficiency typically does not cause peripheral neuropathy or subacute combined degeneration of the spinal cord.
Nursing Considerations
History: Assess for risk factors such as alcoholism, poor dietary intake, pregnancy, or medications like methotrexate.
Lab Correlation: Expect macrocytic anemia (elevated MCV) on CBC. Serum folate levels confirm the diagnosis.
Patient Education: Emphasize dietary sources of folate (leafy green vegetables, fortified grains) and the importance of adherence to supplementation.
Glossitis — Inflammation of the tongue characterized by a smooth, red, and often sore surface, resulting from atrophy of filiform papillae.
Koilonychia — Spoon-shaped fingernails, a classic sign of chronic iron-deficiency anemia due to impaired nail matrix keratinization.
Folate Deficiency Anemia — A megaloblastic anemia caused by insufficient folic acid, impairing DNA synthesis and rapid cell turnover in bone marrow and epithelium.
Megaloblastic Anemia — A type of anemia with large, abnormal red blood cell precursors caused by defective DNA synthesis, commonly due to folate or vitamin B12 deficiency.