Give orally, subcutaneously, IM, or intranasally
Confirm gastric absorption of B12 via Schilling test (for oral dosing)
Most clients can absorb adequate amounts of vitamin B12 if large oral doses are given
Give oral forms with food to enhance absorption
Give intranasally or parenterally to clients who have malabsorption syndrome
Give intranasally 1 hr before or after clients eat hot foods to avoid removal from nasal passages before absorption
Obtain baseline vitamin B12, Hgb, Hct, RBC, and reticulocyte count. Monitor every 3 to 6 months thereafter
Expect lifelong treatment for clients who have irreversible B12 deficiencies, such as pernicious anemia, usually parenterally. With oral forms, high doses are essential
Encourage dietary intake of foods high in vitamin B12 (dairy products, enriched cereal, egg yolks, some seafood)
Obtain baseline blood pressure, CBC, Hgb, BUN, uric acid, phosphorus, potassium, creatinine, transferrin saturation, and ferritin concentration and monitor periodically; for HIV, obtain an erythropoietin level.
Make sure to control blood pressure for clients with chronic renal failure prior to starting drug therapy.
Administer IV or subcutaneously three times a week, or once a week with some types of chemotherapy.
Do not shake vials or mix with other drugs.
Use each vial for one dose only.
Check Hgb twice per week until adequate and then periodically.
Report Hgb that rises above 12 g/dL or increases more than 1g/dL within 2 weeks; for cancer clients, report Hgb that rises to 10 g/dL.
Monitor iron level and maintain it within the expected range, as adequate quantities of iron, folic acid, and vitamin B12 are essential for RBC growth.
Ferrous sulfate (Feosol)Liquid preparationsdilute in another compatible liquidgive through a strawrinse with waterSpread doses evenly across waking hours to maximize the production of RBCsGive the drug on an empty stomach for best absorptionMake sure clients do not crush or chew the sustained release formsExpect to discontinue the drug when anemia resolves (usually 1 to 2 months).Recommend foods high in iron (liver, egg, yolks, muscle meats, whole-grain cereals, leafy green vegetables).Ensure dose of selected preparation is adequate in regard to providing needed amount of elemental ironMonitor Hgb, Hct, and reticulocyte count
Iron dextran (INFeD)Give test dose first - follow with prescribed dose 1 hour later due to possibility of anaphylaxisHave epinephrine available for hypersensitivity reaction.Administer using 2- to 3-inch-long needle using Z-track technique.Give prescribed IV doses no faster than 50 mg/min or dilute the dose for intermittent infusion in 200 to 1,000 milliliters of 0.9% NaCl (normal saline) (NS) and infuse over 1 to 6 hr, depending upon concentration. Monitor blood pressure closely due to risk for hypotensionDo not take oral form of iron when receiving iron dextranMonitor Hgb, Hct, and reticulocyte count