Pernicious Anemia

A 45-year-old woman has been diagnosed with pernicious anemia 2 years after having gastric bypass surgery. She has not followed her prescribed post-surgery diet and medication regimen for 3 months because she thought she “was better” and didn’t need them any longer. Assessment reveals a tongue that is tender, beefy red, and shiny. She reports feeling overall weakness, tingling in her feet, and having no appetite.