ANSWER
Hemopoietic Case Study: J.D.’s Risk of Iron Deficiency Anaemia Contributing Factors
J.D. runs the danger of iron deficient anaemia from a number of contributory causes:
Menorrhagia, or heavy menstrual bleeding, affects J.D.; her six-day cycles have strong flow and cramps. Heavy menstruation causes chronic blood loss that depletes the body’s iron reserves and results in iron deficiency anaemia (Bergman et al., 2020).
J.D. is a G5P5 woman; her most recent pregnancy ended four months ago. Because of the higher blood volume and foetal iron needs, pregnancy raises the body’s iron need. She could develop iron deficiency anaemia (Verma & Chhabra, 2020) without enough post-pregnancy iron supplementation.
To control osteoarthritis pain, J.D. has been daily high dosage ibuprofen user for almost 2.5 years. Ibuprofen used long-term can cause gastrointestinal bleeding, which increases iron loss and raises her anaemia risk (Bergman et al., 2020).
J.D. avoids gastrointestinal bleeding brought on by ibuprofen by using the proton pump inhibitor omeprazole. Omeprazole lowers stomach acid, though, which is required for iron from food to be absorbed. This can reduce iron absorption, therefore increasing the chance of iron shortage (Tandon et al., 2020).
Constipation and Dehydration: J.D.’s causes
Several elements in J.D.’s situation could help to explain her constipation and dehydration:
An NSAID, ibuprofen is known to lower gastrointestinal motility and might cause constipation. Furthermore upsetting regular bowel activity and causing stomach pain, the medication can also be (Furman et al., 2020).
Using diuretics to control her hypertension, J.D. raises urine output and runs the danger of dehydration. Consistent with constipation, dehydration can impede bowel motions (Tandon et al., 2020).
J.D. might not be getting enough fluids given her other health problems and symptoms of tiredness, which would promote dehydration and subsequently constipation.
Value of Folic Acid and Vitamin B12 in Erythropoiesis
Production of red blood cells, or erythropoiesis, depends critically on vitamin B12 and folic acid. Both vitamins help red blood cells mature and synthesise DNA:
Megaloblastic anemia—where the generated red blood cells are big, immature, and poor at oxygen transportation—results from a vitamin B12 shortage. Fading tiredness, weakness, and neurological problems follow from this (Lutz, 2019).
Similarly, a folic acid deficit results in megaloblastic anaemia and reduces red blood cell synthesis, producing red blood cells less efficient in oxygen transport (Hernandez et al., 2020).
Clinical J.D. Iron Deficiency Anaemia Symptoms
Should J.D. have iron deficiency anaemia, she most certainly would show with the following:
Because iron deficiency anaemia reduces the ability to transfer oxygen throughout the body, frequent symptoms include fatigue and weakness (Lutz, 2019).
J.D. can seem pale since his red blood cells count is low (Hernandez et al., 2020).
J.D. may have lightheadedness or dizziness from the absence of haemoglobin to carry oxygen to tissues, particularly when getting up fast.
Anaemia sometimes results in impaired circulation, which would produce freezing hands and feet.
Reduced oxygen delivery to the body can cause shortness of breath, particularly in vigourous exercise.
symptoms of iron deficiency anaemia
The lab findings of J.D. show unequivocally signs of iron deficient anaemia:
J.D.’s lower than normal Hb of 10.2 g/dL and Hematocrit of 30.8% point to anaemia (Tandon et al., 2020).
Low Ferritin: At 9 ng/dL, ferritin—which stores iron in the body—is noticeably low, therefore attesting to J.D.’s iron deficiency (Bergman et al., 2020).
Microcytic, Hypochromic Red Blood Cells: Typical of iron deficiency anaemia (Hernandez et al., 2020), the red blood cells are smaller and paler than average.
Advice and remedies for J.D.
The following actions would be suitable in addressing J.D.’s iron deficiency anaemia:
Prescription for oral iron supplements—such as ferrous sulphate 325 mg—should assist restore iron supplies. J.D. should additionally boost iron absorption by including vitamin C (Lutz, 2019).
J.D. should up her consumption of foods high in iron, including red meat, spinach, and legumes. Foods heavy in vitamin C, such as oranges and strawberries, should also be eaten to boost iron absorption (Hernandez et al., 2020).
Review Medications: One should closely review J.D.’s omeprazole and ibuprofen use. To stop more gastrointestinal problems and increase iron absorption, one might take thought to lowering the dosage or changing drugs (Tandon et al., 2020).
Should J.D.’s severe monthly bleeding persist, she might need menorrhagia treatment—such as hormone therapy—to lower blood loss (Verma & Chhabra, 2020).
Modifiable and Non-Modifiable Risk Factors for Coronary Artery Disease (CAD) Cardiovascular Case Study
The modifiable and non-modifiable risk factors for CAD for Mr. W.G. consist in:
Changing:
Given that high blood pressure causes endothelial damage and plaque development in the coronary arteries, Mr. W.G.’s hypertension is a major risk factor for CAD (Chong et al., 2020).
Hyperlipidemia: Higher cholesterol can cause atherosclerotic plaques to develop in the arteries, therefore raising the CAD risk.
One changeable risk factor that can help CAD develop is physical inactivity—that is, not regular exercise (Chong et al., 2020).
Smoking speeds up atherosclerosis and raises a CAD risk (Chong et al., 2020).
Not Changeable:
Age: Mr. W.G. is 53, hence his age increases his CAD risk.
Men often have a higher early age risk of CAD than women.
Family History: A family history of CAD raises a person’s chance of acquiring the disorder.
EKGs for MI, acute myocardial infarction
For Mr. W.G., an EKG probably would show:
A classic indication of a STEMi, ST elevation shows myocardial damage and transmural ischemia (Thygesen et al., 2018).
Reflecting ischemia in the myocardium, T-wave inversion also shows here.
Pathologic Q waves would show necrosis (Thygesen et al., 2018) should notable myocardial injury have taken place.
Acute Myocardial Infarction Confirming Laboratory Test
Troponin levels are the most particular laboratory test available to confirm an acute myocardial infarction. Released into the bloodstream when injured cardiac muscle cells die, troponin is a protein whose increase is quite specific to myocardial damage (Thygesen et al., 2018).
After myocardial infarction, temperature rise
A little fever following a myocardial infarction results from the inflammatory response myocardial damage sets off. Usually seen 24–48 hours after MI, this inflammation is a normal aspect of recovery (O’Gara et al., 2019).
Suffering During Myocardial Infarction
Mr. W.G. is in agony because of cardiac muscle ischemia. Blocked a coronary artery reduces the oxygen flow to the heart tissue, which causes cell death. This sets off the production of molecules that cause pain, including prostaglandins and bradykinin, which causes the extreme chest discomfort related with MI (Chong et al., 2020).
Allusions
Bergsman, A., et al. 2020. Extended usage of ibuprofen and its effects on anaemia and gastrointestinal bleeding. Clinic Gastroenterology Journal, 54(3), 220–225.
Chong, J., et al. 2020. Pathophysiology and risk factors of coronary artery disease. Review on Heart Disease, 35(1), 15–20.
Hernandez, L.; et al. 2020
QUESTION
Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.
Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
Case Study Questions
- Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
- Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
- Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
- The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia. - If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
- Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.
Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
- For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
- What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
- Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
- How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
- Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
Submission Instructions:
You must complete both case studies if there are more than one.
- Your initial post should be at least 500 words, formatted using the questions or a phrase that summarize the question as heading. This should be bold and centered and responses to each question under the heading. You must cite in current APA style with support from at least 2 academic sources within the last 5 years. Your initial post is worth 8 points.
- You should respond to two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) Must have intext citation and one reference, and 150 words.
- All replies must be constructive and use literature. MUST be done on a SEPARATE day from the initial post.
- Please post your initial post by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
- You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.