Factors influencing J.D.’s iron deficiency anaemia risk

ANSWER

Hemopoietic Case Study 1: Factors influencing J.D.’s iron deficiency anaemia risk

Menorrhagia and intermenstrual bleeding: Long-term, heavy menstrual cycles cause major iron loss.
Five pregnancies in a brief period drain iron supplies because of higher iron demands for foetal growth and blood volume expansion.
Recent childbirth: The risk rises with blood loss during delivery and postpartum recovery.
Long-term ibuprofen use can irritate the stomach and create possible hidden bleeding from NSAIDs.
Iron deficiency can be caused in part by rising demands and poor food.
2. J.D.’s constipation and/or dehydration:

Constipation is a common adverse effect if J.D. is iron self-supplementing. Diuretic usage can also cause constipation by lowering gut hydration.
Dehydration: Diuretics used in the therapy of hypertension might cause more fluid loss; hence, weariness may cause less fluid intake.
In erythropoiesis, the value of folic acid and vitamin B12 is:

Essential for DNA synthesis and red blood cell development, vitamin B12 and folic acid
Deficiencies produce megaloblastic anaemia, in which red blood cells are big (macrocytic), immature, poor at oxygen transport.
4. J.D.’s clinical iron deficient anaemia symptoms could include:

tiredness, frailty, and vertigo.
Pallor—that is, pale skin and mucous membranes.
Brittle nails; hair loss; dry skin.
Tachycardia and shortness of breath on effort.
Pica (craving non-food items) or restless leg syndrome.
5. Indices of an iron deficient anaemia:

Under a microscope, red blood cells show microcytic hypochromic anemia—smaller and paler.
Low haemoglobin (Hb 10.2 g/dL), low hematocrit (Hct 30.8%), and low ferritin (9 ng/dL) point to iron loss.
6. Advice and J.D.’s treatments:

Dietary changes: Add foods high in iron such red meat, beans, spinach, and fortified cereals.
Starting oral ferrous sulphate (325 mg/day) with vitamin C will help to improve absorption. Track for gastrointestinal side effects.
Manage menorrhagia by considering surgical or hormonal treatments for too much bleeding.
Alternatives to NSAIDs are Look at other painkillers to reduce GI irritation and blood loss.
Study of Cardiovascular Cases 1 For coronary artery disease (CAD), both controllable and non-modifiable risk factors abound:

Modifiable are smoking, hypertension, obesity, physical inactivity, high cholesterol, diabetes, a poor diet, and too much alcohol use.
Age (more than 45 years for men), male gender, family history of CAD, and ethnicity—non-modifiable.
Two expected EKG results for an acute coronary event:

STEMI, or ST-segment elevation myocardial infarction, shows active myocardial damage.
Additional modifications: Additionally indicating ischemia or infarction are T-wave inversion or abnormal Q waves.
Case fittingness: Unchecked by NTG, crushing chest discomfort spreading to the neck and jaw points to STEMI.
3. Most exact laboratory test for MI, acute myocardial infarction:

Because of its great sensitivity and specificity, troponin I or T is the most particular biomarketer for myocardial injury. Within 4–6 hours following MI, troponin levels start to rise; peak occurs within 12–24 hours and stays high for days.
4. Reason for post-MI fever:

Tumour necrosis factor-alpha and interleukins are released from myocardial necrosis, therefore triggering an inflammatory reaction.
Part of the healing process, fever could strike 24 to 48 hours and last 3 to 5 days.
5. Justification for MI discomfort

Pathophysiology: Ischemia brought on by lowered coronary blood flow causes myocardial oxygen deprivation. This causes the heart to turn to anaerobic metabolism, which builds lactic acid that irritates nerve endings and sets off discomfort.
Referred pain to the neck and jaw results from common neural pathways linking the heart and upper body parts.
By teaching Mr. W.G. these systems, he will be better able to appreciate the gravity of the incident and the necessity of lifestyle modification to lower future risks.

 

 

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

1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
4. 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.
5. 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.
6. 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

1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. 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?
3. 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?
4. 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.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.