DISCUSSION 1
Case Study 1: Hematopoietic
Question #1
J.D. reports patient experiencing six days of heavy menstrual flow, with significant blood loss. Menorrhagia is one of the common risk factors of iron deficiency anemia, particularly in women who do not get iron supplementation from diet. In addition, the patient reports a 2-month history of intermenstrual bleeding. Intermenstrual bleeding increases the risk of iron deficiency anemia due to excessive blood loss.
Question #2
The main reason for the patient presenting with dehydration is the significant blood loss due to menorrhagia and the 2-month history of intermenstrual bleeding. Losing a significant volume of blood results in fluid loss and subsequent development of dehydration. Her dysregulated progesterone and estrogen levels could also be causing major hormonal shifts, which could be a factor in her constipation. As a result, the interaction between excessive blood loss and hormone dysregulation is most likely what causes the two symptoms.
Question #3
Erythroblasts require vitamin B12 and folate (folic acid) for proliferation during their differentiation (Finkelstein et al., 2021). A deficiency of vitamin B12 or folate contributes to the inhibition of purine and thymidylate syntheses, erythroblast apoptosis, and impaired DNA synthesis, therefore, resulting in anemia due to ineffective erythropoiesis (Finkelstein et al., 2021). This deficiency results in macrocytosis (red blood cells larger than usual size), hence, affecting their functioning.
Question #4
The client presents with some typical signs and symptoms of anemia, including fatigue and palpitations. To confirm the diagnosis of iron deficiency anemia, the gynecologist should conduct a comprehensive assessment. The patient might also present with symptoms like shortness of breath, tachycardia, dizziness, cold extremities, headache, and pallor (Kar et al., 2020). Moreover, she may present some signs of iron deficiency anemia like pica (craving for items), angular cheilitis, and glossitis. The assessment should also include a complete blood count (CBC) to help confirm the diagnosis. In the case of iron deficiency anemia, hemoglobin level is lower than the reference ranges. The levels of MCH and MCHC will also be lower if the patient has iron deficiency anemia (Kar et al., 2020).
Question #5
Fatigue or increased general body weakness- reduction of oxygen concentration in the blood due to lower levels of hemoglobin causes accumulation of lactic acid (Kar et al., 2020). This causes muscles to tire.
Headaches- the significant reduction in the oxygen-carrying capacity of RBCs results in to decrease in the concentration of oxygen reaching the brain.
Palpitations tachycardia- the decreased amount of oxygen reaching tissues and cells makes the heart compensate for this shortage by pumping faster.
Question #6
Dietary modification- encourage the patient to eat foods rich in iron, such as red meat, liver, spinach, and eggs.
Treat/manage the underlying cause- conducting a comprehensive assessment is understanding the OBS/GYN history of the client, including the reason for heavy intermenstrual bleeds. This approach is crucial in determining appropriate interventions that could help in reducing heavy bleeding (Govindappagari & Burwick, 2019).
Iron supplementation- this approach could be beneficial for this patient. Therefore, the health provider can prescribe 150-200 mg of iron for J.D. However, it would be essential to educate her on the potential adverse effects (Govindappagari & Burwick, 2019).
Blood transfusion- this treatment approach is also recommended for severe cases of anemia. Therefore, it would be considered if the patient’s hemoglobin level is less than 6 4g/dl (Govindappagari & Burwick, 2019).
Case Study 2: Cardiovascular
Question #1
Modifiable risk factors: Modifiable risk factors are those that can be controlled during disease prevention or minimizing the worsening of symptoms. These include obesity, hypertension, diabetes, and hypertriglyceridemia. In most cases, these risk factors increase the levels of low-density cholesterol and total triglycerides (Ferry et al., 2020).
Non-modifiable risk factors: They are risk factors risk factors that generally occur in individuals, without any lifestyle involvement or presence of a specific disease process. They include age, gender, ethnicity, and genetics.
Question #2
In this case, I would expect a T-wave inversion on Mr. W.G.’s ECG as a result of myocardial inflammation and increased overload in the left ventricles. Additionally, I would expect to see either depression or elevation of the ST segment, which is a common observation in myocardial infarction (Navinan et al., 2019). Findings that are compatible with acute coronary events include pain that radiates to the lower jaw and the neck; a crushing sensation in the sternal area; and chest discomfort while playing tennis.
Question #3
A troponin test (troponin I or T) would be the most preferred laboratory test to confirm the diagnosis of MI. This test is appropriate because of its specificity and sensitivity to any cardiac abnormalities. Therefore, it is the most recommended cardiac biomarker for MI.
Question #4
In most cases, fever occurs within one to two days from the initial onset of the event, and even persists for up to 4 or 5 days. This is associated with the release of some inflammatory markers directly into the bloodstream, thus, resulting in a significant elevation of prostaglandin E2 in the hypothalamus, which subsequently contributes to an increased body temperature (Navinan et al., 2019).
Question #5
I would explain to Mr. W.G. why he was experiencing pain during his MI by describing how the interruption of blood supply to the cardiac muscle resulted in such clinical manifestation. The blockage of blood supply to the heart tissue led to the death of some cardiac muscles, thus, resulting in pain. The limited supply of oxygen also resulted in the accumulation of lactic acid (Ferry et al., 2020).
DISCUSSION 2
Cardiovascular
Modifiable and non-modifiable risk factors for coronary artery disease and MI.
Coronary heart disease and acute myocardial infarction susceptibility factors are classified into modifiable and non-modifiable factors. Modifiable factors are attributes that can be changed by behavior or lifestyle changes. These include physical activity, eating habits, and unhealthy habits like smoking. However, non-modifiable factors, as the name says are things that cannot be changed. These include aspects like age, race, and family history, are aspects over which there is no control (Brown et al., 2021) coronary heart disease, also known as coronary artery disease (CAD), is the most common type of heart disease in the elderly (Bundhun et al., 2015).
What would you expect to see on Mr. W.G. EKG, and which findings described in the case are compatible with the acute coronary event?
According to (Brown et al., 2021), the electrocardiogram effectively identifies irregular cardiac rhythms (arrhythmias) caused by blocked or constricted arteries in the heart, which can be linked with coronary artery disease and aid in the evaluation of chest discomfort or a heart attack. I anticipated a T-wave inversion due to increased myocardial inflammation in the heart and increased left ventricular burden due to likely left ventricular hypertrophy. I would also anticipate either an S.T. segment elevation or depression indicative of myocardial infarction. The following observations are consistent with an acute coronary event: crushing feeling around the sternum, pain radiating to the neck and lower jaw, and chest pain on exertion (Soppi, 2018).
Laboratory test to confirm the acute myocardial infarct and why?
Cardiovascular troponin I or T are preferential laboratory tests for myocardial infarction. They are the most suggested cardiac biomarker for acute myocardial infarction, and this test is sensitive and specific for any cardiac abnormalities since cardiac myocytes contain the majority of troponin I and T; their presence in the blood signals that the heart muscles have been injured (Dlugasch et al., 2021).
4.How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct? When can that be observed, and for how long? Base your answer on the pathophysiology of the event.
According to Dlugasch et al. (2021), fever usually appears within 24 to 48 hours of the onset of acute myocardial infarction and can last up to the fourth or fifth day. The release of inflammatory markers into the bloodstream causes an increase in prostaglandin E2 in the hypothalamus, resulting in elevated temperature. These inflammatory markers include C -reactive protein, Interleukin-1, and Interleukin-6.
5.Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
The patient’s discomfort was caused by decreased blood vessel diameter, which resulted in myocardial ischemia. This occurrence was painful. Furthermore, the absence of oxygen triggered anaerobic respiration in the cells, which result in the production of lactic acid. The decreased pH induced by lactic acid buildup generated nerve irritation, which resulted in pain during the myocardial infarction. These two occurrences contributed to the agony he was feeling (Wu et al., 2019).
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