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Case study A

Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.

One of the major causes of anemia is the loss of blood. J.D experienced heavy menstrual flows for six days leading to a lot of blood loss. Assuming she does not eat iron-rich food, it could lead to iron deficiency anemia. Furthermore, J.D experienced intermenstrual bleeding for two months which is irregular and led to a lot of blood loss. Heavy blood loss in both cases was a major risk factor for developing anemia due to a lack of iron.

Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.  

The major reason for dehydration is the severe loss of blood J.D was experiencing, while constipation might be due to hormonal changes especially progesterone and dysregulated estrogen. The two hormones build up in the body before and during the menstrual cycle and they are known to slow down the digestive system leading to constipation.

Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?

Erythropoiesis is the process by which red blood cells are formed. The formation of red blood cells requires cell proliferation from red cell precursors erythroblasts (Joseph et al., 2017). Cell differentiation in cell proliferation is aided by vitamin B12 and folic acid. A lack of vitamin B12 and folic acid means that there will be less or no cell differentiation which helps in increasing the red blood cells in the body. The body will experience anemia if there are insufficient red blood cells since they only have a 115-day lifespan.

 

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.

Iron deficiency anemia has multiple symptoms. One of the signs is general body weakness. Lack of enough iron in the body leads to body inability to make the protein hemoglobin which carries oxygen all over the body. With less or no hemoglobin, the body tissues are unable to get the required oxygen, leading to less or no energy (Cappellini et al., 2020). Furthermore, pica is another symptom of iron deficiency anemia in which the body craves for non-food items such as clay and ice cream.

 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. 

Skin paleness- the hemoglobin in the blood gives it a red color. Iron deficiency leads to less hemoglobin in the blood, making it less red, resulting in skin losing color.

Shortness of breath- decreased number of red blood cells makes the blood unable to carry the required amount of oxygen which is required for normal body processes.

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.

The first major recommendation is for J.D. to eat more food rich in iron. It would help to increase the amount of iron in the body. Additionally, the doctors could offer iron supplements to ensure that JD has the required amount of iron in the body (Elstrott et al., 2020). Besides, the doctors should consider treating the menstrual problems causing J.D. to lose a lot of blood eventually treating the underlying anemia deficiency conditions.

 

Case study B

 
For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.

The modifiable risks are factors that an individual can control. They mostly consist of lifestyle diseases and choices. The risk factors include smoking, being overweight, diabetes, lack of physical activity, high blood pressure, and high blood cholesterol (Joseph et al., 2017). The modifiable risks lead to low density and triglycerides being deposited on the coronary artery. The non-modifiable risks are those that cannot be controlled. They include age in which older people above 65 years are at a high risk. Gender, where men are more at risk than women, family history, and ethnic background are additional non-modifiable hazards.

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?

Due to the myocardial infarction, a depression or ST-segment elevation would be observed. Moreover, a T-wave inversion would be seen as a result of increased myocardial inflation in the heart. Findings compatible with the coronary event include; chest pains and discomfort while playing and spreading of pain from neck to the lower jaw.

 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?

The best laboratory test to conduct is troponin T. The reasons for using troponin T is that it increases in patients who have had a recent cardiac problem and it indicates where the problem is and its extent. Moreover, troponin T is very specific and accurate in giving the cardiac abnormality that have just happened and it measures a wide range of cardiac problems making it among the recommended cardiac tests (Collinson, 2021).

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.

Inflammatory markers such as IL-6, IL1, and c-reactive protein are released to the blood stream after myocardial infarct. The inflammatory markers cause an increase in prostaglandin E2 in hypothalamus resulting to increased temperatures. The increased temperatures may be within 24 to 48 after the event. In some instances, the temperatures may stay elevated for 4 to 5 days.

Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

Mr. W.G pain was caused by the blockage of the blood supply to the heart. Lack of blood supply led to the death of the heart muscles. Furthermore, he experienced pain due production of lactic acid which brought about nerve irritation. Lactic acid was produced by anaerobic respiration since the cells could not get enough oxygen due to the blockage which deprived them of blood rich oxygen (Collinson, 2021).

 

References:

Cappellini, M. D., Musallam, K. M., & Taher, A. T. (2020). Iron deficiency anaemia revisited. 
Journal of Internal Medicine
287(2), 153–170.

Collinson, P. (2021). High sensitivity troponin, analytical advantages, clinical benefits and clinical challenges–An update. 
Clinical Biochemistry
91, 1–8.

Elstrott, B., Khan, L., Olson, S., Raghunathan, V., DeLoughery, T., & Shatzel, J. J. (2020). The role of iron repletion in adult iron deficiency anemia and other diseases. 
European Journal of Haematology
104(3), 153–161. https://doi.org/10.1111/ejh.13345

Joseph, P., Leong, D., McKee, M., Anand, S. S., Schwalm, J.-D., Teo, K., Mente, A., & Yusuf, S. (2017). Reducing the global burden of cardiovascular disease, part 1: The epidemiology and risk factors. 
Circulation Research
121(6), 677–694.

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