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Preliminary Workup Add in library

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Question:

Task 1

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay, explain your answer and include rationale.

Task 2

Considering Mr. P’s condition and circumstance, write an essay that includes the following:

• Describe your approach to care.

• Recommend a treatment plan.

• Describe a method for providing both the patient and family with education and explain your rationale.

• Provide a teaching plan .

 

 

Answer:

Task 1

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:

 Hemoglobin = 8 g/dl

 Hematocrit = 32%

 Erythrocyte count = 3.1 x 10/mm

 RBC smear showed microcytic and hypochromic cells

 Reticulocyte count = 1.5%

 Other laboratory values were within normal limits.

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have?

Ms A, by profession is a golf player involving abundant activities in terms of consumption of energy. To fulfill the body requirements for supplying energy for organs, tissues and cells in micro level, she should take enough food and expose to abundant oxygen. The food supplements should contain nutrients and minerals such as iron, calcium and magnesium etc. From case history it appears that she had an abnormality in menstruation (an excessive bleeding, menorrhagia) since 10-12 years. The menorrhagia is further causing to lose abundant blood (Marret, Fauconnier, Chabbert-Buffet, Cravello, Golfier, Gondry, Agostini, Bazot, Brailly-Tabard, Brun, De Raucourt, Gervaise, Gompel, Graesslin, Huchon, Lucot, Plu-Bureau, Roman & Fernandez, 2010) making her to deficit in blood. Therefore the blood volume was low and erythrocyte count and hemoglobin content was below normal value. From the laboratory results, it was evident that the blood cells shape was small (microcytic) and relatively low color (hypo chromic state). The hematocrit values was below the normal value of 36-44% (Todd, 2014). The condition can be referred as an anemic condition due to deficiency of iron and impaired production of hemoglobin (Jain & Kamat, 2009). Iron is required for hemoglobin formation. The bone marrow continuously produces blood cells. As process of maturation, iron is required for the formation of hemoglobin; inadequate quantities of iron failing the cells to acquire normal shape and leading to small cells. Iron is obtained from diet and absorbed in the intestinal tract. Ms A had a habit of taking Aspirin 1000 mg for every 3 to 4 hours during menstruation. The dose is more than the usual dose (Aspirin Label, n.d). Aspirin prevents aggregation of thrombocytes (Schror, 2011) as one of the mechanism leading to prolongation of clotting. The delay in clotting further enhances the bleeding time during menses. In addition, the high doses of aspirin induce ulceration in gastrointestinal tract (Baron, Senn, Voelker, Lanas, Laurora, Thielemann, Brückner & McCarthy, 2013) leading to bleeding. All together make her to lose a huge amount of blood. Therefore the laboratory results showed low volume of blood and low amount of hemoglobin. The adequate amount of hemoglobin is necessary to carry the oxygen to body cells. The low oxygen amount fails to cater the demands of oxygen. In addition, she was playing golf at a high altitude region. The high altitude regions such as mountains are associated with low atmospheric pressure and falls below the inspired oxygen pressure (Peacock, 1998). Therefore she had shown an increased rate of respiration and heart rate. Her condition can be considered as critical as the oxygen carrying vector (hemoglobin) is in low amount due to low volume of blood. It indirectly influences the viability of body cells in general and vital organs in particular. Therefore she has to be treated carefully by infusing blood and/or blood substitutes (Pachtinger & Drobatz, 2008). To restore the vital parameters she should be placed in an environment with high air and ventilation and an appropriate treatment can be given. If required, oxygen supplementation may be provided to sustain the viability of vital organs. She has to be educated for the use of Aspirin as it adversely affects the health condition.

 

References

Aspirin Label (n.d) Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/203697Orig1s000lbl.pdf

Baron, JA., Senn, S., Voelker, M., Lanas, A., Laurora, I., Thielemann, W., Brückner, A & McCarthy, D (2013). Gastrointestinal adverse effects of short-term aspirin use: A meta-analysis of published randomized controlled trials. Drugs in R&D, 13(1), 9-16. doi:10.1007/s40268-013-0011-y

Jain, S & Kamat, D (2009) Evaluation of microcytic anemia. Clin Pediatr (Phila). 48(1), 7-13. doi: 10.1177/0009922808323115.

Marret, H., Fauconnier, A., Chabbert-Buffet, N., Cravello, L., Golfier, F., Gondry, J., Agostini, A., Bazot, M., Brailly-Tabard, S., Brun, JL., De Raucourt, E., Gervaise, A., Gompel, A., Graesslin, O., Huchon, C., Lucot, JP., Plu-Bureau, G., Roman, H & Fernandez, H (2010) Clinical practice guidelines on menorrhagia: management of abnormal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol. 152(2), 133-7. doi:10.1016/j.ejogrb.2010.07.016.

Pachtinger, GE & Drobatz, K (2008) Assessment and treatment of hypovolemic states. Vet Clin North Am Small Anim Pract. 38(3), 629-43, doi:10.1016/j.cvsm.2008.01.009.

Peacock, AJ (1998). Oxygen at high altitude. British Medical Journal, 317(7165), 1063-1066.

Schror, K (2011). Pharmacology and cellular/molecular mechanisms of action of aspirin and non-aspirin NSAIDs in colorectal cancer. Best Pract Res Clin Gastroenterol. 25(4-5), 473-84. doi: 10.1016/j.bpg.2011.10.016.

Todd, G (24-Feb-2014) Hematocrit Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/003646.htm

Task 2

Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him.

Considering Mr. P’s condition and circumstance, write an essay by covering

Mr. P (Age, 76 year) suffering from cardiomyopathy and congestive heart failure. Cardiomyopathy is associated with heart muscles and is characterized by a thick and rigid heart muscle with an enlargement (Jefferies & Towbin, 2010) leading to impaired function of heart (Francis & Tang, 2003). The edema, 4+ pitting edema is an indication of deepness of pit and intensity of disease (Assessment of Pitting Edema, n.d). He was feeling discomfortness and laborious while breathing. The condition of patient is critical therefore an intensive care has to be given to restore the functions as follows

Preliminary assessment

The physical parameters such as body weight and height will be recorded

The vital parameters such as heart rate, pulse rate and blood pressure have to be measured and recorded periodically for at least 1-2 h during the stay in hospital

The details of family history for any health complications and occupation of the patient etc have to asked and recorded. Dietary history will be recorded in terms of diet being used frequently. In general a healthy (i.e., nutritious diet) and physical exercise can be considered as the part of a heart healthy lifestyle (Bhattacharyya, Basra, Sen & Kar, 2012)

Treatment plan

Recommended for the diagnosis of blood sample for creatinine, ions (Na+, K+, Ca+2, Cl-), hemoglobin, clotting time and bleeding etc. The details would help in understanding the causes of edema and CHF

In addition, Mr P has to be diagnosed for abdominal ultrasonography, abdominal fluid analysis, electrocardiography and echocardiogram (Eshar, Peddle & Briscoe, 2010).

Based on the diagnostic outcome treatment has to be initiated. The congestion is relatively high due to accumulation of fluids and enlargement of cardiac muscles, drug that reduces the fluids and congestion has to be injected. Diuretics such as hydrochlorthaizide promote the excretion of fluids and slats; digoxin promotes the tonicity of cardiac muscles and facilities pumping of blood to organs and tissue (Gomberg-Maitland, Baran & Fuster, 2001). Thereby the accumulated water will be excreted and congestion would be decreased.

Patient and family education

The patient should be counseled for relieving the thoughts such as ‘why the God has not taken him’. Such counseling will help in increasing the boldness towards acquiring resistance for the disease symptoms

Mr P should be educated about the importance of physical exercise on health. The exercise facilitates him to excrete the water and reduce the water from the body so that the perception of congestion would be relieved.

He should not consume unnecessary medication such as beta blockers if any as they suppress the heart rate.

The family members of patient should be educated in terms of support to be provided to patient.  In general, heart failure patients without family and those who live alone and are socially isolated are highly vulnerable for poor self-care and should receive focused attention (Dunbar, Clark, Quinn, Gary & Kaslow, 2008). Therefore, they should not leave the patient alone after discharging from hospital. They should assist in taking the medication timely. They should see that the patient should not under go for any kind of emotions and/or tensions

Teaching techniques

Novel techniques may be employed to facilitate the family members to understand the risk associated with symptoms of CHF. How to reduce the symptoms. For instance, when ever Mr P felt congestion in chest, the family members support him in doing certain exercise or walking. In addition, the family members should give a tablet to excrete urine.

Using power point presentations or animations, the family members should be educated for the diet to be provided to Mr P. diet containing high proportion of compounds that aggravate the narrowing of blood vessels should be avoided.

The risk associated with high proportion of salt should be educated to his spouse. The presence of salts enhances the accumulation of water in body and aggravates the symptoms of water retention. Therefore she should be educated for diet to be given. The diet should contain low amount of salts (Rabelo, Aliti, Domingues, Ruschel & de Oliveira, 2007).

 

References

Assessment of Pitting Edema (n.d) Retrieved from https://www.gbhn.ca/ebc/documents/ASSESSMENTOFPITTINGEDEMA.pdf

Bhattacharyya, A., Basra, SS., Sen, P & Kar, B (2012) Peripartum Cardiomyopathy: A Review. Texas Heart Institute Journal, 39(1), 8-16.

Dunbar, SB., Clark, PC., Quinn, C., Gary, RA., & Kaslow, NJ (2008). Family Influences on Heart Failure Self-care and Outcomes. The Journal of Cardiovascular Nursing, 23(3), 258–265. doi:10.1097/01.JCN.0000305093.20012.b8

Eshar, D., Peddle, GD & Briscoe, JA (2010) Diagnosis and treatment of congestive heart failure secondary to hypertrophic cardiomyopathy in a kinkajou (Potos flavus) J Zoo Wildl Med. 41(2), 342-5.

Francis, GS & Tang, WH (2003) Pathophysiology of congestive heart failure. Rev Cardiovasc Med. 4 Suppl 2:S14-20.

Gomberg-Maitland, M., Baran, DA & Fuster, V (2001) Treatment of congestive heart failure: Guidelines for the primary care physician and the heart failure specialist. Arch Intern Med. 161(3), 342-352. doi:10.1001/archinte.161.3.342.

Jefferies, JL & Towbin, JA (2010) Dilated cardiomyopathy. Lancet. 375(9716), 752-62. doi: 10.1016/S0140-6736(09)62023-7.

Rabelo, ER., Aliti, GB., Domingues, FB., Ruschel, KB & de Oliveira, BA (2007) What to teach to patients with heart failure and why: the role of nurses in heart failure clinics. Rev Lat Am Enfermagem. 15(1), 165-70

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