Review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document.
The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students\’ work as all files submitted in this course are registered and saved in turn it in the program.
Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. \”No Straightforward / Simple answer will be accepted\”.
All answers to case studies must have the references cited \”in the text\” for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) per case Study.
Case Studies 3 & 4 (Combined in one)
76 y/o Hispanic female patient, who has been dealing with financial constraints in last years, has not been able to eat properly due to her economic situation, comes to your practice c/o that over the past 3 months she has felt increasingly tired. She states sleeping well at night. Her vital signs are B/P 135/74, R: 16; HR: 80, T 96.8. Pt denies dyspnea or palpitations. You order some blood work. Your patient’s chemistry panel comes back all WNL, and the fecal occult blood test negative. All the other results are shown below:
WBC: 7600/mm3
Hematocrit: 27.3%
Hemoglobin: 8.3 mg/dL
Platelets: 151,000/mm3
RED BLOOD CELL (RBC) indices
MCV: 65mm3
MCH: 31.6 pg
MCHC: 35.1%
RDW: 15.6%
Fe: 30 mcg/dL
TIBC: 422 mcg/dL
Ferritin: 8 mg/dL
Vit B12: 414 pg/mL
Folate: 188 ng/mL
Answer the following questions:
a) Which lab values are normal, and which are abnormal?
b) Explain the significant of each abnormal value.
c) Based on these results and her history. What would be your patient’s diagnosis?
d) Epidemiologically speaking, what individuals are at risk for this condition?
e) What other signs and symptoms of this condition would you assess for in this case?
f) Which question would best help you determine the impact of fatigue on her activities of daily living?
a. Are you upset about feeling more tired?
b. Do you sleep more now that you used to?
c. How far can you walk until you get SOB?
d. Have you been able to do what you would like to do?
g) Discuss the treatment option for her diagnosis
h) What diet you would recommend her:
a. Whole-wheat pastas and skim milk
b. Lean cuts of poultry, pork and fish
c. Beans and dark green, leafy vegetables
d. Cooked cereals, such as oats and bananas.
i) What would be your initial supplement for this patient? (Be specific about the name, dose, frequency, etc.)
j) What teaching you would you provide your patient about the supplement you just prescribed above.
Case Studies 3 & 4
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- Which lab values are normal, and which are abnormal?
The lab values that fall within the normal range include white blood cell count (WBC) and platelets count. For the RBC indices, the MCH, MCHC, RDW, TIBC, and Vitamin B12 counts are normal. However, the values that fall out of the normal range include hematocrit, hemoglobin, MCV, Fe, Ferritin, and Folate.
b) Explain the significance of each abnormal value.
The patient’s hematocrit and hemoglobin levels are lower than normal. As per Nah et al. (2018), low hematocrit levels are an indicator that the body cells are not acquiring sufficient oxygen levels due to issues such as blood loss and poor nutrition with low folate, Vitamin B12, or iron intake. Low levels of hemoglobin are an indication of anemia caused by vitamin or iron deficiencies.
The patient’s MCV value is lower than normal which according to Nah et al. (2018), means that the red blood cells are smaller than normal and may be caused by various conditions including iron deficiency, lead poisoning, and chronic illnesses. The patient’s Fe and Ferritin values are also lower than normal which are also indicators of iron deficiency. In addition, the patient has high folate levels which may indicate vitamin B12 deficiency or excess consumption of folic acid.
c) Based on these results and her history. What would be your patient’s diagnosis?
The patient should be diagnosed with anemia caused by iron deficiency. According to Norton et al. (2020), one of the causes of iron deficiency anemia is consuming a diet that lacks specific nutrients, especially iron. Common symptoms of anemia include extreme fatigue, body weakness, dyspnea, and low body temperature caused by poor circulation of blood. The patient in the case study has not been consuming sufficient food and demonstrates other symptoms such as increased tiredness.
- d) Epidemiologically speaking, what individuals are at risk for this condition?
People who are at risk of developing iron-deficiency anemia include women especially pregnant women who do not consume sufficient iron and those at reproductive age because they lose blood through menstruation. Infants who do not access sufficient iron from formula or breast milk are also at risk. The risk of iron deficiency also gets higher as one gets older. Malnourished people may also develop anemia due to low consumption of iron-rich foods (Chaparro & Suchdev, 2019).
e) What other signs and symptoms of this condition would you assess for in this case?
The patient’s body temperature is slightly lower than normal hence I will assess her for the risk of hypothermia. I would also continuously monitor her blood pressure levels because they are slightly elevated. As per Yoon et al. (2018), anemic patients have low hemoglobin concentration which may inhibit effective blood pressure control leading to hypertension.
- f) Which question would best help you determine the impact of fatigue on her activities of daily living?
Are you upset about feeling more tired?
b. Do you sleep more now than you used to?
c. How far can you walk until you get SOB?
d. Have you been able to do what you would like to do?
Rationale: The patient denied having shortness of breath hence it would be unsuitable to assess fatigue levels by assessing SOB. Fatigue makes it difficult for people to engage in activities they like hence the best question for the patient is question d.
- g) Discuss the treatment option for her diagnosis
The main treatment for anemic patients includes diet changes and oral iron (Norton et al., 2020). The main treatment option for the patient is iron-replacement therapy administered orally. She should also be provided with a diet rich in iron to replenish iron levels in her body.
h) What diet you would recommend to her:
a. Whole-wheat pasta and skim milk
b. Lean cuts of poultry, pork, and fish
c. Beans and dark green, leafy vegetables
d. Cooked cereals, such as oats and bananas.
Rationale: common dietary sources of heme iron include poultry, red meat, liver, and seafood while sources of non-heme iron include beans, vegetables, pasta, cereal, and bread. People who consume little non-heme iron are more likely to suffer from iron deficiency (Norton et al., 2020). Therefore, I believe that the patient’s diet should include more heme iron.
i) What would be your initial supplement for this patient? (Be specific about the name, dose, frequency, etc.)
My initial supplement for the patient will be ferrous sulfate at a dosage of 600mg daily taken three times. She should take the supplement for at least three months. As per Norton et al. (2020), this dosage can replenish iron levels in the body and correct anemia for adult patients.
- j) What teaching would you provide your patient about the supplement you just prescribed above.
I would advise the patient that she should not take a higher dose than prescribed and that she should take the supplement on an empty stomach. She should also take the supplement either four hours after or two hours before ingesting any antacids. As per Norton et al. (2020), antacids inhibit the absorption of iron into the body. Taking iron with other foods may also reduce absorption.
References
Chaparro, C., & Suchdev, P. (2019). Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of The New York Academy of Sciences, 650-655. https://doi.org/10.1111/nyas.14092
Nah, E., Kim, S., Cho, S., & Cho, H. (2018). Complete Blood Count Reference Intervals and Patterns of Changes Across Pediatric, Adult, and Geriatric Ages in Korea. Annals of Laboratory Medicine, 38(6), 503-511. https://doi.org/10.3343/alm.2018.38.6.503
Norton, P., Araujo, N., Pinho, P., Costa Gomes, J., Silva, C., & Gama, C. et al. (2020). Diagnosis, treatment, and work impact of iron deficiency anemia in a Portuguese urban community. Porto Biomedical Journal, 5(4), e064. https://doi.org/10.1097/j.pbj.0000000000000064
Yoon, H., Lee, J., Kim, G., Kim, Y., Hwang, E., Park, C., & Park, J. (2018). The relationship between anemia and pulse pressure and hypertension: The Korea National Health and Nutrition Examination Survey 2010–2012. Clinical and Experimental Hypertension, 40(7), 650-655. https://doi.org/10.1080/10641963.2017.1416123