anemia
In clinical settings, patients often present with many different types of anemia. Each type of anemia has its own causes and implications. For this reason, you must be able to differentiate between types of anemia as well as identify factors that put patients at greater risk of experiencing related complications. As you prepare for this Discussion, consider the following patient case studies:
Case Study 1:
An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault
Case Study 2:
A 28-year old female presents for a routine physical. She has no complaints. Her personal medical history reveals asthma that is well controlled with an albuterol inhaler prn and Advair 250/50 1 puff BID. Social history reveals she is a nursing student who is a non-smoker, rarely uses alcohol, and is mostly vegetarian. Her physical exam is negative, and she is sent for a CBC/differential and lipid profile. Laboratory results reveal the following: Hemoglobin 10, Hematocrit 30.1, MCV increased.
Case Study 3:
A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.
To prepare:
• Review Chapter 213 in Part 18 of the Buttaro et al. text.
• Select one of the three case studies. Reflect on the provided patient information including history, physical exams, and lab reports.
• Think about a differential diagnosis. Consider the role the patient history, physical exam, and lab reports played in the diagnosis.
• Reflect on the pathophysiology of the type of anemia that you diagnosed, as well as potential treatment options. Consider the causes of this type of anemia. Think about whether the patient should be referred for specialized care.
Post on or before Day 4 an explanation of the differential diagnosis for the patient in the case study that you selected. Describe the role the patient history, physical exam, and lab reports played in the diagnosis. Finally, explain the pathophysiology of the type of anemia that you diagnosed, as well as potential treatment options. Include causes for this type of anemia.
Readings
• Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.
o Part 4, “Office Emergencies”
? Chapter 29, “Bradycardia and Tachycardia” (pp. 198–202)
This chapter covers the epidemiology, pathophysiology, clinical presentation, physical examination, and diagnostics of bradycardia and tachycardia. Differential diagnoses for these disorders are also explored.
? Chapter 30, “Cardiac Arrest” (pp. 202–205)
o
? This chapter examines factors contributing to the onset of cardiac arrest, as well as methods for managing patients with cardiac arrest.
? Part 11, “Evaluation and Management of Cardiovascular Disorders” (pp. 487–611)
This part explores diagnostics of cardiovascular disorders, including how to differentiate between normal and abnormal test results. It also outlines components of patient history and physical exams that help determine differential diagnoses for cardiovascular disorders.
? Part 18, “Evaluation and Management of Hematologic Disorders” (pp. 1139–1181)
This part examines causes and effects of hematologic disorders, as well as resulting symptoms and alterations. It also provides a differential diagnosis for hematologic disorders and outlines methods for managing patients.
o Courtenay, M. (2000). Reading and Interpreting the Electrocardiogram. In Advanced nursing skills: Principles and practice (pp. 39–55). London: Greenwich Medical Media. Retrieved fromhttp://assets.cambridge.org/97818411/00364/sample/9781841100364WS.pdf
This chapter examines how the heart functions, as well as how to read and interpret electrocardiograms.
o LearnTheHeart.com. (2005). ECG basics. Retrieved fromhttp://www.learntheheart.com/EKGBasics.html
This website outlines the basics of electrocardiograms (ECG or EKG), including how to interpret results.
Part 2
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