You should respond to at least two of your peers, by extending, refuting/correcting, or adding additional nuance to their posts. With references attached 150 words minimum per response.

RESPONSE 1

Case Study 1; Hematopoietic

J.D. is 37 years old, female complaining of recent intermenstrual bleeding, menorrhagia, urinary frequency and incontinence, fatigue, and weakness. Previous medical history includes G5P5, osteoarthritis of left knee, and hypertension. Currently taking ibuprofen, omeprazole, diuretic and antihypertensive drugs.

Why J.D. might be at risk of developing iron deficiency anemia?

One of the causes of iron deficiency anemia is increased loss because of bleeding, and in Ms. J.D. case, she has been complaining about menorrhagia and intermenstrual bleeding. When you lose blood, you are also losing some iron (Whelan, 2021). High risk populations for this type of anemia are women more than men, children younger than 2 years, and elderly.

Why might J.D. be presenting constipation and or dehydration?

Blood loss can cause dehydration due to losing volume. However, J.D. is also taking a diuretic to control her blood pressure which can lead her to be dehydrated also. With low iron, constipation is not common to happen; however, risk occurs once patient starts taking oral iron or intravenous.

Why vitamin B12 and folic acid are important in the erythropoiesis, and what abnormalities their deficiency might cause in the red blood cells?

Vitamin B12 and folic acid are necessary in addition to erythropoietin, and they are needed for cellular DNA synthesis to happen. Deficiencies can lead to several abnormalities in the red blood cell. For example, cells won’t be able to have normal nuclear division, premature apoptosis, and phagocytosis of the precursor cells (Story, 2020).

Describe clinical symptoms that J.D. might have positive for Iron deficiency anemia.

As mentioned, Ms. J.D. has been complaining of intermenstrual bleeding, menorrhagia, fatigue, and weakness, which are clinical symptoms that can lead to suspect iron deficiency anemia. Loss of volume can lower the iron available in blood.

List and describe signs of Iron deficiency anemia.

Clinical manifestation of iron deficiency anemia includes cyanosis of the sclera, brittle nails, spoon-shaped nails, a decrease of appetite, headache, irritability, stomatitis, unusual food cravings, and delayed healing (Story, 2020). Other symptoms are extreme fatigue, weakness, pale skin, chest pain, tachycardia, or shortness of breath.

Hemoglobin is 10.2 g/dl, hematocrits 30.8%, Ferritin 9 ng/dl and red blood cells are smaller and paler in color than normal. Describe treatment and recommendation for J.D.

In patients with severe iron deficiency anemia anatomy of the cell changes, and so does its color. In order to have an accurate diagnosis, some blood work should be ordered, like complete blood count, serum ferritin, serum iron, and transferring saturation. Treatments J.D. could be adding consumption of iron-rich food or starting oral or intravenous iron replacement. Vitamin C supplement is also recommended since it helps with the absorption of iron.

Case Study 2; Cardiovascular

Mr. W. G. complaining of chest discomfort while doing sports that gradually intensified to a crushing sensation with radiating to the neck and lower jaw. Breathing technique did not help. Mr W.G. also started feeling nauseated, and his friend called 911 due to a concern of Mr. G. was having a heart attack. Oxygen was placed, and so IV fluids. Mr. M.G. received aspirin 325 mg and 2 mg of morphine. After arriving at the ED, the patient received nitroglycerin sublingual 3 times with poor relief.

Describe modifiable and non-modifiable risk factors for patients diagnosed with acute myocardial infarct and with risk of developing coronary artery disease.

Modifiable risk factor for coronary artery disease includes smoking, obesity, physical inactivity, atherogenic diet, stress, diabetes mellitus, hyperlipidemia, and hypertension. Non-modifiable risk factors includes; person age (men older that 45 years old, women older than 55 years old or premature menopause), or family medical history of the disease. Stress can be involving in a platelet activation and endothelial dysfunction process (Zupancic, 2009).

What would you expect to see on Mr. W.G. electrocardiogram and which findings described on the case are compatible with the acute coronary event?

For Mr. W.G., an electrocardiogram might be normal; however, it could show ST-segment depression for patients with acute coronary disease or with chronic ischemia.

Which will be the most specific laboratory test you would choose to confirm an acute myocardial infarct?

There is a few bloodwork that can be done in order to determine a myocardial infarct, but specifically will need a cardiac biomarker called troponin. It might come back within the normal limits if the angina is transient and intermittent (Story, 2020).

Why Mr. W.G. temperature has increased after his myocardial infarct, when that can be observed and for how long?

For Mr. M.G. we can expect temperature to increase between 4 to 8 hours until 24 hours after infarction onset, and we can expect temperature to go down to normal after 4 to 5 days. Research has shown that the larger the infarct, the higher the fever will be.

Explain why pain was experienced during his myocardial infarct.

A prior myocardial infarct, coronary artery disease, diabetes, neuropathy, women and elderly are more likely to have silent myocardial infarct. Mr. M.G. is 53 years old and does not enlist any previous medical history that could contribute to a silent MI. Chest pain is caused due to muscle heart cells not receiving enough blood. It is a mechanism from your body letting you know about possible ischemia. It is the same as when a person is working out and does not receive enough oxygen; the person will get spasms or pain in the muscles (Safdar, 2013).

References

Delugash, L., & Story, L. (2020). Applied Pathophysiology for the Advanced PracticeNurse. Burlington, MA: Jones and Bartlett Learning.

Malik, M. A., Alam Khan, S., Safdar, S., & Taseer, I. (2013). Chest pain as a presenting complaint in patients with acute myocardial infarction (AMI). Pakistan journal of medical sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC38092…

Whelan, C. (2021). Menorrhagia: Causes, symptoms, when to seek help. Healthline. https://www.healthline.com/health/menstruation/menorrhagiaLinks to an external site.

Zupancic, M. L. (2009). Acute psychological stress as a precipitant of acute coronary syndromes in patients with undiagnosed ischemic heart disease: A case report and literature review. Primary care companion to the Journal of clinical psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660161/#:~:text=Acute%20mental%20stress%20causes%20increased,the%20setting%20of%20psychosocial%20stressors.

RESPONSE 2

CASE STUDY 1

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

Many factors in this case study put J.D. at risk for developing iron deficiency anemia. These include her recent pregnancy, menorrhagia, being a woman, and the use of omeprazole. Research has found that women with short intervals between pregnancies do not have adequate time to restore iron lost during the pregnancy and birth (Derman & Patted, 2023). J.D. has had four pregnancies within four years, leaving very little time for her body to build up a healthy supply of iron. According to Dlugash and Story (2023), the use of drugs such as antacids and proton pump inhibitors will decrease the secretion of intrinsic factor in the gastrointestinal system and cause alterations in vitamin B12 absorption, which is a necessary vitamin for hematopoiesis. Although she takes this medication to prevent gastrointestinal upset from NSAID use, it may also be contributing to her anemia.

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

In the case study, J.D. denies constipation. However, constipation would not be a surprising manifestation of her condition. She presents with frequent urination, the use of an antidiuretic, and heavy menstrual bleeding. These factors may contribute to dehydration because she is losing large amounts of volume and also on medication that depletes the body of fluid, especially if the patient does not adequately hydrate. Dehydration can also cause constipation in this patient, as well as the use of omeprazole.

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

Vitamin B12 and folic acid are essential for the creation of red blood cells. According to Dlugash and Story (2023), they are necessary for cellular DNA synthesis and deficiency leads to inability of the cell to undergo nuclear division, premature apoptosis and the phagocytosis of precursor cells. Impairment of DNA synthesis can cause normal cytoplasm development but delayed nuclear development, leading to large, macrocytic red blood cells (Dlugash & Story, 2023). Proper education on diet and minerals can improve the patient’s health on the cellular level. Research from Derman and Patten (2023) also discovered that depleted levels of iron, folate, vitamin B12 and several other micronutrients were associated with poor maternal outcomes. It is important to ensure a diet is fortified with adequate vitamin B12 and folic acid. Iron rich foods are also important which include liver, red meat, fish and beans.

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.

J.D. presents with extreme fatigue and weakness. Other symptoms associated with iron deficiency anemia include cyanosis of the sclera (when the sclera looks blue), weak nails, koiloncychia (spoon-shaped nails), pica (unusual food cravings), headache and irritability (Dlugash & Story, 2023). Further assessment of J.D. should be conducted to discover these clinical symptoms.

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.

Along with physical symptoms, lab testing may be conducted for the diagnosis of iron deficiency anemia. Baldwin (2023) suggests that hemoglobin less than 12g/dL and ferritin level less than 15ng/mL in menstruating women indicates iron deficiency anemia. Dlugash and Story (2023) also suggest that ferritin levels will be low and transferrin will be high due to the body’s attempt to compensate. It is important to obtain a CBC as well as testing serum ferritin, serum iron and transferrin.

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 appropriate recommendations and treatments for J.D.

Along with fortifying the diet with iron rich foods, more therapies may be necessary to improve patient outcomes. Baldwin (2023) recommends a daily iron supplement taken along with vitamin C to help with absorption and also hormonal therapies such as progestin to decrease menstrual iron losses. Treatments can also be tailored to lab values and patient presentation. Baldwin (2023) also found that intravenous iron should be implemented for patients with hemoglobin less than 9g/dL, blood transfusions are also useful in times of acute blood loss. Intravenous iron and transfusions are not indicated in this case study, but increasing dietary iron, folate, and vitamin C would be appropriate for J.D.

CASE STUDY 2

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

According to Dlugash and Story (2023), modifiable risk factors for developing coronary artery disease include tobacco use, obesity, physical inactivity, atherogenic diet, stress, diabetes mellitus, hyperlipidemia, and hypertension. Non-modifiable risk factors are being a male aged greater than 45, being a woman aged greater than 55, and family history of coronary artery disease. W.G. is 53 years old and male, which contributes to his risk of having an acute myocardial infarct. It is unclear whether W.G. has any modifiable risk factors of developing an acute myocardial infarct.

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?

Based on W.G.’s symptoms, it would be expected to see ST segment elevation when obtaining an EKG. ST segment elevation signifies complete blockage of a coronary artery and pain is unrelieved by sublingual nitroglycerin (Dlugash & Story, 2023). The symptoms presented in this case study require immediate interventions.

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?

Obtaining a troponin level, especially at set intervals would be most beneficial in confirming acute myocardial infarction. Dlugash and Story (2023) explain three types of cardiac biomarkers: CK-MB, myoglobin and troponins. Troponins have a greater sensitivity and specificity than CK-MB and are more useful in detecting recent myocardial infarction.

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 Chen et al. (2023), body temperature after a myocardial infarction can increase between four and eight hours after symptom onset, peak in the first to second day of hospital admission and decrease in the fourth to fifth days after the attack. The research provided by Chen et al. (2023), states that post myocardial infarction, monocytes and lymphocytes will migrate to the myocardium and cause a reaction of cytokines to release and pass through the blood-brain barrier where they influence temperature regulatory centers in the brain. Assessing temperature during and after acute myocardial infarctions is just as important as monitoring blood pressure, heart rate, SpO2 and respiratory rate.

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

Chest pain is a classic sign of a myocardial infarction. Chest pain is caused by inadequate blood supply to the muscle of the heart, the mechanism of the pain involves the inflammatory process, ischemia of the organ and nerve activation (Pasupathy et al., 2023). During the inflammatory process, prostaglandins are released and cause pain. According to Pasupathy et al. (2023), chest pain rarely varies between myocardial infarction with non-obstructive coronary arteries and myocardial infarction due to obstructive coronary artery disease. When patients present with chest pain, it is of the utmost importance to assess quality, location, precipitating factors, relieving factors and duration of the pain.

References

Baldwin, M. K. (2023, March). Iron deficiency and anemia in patients with heavy menstrual bleeding: Mechanisms and management. OBG Management, 35(3). https://doi.org/10.12788/obgm.0268

Chen, S.-H., Chang, H.-C., Chiu, P.-W., Hong, M.-Y., Lin, I.-C., Yang, C.-C., Hsu, C.-T., Ling, C.-W., Chang, Y.-H., Cheng, Y.-Y., & Lin, C.-H. (2023). Triage body temperature and its influence on patients with acute myocardial infarction. BMC Cardiovascular Disorders, 23(1), 1–11. https://doi.org/10.1186/s12872-023-03372-yLinks to an external site.

Derman, R. J., & Patted, A. (2023). Overview of iron deficiency and iron deficiency anemia in women and girls of reproductive age. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 162 Suppl 2, 78–82. https://doi.org/10.1002/ijgo.14950

Dlugasch, L., & Story, L. (2023). Applied Pathophysiology for the Advanced Practice Nurse. Jones & Bartlett Learning.

Pasupathy, S., La, S., Tavella, R., Zeitz, C., Worthley, M., Sinhal, A., Arstall, M., & Beltrame, J. F. (2023). Do Chest Pain Characteristics in Patients with Acute Myocardial Infarction Differ between Those with and without Obstructive Coronary Artery Disease? Journal of Clinical Medicine, 12(14), 4595. https://doi.org/10.3390/jcm12144595