Sample Answer for NUR 502 Module 2 Discussion
Hematopoietic and Cardiovascular Case Studies
Contributing Factors That Put J.D. at Risk of Developing Iron Deficiency Anemia
The illness known as iron deficiency anemia is common and has multiple underlying causes. Multiple factors increase J.D.’s risk of developing iron deficiency anemia. J.D. is a 37-year-old woman who presents with intermenstrual bleeding, menorrhagia, frequent urination, lethargy, and weakness. The obstetric history of J.D. is an important consideration. Given her G5P5 status and her four pregnancies in the last four years, including a recent vaginal delivery, she is particularly vulnerable to the increased iron demands of pregnancy and postpartum hemorrhage. J.D.’s symptoms of heavy flow and cramping, lasting for six days, adds significantly to iron loss.
When menorrhagia and intermenstrual bleeding are added, these symptoms create the impression of ongoing blood loss, which puts her at higher risk of iron deficiency anemia. One further significant factor is the long-term use of NSAIDs to treat osteoarthritis pain. J.D. has been using ibuprofen for 2.5 years, which increases the risk of iron deficiency and possible gastrointestinal bleeding.
Reasons Why J.D. Might Be Presenting Constipation and/or Dehydration
Dehydration is a worry because of her three-year history of hypertension, which has been managed with a diuretic and antihypertensive medication. Dehydration and constipation may result from a fluid imbalance caused by increased frequency of urination and moderate incontinence. Long-term ibuprofen use because of a history of knee damage could be the cause of J.D.’s constipation.
Why Vitamin B12 and folic acid are important ? What abnormalities their deficiency might cause?
Folic acid and vitamin B12 are essential for erythropoiesis, which is the process by which red blood cells mature. Their lack may cause erythropoiesis to be ineffective, which would produce more mature, bigger cells (macrocytes). When erythrocytes don’t divide correctly due to insufficient B12 and folic acid, macrocytic anemia results.
Symptoms Indicating J.D. Might Have Iron Deficiency Anemia
J.D. ‘s gynecologist suspected iron deficiency anemia based on clinical signs such as weakness, pallor, exhaustion, and shortness of breath. These symptoms are caused by a decreased ability to carry oxygen, which is a result of inadequate hemoglobin due to an iron shortage.
Signs of Iron Deficiency Anemia
The diagnosis is supported by the results of the laboratory tests, which show a low level of ferritin (9 ng/dL), a lowered hematocrit (30.8%), and an insufficient hemoglobin (Hb) of 10.2 g/dL. Iron deficiency anemia is further confirmed by smaller, paler-than-normal microcytic, hypochromic red blood cells. However, despite the high prevalence and the impact on quality of life, ID/IDA among fertile-age women remains underdiagnosed and undertreated (Petraglia & Dolmans, 2022).
Appropriate Recommendations and Treatments for J.D.
For J.D., appropriate advice and treatments include vitamin B12 and folic acid supplements to enhance erythropoiesis, iron supplementation to replace iron storage, and a comprehensive review of NSAID use to investigate alternative pain management options. An iron-deficient state has been associated with and causes several adverse health consequences, affecting all aspects of women’s physical and emotional well-being ( Cappellini et al., 2022). A thorough intervention plan must address fluid imbalance by controlling hydration and closely monitoring and modifying hypertension therapy.
To sum up, J.D.’s case emphasizes how interrelated the conditions contributing to iron deficiency anemia are. To restore her iron status and general well-being, a comprehensive strategy that addresses her menstrual bleeding, medication use, and related symptoms is essential for an accurate diagnosis and customized therapies.
Cardiovascular
Modifiable and Non-Modifiable Risk Factors
The modifiable ones are those that can be managed and altered to modify the course of the disease and lower the impact. Major ones include lifestyle diseases that can actively hinder the overall health status of the individual (Brown et al., 2018). For instance, conditions such as diabetes and hypertension as well as obesity all play a role in elevating the chances of acute myocardial infarct.
On the other hand, the non-modifiable ones are those that cannot be effectively controlled as they can manifest even without the onset of the condition in the first place. These often include the patient’s age and ethnicity as well as their gender and family histories (McCarthy et al., 2018). Since these are unchanging from a biological point of view, it is difficult to be able to properly account for them.
Mr. W.G.’s Expected EKG
The EKG for Mr. W.G. would probably show distinctive alterations linked to acute coronary episodes. A crushing sensation in the sternum that spreads to the neck and lower jaw is described in the case description. The EKG results may include ST-segment elevation, ST-segment depression, T-wave abnormalities, or the presence of Q waves. These symptoms are suggestive of cardiac ischemia. When sublingual nitroglycerin tablets do not relieve pain, it may be a sign of ongoing ischemia.
Laboratory Test to Confirm the Acute Myocardial Infarct
The most specific laboratory test for verifying acute myocardial infarction is troponin level measurement. When myocardial injury occurs, a cardiac biomarker called troponin is released into the bloodstream. For the diagnosis of acute myocardial infarction, elevated troponin levels are a crucial indicator of heart damage.
Temperature Increase After Myocardial Infarct
Mr. W.G. ‘s elevated temperature following myocardial infarction is a consequence of the inflammatory reaction brought on by cardiac damage. Fever is brought on by a systemic inflammatory state brought on by the production of inflammatory mediators and cytokines. Usually occurring in the first 24 to 48 hours following MI, this symptom eventually goes away as the inflammatory process slows down.
Pain During His Myocardial Infarct
It is necessary to comprehend the biology of ischemia and tissue damage to explain Mr. W.G.’s agony during the myocardial infarction. Ischemia happens when there is insufficient blood supply to the heart muscle, which results in low oxygen levels. Angina is the pain caused by a lack of oxygen in the heart. Acute coronary events, including myocardial infarctions, cause irreparable damage to the heart muscle, which makes the discomfort worse and lasts longer. . Aortic stenosis is increasing in incidence in the United States (4,43 US), driven largely by an aging demographic (Peters et al., 2022). The sense of pain is also influenced by the production of chemicals during ischemia, such as prostaglandins and bradykinin. The crushing sensation and radiation to the neck and jaw are hallmarks of the heart’s nerve innervation, enhancing the pain experience.
Conclusion
In conclusion, effective preventative measures depend on an understanding of the modifiable and non-modifiable risk factors for coronary artery disease. Acute myocardial infarction is diagnosed with certain laboratory testing and EKG abnormalities. This year’s edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association’s 2020 Impact Goals (Virani et al., 2022). Fever and other post-MI reactions are linked to the inflammatory cascade. Deciphering the complicated interactions between ischemia, tissue damage, and neurochemical reactions is necessary to understand the pain experienced during myocardial infarction and to gain an understanding of the intricate nature of cardiac events.
References
Brown, A. J., Ha, F. J., Michail, M., & West, N. E. (2018). Prehospital diagnosis and management of acute myocardial infarction. In T. J. Watson, P. J. L. Ong, & J. E. Tcheng (Eds.), Primary angioplasty: A practical guide. https://doi.org/10.1007/978-981-13-1114-7_2
Links to an external site.
Cappellini, M. D., Santini, V., Braxs, C., & Shander, A. (2022). Iron metabolism and iron deficiency anemia in women. Fertility and Sterility, 118(4), 607–614. https://doi.org/10.1016/j.fertnstert.2022.08.014
McCarthy, C. P., Vaduganathan, M., & Januzzi, J. L. (2018). Type 2 myocardial infarction diagnosis, prognosis, and treatment. JAMA, 320(5), 433–434.
Peters, A. S., Duggan, J. P., Trachiotis, G. D., & Antevil, J. L. (2022). Epidemiology of valvular heart disease. The Surgical Clinics of North America, 102(3), 517–528. https://doi.org/10.1016/j.suc.2022.01.008
Petraglia, F., & Dolmans, M. M. (2022). Iron deficiency anemia: Impact on women’s reproductive health. Fertility and Sterility, 118(4), 605–606. https://doi.org/10.1016/j.fertnstert.2022.08.850
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Khan, S. S., Kissela, B. M., Knutson, K. L., Kwan, T. W., Lackland, D. T., … Tsao, C. W. (2020). Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation, 141(9), e139–e596. https://doi.org/10.1161/CIR.0000000000000757
Sample Answer 2 for NUR 502 Module 2 Discussion
Hematopoietic Module
Iron deficiency Anemia
Iron deficiency anemia is Anemia related to iron levels below 10 µmol/L. Ms. JD has several risk factors for iron deficiency anemia (IDA). The main cause of IDA is blood loss during heavy menses (Munro et al., 2023). The average woman loses approximately 1 mg of iron with each menstrual cycle (Dlugasch & Story, 2020). Ms. JD reported heavy bleeding (menorrhagia) for 6 days on a 28-day cycle, as well as vaginal bleeding between periods, which further increased her blood and iron loss. Pregnancy also increases maternal iron loss as the mother requires an additional 1000 mg of iron (Georgieff, 2020) to support the fetus and placenta.
Ms. JD has also been taking ibuprofen and omeprazole daily. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that causes mucosal injury to the lining of the gut, which can lead to bleeding (Tai & McAlindon, 2021). Omeprazole has been shown to decrease iron absorption, subsequently leading to IDA (Al Ali et al., 2020).
Constipation and Dehydration
Ms. JD is a new mother, and the dietary requirements of a newborn require the mother to increase her fluid intake (Ndikom et al., 2014). If fluid intake is not increased, breastfeeding can lead to postpartum dehydration. Ms. JD also reported urinary frequency and incontinence, which can cause an increase in fluid output. Dehydration is the main contributor to transient constipation. Iron supplements are frequently prescribed during pregnancy (Georgieff, 2020), and iron-containing supplements can cause constipation (Munro et al., 2023). Omeprazole is also known to cause constipation (Al Ali et al., 2020).
Vitamin B12 and Folate
Vitamin B12 and Folate (Vitamin B9) are necessary for DNA synthesis, and all cells require DNA replication as a part of the regular cell cycle (Dlugasch & Story, 2020). Vitamin B12 and folate deficiency will first affect rapidly dividing cells, as they require rapid DNA synthesis. Blood cells are some of the first cells affected by this vitamin deficiency. The early symptoms are fatigue related to anemia. Later signs involve the gastrointestinal (GI) system as the cells of the GI mucosa are also rapidly dividing; these signs include glossitis and a swollen smooth tongue due to loss of papillae. Vitamin B12 deficiency can also lead to neurological symptoms including paresthesias and depression (Means & Fairfeld, 2023).
Iron Deficiency Anemia (IDA)
The early symptoms of IDA are fatigue and weakness, pallor, shortness of breath, and tachycardia. The patient can also display a decreased appetite, neurocognitive impairment, including paresthesia and irritability. Patients showing these signs and symptoms should immediately have a complete blood count (CBC)to evaluate the hemoglobin and hematocrit levels. The morphology of the red blood cells also needs to be evaluated as that can help to determine the cause of the anemia.
Clinical signs of IDA (Dlugasch & Story, 2020)
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Write My Essay For MeLow serum iron
Hemoglobin – less than 12 g/dL for women, the oxygen-carrying capacity of the blood is decreased, which leads to decreased energy.
Low Hematocrit – less than 35% in women. The percentage of red blood cells in the blood is decreased.
Mean Corpuscular volume (MCV) – The blood cells will be smaller (microcystic) due to the decreased amount of hemoglobin during cell production.
Low Ferritin – Iron is stored as ferritin in the body.
High Transferrin – Transferrin transport Iron. If there is a decrease in iron, there is an increase in the transport of unused transport proteins.
Lab Results and Recommendations
Ms. JD has Hemoglobin of 10.2 g/dL, confirming the anemia diagnosis. It is important to ascertain the cause of the anemia so that the causative factor can be corrected. The low ferritin level of 9 ng/dL and microcystic red blood cells further confirm that the anemia is due to low iron levels.The recommendation is for Ms. JD to increase her iron intake. Since there are no dire symptoms at the moment, oral iron supplements are recommended. Ms. JD was instructed to take Iron Sulfate 325 mg daily with orange juice. She was instructed to avoid antacids an hour before or two hours after taking iron as Antacids can decrease the absorption of iron (Al Ali et al., 2020). She was instructed to take Vitamin B12 1000 mcg and Folic acid 1000 mcg per day. She has no additional evidence of deficiency of either vitamin, but both vitamins are safe to take daily with little to no chance of toxicity as the excess is excreted in urine (Means & Fairfeld, 2023). She will follow up for lab work in 4 weeks.
References
Al Ali, H. S., Jabbar, A. S., Neamah, N. F., & Ibrahim, N. K. (2020). Long-Term Use of Omeprazole: Effect on Haematological and Biochemical Parameters. Gastroenterology Research and Practice, 54(4), 585–594.
Dlugasch, L., & Story, L. (2020). Applied Pathophysiology for the Advanced Practice Nurse. Jones and Bartlett Learning.
Georgieff, M. K. (2020). Iron deficiency in pregnancy. American Journal of Obstetrics and Gynecology, 223(4), 516–524. https://doi.org/10.1016/j.ajog.2020.03.006
Links to an external site.
Iron-deficiency anemia. (n.d.). NHLBI, NIH. https://www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia
Links to an external site.
Means, R. T., MD, MACP, & Fairfeld, K. M., MD. (2023, June 16). Clinical manifestations and diagnosis of vitamin B12 and folate deficiency. UpToDate. Retrieved January 17, 2024, from https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-vitamin-b12-and-folate-deficiency
Links to an external site.
Munro, M. G., Mast, A. E., Powers, J. M., Kouides, P. A., O’Brien, S. H., Richards, T., Lavin, M., & Levy, B. S. (2023). The Relationship Between Heavy Menstrual Bleeding, Iron Deficiency, and Iron Deficiency Anemia. American Journal of Obstetrics and Gynecology, 229(1), 1–9. https://doi.org/10.1016/j.ajog.2023.01.017
Links to an external site.
Ndikom, C. M., Fawole, B., & Ilesanmi, R. E. (2014). Extra fluids for breastfeeding mothers for increasing milk production. Cochrane Database of Systematic Reviews, 2014(6). https://doi.org/10.1002/14651858.cd008758.pub2
Links to an external site.
Tai, F., & McAlindon, M. E. (2021). Non-steroidal anti-inflammatory drugs and the gastrointestinal tract. Clinical Medicine, 21(2), 131–134. https://doi.org/10.7861/clinmed.2021-0039
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