ST Thomas University advanced pathophysiology Discussion

Discussion 1: Hematopoietic Case Study

Thaiz 

• Contributing factors to develop Iron deficiency anemia

    Iron deficiency anemia is a prevalent condition characterized by insufficient iron stores leading to impaired red blood cell production. J.D., a 37-year-old woman, presents with symptoms indicative of iron deficiency anemia, including intermenstrual bleeding, menorrhagia, fatigue, weakness, and urinary frequency. Her medical history suggests several contributing factors predisposing her to Iron deficiency anemia (Warner & Kamran, 2023).

    Childbirth is a recognized risk factor for IDA due to significant blood loss during delivery. J.D.’s recent childbirth and multiparity, with four pregnancies in four years, increase her vulnerability to iron depletion, as each pregnancy imposes additional demands on iron reserves (Demuth, 2018).

•     Additionally, chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for osteoarthritis management can lead to gastrointestinal bleeding and subsequent iron loss (Malik et al., 2023).

Reasons for constipation and/o dehydration

    Constipation and dehydration in J.D. could be related from long-term NSAID use, which can irritate the gastrointestinal tract and disrupt fluid balance. Furthermore, increased urinary frequency and mild incontinence may result from NSAID-induced bladder irritation or diuretic therapy for hypertension management (Malik et al., 2023).

Vitamin B12 and Folic Acid in Erythropoiesis

    Vitamin B12 and folic acid are vital for the normal development of the RBCs during the erythropoiesis, and deficiencies in these vitamins can impair red blood cell production, leading to megaloblastic anemia (Dlugasch & Story, 2024). Given J.D.’s symptoms, deficiencies in vitamin B12 and folic acid should be considered in the diagnostic evaluation.

Clinical Symptoms and signs for Iron deficiency anemia

    Clinical manifestations suggestive of iron deficiency anemia include fatigue, weakness, pallor, and dyspnea. Additional symptoms related to iron deficiency may include pica, brittle nails, and hair loss. Physical examination findings consistent with iron deficiency anemia include pallor of the conjunctiva, nail beds, and mucous membranes that is the most important clinical sign, but this can be evident when the values of the hemoglobin are between 7-8 g/dL (Warner & Kamran, 2023).

    Laboratory evaluation confirms the diagnosis of IDA in J.D. with low hemoglobin (Hb) and hematocrit (Hct) levels, decreased serum ferritin levels, and microcytic, hypochromic red blood cells on peripheral smear.

Appropriate Recommendations and Treatments

    Management of iron deficiency anemia focuses on replenishing iron stores and addressing underlying causes, such as gastrointestinal bleeding. Oral iron supplementation is the first-line treatment for mild to moderate iron deficiency anemia, typically with ferrous sulfate or ferrous gluconate. Iron supplementation should be taken without food to increase absorption. Low gastric pH facilitates iron absorption. Rapid response to treatment is often seen in 14 days. (Warner & Kamran, 2023).

    Counseling on proper iron supplementation administration is essential to enhance absorption and minimize gastrointestinal side effects. Additionally, addressing contributing factors such as NSAID use and menstrual bleeding is crucial to prevent iron deficiency anemia recurrence (Warner & Kamran, 2023).

    In conclusion, J.D. presents with symptoms consistent with iron deficiency anemia, with multiple contributing factors identified in her medical history. Prompt diagnosis and appropriate management are essential to alleviate symptoms and prevent complications associated with iron deficiency. By addressing underlying causes and initiating iron supplementation, J.D. can achieve restoration of iron stores and improvement in her overall health and well-being.

References

Demuth, I. M. (2018). Iron supplementation during pregnancy- a cross-sectional study undertaken in four German states. BMC pregnancy and childbirth, 18(1), 491. https://doi.org/10.1186/s12884-018-2130-5

Dlugasch, L., & Story, L. (2024). Applied Pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.

Warner, M. J., & Kamram, M. T. (2023, August 7). Iron deficiency anemia. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK448065/

Malik, T. F., Gnanapandithan, K., & Singh, K. (2023, June 5). Peptic ulcer disease. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/30521213

Discussion 2 : W.G Case Study. Cardiovascular

Thaiz G

Modifiable and non-modifiable risk factors for patients at risk for developing coronary artery disease and patients diagnose with acute myocardial infarction

    Acute myocardial infarction is a life-threatening condition characterized by the occlusion of coronary arteries leading to myocardial ischemia and necrosis. Mr. W.G., a 53-year-old man, presented with chest discomfort progressing to a crushing sensation, radiating to his neck and jaw, suggestive of acute myocardial infarction. Understanding modifiable and non-modifiable risk factors for coronary artery disease and acute myocardial infarction is crucial in managing patients like Mr. W.G.

    Modifiable risk factors for coronary artery disease and acute myocardial infarction include smoking, hypertension, dyslipidemia, diabetes mellitus, obesity, physical inactivity, and poor diet (Arnett et al., 2019). Non-modifiable risk factors include age, male gender, family history of premature CAD, and genetic predisposition (Arnett et al., 2019). Mr. W.G.’s age and male gender represent non-modifiable risk factors, while lifestyle factors such as smoking and diet may contribute to his risk for coronary artery disease and acute myocardial infarction.

Findings in the EKG compatible with Acute Coronary Event

    Electrocardiogram (EKG), findings consistent with acute myocardial infarction include ST-segment elevation or depression, T-wave inversion, and pathological Q waves (Thygesen et al., 2018). The presence of ST-segment elevation in contiguous leads, such as leads II, III, and aVF, is indicative of inferior wall acute myocardial infarction, which can manifest as chest discomfort radiating to the neck and jaw, as described in Mr. W.G.’s case.

Specific laboratory test to confirm the Acute Myocardial Infarction

    To confirm acute myocardial infarction, cardiac troponin levels are the most specific laboratory test (Thygesen et al., 2018). Cardiac troponins are highly sensitive and specific markers of myocardial injury, with elevated levels indicating myocardial necrosis. Troponin levels typically rise within 3-4 hours of symptom onset and remain elevated for several days, making them ideal for diagnosing acute myocardial infarction.

Increase of Temperature in patients with Acute Myocardial Infarction

    Mr. W.G.’s increased temperature post-MI is likely due to the inflammatory response triggered by myocardial necrosis. Body temperature could increase by more than 1 °C as soon as the first 4 to 8 h after onset of symptoms, peak in the first to second day with an average of 37.5 °C, and decrease in the fourth to fifth day after admission. Inflammation mediators, such as interleukins (IL)-1, IL-6, IL-8, tumor necrosis factor-?, and interferon-?, are released and pass through the blood?brain barrier to influence the temperature regulatory center in the hypothalamus. Prostaglandin E2, which is released afterward, plays an essential role in the development of fever. Fever may persist for several days post-MI as part of the acute inflammatory phase (Chen et al., 2023).

Pain in Acute Myocardial Infarction

    The pain experienced by Mr. W.G. during his MI is attributed to myocardial ischemia and subsequent necrosis. Ischemia leads to the release of pain mediators, such as bradykinin and prostaglandins, stimulating pain receptors in the myocardium. Additionally, ischemia-induced acidosis and stretching of ischemic myocardial fibers contribute to the sensation of pain, often described as pressure, tightness, or squeezing, as Mr. W.G. experienced (Chen et al., 2023).

    In summary, acute myocardial infarction is a critical condition with modifiable and non-modifiable risk factors. Diagnosis relies on clinical presentation, EKG findings, and cardiac troponin levels. Post-MI fever is attributed to the inflammatory response, while pain results from myocardial ischemia and necrosis. Providing comprehensive explanations to patients like Mr. W.G. is essential for understanding their condition and facilitating optimal management and recovery.

References

Arnette, D. K., Blumental, R. S., Buroker, M. A., & Goldberger, A. D. (2020). Correction to: 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 141(4), 177–182. https://doi.org/10.1161/cir.0000000000000755Links to an external site.

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, August 4). Triage body temperature and its influence on patients with acute myocardial infarction – BMC cardiovascular disorders. BioMed Central. https://bmccardiovascdisord.biomedcentral.com/arti…

Thygesen, K., Jaffe, J. S., Chaitman, A. S., Bax, B. R., & Morrow, J. J. (2018). Universal definition of myocardial infarction. European heart journal. https://pubmed.ncbi.nlm.nih.gov/179512Links to an external site.

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