Students must review the case study and answer all questions with a scholarly re

Students must 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
Case Study 1 & 2 topics change every semester. Topic
TBD
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 Straight forward / Simple answer will be
accepted.
Turn it in Score must be less than 25 % or will not be accepted
for credit, must be your own work and in your own words. You can resubmit,
Final submission will be accepted if less than 25 %. Copy paste from websites
or textbooks will not be accepted or tolerated. Please see College Handbook
with reference to Academic Misconduct Statement.
All answers to case studies must have reference cited in the
text for each answer and a minimum of 2 Scholarly References (Journals, books)
(No websites) per case Study
Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th
Edition
Iron-Deficiency Anemia
Case Study 1
A 72-year-old man developed chest pain whenever he was
physically active. The pain ceased on
stopping his activity. He has no history of heart or lung
disease. His physical examination was
normal except for notable pallor.
Studies Result
Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads
Chest x-ray study, p. 956 No active disease
Complete blood count (CBC), p.
156
Red blood cell (RBC) count, p.
396
2.1 million/mm (normal: 4.7–6.1 million/mm)
RBC indices, p. 399
Mean corpuscular volume
(MCV)
72 mm3
(normal: 80–95 mm3
)
Mean corpuscular hemoglobin
(MCH)
22 pg (normal: 27–31 pg)
Mean corpuscular hemoglobin
concentration (MCHC)
21 pg (normal: 27–31 pg)
Red blood cell distribution width
(RDW)
9% (normal: 11%–14.5%)
Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 18% (normal: 42%–52%)
White blood cell (WBC) count, p.
466
7800/mm3
(normal: 4,500–10,000/mcL)
WBC differential count, p. 466 Normal differential
Platelet count (thrombocyte
count), p. 362
Within normal limits (WNL) (normal: 150,000–
400,000/mm3
)
Half-life of RBC 26–30 days (normal)
Liver/spleen ratio, p. 750 1:1 (normal)
Spleen/pericardium ratio <2:1 (normal) Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%) Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL) Blood typing, p. 114 O+ Iron level studies, p. 287 Iron 42 (normal: 65–175 mcg/dL) Total iron-binding capacity (TIBC) 500 (normal: 250–420 mcg/dL) Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL) Transferrin saturation 15% (normal: 20%–50%) Case Studies Copyright © 2018 by Elsevier Inc. All rights reserved. 2 Ferritin, p. 211 8 ng/mL (normal: 12–300 ng/mL) Vitamin B12, p. 460 140 pg/mL (normal: 100–700 pg/mL) Folic acid, p. 218 12 mg/mL (normal: 5–20 mg/mL or 14–34 mmol/L) Diagnostic Analysis The patient was found to be significantly anemic. His angina was related to his anemia. His normal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis.. His RBCs were small and hypochromic. His iron studies were compatible with iron deficiency. His marrow was inadequate for the degree of anemia because his iron level was reduced. On transfusion of O-positive blood, his angina disappeared. While receiving his third unit of packed RBCs, he developed an elevated temperature to 38.5°C, muscle aches, and back pain. The transfusion was stopped, and the following studies were performed: Studies Results Hgb, p. 251 7.6 g/dL Hct, p. 248 24% Direct Coombs test, p. 157 Positive; agglutination (normal: negative) Platelet count, p. 362 85,000/mm3 Platelet antibody, p. 360 Positive (normal: negative) Haptoglobin, p. 245 78 mg/dL Diagnostic Analysis The patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs test and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count dropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the RBC reaction. He was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal examination indicated that his stool was positive for occult blood. Colonoscopy indicated a right[1]side colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the surgery well. Critical Thinking Questions 1. What was the cause of this patient's iron-deficiency anemia? 2. Explain the relationship between anemia and angina. 3. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for the answer 4. What other questions would you ask to this patient and what would be your rationale for them? Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition AIDS (Acquired Immunodeficiency Syndrome) Case Studies 2 The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed right-sided pneumonitis. The following studies were performed: Studies Results Complete blood cell count (CBC), p. 156 Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL) Hematocrit (Hct), p. 248 36% (normal: 42%–52%) Chest x-ray, p. 956 Right-sided consolidation affecting the posterior lower lung Bronchoscopy, p. 526 No tumor seen Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP) Stool culture, p. 797 Cryptosporidium muris Acquired immunodeficiency syndrome (AIDS) serology, p. 265 p24 antigen Positive Enzyme-linked immunosorbent assay (ELISA) Positive Western blot Positive Lymphocyte immunophenotyping, p. 274 Total CD4 280 (normal: 600–1500 cells/L) CD4% 18% (normal: 60%–75%) CD4/CD8 ratio 0.58 (normal: >1.0)
Human immune deficiency virus (HIV)
viral load, p. 265
75,000 copies/mL
Diagnostic Analysis
The detection of Pneumocystis jiroveci pneumonia (PCP) supports
the diagnosis of AIDS. PCP is
an opportunistic infection occurring only in immunocompromised
patients and is the most
common infection in persons with AIDS. The patient’s diarrhea
was caused by Cryptosporidium
muris, an enteric pathogen, which occurs frequently with AIDS
and can be identified on a stool
culture. The AIDS serology tests made the diagnoses. His viral
load is significant, and his
prognosis is poor.
The patient was hospitalized for a short time for treatment of
PCP. Several months after he was
discharged, he developed Kaposi sarcoma. He developed
psychoneurologic problems eventually
and died 18 months after the AIDS diagnosis.
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Critical Thinking Questions
1. What is the relationship between levels of CD4 lymphocytes
and the likelihood of
clinical complications from AIDS?
2. Why does the United States Public Health Service recommend
monitoring CD4
counts every 3–6 months in patients infected with HIV?
3. This is patient seems to be unaware of his diagnosis of
HIV/AIDS. How would you
approach to your patient to inform about his diagnosis?
4. Is this a reportable disease in Florida? If yes. What is your
responsibility as a
provider?

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