Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.
Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
Case Study Questions
1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
4. 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.
5. 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.
6. 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 for appropriate recommendations and treatments for J.D.
**Each question must be answered individually. Not in an essay format.
Example: Question 1, followed by the answer to question 1; Question 2, followed by the answer to question 2; etc.
J.D case study
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J.D case study
Introduction
Gynecological conditions can be stressful and detrimental to individual life. Gynecological conditions are illnesses related to the female reproductive tract. Symptoms such as excessive menstrual or virginal bleeding may indicate a gynecological condition (Gujral et al., 2019). In the case study, J.D., a White woman, presents to her gynecologist with complaints of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Based on the case study, this paper answers the short questions to complete the assignment.
Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
J.D. has several factors that could increase her risk of developing iron deficiency. For instance, she experienced intermenstrual bleeding and menorrhagia. These conditions are associated with significant loss of blood (Gujral et al., 2019). During the visit, the patient reiterated that she has had 6 days of heavy blood flow, which has led to significant loss of blood. Also, the patient’s last infant was delivered four months ago. Delivery is normally associated with heavy bleeding (Gujral et al., 2019). These are incidents that increase the risk of iron deficiency. The main cause of iron deficiency is a significant loss of blood.
Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
Loss of blood could lead to dehydration. Any loss in body fluids, including blood, potentially causes dehydration. Another possible cause of dehydration is diuretic drugs (Gujral et al., 2019). Diuretics make people urinate excess, hence, the patient may become dehydrated if she does not drink enough water. J.D. could be constipating due to the build-up of the hormone progesterone during menstrual bleeding (Gujral et al., 2019). Additionally, the patient has been taking OTC ibuprofen and constipation is a common side effect of the drug.
Why Vitamin B12 and folic acid are important in erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
Erythropoiesis is the process of forming new erythrocytes. During the process, vitamin B12 and folic acid promoted the proliferation of erythroblasts during their differentiation (Luis, 2019). The deficiency of vitamin B12 and folic acid prevents purine and thymidylate syntheses, leading to impaired DNA synthesis and erythroblast apoptosis. As a result, the individual may develop anemia due to ineffective erythropoiesis.
The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia. To support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
Iron deficiency can be asymptomatic if the condition is mild. However, signs and symptoms may begin to appear as it worsens. The signs and symptoms include extreme fatigue, weakness, pale skin, and cold hand and feet (Luis, 2019). Other symptoms include chest pain, headache, shortness of breath, sores in the tongue, and brittle nails (Luis, 2019). These are common symptoms of iron deficiency.
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.
Extreme fatigue is a common symptom of anemia. It occurs because the body lacks enough red blood cells to carry oxygen to the cells (Luis, 2019). Frequent Infections-Iron plays a significant role in the synthesis of lymphocytes, which then helps enhance body immunity. Therefore, a lack of sufficient iron leads to a poor immune system (Luis, 2019). Pale Skin-Iron deficiency anemia also leads to low hemoglobin, which in turn leads to paleness. Lack of sufficient flow of blood in the skin due to low hemoglobin levels leads to pale skin (Luis, 2019). Shortness of breath- occurs due to insufficient oxygen to sustain normal breathing (Luis, 2019).
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 for appropriate recommendations and treatments for J.D.
The lab results confirm the presence of iron deficiency. To treat iron deficiency, the doctor may recommend iron supplements to replenish the iron stores in the body (Luis, 2019). The doctor may recommend that the patient take ion tablets on an empty stomach, but if they are upsetting, she may take them with meals. Taking 150-200 mg of elemental iron per day is recommended. J.D. may be advised to take foods rich in ions (Luis, 2019). A blood transfusion may be required if the situation is severe.
Conclusion
Gynecological conditions can have detrimental health effects on women. Heavy menstrual bleeding is a sign of gynecological bleeding. Iron deficiency anemia is caused by heavy bleeding. Iron supplements and dietary recommendations can manage the condition.
Gujral, K., In Kakar, A., & In Nundy, S. (2019). Management of common gynecological problems: A guide for practitioners. Jaypee Brothers Medical Publishers.
Luis, R. (2019). Iron Deficiency Anemia. IntechOpen.