Instructions: Respond by extending, refuting/correcting, or adding additional nuance. Response  must be grammatically correct, in current APA style, be constructive and use academic literature. Must be at least 300 words.

Several factors might put the patient at enhanced risk of anemia. These include heavy menstrual flow and cramping recorded over the last six days, four vaginal deliveries over the last four years, and reports of ulcers and associated gastrointestinal bleeding. These factors directly cause blood loss and the risk of anemia (DeLoughery, 2017). J.D. might be presenting with the symptoms of constipation and/or dehydration due to increased urinary frequency. It can be attributed to diuretics prescription. These drugs used to control and manage hypertension function by causing patients to urinate more frequently. That said, vitamin B12 and folic acid are critical to erythropoiesis. Erythroblasts need them for proliferation during differentiation (DeLoughery, 2017). Deficiency in these elements suppresses purine and thymidylate synthesis and alters the DNA structure leading to erythroblast apoptosis (DeLoughery, 2017). It causes the red cells to appear oval-shaped instead of their usual circular shape.

J.D. might be presenting with the symptoms of iron deficit. The most remarkable one to support this diagnosis is unexplained fatigue. Fatigue occurs due to the body’s inability to make the adequate amount of hemoglobin, which transports oxygen. The lack of energy or weakness since the last pregnancy is also a symptom of anemia. It is caused by a decrease in oxygen supplied to tissues and muscles, leading to deprived energy. If the patient is diagnosed with iron deficiency anemia, the most significant sign would be a hemoglobin level lower than normal due to the shortage of iron and a hematocrit level lower than normal due to the insufficient number of healthy red blood cells (DeLoughery, 2017). Indeed, such labs as Hb 10.2 g/dL, Hct 30.8%, and Ferritin 9 ng/dL are significantly lower than recommended values for women. It certainly supports the iron deficiency anemia diagnosis (DeLoughery, 2017). Appropriate recommendations for this patient include a prescription of iron medication to refill ferric stores, antibiotics such as amoxicillin to manage peptic ulcers, and oral birth control pills to control or regulate the menstrual flow. However, further assessment is necessary to rule out the presence of tumors or fibroids, which can be causing a heavy menstrual flow.

Cardiovascular Case

As for people with coronary artery disease (CAD) development risk and acute myocardial infarct (MI) diagnosis, smoking is one of the modifiable aspects. It adversely affects the right arterial circulation. In addition, high cholesterol levels narrow the arteries (Anderson & Morrow, 2017). Non-modifiable risks are related to age and family cases of heart diseases (Anderson & Morrow, 2017). Aging makes arteries less flexible and inefficient in blood supply, while genetic risk factors present in families leave members vulnerable to heart diseases. In case of acute myocardial infarct, the EKG would reveal taller-than-normal R waves, ST depression, and T waves (Anderson & Morrow, 2017). The findings from the case consistent with this acute coronary event include chest pain with a crushing and radiating sensation in the sternal area that does not appear to change with deep breathing.

The cardiac troponin test is perhaps the best laboratory test that can confirm the presence of an acute myocardial infarct event. It is both very sensitive and specific in that it can detect the variation of troponin concentration in the blood. Normally, troponin exists in small to undetectable quantities, but readily increases in case of damage to heart muscle cells (Anderson & Morrow, 2017). Oftentimes, MI is followed by a temperature rise. The elevated temperature observed in this patient is a manifestation of inflammatory reaction after myocardial necrosis (Anderson & Morrow, 2017). Usually, it begins to increase as early as four hours after the onset of infarction and resolves by the fourth or fifth day (Anderson & Morrow, 2017). Pain is also present in most cases of MI. Mr. W.G. experienced it due to the blockage of blood flowing to the heart muscle (Anderson & Morrow, 2017). It can be attributed to plaques in the arteries.

References

Anderson, J. L., & Morrow, D. A. (2017). Acute myocardial infarction. The New England Journal of Medicine, 376(21), 2053-2064. https://doi.org/10.1056/NEJMra1606915 (Links to an external site.)

DeLoughery, T. G. (2017). Iron deficiency anemia. Medical Clinics of North America, 101(2), 319-332. https://doi.org/10.1016/j.mcna.2016.09.004

Instructions: Respond by extending, refuting/correcting, or adding additional nuance. Response  must be grammatically correct, in current APA style, be constructive and use academic literature. Must be at least 300 words.

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