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Module 2 Discussion

Lakeesha McCloud

St. Thomas University

NUR-502-AP7: Advanced Pathophysiology

Dr. Sabine D. Saintable

August 29th, 2024

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Hematopoietic: J.D.'s Case Study

Contributing Factors for Iron Deficiency Anemia

Several factors contribute to J.D.'s risk for iron deficiency anemia, including the recent

history of childbirth four months ago, heavy menstrual flow (menorrhagia), and the higher

utilization of NSAIDs such as ibuprofen. It is common for postpartum women to experience

anemia because of the blood loss during the delivery process and also because of the heavy flow

brought on by their menstrual cycles after childbirth (Cappellini et al., 2020). The menorrhagic

condition exacerbates this situation even more: resulting in significant blood loss, and

unfortunately less available iron within the body. Furthermore, prolonged consumption in higher

quantities of NSAID can cause gastrointestinal bleeding. This is another major cause that

depletes the iron stores within the body.

Potential Causes of Constipation and Dehydration

J.D. may experience constipation and dehydration due to her continued medications and

diuretics. Diuretics, which are associated with the management of hypertension, can make one

urinate more, leading to dehydration and, consequently, constipation (Andrews & St Aubyn,

2020). In addition, the high doses of ibuprofen and the addition of omeprazole can affect gut

motility and may lead to constipation. Moreover, increased frequency of urination in J.D., if not

balanced with adequate fluid intake, can exacerbate dehydration stages.

Importance of Vitamin B12 and Folic Acid in Erythropoiesis

Vitamin B12 and folate are essential for DNA synthesis and cell division, and thus for the

production of red blood cells in the process of erythropoiesis. A deficiency in either nutrient can

cause anemia known as megaloblastic anemia, characterized by the production of abnormally

large red blood cells that have reduced oxygen-carrying capabilities (Lakshmanan, 2021). Folic
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acid is especially important to the processes of rapid cell division and replication, while Vitamin

B12 is crucial to nerve function and the maturation of red blood cells. In cases of deficiency, this

may lead to macrocytic anemia because the red blood cells become larger and immature.

Clinical Symptoms of Iron Deficiency Anemia in J.D.

Iron deficiency anemia symptoms that J.D. may present with are extreme fatigue,

weakness, pallor, dizziness, shortness of breath, and brittle nails (Kumar et al., 2022).

Furthermore, she also presents with heavy menstrual bleeding and increased frequency of

urination, coupled with complaints of extreme fatigue and weakness, presentation consistent with

clinical symptoms of anemia.

Expected Signs of Iron Deficiency Anemia

Physical examination findings in iron deficiency anemia may include pallor (especially of

the conjunctiva and mucous membranes), tachycardia, a heart murmur, glossitis (an inflamed

tongue), and spoon-shaped nails described as koilonychia (Kumar et al., 2022). Other signs

include a sore or smooth tongue and pica, which is the cravings to eat nonfood items, including

ice or dirt.

Laboratory Results and Recommendations for Treatment

Lab results revealed that J.D. had low hemoglobin (Hb), 10.2 g/dL; hematocrit (Hct),

30.8%; ferritin, 9 ng/dL, thus establishing the diagnosis of iron deficiency anemia.

Recommended treatments include supplementation with oral iron as ferrous sulfate, dietary

modification to increase iron intake, and treatment of menorrhagia to alleviate symptoms and

avoid further blood loss (Kumar et al., 2022). Serial complete blood counts (CBC) and iron

studies are recommended for monitoring and re-evaluation of her response to treatment.

Cardiovascular: Mr. W.G.'s Case Study

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Modifiable and Non-Modifiable Risk Factors for Coronary Artery Disease

Modifiable risk factors for coronary artery disease (CAD) include smoking, high blood

pressure, high cholesterol levels, obesity, sedentary lifestyle, and a diet high in saturated fats.

Non-modifiable risk factors are age, gender, family history of CAD, and ethnicity (Khoja et al.,

2024). Considering the fact that Mr. W.G. comes out to be in an older age group, his age can be a

potential risk factor. Therefore, it is essential to further analyze other risk factors in order to

provide an appropriate risk profile.

Expected EKG Findings in Acute Myocardial Infarction (AMI)

In the case of an AMI, the EKG may show ST-segment elevation, inversion of the T

wave, or even the occurrence of Q waves-all signs of the heart muscle sustaining ischemic

damage. With Mr. W.G.'s chief complaint being chest pain as a crushing sensation and radiating

to his neck and jaw, this is definitely suggestive of an acute coronary syndrome, most likely an

ST-elevation myocardial infarction (STEMI) itself (Barnett, 2019).

Most Specific Laboratory Test for AMI

Amongst the diagnostic laboratory tests that determine whether a patient has an acute

myocardial infarction, the cardiac troponin level is the most specific. Cardiac troponins TnI and

TnT are highly specific biomarkers of myocardial injury (Aydin et al., 2019). Their elevation can

confirm myocardial infarction within a few hours from symptom onset and remain elevated for

up to 14 days, thus being the most preferred diagnostic test.

Explanation for Fever Following Myocardial Infarction

Fever post-myocardial infarction is a sign of the inflammatory response to the necrosis of

the myocardial cell. It is expected that the inflammatory response appears through 24 to 48 hours

following the infarction and may last for days (Putot et al., 2019). Pyrogens are produced as part
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of the body response to cell injury, which manifests in fever that normally peaks in the first 48

hours.

Pain During Myocardial Infarction

The pain experienced during the myocardial infarction comes about because of

myocardial ischemia due to the very minimal amount of oxygen supply to the heart muscle.

Accumulation of metabolites such as lactic acid and activation of the pain receptors in the

myocardium manifest the pain (Shudaifat, 2021). This sensation characterized by crushing chest

pain, as suffered by Mr. W.G., results from reduced coronary blood flow leading to tissue

hypoxia and constitutes a hallmark symptom of the disease.

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References

Andrews, A., & St Aubyn, B. (2020). Assessment, diagnosis and management of

constipation. Nurs Stand, 36(9). https://doi.org/10.7748/ns.2020.e11512

Aydin, S., Ugur, K., Aydin, S., Sahin, İ., & Yardim, M. (2019). Biomarkers in acute myocardial

infarction: current perspectives. Vascular health and risk management, 1-10.

https://doi.org/10.2147/vhrm.s166157

Barnett, R. (2019). Acute myocardial infarction. The Lancet, 393(10191), 2580.

https://doi.org/10.1016/s0140-6736(19)31419-9

Cappellini, M. D., Musallam, K. M., & Taher, A. T. (2020). Iron deficiency anaemia

revisited. Journal of internal medicine, 287(2), 153-170.

https://doi.org/10.1111/joim.13004

Khoja, A., Andraweera, P. H., Lassi, Z. S., Padhani, Z. A., Ali, A., Zheng, M., ... & Arstall, M. A.

(2024). Modifiable and Non-Modifiable Risk Factors for Premature Coronary Heart

Disease (PCHD): Systematic Review and Meta-Analysis. Heart, Lung and Circulation.

https://doi.org/10.1016/j.hlc.2023.12.012

Kumar, A., Sharma, E., Marley, A., Samaan, M. A., & Brookes, M. J. (2022). Iron deficiency

anaemia: pathophysiology, assessment, practical management. BMJ open

gastroenterology, 9(1), e000759. https://doi.org/10.1136/bmjgast-2021-000759

Lakshmanan, M. (2021). Pharmacotherapy of Vitamin B 12 and Folic Acid

Deficiency. Introduction to Basics of Pharmacology and Toxicology: Volume 2:

Essentials of Systemic Pharmacology: From Principles to Practice, 769-779.

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Putot, A., Chague, F., Manckoundia, P., Cottin, Y., & Zeller, M. (2019). Post-infectious

myocardial infarction: new insights for improved screening. Journal of clinical

medicine, 8(6), 827. https://doi.org/10.3390%2Fjcm8060827

Shudaifat, Y. (2021). Managing Pain in Acute Myocardial Infarction Patients. EC Pulmonology

and Respiratory Medicine, 10, 04-10.