NU 665B Week 9 Discussion 1 Hematology Patient

Sample Answer

Ms. Jennifer Robinson is a 65-year-old developmentally delayed woman presenting with symptoms of excessive fatigue and shortness of breath (SOB) after activity. She mentioned that the fatigue has been present for a few months, and over the last week, she has been excessively fatigued and developed SOB. The purpose of this post is to identify differential diagnoses and develop a plan of care for the patient.

Differential Diagnoses

Iron deficiency Anemia (IDA) The clinical manifestations of IDA include fatigue, SOB, pallor, decreased ability to perform activities, leg cramps, cold intolerance, a decreased immunity, hemoglobin <12g/dl, and hematocrit <36% in females (Kumar et al., 2022). The patient has fatigue, pallor, SOB, Hb of 9.5 g/dl and hematocrit of 29%.

Vitamin B12 deficiency anemia Clinical findings include pallor, jaundice, SOB, glossitis, fatigue, paresthesia, poor balance, and weight loss (Azzini et al., 2021). Positive findings include pallor, SOB, and increased fatigue.

Congestive Heart Failure (CHF) CHF presents with SOB on exertion, orthopnea, fatigue, increased exercise intolerance, paroxysmal nocturnal dyspnea, and dyspnea at rest. Positive findings include SOB, fatigue, activity intolerance, and a history of CHF.

Hypothyroidism Manifestations in the cardiopulmonary system include hypotension, SOB, bradycardia, activity intolerance, cardiomegaly, and dysrhythmias (Hegedüs et al., 2022). The patient has SOB and increased fatigue with activity, making this a differential.

Plan of Care Iron Deficiency Anemia

Pharmacology Ferrous sulfate, 325 mg TDS for six months. This is the preferred iron salt and provides 180 mg of iron daily with an absorption of up to 10 mg (Kumar et al., 2022).

Non-pharmacology Transfusion of packed red blood cells if there is a risk of hypoxia.

Labs/diagnostics A Peripheral smear to examine the erythrocytes and identify the cause of anemia.

Referrals/interprofessional communications Referral to a hematologist if the patient’s Hb and RBC mass do not improve with Hematinic therapy (Kumar et al., 2022).

Patient Education

1. Dietary measures to increase consumption of foods high in iron to replenish iron stores and ascorbic acid to promote iron absorption.
2. She will be advised to avoid excess tea and coffee, as they can decrease iron absorption (Kumar et al., 2022).
3. Take the iron supplement between meals for better absorption and reduce GI distress.
4. Increase oral intake of iron from food sources like red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, and raisins (Kumar et al., 2022).
5. Take iron supplements with orange juice since Vitamin C aids iron absorption.
6. Education on the side effects of iron therapy, like constipation and black, tarry stools (Kumar et al., 2022).
7. Adopting an active exercise routine to improve cardiovascular health.
8. Maintain an ideal body weight through low-caloric intake.
9. Minimize alcohol consumption.
10. Quit smoking.
    

Follow-up The patient will be followed up after four weeks for a CBC count and to evaluate treatment progress.

Health maintenance item The patient will be educated on the importance of regular screening for colorectal cancer. The U.S. Preventive Services Task Force recommends screening in adults 45 to 75 (Zheng et al., 2023).

Social determinant of health The factors associated with the onset of anemia include level of income, level of education, area of residence, and household crowding (Habib et al., 2020).

The patient may have a low education level, given that she is developmentally delayed and living in an underprivileged neighborhood with limited access to healthy food and clean water.

References

• Azzini, E., Raguzzini, A., & Polito, A. (2021). A Brief Review on Vitamin B12 Deficiency Looking at Some Case Study Reports in Adults. International journal of molecular sciences, 22(18), 9694. https //doi.org/10.3390/ijms22189694
  
• Habib, N., Abbasi, S. S., & Aziz, W. (2020). An Analysis of Societal Determinant of Anemia among Adolescent Girls in Azad Jammu and Kashmir, Pakistan. Anemia, 2020, 1628357. https //doi.org/10.1155/2020/1628357
  
• Hegedüs, L., Bianco, A. C., Jonklaas, J., Pearce, S. H., Weetman, A. P., & Perros, P. (2022). Primary hypothyroidism and quality of life. Nature Reviews. Endocrinology, 18(4), 230–242. https //doi.org/10.1038/s41574-021-00625-8
  
• Kumar, A., Sharma, E., Marley, A., Samaan, M. A., & Brookes, M. J. (2022). Iron deficiency anemia pathophysiology, assessment, practical management. BMJ Open Gastroenterology, 9(1), e000759. https //doi.org/10.1136/bmjgast-2021-000759
  
• Zheng, S., Schrijvers, J. J. A., Greuter, M. J. W., Kats-Ugurlu, G., Lu, W., & de Bock, G. H. (2023). Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction A Systematic Review and Meta-Analysis. Cancers, 15(7), 1948. https //doi.org/10.3390/cancers15071948