Module 2 Discussion The 50-Year-Old Patient Evaluation and Management Plan
University:
St. Thomas University
Module 2 Discussion The 50-Year-Old Patient Evaluation and Management Plan
Paper Instructions
A 50-year-old woman presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. The woman has a history of congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease.
The CBC results indicate hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patient’s vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. The practitioner suspects the low hemoglobin level is related to the decline in kidney function and begins to address treatment related to the condition. Discuss the following:
- Which test(s) should be performed to determine whether the anemia is related to chronic disease or iron deficiency, and what would those results show?
- How do the kidneys affect blood cell production?
- Which medication(s) should be considered for this patient?
- What test should be performed if you suspect an inflammatory cause, explain how they work?
- What follow-up should the practitioner recommend for the patient?
Submission Instructions
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
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Sample Answer
The case study concerns a 50-year-old female patient with a long-standing history of congestive heart failure and impaired renal function. The patient has a net decrease in erythrocyte indices such as hemoglobin (9.5 g/dL) and hematocrit (29%). This paper will discuss how to distinguish iron deficiency from chronic disease and inflammation as the cause of anemia, the role of the kidneys in blood cell production, tests for investigating inflammation as a cause of anemia, and the management and follow-up of the patient.
Tests To Determine Whether Anemia Is Caused by Iron Deficiency or Chronic Disease
To ascertain the etiology of the anemia, the patient should undergo some tests. A full hematogram should be the initial test. This helps the physician know the complete blood count. Moreover, other parameters of erythrocytes can be evaluated, for example, mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), Anemia from chronic disease typically presents with a lower-than-normal MCV, while the MCHC is normal (Lanser et al., 2021).
Performing iron studies will help rule out iron deficiency anemia. This may include serum iron levels, total iron binding capacity, ferritin, and transferrin saturation. In iron deficiency, the iron study levels are below normal, while in anemia, a chronic disease, the iron study levels are normal.
Role of Kidneys in Blood Cell Production
In the process of erythropoiesis, the kidneys play a crucial role in producing erythropoietin. This is a hormone that stimulates the erythropoietic organs to produce blood cells (Tsiftsoglou, 2021). This process is mediated by hypoxia in situations of high oxygen demand. In patients who suffer from longstanding renal diseases, there is a decrease in the production of erythropoietin, thus anemia develops. The degree of renal failure is proportional to the severity of the anemia because erythropoietin production decreases proportionally.
Medications Considered in Management of The Patient
The management of the patient should consider her medical history. The patient should receive holistic care, which should also include management of congestive heart failure. The patient should receive diuretics, angiotensin-converting enzyme (ACE) inhibitors, or beta-blockers to lower the workload on the failing heart. Managing anemia should also help manage heart failure since the heart works less to perfuse the rest of the organs (Portolés et al., 2021).
If the anemia is a result of iron deficiency, iron replacement therapy should be done. If the anemia is caused by chronic renal disease, agents that stimulate erythropoiesis, such as epoetin, should be administered to supplement the erythropoietin deficiency.
Tests Performed in Inflammation Is the Suspected Cause of Anemia
If inflammation was the suspected cause, markers of inflammation are beneficial in ruling out a chronic illness that may present with chronic inflammation. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate (ESR) are used (Begum & Latunde-Dada, 2019). Chronic inflammation can lead to anemia. More specific inflammatory markers, such as tumor necrosis factor and interleukin-6 (IL-6), may be used to narrow down the exact cause of inflammation.
Follow Up Recommendations from The Practitioner
Follow-up is an essential component in the management of anemia superimposed on chronic disease. Over and above lifestyle modification, the practitioner should recommend regular monitoring of hemoglobin and hematocrit levels (Rizzo et al., 2021). The clinical state of the patient should guide the monitoring. Furthermore, the practitioner should emphasize the need to properly manage heart failure since anemia worsens heart failure. The patient should also be referred to a nephrologist for consultation.
Conclusion
In a patient with a long-standing history of congestive heart failure and renal function impairment, anemia ought to be assessed and managed comprehensively. Identifying the underlying cause is crucial to providing the appropriate medication. Inflammation should be ruled out as a possible cause of anemia. Patient follow-up is an important component in the management of the patient.
References
- Begum, S., & Latunde-Dada, G. O. (2019). Anemia of Inflammation with an Emphasis on Chronic Kidney Disease Nutrients, 11(10), 2424. https //doi.org/10.3390/nu11102424
- Lanser, L., Fuchs, D., Scharnagl, H., Grammer, T., Kleber, M. E., März, W., Weiss, G., & Kurz, K. (2021). Anemia of Chronic Disease in Patients with Cardiovascular Disease Frontiers in Cardiovascular Medicine, 8. https //www.frontiersin.org/articles/10.3389/fcvm.2021.666638
- Portolés, J., Martín, L., Broseta, J. J., & Cases, A. (2021). Anemia in Chronic Kidney Disease From Pathophysiology and Current Treatments to Future Agents Frontiers in Medicine, 8, 642296. https //doi.org/10.3389/fmed.2021.642296
- Rizzo, C., Carbonara, R., Ruggieri, R., Passantino, A., & Scrutinio, D. (2021). Iron Deficiency A New Target for Patients with Heart Failure Frontiers in Cardiovascular Medicine, 8, 709872 https //doi.org/10.3389/fcvm.2021.709872
- Tsiftsoglou, A. S. (2021). Erythropoietin (EPO) as a Key Regulator of Erythropoiesis, Bone Remodeling, and Endothelial Transdifferentiation of Multipotent Mesenchymal Stem Cells (MSCs) Implications in Regenerative Medicine Cells, 10(8), 2140. https //doi.org/10.3390/cells10082140
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