NURS 6501 WEEK 7 & WEEK 8 Discussion

NURS 6501 Week 7

In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided (not all may apply to each scenario):

• The factors that affect fertility (STDs).
• Why inflammatory markers rise in STD/PID.
• Why prostatitis and infection happens. Also explain the causes of systemic reaction.
• Why a patient would need a splenectomy after a diagnosis of ITP.
• Anemia and the different kinds of anemia (i.e., micro and macrocytic).

 

Case Scenario:

A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. PMH not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning.
Labs at urgent care demonstrated normal hgb and hct with normal WBC differential.

Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at urgent care referred the patient and her mother to the ED for a complete work-up of the low platelet count, including a peripheral blood smear for suspected immune thrombocytopenia purpura.

 

Case Scenario – The 14-Year-Old Girl sample

The case study presents a 14-year-old girl accompanied by her mother to seek medical interventions after she developed an increased number of abnormal bruises, including various red splotches that are easily noticed in her leg. The paper’s main purpose is to elaborate on the need to engage in splenectomy after immune thrombocytopenia diagnosis (ITP).

The scenario presented by the case study proves the existence of a bleeding disorder that may be caused by immune thrombocytopenia (ITP). ITP is a medical issue that leads a patient to bleed and bruise excessively. The disorder is autoimmune since autoantibodies decrease platelet production and increases platelet destruction. Worrest et al. (2020) postulate that the poor immune system portrayed by the case study patient is mainly attributed to or prompted by the immune thrombocytopenia platelets. That happens especially when the platelet levels decrease since these platelet cells help the individual body towards blood clotting.

Splenectomy works toward autoantibody production and removing the platelet’s primary site clearance. According to Kochhar and Neunert (2021), splenectomy is more effective than other ITP therapies. Before the development and introduction of drug therapy, splenectomy was mainly used as the main ITP treatment, and still, it stands as the common treatment for patients with chronic ITP (Chaturvedi et al., 2018). The health specialists need to intervene in the case study’s patient condition by removing the spleen through a laparoscopic procedure or open surgery depending on the patient’s condition to prevent further damage to the platelets by the spleen, thus increasing these platelets’ body circulation.

The advantage of engaging the laparoscopic procedure known as keyhole surgery is that the patient will always have fewer days in hospitalization and recover much quicker than when the surgeon conducts an open surgery (Kuriyama et al., 2022). However, the condition that may require the engagement of open surgery is if the patient’s spleen is large or presence of other complications that may interfere with the procedure. In conclusion, healthcare providers must effectively assess the patient’s conditions to determine the most appropriate ITP procedure.

 

References

Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, The Journal of the American Society of Hematology, 131(11), 1172-1182. https://doi.org/10.1182/blood-2017-09-742353

Kochhar, M., & Neunert, C. (2021). Immune thrombocytopenia: A review of upfront treatment strategies. Blood Reviews, 49, 100822. https://doi.org/10.1016/j.blre.2021.100822

Kuriyama, N., Maeda, K., Komatsubara, H., Shinkai, T., Noguchi, D., Gyoten, K., … & Mizuno, S. (2022). The usefulness of modified splenic hilum hanging maneuver in laparoscopic splenectomy, especially for patients with huge spleen: a case-control study with propensity score matching. Surgical Endoscopy, 36(2), 911-919. https://doi.org/10.1007/s00464-021-08348-7

Worrest, T., Cunningham, A., Dewey, E., Deloughery, T. G., Gilbert, E., Sheppard, B. C., & Fischer, L. E. (2020). Immune thrombocytopenic purpura splenectomy in the context of new medical therapies. Journal of Surgical Research, 245, 643-648. https://doi.org/10.1016/j.jss.2019.06.092

 

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NURS 6501 WEEK 8

In your Case Study Analysis related to the scenario provided, explain the following:

• Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.

Case Scenario:

A 72-year-old woman is brought to the clinic by her daughter. The daughter reports that her mother had an acute onset of slurred speech that morning, but it resolved within an hour. About an hour later she noted her mother was a lethargic and speechless. When she attempted to get her mother to stand, she panicked when her mother slumped over to the right side and couldn’t seem to push herself to an upright position or stand. The daughter reports that her mother had a stroke 2 years ago and exhibited similar symptoms resulting in a 5-day hospital stay followed by intensive rehabilitation where she was able to return to normal functioning. When you see the patient, she is alert, ambulating, and has 4/5 strength bilaterally in the upper and lower extremities. DTRs are 2+ bilaterally. A CT of the head reveals an old left sided infarct within the temporal region. A CT of the carotids reveals a 35% blockage on the left and 40% on the right. Blood pressure is 134/84, P 84, and respirations 18. Labs tests reveal a cholesterol of 306, HDL of 36, and an LDL of 140.

 

NURS 6501 Week 8 sample

Neurologic and Musculoskeletal Pathophysiologic Processes

Ischaemic stroke results from either embolic or thrombotic events that lead to a decrease in blood flow to the brain. The Na+/K+ ATPase pumps fail due to the poor production of adenosine triphosphate and failure of the aerobic mechanism (Hui et al., 2022). In embolic cases, debris from elsewhere in the body obstructs blood flow through the affected vessel. The most common source of the clot is; chambers or valves of the heart. Other causes include; air, fat, venous or septic emboli. On the other hand, a thrombotic event, blood flow is blocked within the blood vessel secondary to dysfunction within the vessel itself such as arterial dissection, inflammatory condition and atherosclerotic disease (Meschia & Brott, 2017). The clinical presentation depends on the particular area of reduced blood flow.

Racial/ethnic variables that impact physiologic functioning

The prevalence of stroke and death rates from the disease are increased among African Americans than any other racial group. According to the American Heart Association, African Americans are at a greater risk of stroke and more severe strokes than whites (Howard et al., 2019).  The ethnic discrepancy is associated with some of the risk factors in African Americans such as; biological differences and lower socioeconomic status in African Americans compared with whites.

How the processes interact to affect the patient

African Americans people often have an increased risk of stroke due to predisposing factors such as; diabetes, elevated blood pressure, high cholesterol levels, obesity and smoking (Boehme et al., 2017). Lower social economic status is associated with a reduced likelihood for receiving the necessary treatment intervention (Albright et al., 2018). Access to health care services is a leading cause of racial disparities.

 

References

Albright, K. C., Huang, L., Blackburn, J., Howard, G., Mullen, M., Bittner, V., Muntner, P., & Howard, V. (2018). Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality. Neurology, 91(19), e1741–e1750. https://doi.org/10.1212/wnl.0000000000006467

Boehme, A. K., Esenwa, C., & Elkind, M. S. V. (2017). Stroke Risk Factors, Genetics, and Prevention. Circulation Research, 120(3), 472–495. https://doi.org/10.1161/circresaha.116.308398

Howard, V. J., Madsen, T. E., Kleindorfer, D. O., Judd, S. E., Rhodes, J. D., Soliman, E. Z., Kissela, B. M., Safford, M. M., Moy, C. S., McClure, L. A., Howard, G., & Cushman, M. (2019). Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors. JAMA Neurology, 76(2), 179. https://doi.org/10.1001/jamaneurol.2018.3862

Hui, C., Prasanna Tadi, & Patti, L. (2022, May). Ischemic Stroke. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499997/

‌ Meschia, J. F., & Brott, T. (2017). Ischaemic stroke. European Journal of Neurology, 25(1), 35–40. https://doi.org/10.1111/ene.13409