Please editing the following responses to have a better flow in APA 7th edition format. Please add any additional supporting information. Include intext citations and the references provided.
Mr. X, age 57, presented to his physician with marked fatigue,
nausea with occasional diarrhea, and a sore, swollen tongue. Lately he also has
been experiencing a tingling feeling in his toes and a feeling of clumsiness.
Microscopic examination of a blood sample indicated a reduced number of
erythrocytes, many of which are megaloblasts, and a reduced number of
leukocytes, including many large, hypersegmented cells. Hemoglobin and serum
levels of vitamin B12 were below normal. Additional tests confirm pernicious
anemia.
Discussion Questions
1.
Relate
the pathophysiology of pernicious anemia to the manifestations listed above.
pernicious
anemia results from a vitamin B12 deficiency due to lack of intrinsic factor,
(IF) a protein that helps your intestines absorb vitamin B12.
2.
Discuss
how the gastric abnormalities contribute to vitamin B12 and iron deficiency and
how vitamin B12 deficiency causes complications associated with pernicious
anemia.
This
protein is released by cells in the stomach. When the stomach does not make
enough intrinsic factor, the intestine cannot properly absorb vitamin B12. Gastrectomy
can significantly reduce the production of IF. A rare congenital autosomal
recessive disorder can result in deficiency of IF without gastric atrophy.
3.
Discuss
other tests that could be performed to diagnose this type of anemia.
Folic acid deficiency, altered pH in the small
intestine, and lack of absorption of B12 complexes in the terminal ileum can
also cause megaloblastic anemia. Pernicious anemia must be differentiated from
other disorders that interfere with the absorption and metabolism of vitamin
B12.
4.
Discuss
the treatment available and the limitations.
Pernicious anemia
usually is easy to treat with vitamin B12 shots or pills. If you have
severe pernicious anemia, your doctor may recommend shots first. Shots usually
are given in a muscle every day or every week until the level of vitamin B12 in
your blood increases. You may need lifelong treatment, which include
taking vitamin B12 supplements daily. If you have complications of pernicious
anemia, such as nerve damage, early treatment may help reverse the damage. You’re
also at higher risk for stomach cancer.
Ms. L, a 19-year-old woman with no previous medical history, was
involved in a serious automobile accident in which her best friend died.
Examination by EMT personnel first on the scene revealed she had only minor
scrapes and bruises and no sign of head trauma. While en route by ambulance to
the hospital, Ms. L complained of thirst and appeared restless. Further
examination indicated a rapid pulse and respirations, with her blood pressure
now at 100/60 mm Hg. She appeared less responsive to the paramedics. She was
slipping into circulatory shock as they checked her again for internal
injuries.
Discussion Questions
1.
Discuss
the contributing factors to shock in this case and the pathophysiologic changes
causing the changes in vital signs.
Being
a witness to her bestfriend’s death may have caused by trauma. Shock may result
from trauma, heatstroke, blood loss, an allergic reaction, severe
infection, poisoning, severe burns or other causes.
2.
Discuss
the signs and symptoms of shock, including the rationale for each, as seen in
the early stage, and as compensation mechanisms respond.
When
a person is in shock, his or her organs aren’t getting enough blood or oxygen. Changes
in mental status or behavior, such as anxiousness or agitation. Blood pressure
tends to drop to dangerous levels. Nausea or vomiting, enlarged pupils, weakness
or fatigue may also occur.
3.
Discuss
emergency and follow-up treatment for shock and for complications that may
arise if not treated quickly.
Lay the person down and elevate the legs and feet slightly,
unless you think this may cause pain or further injury. Keep the person still
and don’t move him or her unless necessary. Begin CPR if the person shows no
signs of life, such as not breathing, coughing or moving. Loosen tight clothing
and, if needed, cover the person with a blanket to prevent chilling.
If untreated, this can lead to permanent organ damage or even
death.
4.
Compare
the types of shock, giving a specific cause, classification, and any
significant changes in onset or manifestations.
·
Cardiogenic shock (due to heart problems) – bradycardia
·
Hypovolemic shock (caused by too little blood volume, traumatic
injury) – decreased urine output, weakness, pallor
·
Anaphylactic shock (caused by allergic reaction) – Wheezing or
gasping for air
·
Septic shock (due to infections) – feeling cold, extreme pain, tachycardia
·
Neurogenic shock (caused by damage to the nervous system) –
cyanosis, lack of consciousness, slow heart rhythm
References
https://emedicine.medscape.com/article/204930-overview
https://www.nhlbi.nih.gov/health-topics/pernicious-anemia#:~:text=Types%20of%20Treatment-,Pernicious%20anemia%20usually%20is%20easy%20to%20treat%20with%20vitamin%20B12,B12%20in%20your%20blood%20increases.
https://www.mayoclinic.org/first-aid/first-aid-shock/basics/art-20056620#:~:text=Shock%20may%20result%20from%20trauma,getting%20enough%20blood%20or%20oxygen.
https://medlineplus.gov/ency/article/000039.htm
Last Completed Projects
| topic title | academic level | Writer | delivered |
|---|