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UT Arlington NURS 5315 - M4 Case study

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1Module 4 Case Study Department of Nursing, The University of Texas at ArlingtonCollege of Nursing and Health Innovation NURS 5315- Advanced Pathophysiology 20212Questions1. The clinical scenario is most consistent with which type of anemia? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. - Hemolytic anemia, sickle cell anemia2. What data in the clinical scenario supports your diagnosis? You may simply list your answers below using a bullet point format. This does not have to be in a complete sentence. Interpret the labs that you list as part of your answer by indicating normal, high or low.- Sodium 139 mEq/L - Normal - Potassium 5.0 meq/l - Normal - Creatinine 0.47 mg/dl - Low - Total bilirubin 10 mg/dl - High - BUN 7 mg/dl - Normal - WBC 15,200 - High- Hematocrit 19% - Low - Hemoglobin 6.5 g/dl - Low - Ferritin 3155 ng/ml -High - Chest X-Ray - negative3. What risk factor(s) caused the exacerbation of the anemia you identified in question 1? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.- Diarrhea- Fever- Dehydration due to diarrhea4. Describe the key pathophysiologic concepts. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question maybe answered in 1-6 sentences.1. Describe the genetic alteration which results in sickle cell anemia.- Sickle cell disease is an inherited autosomal recessive pattern, where each parent carries a copy of the mutated gene. This disorder is known for the presence of an atypical form of hemoglobin called hemoglobin S ( HbS, sickle hemoglobin). HbS is formed by a genetic point mutation in B-globin that leads to replacement of one glutamate amino acid with a valineamino acid. Abnormal B-globin distorts erythrocytes into a sickle shape. Cycles of oxygenation and deoxygenation cause the HbS molecule to3polymerize and stiffen. The polymers can damage the RBC structure, causing sickle shaped RBC’s. Due to this change, the sickle shaped red blood cells die prematurely and leads to hemolytic anemia, microvascular obstruction, and ischemic tissue damage. (McCance & Huether, 2019) 2. What is the pathological process which is responsible for causing this patient’s joint pain?- Vaso-occlusive crises are very common in children. This is a condition that affects RBC’s and causes reduced oxygen to all cells of the body. Hypoxic injury and infarction can cause sensory pain. Most common sites are; bones, lungs, spleen, liver, brain, and penis. (McCance & Huether, 2019) 3. Why did this patient have a stroke 16 years ago?- Vaso-occlusive crises are most common in children, and 16 years ago the patient would have been 14 years old. These crises can affect any part of the body, they are events of hypoxic injury and infarction. Among the mostcommon affected sites is the brain. Vaso-occlusion in the vessels of the brain can end in a stroke. (McCance & Huether, 2019) 4. Why did this patient have a splenic infarct?- The spleen’s function is to destroy red blood cells. When sickle cells enter the spleen for destruction, they become trapped in the sinusoids of the spleen. The patient had a sequestration crisis. This crisis is characterized by large amounts of blood pooling in the spleen causing obstruction resulting in ischemia and splenic infarct. Extremely large amounts of sickle red cells lead to a rapid splenic enlargement, hypovolemia, or shock.(McCance & Huether, 2019) 5. Why does this patient have icteric sclera and an elevated bilirubin?- Hyperhemolytic crisis causes an accelerated rate of RBC destruction. Although unusual, this crisis may occur due to certain drugs or infection, and is characterized by anemia, jaundice, and reticylocytosis. (McCance &Huether, 2019) The patient’s elevated WBC count is indicative of an infection. The gall bladder and cystic duct become inflamed due to hemolysis of sickle cells. The bile flow becomes obstructed and4reabsorbed into the body’s circulation, this results in icteric sclera and elevated bilirubin levels.6. What is Acute Chest Syndrome? Does she or does she not have this?- Acute chest syndrome is a type of vaso-occlusive crisis involving the lungs. Common symptoms are cough, fever, chest pain, and accumulations of lung infiltrates (McCance & Huether, 2019). The patient in this case study has a negative CXR, and the lungs are clear bilaterally.5. For what actual or potential complications related to the diagnosis in question 1 does she need to be monitored? You may simply list your answer(s) below using a bullet point format. This does not have to be in a complete sentence.- Hypoxia- Ischemia and infection- Heart failure- Renal impairment/ glomerular disease- Acute chest syndrome5ReferencesMcCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biological basis for disease in adults and children (8th ed.).


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