J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month
history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence,
extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have
been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and
constipation. She has not had her usual energy levels since before her last pregnancy.
Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with
four pregnancies within four years, the last infant having been delivered vaginally four months
ago. All five pregnancies were unremarkable and without delivery complications. All infants were
born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee,
probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years
old. When asked what OTC medications she is currently taking for her pain and for how long she
has been taking them, she reveals that she started taking ibuprofen, three tablets each day,
about²¹⁄years ago for her left knee. Due to a slowly progressive increase in pain and a loss of
adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the
recommendation from her nurse practitioner and because long-term ibuprofen use can cause
pep-tic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal
bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated
with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
Case Study Questions
1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their
deficiency might cause on the red blood cells?
4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have
positive for Iron deficiency anemia.
5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of
this type of anemia? List and describe.
6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood
cells are smaller and paler in color than normal. Research list and describe for appropriate
recommendations and treatments for J.D.
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing
tennis with a friend. At first, he attributed his discomfort to the heat and having had a large
breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area
and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not
seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began
rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and
called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and
arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was
placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2
mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15
minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not
relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
1. For patients at risk of developing coronary artery disease and patients diagnosed with acute
myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are
compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial
infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when
that can be observed and for how long? Base your answer on the pathophysiology of the
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and
support your answer.
Contributing factors on J.D that might put her at risk to develop iron deficiency anemia
Factors on J.D that might put her at risk to develop iron deficiency anemia include her heavy menstruation period. She has been experiencing 6 days of heavy flow. This is because heavy flow leads to loss of red blood cells thereby increasing the risk of anemia (Kocaoz et al., 2019). Other factors include ulcers and having 4 deliveries in the last 4 years which may contribute to loss of blood.
reasons why J.D. might be presenting constipation and or dehydration
The patient is taking diuretic pills, which make her urinate often, which may lead to constipation (Hoppe et al., 2019). ….Click link below to purchase full tutorial at $10