Iron-Deficiency Anemia? According File ‘Case study 1’ Critical Thinking Questions? 1. What was the cause of this patient’s iron-deficie

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Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

Iron-Deficiency Anemia

Case Study

A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on

stopping his activity. He has no history of heart or lung disease. His physical examination was

normal except for notable pallor.

Studies Result

Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads

Chest x-ray study, p. 956 No active disease

Complete blood count (CBC), p.

156

Red blood cell (RBC) count, p.

396

2.1 million/mm (normal: 4.7–6.1 million/mm)

RBC indices, p. 399

Mean corpuscular volume

(MCV)

72 mm 3 (normal: 80–95 mm

3 )

Mean corpuscular hemoglobin

(MCH)

22 pg (normal: 27–31 pg)

Mean corpuscular hemoglobin

concentration (MCHC)

21 pg (normal: 27–31 pg)

Red blood cell distribution width

(RDW)

9% (normal: 11%–14.5%)

Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL)

Hematocrit (Hct), p. 248 18% (normal: 42%–52%)

White blood cell (WBC) count, p.

466

7800/mm 3 (normal: 4,500–10,000/mcL)

WBC differential count, p. 466 Normal differential

Platelet count (thrombocyte

count), p. 362

Within normal limits (WNL) (normal: 150,000–

400,000/mm 3 )

Half-life of RBC 26–30 days (normal)

Liver/spleen ratio, p. 750 1:1 (normal)

Spleen/pericardium ratio <2:1 (normal)

Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%)

Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL)

Blood typing, p. 114 O+

Iron level studies, p. 287

Iron 42 (normal: 65–175 mcg/dL)

Total iron-binding capacity

(TIBC)

500 (normal: 250–420 mcg/dL)

Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL)

Transferrin saturation 15% (normal: 20%–50%)

Copyright © 2018 by Elsevier Inc. All rights reserved.

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

AIDS (Acquired Immunodeficiency Syndrome)

Case Studies

The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic

diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed

right-sided pneumonitis. The following studies were performed:

Studies Results

Complete blood cell count (CBC), p. 156

Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)

Hematocrit (Hct), p. 248 36% (normal: 42%–52%)

Chest x-ray, p. 956 Right-sided consolidation affecting the posterior

lower lung

Bronchoscopy, p. 526 No tumor seen

Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)

Stool culture, p. 797 Cryptosporidium muris

Acquired immunodeficiency syndrome

(AIDS) serology, p. 265

p24 antigen Positive

Enzyme-linked immunosorbent assay

(ELISA)

Positive

Western blot Positive

Lymphocyte immunophenotyping, p. 274

Total CD4 280 (normal: 600–1500 cells/L)

CD4% 18% (normal: 60%–75%)

CD4/CD8 ratio 0.58 (normal: >1.0)

Human immune deficiency virus (HIV)

viral load, p. 265

75,000 copies/mL

Diagnostic Analysis

The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is

an opportunistic infection occurring only in immunocompromised patients and is the most

common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium

muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool

culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his

prognosis is poor.

The patient was hospitalized for a short time for treatment of PCP. Several months after he was

discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually

and died 18 months after the AIDS diagnosis.

MSN 5550 Health Promotion: Prevention of Disease Case Study Module 2 Instructions: Read the following case study and answer the reflective questions. Please provide evidence-based rationales for your answers. APA, 7th ed. must be followed.

CASE STUDY: An Older Immigrant Couple: Mr. and Mrs. Arahan

Mr. and Mrs. Arahan, an older couple in their seventies, have been living with their oldest daughter, her husband of 15 years, and their two children, ages 12 and 14. They all live in a middle-income neighborhood in a suburb of a metropolitan city. Mr. and Mrs. Arahan are both college educated and worked full-time while they were in their native country. In addition, Mr. Arahan, the only offspring of wealthy parents, inherited a substantial amount of money and real estate. Their daughter came to the United States as a registered nurse and met her husband, a drug company representative. The older couple moved to the United States when their daughter became a U.S. citizen and petitioned them as immigrants. Since the couple was facing retirement, they welcomed the opportunity to come to the United States. The Arahans found life in the United States different from that in their home country, but their adjustment was not as difficult because both were healthy and spoke English fluently. Most of their time was spent taking care of their two grandchildren and the house. As the grandchildren grew older, the older couple found that they had more spare time. The daughter and her husband advanced in their careers and spent a great deal more time at their jobs. There were few family dinners during the week. On weekends, the daughter, her husband, and their children socialized with their own friends. The couple began to feel isolated and longed for a more active life. Mr. and Mrs. Arahan began to think that perhaps they should return to the home country, where they still had relatives and friends. However, political and economic issues would have made it difficult for them to live there. Besides, they had become accustomed to the way of life in the United States with all the modern conveniences and abundance of goods that were difficult to obtain in their country. However, they also became concerned that they might not be able to tolerate the winter months and that minor health problems might worsen as they aged. They wondered who would take care of them if they became very frail and where they would live, knowing that their daughter had only saved money for their grandchildren’s college education. They expressed their sentiments to their daughter, who became very concerned about how her parents were feeling. This older couple had been attending church on a regular basis, but had never been active in other church-related activities. The church bulletin announced the establishment of parish nursing with two retired registered nurses as volunteers. The couple attended the first opening of the parish clinic. Here, they met one of the registered nurses, who had a short discussion with them about the services offered. The registered nurse had spent a great deal of her working years as a community health nurse. She informed Mr. and Mrs. Arahan of her availability to help them resolve any health-related issues.