Anemia Case Study Please answer the questions for this case study.Thank you!CASE STUDY WS5
CASE STUDY: ANEMIA
INITIAL HISTORY:
➢ 47 year old male presents with gradual onset of dyspnea on exertion and fatigue
➢ Also complains of frequent dyspepsia with nausea and occasional epigastric pain
➢ Has a history of alcohol abuse
Question 1: What questions would you like to ask this patient about his symptoms?
ADDITIONAL HISTORY:
➢ He says he has not had his usual energy levels for months; dyspnea has become much
worse in the last few weeks
➢ Denies chest pain, orthopnea, edema, cough, wheezing, or recent infections
➢ States he has occasional episodes of hematemesis after drinking heavily, and
subsequently has had several days of dark stools
➢ Consumes up to 2 six-packs of beer a day for the past 8 years since losing his job
➢ Nothing seems to make his breathing any better, but antacids help with is epigastric
discomfort and dyspepsia
Question 2: What questions would you like to ask about his past medical history?
PAST MEDICAL HISTORY:
➢ Denies history of cardiac or pulmonary disease
➢ Diagnosed with duodenal ulcer in the past and was on “3 drugs at once” for a while 2
years ago, but stopped taking them due to the expense
➢ His only surgical history was a childhood tonsillectomy
➢ De does not smoke or take any medications except for over the counter antacids
➢ He has no known allergies
PHYSICAL EXAMINATION:
➢ Thin and pale white male looking older than his stated age with no acute distress
➢ T = 37 C orally; P = 95 and regular; RR = 16 and unlabored; B/P = 128/72 sitting
Skin, HEENT, Neck:
➢ Skin pale without rash, no spider angiomata
➢ Sclera pale with no icterus
➢ PERRLA, fundi without lesions
➢ Pharynx is clear without postnasal drainage
➢ NO thyromegaly, adenopathy, or bruits
Lungs, Cardiac:
➢ Good lung expansion, lungs clear to auscultation and percussion
➢ PMI at 5th intercostal space at midclavicular line
➢ Heart rhythm regular with a grade II/VI systolic ejection murmur at left sternal border
➢ No gallops, heaves, or thrills
Abdomen, Rectal:
➢ Abdomen nondistended; bowel sounds present
➢ Liver 8 cm. At midclavicular line
➢ Moderate epigastric tenderness without rebound or guarding
➢ Prostate not enlarged and nontender
➢ Stool guaiac positive
Extremities, Neurological:
➢ No joint deformity, muscle tenderness or edema
➢ Alert and oriented X 3
➢ Strength is 5/5 throughout and sensation intact
➢ Gait normal. DTR 2 + and symmetrical throughout
Question 3: What are the pertinent positives and negatives on examination?
Question 4: What is your differential diagnosis at this time?
Question 5: What laboratory studies should be obtained at this time?
LABORATORY RESULTS:
➢ WBC = normal with a normal differential and platelet count
➢ Hct = 29%; MCV = normal, MCHC = slightly decreased; RDW = markedly increased;
reticulocyte count < 2% ➢ Smear with mixed microcytic/hypochromic and macrocytic/normochromic red blood cells; WBC and platelets appear normal ➢ PT/PTT, liver function tests, electrolytes, and amylase normal ➢ Upper endoscopy with 2 cm. duodenal ulcer with evidence of recent but no acute hemorrhage ➢ Question 6: What might the hematologic findings indicate and what should be done to further evaluate them? ADDITIONAL LABORATORY RESULTS: ➢ Serum iron, total iron binding capacity, saturation, and ferritin all reduced ➢ Bone marrow biopsy with megaloblastic changes and low iron stores ➢ Serum folate and red blood cell folate low; B12 normal Question 7: Based on theses findings, what are the diagnoses for this patient? Question 8: How should this patient be managed? Brashers, V. L. (2006). Clinical applications of pathophysiology: An evidence-based approach. St. Louis, MO: Mosby. Purchase answer to see full attachment




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