NURS 6501 Module 7 Case Study Analysis

Sample Answer for NURS 6501 Module 7 Case Study Analysis Included After Question

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided (not all may apply to each scenario):

  • The factors that affect fertility (STDs).
  • Why inflammatory markers rise in STD/PID.
  • Why prostatitis and infection happens. Also explain the causes of systemic reaction.
  • Why a patient would need a splenectomy after a diagnosis of ITP.
  • Anemia and the different kinds of anemia (i.e., micro and macrocytic).

A Sample Answer For the Assignment: NURS 6501 Module 7 Case Study Analysis

Title: NURS 6501 Module 7 Case Study Analysis

Case Study Analysis

The case study focuses on a 14 –year –old female who required urgent care. The patient was in the company of her mother. The mother stated that the girl was facing an abnormal number of funny-looking red spotless and had an abnormal number of bruises on her legs. However, the mother objected that the trauma was related to the bruises noted after two weeks. She also noted that the girl had been experiencing a bad rest at home for the past three weeks, led by a bad case of mono. The girl was identified to have bleeding gums when brushing her teeth in the morning. The lab report identified that the girl had a normal WBC differential and hgb and hct.

However, platelet abnormal lab results are based on the platelet count of 100,000/mm3. Bleeding in her gums was also noticed when she brushed her teeth in the morning. A complete workup on the peripheral blood smear immune thrombocytopenic purpura was recommended at the ED. The paper focuses on factors that interfere with fertility and gives the reason for the rise of STD/PID due to the inflammatory markers.

Pathophysiology of Immune Thrombocytopenia Purpose (ITP)

According to Chen et al. (2022), immune thrombocytopenia purpura (ITP) pathophysiology is complex since it consists of T-cell and B-cell abnormalities. There are four causes of thrombocytopenia mechanism, which are consumption, hyperproliferation, destruction, and sequestration. In addition, the mechanism involves a significant proportion of cases and increases platelet destruction, which is an impaired platelet production. Therefore, the megakaryopoiesis and thrombopoiesis defect is experienced due to increased platelet destruction (Grodzielski et al., 2019).

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The phagocytosis process helps remove the sanitized platelet, which occurs in the sequestration of the anti-platelet IgG antibodies (Carter, 2018). The sanitized platelet happens a few hours compared to the normal platelet half-life of 8 to 9 days. The drug-induced ITP absorption happens in the platelet cell membrane (McCance & Huether, 2019). Therefore, the autoantibodies react against the platelet glycoproteins. Platelet destruction can also occur when abnormal apoptosis occurs in the bone marrow (McCance & Huether, 2019).

NURS 6501 Module 7 Case Study Analysis
NURS 6501 Module 7 Case Study Analysis

Clinical Manifestation of Immune Thrombocytopenia Purpose (ITP)

Initially, ITP was perceived as a minor injury. However, the purpura and petechiae development occurred every several days, leading to an increase in bleeding from the mucosal site (McCance & Huether, 2019). Patients with ITP show signs like blood in the urine, bleeding gums, and increased bleeding. The main cause of accelerated platelet consumption is increased splenic sequestration or decreased bone marrow production (McCance & Huether, 2019). The lab test helps predict the diagnosis, evaluating the anti-glycoprotein erythrocyte and leukocyte count.

Genetic/Ethnic Considerations of Immune Thrombocytopenia Purpose (ITP)

ITP highly occurs in women (Kjaer et al., 2020). In comparison to acute, the chronic ITP is progressively worse. Acute ITP lasts for approximately one to two months and is common in children (Kjaer et al., 2020). It is not common for a patient to present the intracranial bleeding for the organs or any other sites.ITP is also likely to occur in the newborn as thrombocytopenia.

Conclusion

The patient presents ITP, which is associated with the previous diagnosis of Mononucleosis. It is important to review a patient platelet, which helps determine the anti-platelet antibodies when performing a diagnostic test. ITP highly occurs in women between 20 to 40 years.

References

Carter, C. M. (2018). Alterations in blood components. Comprehensive Toxicology, 249. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7152208/

Chen, D. P., Lin, W. T., Wen, Y. H., & Wang, W. T. (2022). Investigation of the correlation between immune thrombocytopenia and T cell activity-regulated gene polymorphism using functional study. Scientific Reports12(1), 1-8. https://www.nature.com/articles/s41598-022-10631-z

Grodzielski, M., Goette, N. P., Glembotsky, A. C., Constanza Baroni Pietto, M., Méndez-Huergo, S. P., Pierdominici, M. S., … & Marta, R. F. (2019). Multiple concomitant mechanisms contribute to low platelet count in patients with immune thrombocytopenia. Scientific Reports9(1), 1-10. https://www.nature.com/articles/s41598-018-38086-1

Kjær, M., Geisen, C., Akkök, Ç. A., Wikman, A., Sachs, U., Bussel, J. B., … & Skogen, B. (2020). Strategies to develop a prophylaxis for the prevention of HPA-1a immunization and fetal and neonatal alloimmune thrombocytopenia. Transfusion and Apheresis Science59(1), 102712. https://www.sciencedirect.com/science/article/pii/S147305021930285X

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier

Case Study Analysis: Implications for Disease Diagnosis and Treatment Based on Patient Characteristics

Understanding the intricacies of human health requires a holistic approach, considering not just the overt symptoms but also the nuanced differences that arise due to gender, racial, and ethnic variations. Diseases and disorders, especially in the realms of fertility, infections, and hematologic disorders, often manifest distinctly based on such parameters. The following analysis explores the specific scenario of a 32-year-old female patient presenting with symptoms consistent with sexually transmitted diseases (STDs) and pelvic inflammatory disease (PID).

Patient Presentation

A 32-year-old female presented to the emergency department (ED) with a constellation of symptoms including fever, chills, nausea, vomiting, vaginal discharge, left lower quadrant (LLQ) pain, bilateral lower back pain, and 99% on room air. Cardio-respiratory exam within normal limits with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Despite the absence of dysuria, the patient’s pelvic exam revealed significant findings, including copious foul-smelling green drainage, reddened cervix, and bilateral adenexal tenderness, suggestive of an active infectious process.

Lab Findings

The patient’s complete blood count (CBC) was significant for leukocytosis (WBC 18), which suggests an active systemic inflammatory process. The elevated sedimentation rate (46 mm/hr) and C-reactive protein (67 mg/L) further reinforced the presence of inflammation. The wet prep from the pelvic examination was positive for clue cells, while the gram stain demonstrated gram-negative diplococci. These findings are consistent with bacterial vaginosis and gonorrhea, respectively.

Factors That Affect Fertility (STDs)

Sexually transmitted diseases can significantly impact fertility in both men and women. Chlamydia and gonorrhea, in particular, can lead to pelvic inflammatory disease (PID) in women, resulting in tubal blockage, which prevents the union of sperm and egg (Ogbonmwan et al., 2021). The patient in the scenario presented with foul-smelling vaginal discharge, a critical symptom indicative of STDs, specifically pointing towards gonorrhea given the presence of gram-negative diplococci. The presence of such infections, if left untreated, can pose risks to her fertility.

Why Inflammatory Markers Rise in STD/PID

Pelvic inflammatory disease, commonly resulting from untreated STDs like chlamydia and gonorrhea, causes inflammation of the female reproductive organs. This inflammation triggers the body to release inflammatory cytokines and chemokines. Consequently, inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) elevate (Anthony et al., 2019). In the patient’s scenario, her raised ESR (46 mm/hr) and elevated CRP (67 mg/L) signify active inflammation in her body, likely pointing towards the PID arising from the suspected STD. The heightened inflammatory response is the body’s attempt to combat the infection, which explains the elevated white blood cell count.

Prostatitis and Its Causes

Prostatitis refers to the inflammation of the prostate gland. It can be caused by a bacterial infection, though most cases are nonbacterial. Bacterial prostatitis may arise from a urinary tract infection, STDs like gonorrhea, or following medical procedures. In the above case study, the patient was found to have gonorrhea, which is an STD that can be associated with bacterial infections leading to conditions like prostatitis. The body’s response to the infection leads to inflammation of the prostate gland, causing pain, urinary problems, and other symptoms. Systemic reactions, including fever and chills, can also occur if the infection spreads or if the body mounts a robust immune response (Mendoza-Rodríguez et al., 2023).

Splenectomy After a Diagnosis of ITP

Immune thrombocytopenia (ITP) is a condition where the immune system destroys platelets, which are essential for blood clotting. If ITP is chronic and refractory to other treatments, splenectomy, or surgical removal of the spleen, may be considered. Although the case study does not directly mention ITP, it is essential to note that various systemic inflammatory and immune responses, such as those indicated by the patient’s leukocytosis, can hint at underlying hematological conditions. The spleen is involved in the destruction of platelets in ITP; therefore, its removal can increase the platelet count in the blood and alleviate the symptoms (article Editorial, 2022).

Anemia and Different Kinds of Anemia

Anemia is a condition characterized by a decrease in the total amount of red blood cells or hemoglobin in the blood, leading to reduced oxygen-carrying capacity. In the context of the patient from the case study, while anemia is not directly mentioned, it’s worth noting that infections, especially chronic ones, can lead to conditions like anemia of chronic disease. There are various types of anemia:

        Microcytic Anemia: Often caused by iron-deficiency, where the red blood cells are smaller than normal (e.g., Iron-deficiency anemia).

        Macrocytic Anemia: Where red blood cells are larger than usual, typically due to a deficiency in vitamin B12 or folate, leading to conditions like pernicious anemia or megaloblastic anemia (Yang et al., 2023).

Conclusion

Based on the presented scenario, the patient exhibits multiple symptoms indicative of an STD: foul-smelling vaginal discharge, LLQ pain, bilateral adenexal tenderness, and a positive result for clue cells and gram-negative diplococci. Such infections, especially gonorrhea, can lead to pelvic inflammatory disease (PID), further evidenced by the patient’s presentation of lower abdominal pain, fever, chills, and the chandelier sign. The high WBC count and C-reactive protein levels highlight the presence of an active infection.

The criticality of early diagnosis and treatment in such cases cannot be overstressed. Untreated STDs can escalate to PID, potentially resulting in long-term complications, including infertility. This case emphasizes the importance of being cognizant of the nuances in disease presentation. As healthcare professionals, understanding these variations is crucial for accurate diagnosis and effective treatment planning, ensuring the best possible outcomes for patients.

References

Anthony Kayiira, Daniel Zaake, Michael Webba Lwetabe, & Peter Sekweyama. (2019). Impact of genital Chlamydia trachomatis infection on reproductive outcomes among infertile women undergoing tubal flushing: a retrospective cohort at a fertility centre in Uganda. Fertility Research and Practice5(1), 1–8. https://doi.org/10.1186/s40738-019-0069-5

article Editorial. (2022). American Society of Hematology. 48th Annual meeting. Онкогематология2, 63–75. https://doi.org/10.17650/1818-8346-2007-0-2-63-75

Mendoza-Rodríguez, R., Hernández-Chico, I., Gutiérrez-Soto, B., Navarro-Marí, J. M., & Gutiérrez-Fernández, J. (2023). [Microbial etiology of bacterial chronic prostatitis: systematic review]. Revista Espanola de Quimioterapia :Publicacion Oficial de La Sociedad Espanola de Quimioterapia36(2), 144–151. https://doi.org/10.37201/req/099.2022

Ogbonmwan, D., Hussey, J., & Gudipati, M. (2021). Time to re-evaluate the guidance on sexual infections in fertility services. Human Fertility24(4), 230–235. https://doi.org/10.1080/14647273.2020.1714086

Yang, J., Li, Q., Feng, Y., & Zeng, Y. (2023). Iron Deficiency and Iron Deficiency Anemia: Potential Risk Factors in Bone Loss. International Journal of Molecular Sciences24(8), 6891. https://doi.org/10.3390/ijms24086891