Please editing the following responses to have a better flow in APA 7th edition format. Please add any additional supporting information. Include intext citations and the references provided.
Mr. X, age 57, presented to his physician with marked fatigue,nausea with occasional diarrhea, and a sore, swollen tongue. Lately he also hasbeen experiencing a tingling feeling in his toes and a feeling of clumsiness.Microscopic examination of a blood sample indicated a reduced number oferythrocytes, many of which are megaloblasts, and a reduced number ofleukocytes, including many large, hypersegmented cells. Hemoglobin and serumlevels of vitamin B12 were below normal. Additional tests confirm perniciousanemia.
Discussion Questions
1.Relatethe pathophysiology of pernicious anemia to the manifestations listed above.
perniciousanemia results from a vitamin B12 deficiency due to lack of intrinsic factor,(IF) a protein that helps your intestines absorb vitamin B12.
2.Discusshow the gastric abnormalities contribute to vitamin B12 and iron deficiency andhow vitamin B12 deficiency causes complications associated with perniciousanemia.
Thisprotein is released by cells in the stomach. When the stomach does not makeenough intrinsic factor, the intestine cannot properly absorb vitamin B12. Gastrectomycan significantly reduce the production of IF. A rare congenital autosomalrecessive disorder can result in deficiency of IF without gastric atrophy.
3.Discussother tests that could be performed to diagnose this type of anemia.
Folic acid deficiency, altered pH in the smallintestine, and lack of absorption of B12 complexes in the terminal ileum canalso cause megaloblastic anemia. Pernicious anemia must be differentiated fromother disorders that interfere with the absorption and metabolism of vitaminB12.
4.Discussthe treatment available and the limitations.
Pernicious anemiausually is easy to treat with vitamin B12 shots or pills. If you havesevere pernicious anemia, your doctor may recommend shots first. Shots usuallyare given in a muscle every day or every week until the level of vitamin B12 inyour blood increases. You may need lifelong treatment, which includetaking vitamin B12 supplements daily. If you have complications of perniciousanemia, such as nerve damage, early treatment may help reverse the damage. You’realso at higher risk for stomach cancer.
Ms. L, a 19-year-old woman with no previous medical history, wasinvolved in a serious automobile accident in which her best friend died.Examination by EMT personnel first on the scene revealed she had only minorscrapes and bruises and no sign of head trauma. While en route by ambulance tothe hospital, Ms. L complained of thirst and appeared restless. Furtherexamination indicated a rapid pulse and respirations, with her blood pressurenow at 100/60 mm Hg. She appeared less responsive to the paramedics. She wasslipping into circulatory shock as they checked her again for internalinjuries.
Discussion Questions
1.Discussthe contributing factors to shock in this case and the pathophysiologic changescausing the changes in vital signs.
Beinga witness to her bestfriends death may have caused by trauma. Shock may resultfrom trauma, heatstroke, blood loss, an allergic reaction, severeinfection, poisoning, severe burns or other causes.
2.Discussthe signs and symptoms of shock, including the rationale for each, as seen inthe early stage, and as compensation mechanisms respond.
Whena person is in shock, his or her organs aren’t getting enough blood or oxygen. Changesin mental status or behavior, such as anxiousness or agitation. Blood pressuretends to drop to dangerous levels. Nausea or vomiting, enlarged pupils, weaknessor fatigue may also occur.
3.Discussemergency and follow-up treatment for shock and for complications that mayarise if not treated quickly.
Lay the person down and elevate the legs and feet slightly,unless you think this may cause pain or further injury. Keep the person stilland don’t move him or her unless necessary. Begin CPR if the person shows nosigns of life, such as not breathing, coughing or moving. Loosen tight clothingand, if needed, cover the person with a blanket to prevent chilling.
If untreated, this can lead to permanent organ damage or evendeath.
4.Comparethe types of shock, giving a specific cause, classification, and anysignificant changes in onset or manifestations.
Cardiogenic shock (due to heart problems) – bradycardia
Hypovolemic shock (caused by too little blood volume, traumaticinjury) decreased urine output, weakness, pallor
Anaphylactic shock (caused by allergic reaction) Wheezing orgasping for air
Septic shock (due to infections) feeling cold, extreme pain, tachycardia
Neurogenic shock (caused by damage to the nervous system) cyanosis, lack of consciousness, slow heart rhythm
References
https://emedicine.medscape.com/article/204930-overview
https://www.nhlbi.nih.gov/health-topics/pernicious-anemia#:~:text=Types%20of%20Treatment-,Pernicious%20anemia%20usually%20is%20easy%20to%20treat%20with%20vitamin%20B12,B12%20in%20your%20blood%20increases.
https://www.mayoclinic.org/first-aid/first-aid-shock/basics/art-20056620#:~:text=Shock%20may%20result%20from%20trauma,getting%20enough%20blood%20or%20oxygen.
https://medlineplus.gov/ency/article/000039.htm
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