PLEASE EDIT THE FOLLOWING ANSWERS AND INCLUDE INTEXT CITATIONS USING PROPER 7TH EDITION APA FORMATTING OF BOTH THE IN TEXT CITATIONS AND THE REFERENCES. PLEASE USE THE REFERNCES THAT I HAVE PROVIDED.
Mr. X, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and a sore, swollen tongue. Lately he also has been experiencing a tingling feeling in his toes and a feeling of clumsiness. Microscopic examination of a blood sample indicated a reduced number of erythrocytes, many of which are megaloblasts, and a reduced number of leukocytes, including many large, hypersegmented cells. Hemoglobin and serum levels of vitamin B12 were below normal. Additional tests confirm pernicious anemia.
Discussion Questions
1. Relate the pathophysiology of pernicious anemia to the manifestations listed above.
pernicious anemia results from a vitamin B12 deficiency due to lack of intrinsic factor, (IF) a protein that helps your intestines absorb vitamin B12.
2. Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia.
This protein is released by cells in the stomach. When the stomach does not make enough intrinsic factor, the intestine cannot properly absorb vitamin B12. Gastrectomy can significantly reduce the production of IF. A rare congenital autosomal recessive disorder can result in deficiency of IF without gastric atrophy.
3. Discuss other tests that could be performed to diagnose this type of anemia.
Folic acid deficiency, altered pH in the small intestine, and lack of absorption of B12 complexes in the terminal ileum can also cause megaloblastic anemia. Pernicious anemia must be differentiated from other disorders that interfere with the absorption and metabolism of vitamin B12.
4. Discuss the treatment available and the limitations.
Pernicious anemia usually is easy to treat with vitamin B12 shots or pills. If you have severe pernicious anemia, your doctor may recommend shots first. Shots usually are given in a muscle every day or every week until the level of vitamin B12 in your blood increases. You may need lifelong treatment, which include taking vitamin B12 supplements daily. If you have complications of pernicious anemia, such as nerve damage, early treatment may help reverse the damage. You’re also at higher risk for stomach cancer.
Ms. L, a 19-year-old woman with no previous medical history, was involved in a serious automobile accident in which her best friend died. Examination by EMT personnel first on the scene revealed she had only minor scrapes and bruises and no sign of head trauma. While en route by ambulance to the hospital, Ms. L complained of thirst and appeared restless. Further examination indicated a rapid pulse and respirations, with her blood pressure now at 100/60 mm Hg. She appeared less responsive to the paramedics. She was slipping into circulatory shock as they checked her again for internal injuries.
Discussion Questions
1. Discuss the contributing factors to shock in this case and the pathophysiologic changes causing the changes in vital signs.
Being a witness to her bestfriend’s death may have caused by trauma. Shock may result from trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes.
2. Discuss the signs and symptoms of shock, including the rationale for each, as seen in the early stage, and as compensation mechanisms respond.
When a person is in shock, his or her organs aren’t getting enough blood or oxygen. Changes in mental status or behavior, such as anxiousness or agitation. Blood pressure tends to drop to dangerous levels. Nausea or vomiting, enlarged pupils, weakness or fatigue may also occur.
3. Discuss emergency and follow-up treatment for shock and for complications that may arise 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 still and don’t move him or her unless necessary. Begin CPR if the person shows no signs of life, such as not breathing, coughing or moving. Loosen tight clothing and, if needed, cover the person with a blanket to prevent chilling.
If untreated, this can lead to permanent organ damage or even death.
4. Compare the types of shock, giving a specific cause, classification, and any significant changes in onset or manifestations.
· Cardiogenic shock (due to heart problems) – bradycardia
· Hypovolemic shock (caused by too little blood volume, traumatic injury) – decreased urine output, weakness, pallor
· Anaphylactic shock (caused by allergic reaction) – Wheezing or gasping 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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