Week 5 Preparing APRNs for Practice Discussion Response

Frantz Jacob

Weekly discussion 5

Did you face any challenges, any success? If so, what were they?

Preparing APRNs for practice and fostering the role of APRNs in a variety of educational, clinical, and research settings are necessary steps toward achieving this vision. Given the current economic and political climate in the United States, however, success may be tenuous.

Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential diagnosis.

41-year-old black female comes to the clinic reporting dizziness and fatigue. The patient states dizziness is getting worse when she gets up or doing chores. Patient reports the symptoms started 2 weeks ago while she was at work. Patient confirms the aggravating element as standing and doing chores, and the relieving element is laying down. Patient also reports shortness of breath and palpitations from time to time. Patient states she had been taking over the counter Apple cider vinegar and Dr Ho cleanser for weight lost and have been skipping meals for the past 2 months.

Examination:

Physical Examination

BP: 130/78, Temp: 36.9, HR 80: RR 18, Height: 5’11” Weight 183 lb., BMI: 28. Pain:0

On physical examination patient noted with pale skin, unexplained fatigue, and shortness of breath especially with activity.

Differential diagnosis:

Anemia of chronic disease

Thalassemia

Sideroblastic anemia

Plan of Care: Iron deficiency anemia ICD code: D50 9

Iron-deficiency anemia is a common type of anemia that occurs if you do not have enough iron in your body. People with mild or moderate iron-deficiency anemia may not have any signs or symptoms. More severe iron-deficiency anemia may cause fatigue or tiredness, shortness of breath, or chest pain. Dr Edy ordered CBC to check Hg level, A serum ferritin was also ordered. In addition, fecal occult blood test to rule out any bleeding in the GI tract.

Management:

Increase daily intake of iron-rich foods to help treat your iron-deficiency anemia. Increase your intake of vitamin C to help your body absorb iron. Avoid drinking black tea, which reduces iron absorption. Consumes food rich in Iron such as legumes, dark green leafy vegetables(spinach)

Therapeutic: Ferrous sulfate 325 mg by mouth every day for 30 days

Support your plan of care with the current peer-reviewed research guidelines.

Anemia affects one-fourth of the world’s population, and iron deficiency is the predominant cause. Anemia is associated with chronic fatigue, impaired cognitive function, and diminished well-being. Patients with iron deficiency anemia of unknown etiology are frequently referred to a gastroenterologist because in most cases the condition has a gastrointestinal origin. Proper management improves quality of life, alleviates the symptoms of iron deficiency, and reduces the need for blood transfusions. Treatment options include oral and intravenous iron therapy; however, the efficacy of oral iron is limited in certain gastrointestinal conditions, such as inflammatory bowel disease, celiac disease, and autoimmune gastritis. The World Health Organization defines anemia as a level of Hb below 13.0 g/dL in male adults, below 12.0 g/dL in female adults who are not pregnant, and below 11.0 g/dL in pregnant women. Hb levels may vary across age and race. (Matthew W, Short, Jason Domagalski, 2013)

Reference

Matthew W, Short, Jason Domagalski. (2013). Iron deficiency : Evaluation and Management American Family Physician. American Family Physician, 15;87(2):98-104.