Feb 23, 2024 NURS 6501 CASE STUDY ANALYSIS MODULE 7
NURS 6051CASE STUDY ANALYSIS MODULE 7
NURS 6501 CASE STUDY ANALYSIS MODULE 7
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.
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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 Practice, 5(1), 1–8. https://doi.org/10.1186/s40738-019-0069-5
article Editorial. (2022). American Society of Hematology. 48th Annual meeting. Онкогематология, 2, 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 Quimioterapia, 36(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 Fertility, 24(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 Sciences, 24(8), 6891. https://doi.org/10.3390/ijms24086891
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).
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).
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 Reports, 12(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 Reports, 9(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 Science, 59(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
An understanding of the factors surrounding women’s and men’s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient.
Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact..
An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
RESOURCES
Be sure to review the Learning Resources before completing this activity.Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
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).
BY DAY 7 OF WEEK 10
Submit your Case Study Analysis Assignment by Day 7 of Week 10.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates Links to an external site.). All papers submitted must use this formatting.
SUBMISSION INFORMATION
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To submit your completed assignment, save your Assignment as MD7Assgn1_LastName_Firstinitial
Then, click on Start Assignment near the top of the page.
Next, click on Upload File and select Submit Assignment for review.
Pneumonia is an infection that inflames the air sacs in both lungs. Pneumonia develops when the air sacs are filled with fluid or pus, causing fever, difficulty breathing, and chills (Rosenthal & Burchum, 2021). The disease can either be acquired in a community setting or influenced by Streptococcus pneumonia or respiratory viruses (Rosenthal & Burchum, 2021). The use of monotherapy with a macrolide or doxycycline is recommended. For instance, it can choose to use azithromycin or clarithromycin.
The macrolide antibiotics that serve as first-line treatment for pneumonia include azithromycin. Azithromycin is a drug that helps prevent bacteria from growing and interferes with protein synthesis (Ding et al., 2019). It helps inhibit mRNA translation and binds with subunits of the bacterial ribosome. The drug is taken orally and helps protect a patient from gastric acids, making the absorption greater in the stomach (Ding et al., 2019). The time peak concentration in adults ranges between 2.1 to 3.2 hours administered through an oral form (Ding et al., 2019). The half-life allows the administration of a large single dose for several days. The drug’s side effect is that it causes abdominal pain, stomach upset, and vomiting (Ding et al., 2019).
The case study shows that the patient has a moderate risk of CAP, diabetes, hypertension, and hyperlipidemia. Therefore, the patient should receive empirical antibody therapy since there is no causative organism of the condition that has been identified (Rosenthal & Burchum, 2021). It is essential to identify the targeted antibiotic therapy administered to ensure that a patient processes treatment and management.
References
Ding, W., Zhou, Y., Qu, Q., Cui, W., God’spower, B. O., Liu, Y., … & Li, Y. (2018). Azithromycin inhibits biofilm formation by Staphylococcus xylosus and affects the histidine biosynthesis pathway. Frontiers in Pharmacology, 9, 740. https://www.frontiersin.org/articles/10.3389/fphar.2018.00740/full
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier.
Rubric
NURS_6501_Module7_Case Study_Assignment_Rubric
NURS_6501_Module7_Case Study_Assignment_RubricCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeDevelop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following as it relates to the case you were assigned (omit section that does not pertain to your case, faculty will give full points for that section):Explain the factors that affect fertility (STDs)25 to >22.0 pts Excellent The response accurately and thoroughly describes the patient symptoms. … The response includes accurate, clear, and detailed explanations of the processes related to women’s and men’s health, infections, and hematologic disorders and is supported by evidence and/or research, as appropriate, to support the explanation. 22 to >19.0 pts Good The response describes the patient symptoms. … The response includes accurate, explanations of the processes related to women’s and men’s health, infections, and hematologic disorders and is supported by evidence and/or research, as appropriate, to support the explanation. 19 to >17.0 pts Fair The response describes the patient symptoms in a manner that is vague or inaccurate. … The response includes explanations of the processes related to women’s and men’s health, infections, and hematologic disorders, with explanations that are vague or based on inappropriate evidence/research. 17 to >0 pts Poor The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing. … The response does not include explanations of the processes related to women’s and men’s health, infections, and hematologic disorders, or the explanations are vague or based on inappropriate evidence/research.25 ptsThis criterion is linked to a Learning OutcomeExplain why inflammatory markers rise in STD/PID20 to >17.0 pts Excellent The response includes an accurate, complete, detailed, and specific analysis of the concepts and principles of pathophysiology across the life span and is supported by evidence and/or research, as appropriate, to support the explanation. 17 to >15.0 pts Good The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 15 to >13.0 pts Fair The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research. 13 to >0 pts Poor The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.20 ptsThis criterion is linked to a Learning OutcomeExplain why prostatitis and infection happen. Also explain the causes of systemic reaction.20 to >17.0 pts Excellent The response includes an accurate, complete, detailed, and specific explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 17 to >15.0 pts Good The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 15 to >13.0 pts Fair The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research. 13 to >0 pts Poor The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.20 ptsThis criterion is linked to a Learning OutcomeExplain why a patient would need a splenectomy after a diagnosis of ITP.10 to >4.0 pts Excellent The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 4 to >3.0 pts Good The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 3 to >2.0 pts Fair The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations are based on inappropriate evidence/research. 2 to >0 pts Poor The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.10 ptsThis criterion is linked to a Learning OutcomeExplain anemia and the different kinds of anemia (i.e., micro and macrocytic).10 to >4.0 pts Excellent The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 4 to >3.0 pts Good The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 3 to >2.0 pts Fair The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations are based on inappropriate evidence/research. 2 to >0 pts Poor The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.10 ptsThis criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas
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