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Module 1 Discussion 1
Discussion 1
Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.
Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
Case Study Questions
Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.
Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
Submission Instructions:
Include both case studies in your post.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

Students, this module gives you the opportunity to explore the HWE standards we won’t have time to discuss:Effective Decision Making; Adequate Staffing and Meaningful Recognition. 
For our DB we will be focusing on Meaningful Recognition; please make sure to review the critical elements associated with this standard as they need to be addressed/discussed. 
For this assignment you will be randomly paired with one of your classmates; take time to get to know each other – perhaps over a cup of tea, via zoom or face time – or maybe even in person. In order to authentically recognize each other you must have some depth of understanding of the challenges you each face, ways that you’ve overcome the challenges – your successes as well as perhaps an incident which you wish you’d handled differently. You must evidence knowing each other in order to successfully complete this assignment. I’ll make sure to pair you early in the quarter so you have plenty of time to prepare. 
Write a letter to your colleague thanking them for their contribututions based on what is meaningful to them. This could reference a clinical scenario which you discussed; perhaps it relates to material or contributions they’ve made during our class [during classes or on the DB]. Many students share with me that they’re so glad that another colleague opened up about… [some difficulty] as it was something also troubling them [the student writing to me]. Invariably I ask them to please give that feedback to the other student. If you’ve been in a situation like this you’ll know it will absolutely make their day. 
I expect this letter to have depth; it would be the equivalent of a 2-page hand-written card. [you may wish to also send each other a card with perhaps more personal information than can be shared publically] Be mindful that this is a public forum; you may allude in broad terms to events discussed in private but don’t spell out any details. I know this is tricky: spell out enough detail for me to know that you both know what you’re discussing while maintaining privacy. Trust yourself – run your ideas by each other; work in teams with your partner for the big ideas but please don’t share the actual letter until it’s published on BB. It should be a wonderful, heart-warming surprise. 
Address critical elements of Meaningful Recognition discuss them in the body of the letter using language reflective of the wording of the AACN. It might go like this ‘Susan, I wish that we both worked in the same health care system as I would like to nominate you for [such and such] award. This award is given out to nurses on our unit who exhibit [specific qualities]. You demonstrated these qualities [values] in these specific ways…’ 
IF you are having difficulty getting in touch with each other then please complete the assignment by writing an ‘as if’ letter to a work colleague following the same directions as I gave in the DB. Because you won’t have a letter written to you to which you are to reply you may then write an ‘as if’ thank you letter to that same colleague thanking them for the recognition that they gave you.