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Nursing Case

Case Study #1

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current

golf season, Ms. A has noted increased shortness of breath and low levels of energy and

enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf

tournament at a high, mountainous course, she became light-headed and was taken by her golfing

partner to the emergency clinic. The attending physician’s notes indicated a temp of 98 degrees

F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia

and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3

to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she

also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:

Hemoglobin = 8 g/dl

Hematocrit = 32%

Erythrocyte count = 3.1 x 10/mm

RBC smear showed microcytic and hypochromic cells

Reticulocyte count = 1.5%

Other laboratory values were within normal limits.

Question

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A

most likely have? In an essay of 500-750 words, explain your answer and include rationale.

Case Study #2

Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been

hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions

and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields,

and labored breathing. There is no family other than his wife, who verbalizes sadness over his

declining health and over her inability to get out of the house. She is overwhelmed with the stack

of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks

why God has not taken him.

RESPONSES

CASE 1

Ms. A’s case and the clinical results give very symptomatic indications of the type of anemia she

may be suffering from at the moment. In the first place, it is important to establish that Ms. A

currently is privilege to both symptoms of her anemia in general and signs pointing to the type of

anemia she is suffering from. It is important to establish these two clear distinctions because of

the rationale that a problem well identified is a problem that can get good management and

subsequent cure. Firstly, quoting from various sources, Annette (2003) observes that “anemia

refers to red blood cell (RBC) mass, amount of hemoglobin, and/or volume of packed RBCs less

than normal.” The predetermined conditions for measuring the normalcy or otherwise of the red

blood cell as given by Annette (2003) is “either as a hematocrit or hemoglobin concentration > 2

standard deviations below the normal mean for age (Abshire, 2001; Cohen, 1996; Korones &

Cohen, 1997; Walters & Abelson, 1996). From this definition, it could be observed that

symptoms such as shortness of breath, low levels of energy and lowered enthusiasm are actually

symptoms only to the anemia she is suffering in general. Indeed there would be shortness of

breath because of the ill-functioning nature of red blood cells, which are supposed to transport

blood to the heart to make the heart function in a normal way with reference to both external and

internal respiration. There also exist low levels of energy and enthusiasm because there is

impairment to the use of energy by the heart (Saari, 1999).

The traces of clinical events and general rationale bring the discussion closer to knowing the type

of anemia Ms. A was suffering from. It is reported that there exists over 400 types of anemia

(Web MD, 2012). Careful consideration would however reveal that Ms. A is suffering from

moderate anemia, which is highly nutritional. First, the anemia is regarded as moderate

particularly because of the levels of hemoglobin, hematocrit and Erythrocyte count. Annette

(2003) for instance observes that in moderate anemia, hemoglobin of 8-9.5 g/dl may present. The

current hemoglobin is also quoted as 8.0 g/dl. In a normal female who is 26 years old, this value

represents a drop of nearly 30% of the normal hemoglobin value, which ideally should be 12-14

g/dl. With further support from Saari (1999), she also notes that “moderate anemia occurs when

associated with a drop of Hb by 25- 50% of normal.” The other indication on the type of anemia,

which is given as nutritional is related to the signs of changes experienced in the patient. For

instance it is reported of how often Ms. A takes in Aspirin. On this particular one, Saari (1999)

writes on nutritional anemia stating that “the most common type of anemia is iron deficiency

anemia and the leading cause of iron deficiency anemia is chronic blood loss.” She goes on

further to emphasize that “common sites of chronic blood loss include chronic intake of aspirin.”

The other indication that Ms. A is suffering from nutritional anemia is the fact that her anemia

can easily be related to iron deficiency as she is particularly found wanting when she is having

her menses and supposedly loosing a lot of blood (iron) without proper nutritional replacement.

CASE 2

The current situation at hand can be described as one that indeed goes beyond the confines of

strict medical care. This is said because there can be other elements of the problem such as the

need to deal with a psychological problem and an economic one as well. It is advocated that in

situations such as this, the nurse shows professionalism by not only being concerned with the

medical aspect of the situation as psychological and emotional disorders also have very deterrent

effects on the general health care of patients (Cumberland, 2005). Considering the age of Mr. P,

which is 76, the present psychological trauma that is being experienced by his wife amidst

economical concerns of how to raise funds to cater for the bills may be a huge source of worry to

him and subsequently worsen his already deteriorating health situation. It is for this reason that it

is important to be extra careful in the selection of an approach to care.

To this end, a holistic approach to care that integrates other personal concerns and aspects of Mr.

P would be adopted. In this approach, the nurse shall look at the totality of family care of the

couple. Therefore, basic issues like helping the couple recover emotionally through counseling

and guidance shall be included in the holistic care. Where necessary, psyching the couple to hope

in their God for bringing a light at the end of the tunnel shall also used. This is particularly

mentioned as the wife of Mr. P makes reference to God in her supplications. Above all however,

a highly responsive loom that targets resuscitating health improvement in Mr. P shall be taken to

ensure that in the midst of the hope that the nurse tries to build in the couple, they would see

practical improvement in health to that effect. It is hoped that this approach would work to

perfection especially with the inspiration of the rationale that ““Nonpharmacological

interventions are used to complement, not replace, pharmacological interventions” (Ackley &

Ladwig, 2008, p. 610).

The long term goal of the education to be given to the patient and his family would be to help

them verbalize pain management plan by the time of discharge. To this end, education shall

centre on the need to keep to medication in order to keep pain under control. Since there are clear

indications of failure of certain pharmacological approaches, which is evident in failure of Mr. P

to get better despite his numerous hospital admissions, the nurse shall also educate the family on

non-pharmacological approaches and strategies to overcoming some of the present inabilities.

Some of these shall include the need to partake in mild games and hobbies, engaging in frequent

conversation that will take patient’s mind off the disease, taking to the watching of comic shows

and listening to comic programs. There shall also be education on some important don’ts with

reference to practices that worsen the current health situation. To this end, prevention shall be a

major approach. It is hoped that if the patient would not incur any more liabilities as far as his

current health status is concerned, he is hoped to have a stable heart functioning.

REFERENCE LIST

Web MD. Anemia Causes, Types, Symptoms, Diet and Treatment. 2012. Web. February 6, 2012

<http://www.webmd.com/a-to-z-guides/understanding-anemia-basics>

Saari, Joan T. Anemia. 1999. Web. February 6, 2011 < http://www.ithyroid.com/anemia.htm>

Annette, Carley. Anemia: When it is not iron deficiency. 2003. Pediatric Nursing. 2003;29(3)

Jannetti Publications, Inc. available from < http://www.medscape.com/viewarticle/457482>

Cumberland, Richlove. Nursing Universally. 2005. Print. Marvelous Press House Limited:

Madrid.

Ackley, B.J., & Ladwig, G.B. Nursing diagnosis handbook: An evidence-based guide to

planning care (8

ed.). 2008. Print. St. Louis: Mosby Elsevier.

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