Case study represents two cases in nursing practice: Ms. A. and Mr. P.
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 also presented in the essay. The question to the case 1 is as follows: Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have?
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. The question to the case 2 is as follows: Which nursing approach to care will be the best to fit this case?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