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Posted: September 4th, 2023

Wk10 Discussion-Examining Endocrine Disorders

Wk10 Discussion-Examining Endocrine Disorders

Discussion: Examining Endocrine, Metabolic, and Hematologic Disorders

Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes.

For this Discussion, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders.

Hematological Disorders:

Case Study 1

An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following: Eyes: + pallor conjunctiva Cardiac: irregular rhythm. No S3 S4 or M. NO JVD Lungs: CTA w/o rales, wheezes, or rhonchi Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding Rectal: no stool in rectal vault

Task:

· Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.

· Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.

· Reflect on a possible diagnosis for the patient.

· Review the Marroquin article in this week’s Resources. If you suspect prostate cancer, consider whether or not you would recommend a biopsy.

· Think about potential treatment options for the patient.

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

_____________________—
Case Study 1: Hematological Disorder

Primary Diagnosis: Anemia

Differential Diagnoses:

Iron-deficiency anemia: Given the patient’s age, gender, and symptoms of fatigue, weakness, and pallor conjunctiva, iron-deficiency anemia is a possible diagnosis. It could be related to chronic blood loss from underlying conditions such as gastrointestinal bleeding.
Vitamin B12 deficiency anemia: This diagnosis should be considered due to the patient’s age, symptoms of fatigue, weakness, and potential risk factors such as malabsorption or inadequate dietary intake of vitamin B12.
Anemia of chronic disease: The patient’s history of atrial fibrillation, hypertension, and hyperlipidemia suggests the possibility of anemia of chronic disease, which can be caused by chronic inflammation or underlying chronic conditions.
The patient history and physical exam played a crucial role in the diagnosis. The symptoms reported by the patient, including fatigue, dizziness, weakness, and dyspnea on exertion, raised concerns about a hematological disorder. The physical exam findings of pallor conjunctiva and irregular heart rhythm further supported the suspicion of anemia.

To confirm the diagnosis and determine the underlying cause, the following diagnostics may be appropriate:

Complete blood count (CBC): This test can provide information about the patient’s red blood cell count, hemoglobin level, and hematocrit, which are essential for diagnosing anemia and determining its severity.
Peripheral blood smear: Examination of the blood smear can help identify any abnormalities in the shape, size, or structure of the red blood cells, providing clues to the specific type of anemia.
Iron studies: Evaluating serum iron, ferritin, and total iron-binding capacity (TIBC) can aid in diagnosing iron-deficiency anemia and differentiating it from other forms of anemia.
Vitamin B12 and folate levels: Measuring these levels can help diagnose deficiencies that may contribute to anemia.
Regarding treatment options, they will depend on the specific diagnosis. However, some general treatment approaches for anemia include:

Iron supplementation: If iron-deficiency anemia is diagnosed, iron supplements may be prescribed to replenish iron stores.
Vitamin B12 or folate supplementation: In the case of vitamin deficiencies, appropriate supplementation can be initiated to correct the deficiency and treat the underlying anemia.
Treatment of underlying causes: If anemia is secondary to an underlying condition, such as chronic inflammation, addressing the primary cause becomes important in managing the anemia.
In addition to the specific treatment, it is crucial to address the patient’s underlying comorbidities, such as atrial fibrillation, hypertension, and hyperlipidemia, to optimize their overall health and well-being. Regular follow-up, monitoring of symptoms, and adjustment of treatment plans may be necessary based on the patient’s response and progress.

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