Last Updated on March 10, 2023 by Admin
Choose one of the following case studies from the Bruyere textbook and complete. Please post your answers, and then reply to two classmates.
#4 – DVT
#6 – hypovolemic shock
#7 – infective endocarditis
#8 – peripheral arterial disease
Expert Answer and Explanation
Q1 Definition of unfamiliar Terms to you
DVT – Acronym for , Deep Venus Thrombosis which refers to the clotting of blood within the vein of an extremity such as the pelvis, calf or thigh and is the main cause of pulmonary embolism.
Q2 Specific Diagnosis Be For J.B, Signs and Symptoms
The specific diagnosis for JB is Atherosclerosis. The signs and symptoms include Swelling in left foot and ankle, Elevated cholesterol and Triglycerides, Pain in left calf. Calf swollen to double the size, History of previous DVT. Asymmetric leg swelling
Q3. Risk Factors for J. B.
The main risk factors include DM II, overweight, prior venous thromboembolism, and also a cigarette smoker.
Q4 Significance of the Results to the Lab Testing
The first results from the lab tests arise the Protein C deficiency. The significance of the result includes the following.
- Reduced Protein C can lead to venous thrombosis
- Decrease in protein C can also occur during warfarin therapy
- Protein C is a natural plasma anticoagulant and dependent on Vitamin-K
The second result from the lab test denotes Homocysteine = 91 micromol/L. The significance of the result is that a high volume of homocysteine could predispose the patient to possible arterial thrombosis and venous thromboembolism.
Q5 Doppler ultrasound
Doppler ultrasound is a medical imaging technique that is used to detect and measure the movement of blood through blood vessels. It works on the principle of the Doppler effect, which is the change in frequency of sound waves that occurs when there is relative motion between the source of the waves and the observer.
High-frequency sound waves are emitted from a transducer, which is a hand-held device that is placed on the skin over the area being examined. The sound waves are then reflected back to the transducer by the moving red blood cells in the blood vessels.
Q6 Treatment Recommendation for J.B.
From the case, the treatment recommendation would be for the patient to be provided with the initial heparin injection as a precursor to starting warfarin, IVC filter, and thrombolytic drugs.
Q7 Long Term Treatment
Other than the short-term immediate medication, the long terms treatment would be efficient of the patient. The main form of treatment would include the use of anticoagulants, drug treatment for diagnosed risk factors such as diabetes, and the use of statins to reduce atherosclerosis or its related mortality.
Q8 Lifestyle Changes
The main lifestyle changes to recommend of the patient is to watch on the intake diet, and ensure regular physical activity. The diet should entail reduced carbohydrates, more fiber.
Q9 Tracing Blood Flow
Left Posterior tibial » left Popliteal » left Femoral » left External iliac vein » Common
iliac vein » inferior vena cava » right atrium » right ventricle » pulmonary trunk »
pulmonary arteries » pulmonary capillaries » pulmonary veins » left atrium
Q10 J.B. Complication and Development of Pulmonary Embolism
The higher clot burden within DVT has a high likelihood of causing pulmonary embolism (PE). Majority of the pulmonary emboli originates from the thrombi within the veins. In this regard, the development of PE is common since the conditions impair the venous return and there is increased conditions causing endothelial injury.
Alternative Expert Answer
- For what condition is this patient taking Glyburide?
Glyburide is a medication that belongs to a class of medicines called sulfonylureas (Mayo Clinic, n.d.). This medication is used to treat high blood sugar that is caused by Diabetes Mellitus Type II.
Glyburide is orally administered in typical initial dosages of 2.5 mg to 5 mg, with a maximum of 40 mg daily – the maximum dosage is rarely used, as many patients with type 2 diabetes mellitus do not require dosages higher than 10 mg per day (Hardin & Jacobs, 2022). Since the patient has been diagnosed with Diabetes Mellitus Type 2, it is likely that this medication has been prescribed for him.
- What is the basic pharmacologic mechanism of action for glyburide?
This medication mainly acts by increasing the secretion of insulin from the beta cells in the pancreas. Moreover, for Sulfonylureas, they bind to the SUR1 receptors in the membranes of the beta cells of potassium ATP-dependent channels. These agents act by blocking these channels, and insulin is released after the cell becomes depolarized (Hardin & Jacob, 2022).
- Which two of J.B.’s vital signs are abnormal and why are these abnormal vital signs consistent with a diagnosis of DVT?
J.B. having a low-grade fever of 99.8 (cedars-sinai.org) and an increased heart rate of 110 is consistent with Deep Vein Thrombosis. According to UTSouhtwestern Medical Center (n.d.), tachycardia and a slight fever are some of the symptoms of DVT.
- Is J.B. considered underweight, overweight, or obese or is his weight technically considered normal or healthy?
According to NHS.UK, the ideal body weight index (BMI) is in the 18.5 to 24.9 range.
BMI Categories (National Heart, Lung, and Blood Institute).
Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater
J.B’s BMI when calculated is 35.1 which classifies him as obese or an individual with abnormal or excessive fat accumulation which may impair his health (NHS.UK, n.d.).
- Identify two risk factors for DVT from the laboratory data directly above.
The patient’s laboratory results indicate an elevated Homocysteine level of 91 umo/L and protein C deficiency. In a healthy person, homocysteine levels are around five to 15 micromoles per liter (mcmol/L) (Cleveland Clinic, n.d.). Elevated Homocysteine levels are directly associated with an increased risk of DVT (Heijer et al., 2007). On the other hand, Protein C deficiency is a disorder that increases the risk of developing abnormal blood clots which makes the patient at risk for developing DVT (Medline Plus, n.d.).
- Identify two other abnormal laboratory findings consistent with a diagnosis of DVT?
Protein S deficiency predisposes an individual to blood clots. It is commonly pathological or congenital. It is an inherited thrombophilia associated with an increased risk of thromboembolism (Gupta et al., 2022).
Also, an individual with a Factor V Leiden puts them at risk for DVT. It is a mutation of one of the clotting factors in the blood. This mutation can increase the chances of developing abnormal blood clots, most commonly in the legs or lungs. It causes to resist other proteins that stop excessive clotting. As a result, the blood may clot more easily than it should, leading to serious complications (Cleveland Clinic, n.d.).
- Identify three other abnormalities from the laboratory data above that may be unrelated to DVT but nevertheless should be addressed by the patient’s PCP.
The patient has an elevated WBC of 12,200/mm3, Cholesterol of 280 mg/dL and Triglyceride level of 160 mg/dL.
- Prior to warfarin therapy, list two drugs that may serve as initial treatment for this patient.
Initial treatment for DVT includes injectable heparin (unfractionated or low molecular weight) followed several days by long-term treatment with an oral drug (warfarin, a factor Xa inhibitor, or a direct thrombin inhibitor) as well as initial and long-term treatment with certain oral Xa inhibitors (rivaroxaban or apixaban) (Douketis, 2022).
Furthermore, Fondaparinux (Arixtra®) is a new type of anticoagulant that has been used for the prevention of DVT and has recently been approved by the FDA for the treatment of DVT (National Blood Clot Alliance, n.d.).
- For how long should this patient be treated with warfarin?
Treatment depends on different factors such as risk factors that contributed to the clot, assessment of risk for developing future clots, location of clot etc. In general, if the risk of another clot is low, then short-term treatment for 3 months is often sufficient. This is long enough for the present clot to heal. However, if the risk for developing another clot is high, then treatment for >3 months may be appropriate.
This typically means long-term (also referred to as extended) treatment, which can last several years and, in some cases, life-long (Waldron & Moll, 2014). So, for this patient, since he has a history of DVT he should be on the medication for more than 3 months and should be re-assessed by a provider after the time comes if he needs to stay longer on the medication.
Cedars-Sinai.org. (n.d.). Fever. https://www.cedars-sinai.org/
Cleveland Clinic. (n.d.). Homocysteine. https://my.clevelandclinic.org/health/articles/21527-Homocysteine
Cleveland Clinic. (n.d.). Factor V Leiden. https://my.clevelandclinic.org/health/diseases/17896-factor-v-leiden
Douketis, J.D. (2022). Drugs for Deep Venous Thrombosis. MSD Manual. https://www.msdmanuals.com/en-jp/professional/cardiovascular-disorders/peripheral-venous-disorders/drugs-for-deep-venous-thrombosis
Gupta, A., Tun, A. M., Gupta, K., & Tuma, F. (2022). Protein S Deficiency. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544344/
Hardin, M.D. & Jacobs, T. F. (2022). Glyburide. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK545313/
Heijer, M., Willems, H., Blom, H., Gerrits, W., Cattaneo, M., Eichinger, S., Rosendaal, F.,
& Bos, G.M. (2007). Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism: a randomized, placebo-controlled, double-blind trial. ASH publications. 109(1). 139-144. https://doi.org/10.1182/blood-2006-04-014654
Mayo Clinic. (n.d.). Glyburide. https://www.mayoclinic.org/drugs-supplements/glyburide-oral-route/description/drg-20072094
Medline Plus. (n.d.). Protein C Deficiency. https://medlineplus.gov/genetics/condition/protein-c-deficiency/
National Blood Clot Alliance. What is the initial treatment of DVT? https://www.stoptheclot.org/initial_treatment/what_is_iniitial_treatment/
National Heart, Lung, and Blood Institute. (n.d.). Calculate Your Body Mass Index. https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
NHS.UK. (n.d.). What is the body mass index (BMI)? https://www.nhs.uk/common-health-questions/lifestyle/what-is-the-body-mass-index-bmi/
UTSouthwestern Medical Center. (n.d.). Deep Vein Thrombosis. https://utswmed.org/conditions-treatments/deep-vein-thrombosis/
Waldon, B., & Moll, S. (2014). A Patient’s Guide to Recovery After Deep Vein Thrombosis or Pulmonary Embolism. Ahajournals. 129:e477-e479. https://doi.org/10.1161/CIRCULATIONAHA.113.006285
Module 3 Assignment
Create a presentation addressing all of the following topics:
- Create a table differentiating the types of anemia, their clinical presentations, causes, and diagnostic tests
- What compensatory measures does the body employ in an attempt to restore cardiac output? What are the effect of these compensatory measures?
- Discuss the difference between right-sided and left-sided HF, their causes, clinical presentations, and diagnostic tests.
- How do the clinical presentations, prognosis, and management of acute and chronic leukemia differ?
This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 15 slides (maximum of 17 slides), including a title, introduction, conclusion and reference slide, with detailed speaker notes and recorded audio comments for all content slides. Use the audio recording feature with the presentation software. Use at least four scholarly sources and make certain to review the module’s Signature Assignment Rubric before starting your presentation.
Does Not Meet 0%
Content/Quality of Information Weight: 40%
Topic is inappropriate to assignment, not based on scholarly information (if required), unclear and difficult to understand, no hyperlinks to credible sites; did not include required assignment components; slide notes missing (if required).
Topic is mostly covered and appropriate to assignment, but not based on scholarly information (if required); mostly clear and understandable; may contain hyperlinks to non-credible sites; some of required assignment components are present; minimal use of slide notes (if required).
Good coverage of topic and appropriate to assignment; sound, research-based (if required) information; clear and understandable; hyperlinks to credible sites; all required assignment components are accurate and present; slide notes used appropriately (if required).
In-depth coverage of topic and assignment components; outstanding clarity of information; detailed slide notes ensure all required content is well explained (if required).
Score of Content/Quality of Information Weight: 40%,
Presentation Weight: 20%
Unattractive; difficult to interpret; poor color choice and slide contrast; slide presentation unorganized; slide effects detract from the content; missing slide headings or sub-headings (if required for organization purposes); missing title/reference slides.
Attractive but somewhat difficult to interpret; somewhat pleasing contrast between text and background, slide presentation may be somewhat disorganized; transitions and slide effects detract from the content; may be missing title or reference slides; included slide headings/sub-headings may detract from presentation.
Attractive; easy to interpret, pleasing colors with strong contrast between text and background, slide presentation organized, good use of transitions and slide effects which enhance the presentation; both title and reference slides are present. Slide headings/sub-headings are used appropriately to organize the presentation.
Excellent use of transitions and effects that enhance the presentation. Presentation is organized and designed for maximum impact of content.
Score of Presentation Weight: 20%,
Use of Multimedia, Graphics, Diagrams, and/or Illustrations Weight: 30%
Does not include required multimedia, graphics, diagrams, and/or illustrations or they are irrelevant to topic or detract from slide content or presentation as a whole.
Required multimedia, graphics, diagrams, and/or illustrations are generally relevant but some may not appropriately support the slide content.
Required multimedia, graphics, diagrams, and/or illustrations are highly relevant and acceptably support the slide content; sized and positioned appropriately.
Required multimedia, graphics, diagrams, and/or illustrations add clarity and sophistication to the presentation content; they improve the effectiveness of the presentation.
Score of Use of Multimedia, Graphics, Diagrams, and/or Illustrations Weight: 30%,
Writing, Mechanics, and APA Weight: 10%
Style is inappropriate or does not address given audience, purpose, etc. Inconsistent grammar, spelling, and punctuation; APA format and style are not evident throughout the presentation.
Style is somewhat appropriate to given audience and purpose. Repetitive mechanical errors distract the reader. Inconsistencies in language, sentence structure, and/or word choice are present. There are missing APA elements or some are incorrectly formatted throughout the presentation.
Style is appropriate to the given audience and purpose. Word choice is specific and purposeful, and somewhat varied throughout. Minimal mechanical or typographical errors are present, but are not overly distracting. Reference slide and in-text citations have few formatting errors.
Style shows originality and creativity. Word choice is dynamic and varied. Free of mechanical and typographical errors. Reference slide and other in-text citations are formatted correctly using APA elements.
Score of Writing, Mechanics, and APA Weight: 10%,
There are several types of anemia, but the most common are:
- Iron-deficiency anemia: This occurs when the body doesn’t have enough iron to produce hemoglobin, which is necessary for red blood cells to carry oxygen throughout the body.
- Vitamin-deficiency anemia: This occurs when the body doesn’t have enough vitamin B12 or folate, which are necessary for the production of red blood cells.
- Hemolytic anemia: This occurs when red blood cells are destroyed faster than the body can replace them. This can happen due to certain medications, autoimmune disorders, infections, or genetic conditions.
- Aplastic anemia: This occurs when the bone marrow fails to produce enough red blood cells, white blood cells, and platelets.
- Sickle cell anemia: This is a genetic disorder that causes red blood cells to become misshapen and break down more easily, leading to anemia and other complications.
- Thalassemia: This is a genetic disorder that affects the production of hemoglobin, leading to anemia and other complications. There are two main types of thalassemia: alpha thalassemia and beta thalassemia.
Treatment of anemia
The treatment of anemia depends on the underlying cause and severity of the condition. Here are some common treatments for anemia:
- Iron-deficiency anemia: This type of anemia can be treated with iron supplements, either in pill form or through injections. It’s also important to consume iron-rich foods such as red meat, dark leafy greens, and beans.
- Vitamin-deficiency anemia: Treatment involves increasing the intake of foods rich in vitamin B12 and folate or taking supplements. In severe cases, injections of these vitamins may be required.
- Hemolytic anemia: Treatment for this type of anemia depends on the underlying cause. It may involve medications to suppress the immune system or to remove antibodies from the blood.
- Aplastic anemia: Treatment for this type of anemia may involve blood transfusions to increase the number of red blood cells in the body. In severe cases, a bone marrow transplant may be necessary.
- Sickle cell anemia: Treatment involves managing symptoms, such as pain, infections, and organ damage. This may involve medications, blood transfusions, and other treatments.
- Thalassemia: Treatment may involve regular blood transfusions to replace the missing or abnormal hemoglobin. In some cases, bone marrow transplant may be recommended.
Compensation mechanisms for decreased cardiac output in cases of congestive heart failure include
Congestive heart failure (CHF) occurs when the heart is unable to pump blood effectively. This can lead to decreased cardiac output, which refers to the amount of blood pumped out of the heart each minute. Compensation mechanisms are processes that the body uses to help maintain cardiac output when it is decreased. Some of the compensation mechanisms for decreased cardiac output in CHF include:
- Activation of the renin-angiotensin-aldosterone system (RAAS): This system is activated when blood pressure drops or blood volume decreases. It causes the release of hormones that increase blood pressure and blood volume, helping to maintain cardiac output.
- Sympathetic nervous system activation: The sympathetic nervous system is activated in response to decreased cardiac output, causing an increase in heart rate and contractility, as well as vasoconstriction of blood vessels, to help maintain blood pressure and cardiac output.
- Myocardial hypertrophy: The heart muscle can thicken in response to increased workload, which helps to maintain cardiac output.
- Ventricular dilation: In response to increased workload, the ventricles of the heart can enlarge, which helps to maintain cardiac output.
- Fluid retention: The body can retain fluid in response to decreased cardiac output, which helps to increase blood volume and maintain cardiac output.
While these compensation mechanisms can help maintain cardiac output in the short term, they can also contribute to the progression of CHF over time. Therefore, it’s important for individuals with CHF to receive appropriate medical treatment to manage the underlying condition and prevent complications.
What compensatory mechanism is responsible for fluid overload in heart failure?
The compensatory mechanism responsible for fluid overload in heart failure is the activation of the renin-angiotensin-aldosterone system (RAAS). When the heart is unable to pump blood effectively in heart failure, the body perceives this as a decrease in blood pressure and activates the RAAS. The RAAS causes the release of hormones, including aldosterone, which signals the kidneys to retain sodium and water. This retention of sodium and water increases blood volume and helps to maintain blood pressure and cardiac output in the short term.
However, over time, this retention of sodium and water can lead to fluid overload, which exacerbates heart failure symptoms and can lead to complications such as pulmonary edema. In addition, the increased blood volume places additional strain on the heart, which can further worsen heart failure.
Therefore, it’s important for individuals with heart failure to receive appropriate medical treatment to manage fluid overload, which may include medications such as diuretics to help the body eliminate excess fluid. Lifestyle modifications such as reducing salt intake and limiting fluid intake may also be recommended.
Compensated heart failure symptoms
Compensated heart failure refers to a stage of heart failure where the body has activated compensatory mechanisms to maintain cardiac output and blood pressure, and symptoms may be mild or absent. However, even in compensated heart failure, the underlying condition is still present and can progress if left untreated. Here are some possible symptoms that may be present in compensated heart failure:
- Fatigue: Individuals with compensated heart failure may feel tired or weak due to the heart’s reduced ability to pump blood.
- Shortness of breath: Shortness of breath or dyspnea may occur with physical activity or exertion.
- Swelling: Swelling or edema in the legs, ankles, feet, or abdomen may be present due to fluid retention.
- Rapid or irregular heartbeat: Heart palpitations or an irregular heartbeat may occur due to the heart’s compensatory mechanisms.
- Reduced exercise tolerance: Individuals with compensated heart failure may have a reduced ability to exercise or perform physical activities.
- Cough: A persistent cough may occur due to fluid buildup in the lungs.