NURS 6501 Module 7 Assignment: Case Study Analysis
NURS 6501 Module 7 Assignment: Case Study Analysis
NURS 6501 Module 7 Assignment: Case Study Analysis
Advanced Pathophysiology
Although they are complimentary, males and women have vastly different reproductive systems. Because the reproductive systems of both genders might be affected by remote events, it is difficult for an inexperienced clinician to make a reliable diagnosis due to differences in anatomy and physiology. The female reproductive system is particularly perplexing since the symptoms may appear to be those of a sexually transmitted infection (STI), yet the true disease lies elsewhere. To establish the diagnosis, the clinician must be skilled in gleaning subjective information and interpretation of physical examination and laboratory evidence. The purpose of this paper is to respond to diagnostic questions about a 32-year-old woman who appears with a fever, left lower quadrant (LLQ) discomfort, symmetrical back pain, foul-smelling p.v. discharge, and other complaints.
Sexually Transmitted Infections as a Factor that Affects Fertility
Sexually transmitted infections (STIs) are a major cause of infertility in females like the one in the case study. This is particularly true for STIs that have been left untreated for an extended period of time. If not treated promptly, STIs can create scars in the reproductive organs, which can compromise the reproductive tract’s functionality. The inflammatory process leaves scar tissue that contracts and clogs the tubes when the STI’s infectious process ascends upwards into the female’s Fallopian tubes. Chlamydia trachomatis, which causes chlamydia, and Neisseria gonorrhoeae, which causes gonorrhea, are two organisms that have been linked to infertility (Hammer & McPhee, 2018). Tsevat et al. (2017) define infertility as a woman’s inability to conceive after at least 12 months of continuous unprotected intercourse without using contraceptives.
The Reason Why Inflammatory Markers Rise in Sexually Transmitted Infections (STIs) and Pelvic Inflammatory Disease or PID
C-reactive protein (CRP) is an inflammatory marker that is commonly used to assess if the body is undergoing an
NURS 6501 Module 7 Assignment Case Study Analysis
infectious process. A value of more than 10 mg/L is concerning and indicates that the patient should be investigated further to find the source of the inflammation. The patient in this case had a foul-smelling vaginal discharge and a CRP level of 67 mg/L, which is quite high. Inflammation is the cause of increased levels of inflammatory indicators such as CRP and erythrocyte sedimentation rate, or ESR, in females with PID and STIs. Some specific markers are recognized to be diagnostically predictive of certain illnesses. The CA-125 protein, for example, can indicate a diagnosis of PID and ovarian cancer. The STIs gonorrhea and chlamydia, according to Park et al. (2017), produce an increase in the inflammatory markers CRP, ESR, and CA-125.
Causes of a Systemic Reaction
A localized reaction occurs when a reaction only affects one part of the body. A systemic reaction occurs when inflammation extends from a limited location of one organ (such as the ovaries) to other organ systems in the body. Toxins, allergies, and infections can all cause inflammation. Sepsis is one example of a systemic reaction and may result from an untreated STI that has spread to become a PID (Hammer & McPhee, 2018). Sepsis will result to septic shock and is a life-threatening medical emergency.
The Diagnosis of Immune Thrombocytopenia or ITP and the Need for Splenectomy
Low platelet count or thrombocytopenia characterizes immune thrombocytopenia, or ITP. The cause is an autoimmune reaction in which the spleen produces antibodies against platelets. Platelets are also removed from the blood by the spleen. As a result of the thrombocytopenia, the ITP patient will experience major bleeding episodes. Although pharmacotherapy with medicines like rituximab can help, splenectomy is the best option for ITP patients (Chaturvedi et al., 2018). It gets rid of the platelet sequestration center, as well as the source of autoimmunity.
Different Types of Anemia
The amount of hemoglobin (Hb) in a person’s blood affects whether or not they have anemia. Because hemoglobin is carried in erythrocytes or red blood cells, a complete blood count (CBC) will reveal whether or not the patient is anemic. Aplastic anemia, iron-deficiency anemia or microcytic anemia, macrocytic or megaloblastic anemia, and haemolytic anemia or sickle cell anemia are among the numerous kinds of anemia, according to Hammer and McPhee (2018).
Conclusion
Treating reproductive disorders in females requires deeper clinical acumen to come up with the correct diagnosis. This is because of the intricate nature of the female reproductive system. Presentations such as vaginal discharge often mimic several possible conditions. Males also have their intricacies especially to do with the prostate gland that surrounds a part of the urethra and has a duct leading to its lumen. Apart from conditions of the reproductive systems, this paper has also discussed matters to do with inflammatory markers, immune thrombocytopenic purpura or ITP and the need for splenectomy; as well as the different types of anemia.
References
Chaturvedi, S., Arnold, D.M., McCrae, K.R. (2018). Splenectomy for immune thrombocytopenia: Down but not out. Blood, 131(11), 1172-1182. http://dx.doi.org/10.1182/blood-2017-09-742353
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Park, S.T., Lee, S.W., Kim, M.J., Kang, Y.M., Moon, H.M., & Rhim, C.C. (2017). Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease. BMC Women’s Health, 17(1), 1-7. https://doi.org/10.1186/s12905-016-0356-9
Tsevat, D.G., Wiesenfeld, H.C., Parks, C., & Peipert, J.F. (2017). Sexually transmitted diseases and infertility. American Journal of Obstetrics and Gynecology, 216(1), 1–9. http://dx.doi.org/10.1016/j.ajog.2016.08.008
Various factors affect fertility. The presence of the STDs such as Chlamydia and gonorrhea are examples of some of the common forms of STDs that lead to infertility in a person. The reason inflammatory markers tend to rise in STD/PID is the high level of white cell count. The high level of white cells count indicates that the pelvic inflammatory disease is excessively severe (Low, N. & Broutet N. J. 2017). Hence, the inflammatory response is an indication of the presence of an infection and is a response as the first line of defense (Chaparro & Suchdev, 2019).
Acute bacterial prostatitis is caused by the presence of common strains of bacteria. The infections begin when the bacteria that are present in the urine find their way onto the prostate area. Most of the time, the common forms of treatment entail antibiotics to ensure that the infection is effectively treated. Notably, prostate massage should not be performed for patients that have acute prostatitis condition, given that it will end up causing sepsis (Le, 2016). It is rare to witness sepsis that arises from prostatitis but can occur among patients whose immunity has been compromised.
A patient that has been diagnosed with ITP needs splenectomy given that the immune system of the patient treats the platelets as foreign material to the body and hence will destroy them. The spleen is the part that is responsible for the removal of the damaged platelets from the body. For this reason, removing the spleen of the patient is a strategy that will ensure that there are more platelets in the body (Chaparro & Suchdev, 2019).
The presence of macrocytic anemia is an indication that the red blood cells have low levels of hemoglobin in the body. Hemoglobin is a form of protein that contains high levels of iron that is responsible for the transportation of oxygen around the body. The underlying causes of macrocytic anemia include deficiency in B-12 or folate in the body (Le, 2016). For this reason, the condition is sometimes called vitamin deficiency anemia.
Microcytic anemia is defined as a state in which there is the presence of small and hypochromic red blood cells in the peripheral of the blood smear that is characterized by a low level of the MCV. A low level of MVC means less than 83 microns 3. Hence, the most common cause of microcytic anemia is iron deficiency.
The different kinds of anemia include:
- Hypochromic microcytic anemias include iron-deficient anemia, thalassemia, and sideroblastic anemia.
- Normochromic microcytic anemia
- Anemia of inflammation of chronic diseases including infectious diseases such as tuberculosis, HIV/AIDS, and inflammatory diseases such as rheumatoid arthritis.
- Hypochromic microcytic anemias are caused by a genetic condition that is regarded as congenital spherocytic anemia.
Other causes of microcytic anemia include:
- Lead toxicity
- Copper deficiency
- Excess zinc leading to deficiency in copper
- Excessive alcohol consumption
- Drug abuse
References
Chaparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences. https://doi.org/10.1111/nyas.14092
Le, C. H. (2016). The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003-2012). PLOS ONE, 11(11), e0166635. https://doi.org/10.1371/journal.pone.0166635
Low, N. & Broutet N. J. (2017). Sexually transmitted infections – Research priorities for new challenges. PLoS Medicine, (12), e1002481