Practical Week 10 Management Plan: Iron Deficiency Anemia Assignment 2 Paper

Practical Week 10 Management Plan: Iron Deficiency Anemia Assignment 2 Paper

Practical Week 10 Management Plan: Iron Deficiency Anemia Assignment 2 Paper

Management Plan

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Primary Diagnosis: D50. 9 Iron deficiency anemia

The patient demonstrates clinical manifestations consistent with Iron Deficiency Anemia (IDA), such as profound fatigue, muscular weakness, dyspnea, tachycardia, and reduced exercise tolerance. Additionally, her blood tests indicate decreased concentrations of iron, hematocrit, and hemoglobin. The total iron-binding capacity exhibits elevated levels as well. In light of the patient’s status as a postmenopausal female, additional diagnostic measures may be undertaken, including upper and lower endoscopy, as well as a urine examination to detect the presence of blood or hemoglobin (Al-Daghri et al., 2022). In light of the patient’s reflux issues, it is advisable to request an esophagogastroduodenoscopy (EGD) to exclude the possibility of esophageal cancer.

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Guidelines:

 The confirmation of iron deficiency should be conducted through iron studies, as recommended by the clinical practice guidelines of the British Society of Gastroenterology (BSG) and the American Academy of Family Physicians (Ko et al., 2020). The measurement of serum ferritin is considered the most valuable indicator for identifying IDA. However, in cases where there is suspicion of falsely normal ferritin levels, additional blood tests such as transferrin saturation can provide supplementary diagnostic assistance. A strongly positive reaction to iron replacement therapy, characterized by a Hb increase of at least 10 g/L within two weeks, provides substantial evidence for the presence of absolute iron deficiency, even in cases where the results of iron studies are inconclusive. The initial assessment of confirmed IDA should encompass urinalysis or urine microscopy, screening for celiac disease, and, when deemed suitable, upper and lower gastrointestinal endoscopy. Celiac disease is present in approximately 3-5% of cases of IDA and it is recommended to conduct regular screening for this condition through serological testing or small-bowel biopsy during gastroscopy procedures.

Differential Diagnoses:

  1. Congestive Heart Failure (22): The commonly used Framingham Diagnostic Criteria for Heart Failure states that to be diagnosed with heart failure, the disease must fulfill either two major criteria or one major and two minor criteria. One of the minor criteria for the diagnosis of CHF was found on the patient’s EKG, which was sinus tachycardia. A complete laboratory study, including testing for anemia, iron deficiency, renal dysfunction, and liver dysfunction, is necessary to identify the cause and/or severity of heart failure.
  2. Hyperthyroidism (E05): Thyroid hormone levels, specifically T4 and T3, are assessed through the utilization of blood tests to establish a diagnosis of hyperthyroidism (Ahmad & Jiang, 2021). The patient’s free thyroxine (T4) level was measured to be 1.1, while their thyroid-stimulating hormone level was found to be 1.3. These values fall within the established normal range. Nevertheless, the patient presented symptoms indicative of hyperthyroidism, such as an elevated heart rate, thereby suggesting a potential diagnosis. The diagnostic process may involve the utilization of an Iodine Uptake Scan and thyroid scan to exclude this particular diagnosis.
  3. Malignant Neoplasm of the colon (): The patient has a history of acid reflux, worsening constipation, and signs of iron deficiency anemia. All of these might be brought on by colon cancer. To confirm or rule out this diagnosis, however, a stool test, flexible sigmoidoscopy, colonoscopy, and CT colonography should be performed (Lennart Möller et al., 2023).
  4. Occult Infection (9): When a patient has a fever but otherwise seems healthy and lacks a visible infection source, such as in the case study described, this condition is known as occult (hidden) bacteremia. Streptococcus pneumoniae bacteria, which may be detected by complete blood count and blood culture, are the most prevalent cause of occult bacteremia (Cogliati Dezza et al., 2020). Measurements of C-reactive protein may also be used to check for hidden bacteremia.
  5. Ejection Systolic Murmur ( 1): The patient had an increased heart rate and early systolic murmurs, according to a physical examination. She also discusses her history of hypertension, which she now manages with medication. A person with an abnormal heart murmur could also show signs of the underlying problem. These include a sense of fatigue or weakness. a lack of breath, especially after exercise. To rule out this diagnosis, the following tests may be ordered: a chest x-ray, ECG, catheterization, transthoracic echocardiogram (echo), or transoesophageal echo (TEE) (Jolobe, 2021).

Medications

            The recommended initial treatment for IDA involves the administration of a single tablet of ferrous sulfate (Feratab), fumarate, or gluconate every 24 hours. If the current situation is not deemed acceptable, it may be prudent to consider a lower dosage regimen (administering one tablet every 48 hours), explore alternative oral formulations, or contemplate the use of intravenous iron therapy as suggested by Ko et al. (2020). In certain cases, there may be a need for a restricted administration of packed red blood cells (PRBCs) to address symptomatic iron deficiency anemia (IDA). However, it is important to note that iron replacement therapy (IRT) remains essential even after the transfusion has taken place. It is recommended that patients undergo monitoring during the initial four-week period to assess the response of hemoglobin levels to oral iron treatment. Furthermore, it is advised that treatment be sustained for approximately three months following the normalization of hemoglobin levels. It is imperative to provide patients with comprehensive education regarding the significance of adhering to their prescribed treatment regimen to achieve favorable outcomes. If symptoms continue, it is recommended that the patient be referred to a hematologist to undergo additional assessment and potential modification of treatment.

Problem Statement:

The most prevalent nutritional deficit in the world in terms of disability-adjusted life year is iron insufficiency, which is also the 13th most significant nutritional deficiency. Currently, iron deficiency (ID) is widely acknowledged in more than 30% to 50% of patients with stable chronic HF, which lowers the prognosis for individuals like the one in the case study reported. Anemic HF patients have worse functional status, lower physical performance, worse health-related quality of life (QoL), extra edema, lower blood pressure, a greater need for diuretics, higher levels of neurohormonal and pro-inflammatory cytokine activation, and are older, more likely to be female, more likely to have diabetes, chronic kidney disease (CKD), severe HF, and worse health-related QoL.The increased cardiac workload from decreased oxygen supply to metabolizing tissues in anemic individuals results in a variety of hemodynamic, neurohormonal, and renal changes that may have a negative impact on LV remodeling and LV hypertrophy.

Social Determinants of Health

According to extensive research on the socioeconomic determinants of iron deficiency anemia, family and per capita income, level of education, area of residence, and household crowding are the variables that have the most effect on the onset of this deficiency (Krist et al., 2019). The patient is at risk for this medical issue since she is female and elderly. She may also be uneducated and from an underprivileged area with no access to clean water. Her restricted access to treatment as a result of her low income may have contributed to the condition’s late discovery as a result of a lack of regular screening and the adoption of suitable preventative measures.

The USPSTF advises regular testing for iron deficiency anemia in asymptomatic at-risk women to promote their health. Old age, being a woman, dietary deficits, blood loss, using certain drugs, and poor absorption are risk factors. Alcohol misuse, a protracted Helicobacter pylori infection, chemotherapy, anticonvulsant medicines, celiac sprue illness, impaired renal function, cancer, hypothyroidism, and hyperthyroidism are other factors that contribute to anemia in the elderly (Krist et al., 2019). The USPSTF advises routine screening for breast cancer, falls, depression, suicidal ideation, hearing loss, cognitive impairment, visual impairment, cervical cancer, osteoporosis, lung cancer, diabetes, and colorectal cancer due to the patient’s advanced age, female gender, and history of CHF among other chronic comorbidities.

References

Ahmad, S. M., & Jiang, B. (2021). The Grave Hematologic and Hepatic Effects of Hyperthyroidism. Journal of the Endocrine Society, 5(Supplement_1), A959–A959. https://doi.org/10.1210/jendso/bvab048.1960

Al-Daghri, N. M., Yakout, S., Ghaleb, A., Hussain, S. D., & Sabico, S. (2022). Iron and 25-hydroxyvitamin D in postmenopausal women with osteoporosis. American Journal of Translational Research, 14(3), 1387–1405. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991132/

Cogliati Dezza, F., Curtolo, A., Volpicelli, L., Ceccarelli, G., Oliva, A., & Venditti, M. (2020). Are Follow-Up Blood Cultures Useful in the Antimicrobial Management of Gram-Negative Bacteremia? A Reappraisal of Their Role Based on Current Knowledge. Antibiotics, 9(12), 895. https://doi.org/10.3390/antibiotics9120895

Jolobe, O. M. P. (2021). Murmurs other than the early diastolic murmur in aortic dissection. The American Journal of Emergency Medicine, 49, 133–136. https://doi.org/10.1016/j.ajem.2021.05.041

Ko, C. W., Siddique, S. M., Patel, A., Harris, A., Sultan, S., Altayar, O., & Falck-Ytter, Y. (2020). AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology, 159(3), 1085–1094. https://doi.org/10.1053/j.gastro.2020.06.046

Krist, A. H., Davidson, K. W., & Ngo-Metzger, Q. (2019). What Evidence Do We Need Before Recommending Routine Screening for Social Determinants of Health? American Family Physician, 99(10), 602–605. https://www.aafp.org/pubs/afp/issues/2019/0515/p602.html?utm_medium=email&utm_source=transaction

Lennart Möller, Wellmann, I., Stang, A., & Hiltraud Kajüter. (2023). The epidemiology of colorectal cancer in younger and older patients. https://doi.org/10.3238/arztebl.m2023.0041

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Please ensure the paper is in 7th edition APA format and references are from 2018-current.

I want to speak to the fact of learning to interpret EKG’s better but could use more practice. I also think there is room for improvement in prescribing medications and knowing what risk factors to consider.

Three hardest patients: 1. kidney transplant patient who had diarrhea for three months that was unrelieved and elevated Cr and BUN, difficult because I was unsure if the patient was rejected transplant or if kidney function was up due to dehydration. 2. middled age Caucasian female going through menopause experiencing abdominal tenderness from simply being touched on the abdomen, and all tests came back negative, yet she was refusing colonoscopy. 3. make up this patient.

Reources used to help assist in caring for these patients, epocrates, uptodate website, and MDCalc

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