Posted: February 14th, 2023

Examining Endocrine, Metabolic, and Hematologic Disorders

Examining Endocrine, Metabolic, and Hematologic Disorders
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Review Part 17 and 21 of the Buttaro et al. text in this week’s Resources.
You will either select or be assigned to a patient case study for this Discussion.
Review the patient case study and reflect on the information provided about the patient.
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 Assessment.
Consider types of physical exams and diagnostics that might be appropriate for Assessment of the patient in the study.
Reflect on a possible diagnosis for the patient.
Think about potential treatment options for the patient.

Examining Endocrine, Metabolic, and Hematologic Disorders
In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. 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.

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

Case Study 2
A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.
Case Study 3
V.G. is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use. SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415.
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Examining Endocrine, Metabolic, and Hematologic Disorders

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Examining Endocrine, Metabolic, and Hematologic Disorders
Case Study One
Additional Information and Questions
Additional information is necessary to find out the family and medical history of the patient. It is also important to ask the patient if she is experiencing shortness of breath. Other conditions to check to include pale skin, pale coloring inside the lower eyelids, and headache. Other conditions to check to include the heart palpitations, dry and damaged hair and skin, restless legs, and swelling and soreness of the tongue and mouth. The provider should also check the eyes to identify significant changes that may be present.
The questions will include;
1. Do you take a balanced diet?
2. Have you suffered from a blood disorder or anemia in the past?
3. Do you have a family member with anemia or a blood disorder?
4. When did you start experiencing the symptoms?
5. On a scale of 0-10, how can you rate the severity of the condition?
6. Do you experience loss of vision?
7. Do you experience shortness of breath?
8. Have you suffered from a blood disorder in the past?
9. Have you had a significant medical problem in the past or an accident?
10. Do you have a family member or parent who has suffered from a blood disorder?
11. Have you taken any medication to treat the symptoms?
12. Is there a time when the symptoms exacerbate?
13. Is there any cause you can attach to the illness?
Physical Exams and Diagnostics
The provider will carry out a complete blood count (CBC) and tests to check the red blood cells’ shape and size. It helps check the presence of unusual sizes, shapes, and colors of the blood cells (Camaschella, 2017). The purpose is to evaluate the cells circulating in the body, including white and red blood cells and platelets. The test is effective in detecting anemia or other blood conditions like leukemia (Camaschella, 2017). It is essential to check the nail beds, oral mucosa, palmar creases, and lips.
Possible Diagnosis
The differential diagnosis for the patient includes iron deficiency anemia, thalassemia, and sideroblastic anemia. The three conditions have similarities in their symptoms.
Iron deficiency anemia involves a lack of sufficient red blood cells to transport oxygen throughout the body (Gkamprela et al., 2017). The iron deficiency leads to poor production of the red blood cells, thus leading to anemia. The symptoms include dizziness, fatigue, light-heartedness, heart palpitations, brittle nails, pale skin, and shortness of breath. Some of the causes of the condition include blood loss, lack of iron in the diet, inability to absorb iron, and biological conditions such as pregnancy (Gkamprela et al., 2017). Iron deficiency anemia requires urgent treatment since a lack of sufficient oxygen can damage the body organs. The most likely condition iron deficiency anemia due to the similarities of the symptoms.
Thalassemia is an inherited blood disorder that leads to a low amount of hemoglobin in the blood. Hemoglobin is essential in carrying oxygen in the blood to various body organs. Low levels of hemoglobin lead to fatigue since body cells do not receive sufficient oxygen (Auerbach & Adamson, 2016). It is a fatal condition that requires urgent medical conditions. The only cure for thalassemia is stem cell transplant. Patients with thalassemia experiences, different symptoms include fatigue, slow growth, abnormal bleeding, dark urine, weakness, pale skin, and facial bone deformities (Auerbach & Adamson, 2016).
In some cases, people with thalassemia experience jaundice. The major cause of thalassemia is the mutation of DNA cells that make hemoglobin (Auerbach & Adamson, 2016). The condition can be passed from parents to children.
Sideroblastic anemia is another blood disorder that occurs when the body has sufficient iron, but it cannot utilize it to make enough hemoglobin. Consequently, iron accumulates in the mitochondria leading to a ringed appearance of the nucleus called ringed sideroblast (Breymann et al., 2017). The symptoms include weakness, fatigue, racing heart, shortness of breath, irritability, chest pain, and headache. Some causes include zinc overdose, lead poisoning, nutritional deficiencies, alcohol, and hypothermia (Breymann et al., 2017). Treatment of sideroblastic anemia includes bone marrow or liver transplant, blood transfusion, and toxic agents’ removal.
Potential Treatment Options
The possible treatment options will depend on the condition’s cause and severity after carrying out the diagnostic tests. Providers can recommend blood transfusion, increase vitamin C and B intake, and drink more water (Mirza et al., 2018). The patient should rest for a few days to enhance recovery, eat a balanced diet, and exercise regularly. Dietary changes are essential since iron deficiency disorder can reoccur if a patient does not take the iron nutrients.
Patients should take iron supplements to boost the level of iron in their blood. In severe conditions, patients may require intravenous (IV) iron therapy or blood transfusion (Mirza et al., 2018). Blood transfusion is necessary if the condition is threatening the survival of a patient.
Patients should also take iron-rich food and water daily. The lifestyle changes will treat the anemic condition and improve the health of a patient. Patients should start realizing changes in their health condition after a week of taking the supplements (Mirza et al., 2018). They should also take a medical test to check the level of iron in the blood. Lifestyle changes should ensure that patients do not resume past lifestyles, such as lack of proper nutrition, which led to anemic.
Lifestyle changes should include diet changes, such as taking iron-rich foods and fruits. They include oranges, tomatoes, and strawberries that improve the level of iron in the body (Mirza et al., 2018). Others, such as red pepper and beets, contain beta carotene that improves iron absorption in the body (Mirza et al., 2018). It is also essential to take whole grain cereals, milk, sorghum, corn, grapes, oats, wheat and barley.
The patient should also take Ferrous sulfate, which is an essential drug for replenishing iron in the body. It is important to continue the medication for two months to replenish the body of the iron fully. The 82-year old patient should ferrous sulfate 200 mg twice daily (Camaschella, 2017). There is a need to avoid taking other medications since they can compromise the efficacy of the drug.
The patient should report back to the clinic for another assessment after a week. The purpose is to assess the progress of the patient (Camaschella, 2017). It is expected that after a week of taking the supplements and taking the medication, the patient’s condition will have improved significantly.
The patient should avoid taking alcohol or minimize consumption. The purpose is to ensure the alcohol consumption does not lead to negative behaviors that will undermine the recovery process (Camaschella, 2017).
The treatment method also involves prevention methods that will prevent a similar condition from reoccurring in the future. The patient should continue with the current medication for other conditions to improve full recovery and good health (Gkamprela et al., 2017). Embracing lifestyle changes will improve the recovery process since multiple conditions threaten the health of the elderly patient.

References
Auerbach, M., & Adamson, J. W. (2016). How we diagnose and treat iron deficiency anemia. American Journal of Hematology, 91(1), 31-38.
Breymann, C., Milman, N., Mezzacasa, A., Bernard, R., & Dudenhausen, J. (2017). Ferric carboxymaltose vs. oral iron in the treatment of pregnant women with iron deficiency anemia: an international, open-label, randomized controlled trial (FER-ASAP). Journal of Perinatal Medicine, 45(4), 443-453.
Camaschella, C. (2017). New insights into iron deficiency and iron deficiency anemia. Blood Reviews, 31(4), 225-233.
Gkamprela, E., Deutsch, M., & Pectasides, D. (2017). Iron deficiency anemia in chronic liver disease: etiopathogenesis, diagnosis and treatment. Annals of Gastroenterology, 30(4), 405.
Mirza, F. G., Abdul-Kadir, R., Breymann, C., Fraser, I. S., & Taher, A. (2018). Impact and management of iron deficiency and iron deficiency anemia in women’s health. Expert Review of Hematology, 11(9), 727-736.

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