PATHOPHYSIOLOGY CASE STUDY # 2

This the CASE STUDY QUESTIONS BELOW. Please write each question and give an answer to it
1. You are taking care of a 25-year-old African American man whose admitting diagnosis was chest pain. He was admitted to the hospital six times last year with the same diagnosis, and he was last discharged 2 months ago. You review his chart and learn that he presented to the emergency room complaining of chest pain and also reported abdominal and bilateral lower extremity pain; but it is documented that the abdominal and leg pain are his usual sites of pain. When you examine him, you note he is febrile to 101F, respiratory rate 25 breaths per minute, normal blood pressure, and slight tachycardia of 100 bpm. His oxygen saturation on 2 L/min nasal cannula is 92%. Although he is tender on palpation of his extremities, the remainder of his examination is normal.
His laboratory examinations reveal elevated white blood cell and reticulocyte counts, and a hemoglobin and hematocrit that are slightly lower than baseline.
Normal white blood cell count4,500-10,000
Normal adult Reticulocyte0.5%-1.5%
Normal male Hemoglobin 14.0- 17.4 g/dL
Normal male Hematocrit42%-52%
a. After reviewing his labs, and comparing them to the normal values you determine that he has a blood disorder known as:_________________

b. Sickle and target cells are seen on the peripheral smear. Based upon this result you would determine that he has which type of anemia?

c. Discuss the pathophysiology related to sickle cell anemia.

d. You provide patient education to this patient about his sickle cell anemia. What particular conditions would you tell him are associated with increased sickling?

e. On the next day you are assigned this same patient. Right after shift he begins to complain of chest pain, which is worse on inspiration. You most likely suspect:

2. Why are patient’s with sickle cell anemia at risk for myocardial infarct?

a. Discuss the implication of monitoring troponin levels for patients suspected of having a myocardial infarct.

3. You perform an EKG. Results indicate that he has no PR interval and a variable QRS rate with rhythm irregularity. You recognize this rhythm as atrial fibrillation (see rhythm strip below).

a. The patient ask you to explain why his heart has switched from a normal rhythm. You answer him based upon your knowledge that dysrhythmias occur….

b.How would this rhythm be treated in the hospital setting?

4. George arrives in the emergency department by ambulance with acute dyspnea, tachypnea, and cyanosis. His arterial blood gases are: pH 7.232, PaO2 54 mmHg, PaCO2 56 mmHg.
a. How would you interpret these, and what do these values indicate?

b. His daughter arrives to the ICU and would like for you to explain to her what the diagnosis of acute respiratory failure is. You answer by saying..

c. While in your care he develops a fever of 101F. On examination, he has dullness to percussion in the right and left lower lobes and inspiratory crackles. He has bibasilar consolidation on radiograph. His chest x-ray showed Pneumonia. Pneumonia can be caused by?

d. George is later moved to a step-down unit. He has been told that his COPD exacerbation prompted the respiratory failure. More of his family comes to visit. His family is very concerned and do not understand what is causing his exacerbations and recurrent infections What would you tell them?

e. On your 3rd shift you review George’s morning lab’s. His erythrocyte count, hemoglobin, and hematocrit are all elevated. What is the name of this type of disorder?

f. What is the likely cause?

In addition to my book and choice of selected
references which will be uploaded to the contact writer box please incorporate information from the provided PDF on Cardiac Troponin
Update on cardiac troponin levels File. I will upload the PDF on Cardiac Troponin to contact writer box

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