NURS 3366 / NURS 3366 ASSIGNMENT 4 ANSWERS, Alterations in Hematologic and Lymphatic Systems

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Questions 1-4 refer to the following scenario: A young woman presents to her nurse practitioner complaining of SOB and fatigue. She states that her menstrual periods have been very heavy. (norm RBC ... = 4-6million; norm MCV = 80-95). 1. What is her most likely diagnosis and CBC results? a. macrocytic anemia; RBCs = 3 mill & MCV = 102. Wrong—MCV high, meaning cells BIG in size—doesn’t fit with scenario of losing blood (and iron) steadily during menses, which usually results in compensatorily SMALLER RBCs. b. microcytic anemia; RBCs = 3 mill & MCV = 70. Correct—RBCs < 4mill ! anemia (with its “usual” S&S of SOB & fatigue); MCV <80= small cells, which goes along with steady blood loss (see answer A) c. normocytic anemia; RBCs = 5 mill & MCV = 90. Wrong—RBCs are in normal range (not even an anemia) & so is MCV. d. polycythemia vera; RBCs = 20 mill & MCV = 90. Wrong—RBCs numbers are very HIGH, indicating erythrocytosis; diagnosis of polycythemia would be consistent with high RBCs, but NOT consistent with this scenario. 2. Based on the diagnosis, the patient’s S&S can be explained by the following: a. a malfunction in DNA during erythropoiesis causes inadequate ATP formation. Wrong—this is a mix of facts that doesn’t relate to each other or scenario. b. an underlying chronic disease causes a sudden loss in RBCs. Wrong—usually chronic diseases result in slow loss of RBCs or Hgb (not sudden), and the result is a normocytic anemia, not microcytic (the correct MCV answer of 70 above, answer B in question 1 = microcytic anemia). c. a steady loss of iron results in insufficient hemoglobin production. Correct-- with chronically heavy menses, there is loss of iron because of loss of RBCs. Eventually the body runs low on iron to create Hgb. d. a malformed hemoglobin molecule that decreases oxygen-carrying capacity of each RBC. Wrong—this is descriptive of sickle cell rather than blood loss situation. 3. The patient probably has a certain degree of hypoxemia because a. her low levels of iron have decreased the O2-carrying capacity of her Hgb. Correct— each Hgb molecule can carry 4 O2 molecules, so less Hgb = less O2. b. a secondary polycythemia has resulted from an underlying lung disease. Wrong—you are given in answer 1 that her RBCs are 3million = anemia, not polycythemia. c. she is not breathing in enough oxygen, resulting in unsaturated Hgb molecules. Wrong—there is no indication that this patient is having trouble breathing, as is implied in this answer. Instead, she is having shortness of breath BECAUSE of the underlying anemia. d. her heavy periods have led to a loss of Von Willebrand factor. Wrong—the coagulopathy known as von Willebrand disease can CAUSE heavy periods, not vice versa. 4. Which of the following will most likely be part of the treatment rationales for this patient? a. Iron (Fe) supplements will help the SOB by increasing the capacity of Hgb to carry O2. Correct—as explained in previous question, patient is losing iron, so this treatment will fix that. b. A well-rounded diet will provide nutrients to increase production of intrinsic factor. Wrong—a well-rounded diet is always a good thing, but it will not increase production of the hormone called intrinsic factor that is made by the parietal cells of the stomach and is needed to absorb vitamin B12. Low intrinsic factor is a cause of pernicious anemia, not iron-deficient anemia. Answers ASSIGNMENT #4 (Alterations in Hematologic and Lymphatic Systems) Academic honesty reminder: It is ok to discuss the assignments with other students as a learning tool, but it is considered a breach of academic honesty to copy answers directly from each other. Also, when taking a test, do not have this or any other document visible before you. c. Give her blood thinners for the polycythemia. Wrong—if this patient did have polycythemia, blood thinners would be appropriate, but she has anemia, which is the opposite of polycythemia. d. Injections of vitamin B12 will increase the size of the RBCs. Wrong—injections of B12 will help pernicious anemia, which is not the problem here; the other wrong aspect is that B12 doesn’t increase RBC size, but instead helps to correct the malfunction that made the RBCs too big. 5. A patient recently diagnosed with a vertebral fracture says, “I can’t understand how I broke it. I sat down a little too hard, but not hard enough to break anything.” His diagnosis is possibly _____because _____. a. Hodgkin’s lymphoma: it causes widespread lymphadenopathy. Wrong—Hodgkin’s is a cancer that does cause lymphadenopathy but doesn’t fit the scenario. b. idiopathic thrombocytopenia purpura (ITP): the low platelet count causes increased risk of bleeding. Wrong—these two parts do go together but don’t fit the scenario. c. anemia: suppression of bone marrow stem cell proliferation causes pancytopenia. Wrong—again, in some situations these two parts match, but don’t fit scenario. d. multiple myeloma: increased osteoclastic activity causes osteoporosis. Correct— multiple myeloma is a cancer in which pathologically increased plasma cells create overabundance of immunoglobulins, which attack bone and cause increase osteoc [Show More]

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