Case Studies: Anemia and Congestive Heart Failure

Case Study 1

Ms. A’s case is strongly pointing towards a case of anemia. The specific type of anemia needs some more in-depth analysis based on her symptoms. Importantly, Ms. A is privileged to show symptoms of her anemia and this is critical in the determination of the specific type of anemia. A proper diagnosis of her condition is important precedence to proper medical response and management of her situation. As described by Beutler and Waalen (2006), anemia can be defined as a less than normal volume of packed red blood cells, hemoglobin, or red blood cell mass. To measure the normalcy or lack of it thereof Annette (2003) describes two ways; one, hematocrit and two, hemoglobin concentration that is lesser than the two standard deviation of the normal mean for a given age. 

Given the above definitions, it is apparent that some of the observed symptoms; for instance, shortness of breath, low energy levels, and reduced enthusiasm are indicative of general symptoms of anemia. Due to lack of sufficient carriers of oxygen (red blood cells) in the body, there is shortness of breath and muscular weakness since important muscular organs like the heart and others are not getting sufficient supply of oxygen, which is critical in the cellular combustion process that yields energy. As such, there are low energy levels available for critical organs such as the heart and muscles responsible for movement. 

The clinical assessment of the symptoms will explain the specific type of Anemia Ms. A is suffering from. According to Shavelle, MacKenzie, and Paculdo (2012), there are numerous types of anemia and there should be a careful consideration of the different types to ensure that the problem is well identified. After careful consideration of the signs and symptoms exhibited by Ms. A, it is evident that she is suffering from moderate anemia, which is highly caused by nutritional factors. The word ‘moderate’ in the description of the anemia is indicative of the levels of hemoglobin and red blood cells (erythrocyte) count. A laboratory analysis indicated that the hemoglobin levels of Ms. A are 8.0 g/dl, which according to Annete (2003) lies within the threshold of moderate anemia that is calibrated at levels 8-9.5g/dl. Ideally, a 26-year-old healthy female should be having 12-14g/dl, indicating that Ms. A is having a reduced hemoglobin level by about 30% from normal levels, which is within the description of moderate anemia. The number of times Ms. A takes Aspirin is indicative of nutritional anemia since aspirin reduces the formation of iron as expressed by Xu et al. (2015) since a continued intake of Aspirin lead to a chronic loss of blood. During her menses, it is evident that she is losing much blood, which takes long before she can replace it using nutritional means. Lastly, Hematocrit levels are indicative of moderate anemia. Ms. A has Hematocrit levels of 32% against a recommended level of between 35-44.5%. This indicates that she is below the recommended levels of oxygen to blood volume ratio. 

References

Annette, Carley. Anemia: When it is not iron deficiency.  2003. Pediatric Nursing. 2003;29(3)  

Beutler, E., & Waalen, J. (2006). The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration?. Blood, 107(5), 1747-1750.

Shavelle, R. M., MacKenzie, R., & Paculdo, D. R. (2012). Anemia and mortality in older persons: does the type of anemia affect survival? International journal of hematology, 95(3), 248-256.

Xu, Y. X., Du, F., Jiang, L. R., Gong, J., Zhou, Y. F., Luo, Q. Q., … & Ke, Y. (2015). Effects of aspirin on expression of iron transport and storage proteins in BV-2 microglial cells. Neurochemistry international, 91, 72-77.

Case Study 2

The case of Mr. P is one that calls for empathy and calls for interventions that transcend ordinary medical care.  This can be emphasized since the problems Mr. P is facing extend to psychological and economic issues. Such situations call for a deliberate and conscious application of the tenets of caring in nursing at their best and without reservations, as explained by the Watson’s Theory of Caring (Smith, Turkel, and Wolf, 2012). The nurse needs to be very professional with Mr. P since he is mentally disturbed, which is an element that has been proved to be a significant deterrent to the health of patients as expressed by Cumberland (2005). The concern for his ability to cater to his medical expenses and a wife whose health is deteriorating makes a dangerous cocktail of trauma. 

To be of assistance in an impactful way to Mr. P., a holistic approach needs to be adopted. The approach takes into consideration the different problems that Mr. P is having in their entirety. A step that would lead to the offering of guidance and counseling of the couple would be important as it would ensure that the couple gets psyched up. An invocation of the couple’s religious aspect would be important since nursing takes into account the physical, mental, and spiritual aspects of patients. It is evident that the religious string can be pulled without much of a tussle or controversy since the wife of Mr. P makes references to God. With raised hopes after referencing the spiritual element to the couple, the nurse has a better opportunity to intervene medically. The underlying principle in this approach is that both non-pharmacological and pharmacological approaches need to work together but none should replace the other as indicated by Ackley and Ladwig (2008). 

It is important to note that Mr. P has a challenge when it comes to maintenance of diet restrictions and also in the management of polypharmacy. To address the situation, patient education should be taken into consideration. This will be critical in ensuring that the patient is able to adhere to treatment plans even in the absence of the nurse. Further, it helps the patient in the sustenance of non-pharmacological interventions, which are critical in the development of a highly charged environment characterized by the will to change. For instance, the nurse can organize and advocate for short but regular walks, hobbies, watching comic TV shows, and engaging in conversations with each other, as well as, with any available person. As such, patient education in this sense will have taken care of both pharmacological and non-pharmacological approaches. 

A teaching plan in this sense should capture the most important aspects of the couple and can be adopted as follows. 

Item	Description
Title	Adherence to Pharmacological and Non-Pharmacological approaches to wellbeing
Audience	Mr. and Mrs. P
Length	15 minutes
Objectives	Teach Mr. and Mrs. P to adhere to medical plans and introduce non-pharmacologically related activities after studying their likes and dislikes.
Implementation	Engage the couple in a lively discussion and in the process of casual talk, pass on important information and emphasize it.
Evaluation	Check if there are improvements in behavior and thought processes

References

Ackley, B.J., & Ladwig, G.B. Nursing diagnosis handbook: An evidence-based guide to planning care (8^th ed.). 2008. Print. St. Louis: Mosby Elsevier.

Cumberland, Richlove. Nursing Universally. 2005. Print. Marvelous Press House Limited: Madrid.

Smith, M. C., Turkel, M. C., & Wolf, Z. R. (Eds.). (2012). Caring in nursing classics: An essential resource. Springer Publishing Company.