Assignment: Physiology and Pathophysiology
Assignment: Physiology and Pathophysiology
Gastrointestinal Case Study
A patient presents in the ER with a severely low hemoglobin and hematocrit count. Symptomatology includes listlessness, pale, pallor, and hypotensive. The initial assumption is blood loss via the gastrointestinal tract. As either an FNP or an AGACNP learner, provide an initial evaluation for either a pediatric or an adult patient. In addition, include the following in your presentation:
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provide a rationale explaining a proposed treatment for the patient.
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Physiology and Pathophysiology
In the case study, a patient presents to the ER with a severely low hemoglobin and hematocrit count. The initial assumption is that a GI bleed has led to blood loss causing the symptoms. The AGACNP learner should evaluate the patient to rule out or confirm the following differential diagnoses: Chronic Anemia secondary to GI bleeding, Iron Deficiency Anemia, and Acute GI Bleed. Chronic anemia is a differential diagnosis based on the patient’s symptoms of listlessness, pale, pallor, hypotension, and low hemoglobin and hematocrit count. Findings consistent with Iron Deficiency Anemia include listlessness, pallor, hypotension, and low hemoglobin and hematocrit count (Kumar et al., 2022). Furthermore, Acute GI bleeding is a differential diagnosis based on symptoms of pale, pallor, hypotension, and low hemoglobin and hematocrit count.
The proposed treatment for this patient is packed Red blood cell (PRBC) transfusion. Packed RBCs transfusion is recommended for patients with a severely low hemoglobin and hematocrit count. PRBCs transfusions are used to improve blood oxygen-carrying capacity and restore blood volume. Besides, PRBCs are used only to treat clinically symptomatic anemia because they do not contain platelets or clotting factors.
The patient in this case has symptomatic anemia characterized by listlessness, pale, and pallor. Packed RBCs transfusion will aim to restore tissue oxygenation that was previously compromised by the loss of hemoglobin and oxygen-carrying capacity (Lasocki et al. 2020). A restrictive RBC transfusion should be considered for adult patients with a Hb of 7 g/dL or less who are hemodynamically stable. Kumar et al. (2022) explain that patients with severe anemia are highly likely to require further iron supplementation to adequately replenish their iron stores, particularly if the cause for the anemia is chronic and not easily treatable.
References
Kumar, A., Sharma, E., Marley, A., Samaan, M. A., & Brookes, M. J. (2022). Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ open gastroenterology, 9(1), e000759. https://doi.org/10.1136/bmjgast-2021-000759
Lasocki, S., Pène, F., Ait-Oufella, H., Aubron, C., Ausset, S., Buffet, P., Huet, O., Launey, Y., Legrand, M., Lescot, T., Mekontso Dessap, A., Piagnerelli, M., Quintard, H., Velly, L., Kimmoun, A., & Chanques, GL. (2020). Management and prevention of anemia (acute bleeding excluded) in adult critical care patients. Annals of intensive care, 10(1), 97. https://doi.org/10.1186/s13613-020-00711-6
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