Module 7 Assignment: Case Study Analysis 

Module 7 Assignment: Case Study Analysis 

Module 7 Assignment: Case Study Analysis

The provided case study demonstrates a 14-year-old female patient with bruises and red splotches on her legs. The bruises are not related to trauma. The patient has been recovering from severe mononucleosis. Additional symptoms include bleeding gums and excessive oozing from the venipuncture site. Based on lab findings, it was discovered that the patient has a low platelet count. The patient is suspected to be suffering from immune thrombocytopenic purpura (ITP) caused by the Epstein-Barr virus (EBV). The purpose of this paper is to illustrate how the patient’s presenting condition can affect her fertility and inflammatory markers involved, among other complications like anemia, splenectomy, and prostatitis.

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The Factors Affecting Fertility

The patient in the provided case study is recovering from a bad case of mononucleosis. This disease is normally caused by EBV and transmitted through saliva. EBV belongs to the herpes family and can be considered as an STI, but not all cases. Studies suggest that EBV may be associated with autoimmune ovarian failure, which can lead to infertility among women(Smolarczyk et al., 2021). Consequently, the patient displayed signs of ITP, which is normally caused by EBV. IPT is also associated with infertility among women. Recent research findings revealed that pregnant women diagnosed with ITP may be at high risk of fetal loss, stillbirth, and premature delivery.

Reasons Behind A Rise In Inflammatory Markers In STD/PID

Persistent pathogens like latent herpesviruses including EBV can trigger an inflammatory response. Replication of EBV can induce the production of proinflammatory cytokines hence influencing systemic inflammation. A study conducted by Ke et al., (2020) found out that higher EBV antibody titers in chronic mononucleosis were associated with increased levels of C-reactive protein (CRP), interferon-γ (IFNγ), interleukine-18(IL-18), and interleukine-6 (IL-6). The levels of these inflammatory markers depend on the severity of the patient’s condition, as they act as the body’s response mechanism against the viral infection.

Reasons behind Prostatitis and Associated Infections

Prostatitis normally occurs secondary to leakage of microorganisms such as viruses or bacteria into the prostate gland from the urinary tract. It may also occur as a result of the extension or spread lymphatic from the rectum. Microorganisms that might lead to prostatitis include EBV, HIV, Neisseria gonorrhoeae,and Chlamydia trachomatis among others (Dikov et al., 2020). Studies have reported cases of EBV among patients with prostate cancer. Consequently, patients diagnosed with prostate cancer are at a higher risk of developing ITP caused by EBV.

Reasons Behind Splenectomy Among Patients Diagnosed With Immune Thrombocytopenia

Splenectomy is normally recommended forsteroid-refractory or dependent immune thrombocytopenia (ITP). However, it is only advisable among adult patients who require second-line therapy as a result of the failure of steroids in managing the disorder (Chaturvedi et al., 2018). Splenectomy is effective in this case as it removes the main destruction site, and is the primary source of synthesis of antiplatelet antibodies.

Anemia and Its Classifications

The patient in the provided case study recorded a low platelet level which is an indication of aplastic anemia. Generally, anemia can be defined as a blood disorder associated with the production of few red blood cells (RBC) by the body, the destruction of too many RBC, or the loss of too many blood cells. An inadequate amount of red blood cells deprives the body tissues of adequate oxygen, for normal body functioning (Chaparro & Suchdev, 2019). Based on the mean corpuscular volume (MCV) anemia can be classified into four categories, microcytic, macrocytic, normocytic, and non-hemolytic normocytic anemia. Other types of anemia based on the causative mechanism include iron deficiency anemia, aplastic anemia, hemolytic anemia, and sickle cell anemia. Several risk factors are associated with anemia such as race and ethnicity. For instance, blacks are more prone to anemia as compared to whites. This might be a result of socioeconomic advantages among other reasons.

Conclusion

            The assigned case study presents an example of an adolescent suffering from ITP caused by EBV. This condition can be classified as an STI, can compromise the patient’s fertility given her childbearing age. ITP is also associated with low platelet count, which suggests possibilities of aplastic anemia.

References

Chaparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low-and middle-income countries. Annals of the New York Academy of Sciences, 1450(1), 15. https://doi.org/10.1111/nyas.14092

Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, The Journal of the American Society of Hematology, 131(11), 1172-1182. https://doi.org/10.1182/blood-2017-09-742353

Dikov, D. I., Koleva, M. S., Boivin, J. F., Lisner, T., Belovezhdov, V. T., & Sarafian, V. (2020). Histopathology of nonspecific granulomatous prostatitis with special reference to eosinophilic epithelial metaplasia: Pathophysiologic, diagnostic and differential diagnostic correlations. Indian Journal of Pathology and Microbiology, 63(5), 34. https://doi.org/10.4103/IJPM.IJPM_568_18

Ke, X., He, H., Zhang, Q., Yuan, J., &Ao, Q. (2020). Epstein–Barr virus‐positive inflammatory follicular dendritic cell sarcoma presenting as a solitary colonic mass: two rare cases and a literature review. Histopathology, 77(5), 832-840. https://doi.org/10.1111/his.14169

Smolarczyk, K., Mlynarczyk-Bonikowska, B., Rudnicka, E., Szukiewicz, D., Meczekalski, B., Smolarczyk, R., & Pieta, W. (2021). The Impact of Selected Bacterial Sexually Transmitted Diseases on Pregnancy and Female Fertility. International Journal of Molecular Sciences, 22(4), 2170. https://doi.org/10.3390/ijms22042170

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Module 7 Assignment: Case Study Analysis

An understanding of the factors surrounding women’s and men’s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient.
Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact..
An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided (not all may apply to each scenario):
• The factors that affect fertility (STDs).
• Why inflammatory markers rise in STD/PID.
• Why prostatitis and infection happens. Also explain the causes of systemic reaction.
• Why a patient would need a splenectomy after a diagnosis of ITP.
• Anemia and the different kinds of anemia (i.e., micro and macrocytic).

 

Group B

Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. PMH not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning.
Labs at urgent care demonstrated normal hgb and hct with normal WBC differential. Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at urgent care referred the patient and her mother to the ED for a complete work-up of the low platelet count, including a peripheral blood smear for suspected immune thrombocytopenia purpura.

Learning Resources

Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
• Chapter 24: Structure and Function of the Reproductive Systems (stop at Tests of reproductive function); Summary Review
• Chapter 25: Alterations of the Female Reproductive System (stop at Organ prolapse); pp. 787–788 (start at Impaired fertility) (stop at Disorders of the female breast); Summary Review
• Chapter 26: Alterations of the Male Reproductive System (stop at Hormone levels); Summary Review
• Chapter 27: Sexually Transmitted Infections, including Summary Review
• Chapter 28: Structure and Function of the Hematological System (stop at Clinical evaluation of the hematological system); Summary Review
• Chapter 29: Alterations of Erythrocytes, Platelets, and Hemostatic Function, including Summary Review
• Chapter 30: Alterations of Leukocyte and Lymphoid Function, including Summary Review

Low, N. & Broutet N. J. (2017). Sexually transmitted infections – Research priorities for new challenges. PLoS Medicine, (12), e1002481

Kessler, C. M. (2019). Immune thrombocytopenic purpura [LK1] (ITP). Retrieved from https://emedicine.medscape.com/article/202158-overview

Nagalia, S. (2019). Pernicious anemia[LK1] . Retrieved from https://emedicine.medscape.com/article/204930-overview#a3

Stauder, R., Valent, P., & Theurl, I. [LK1] (2019). Anemia at older age: Etiologies, clinical implications and management. Blood Journal, 131(5). Retrieved from http://www.bloodjournal.org/content/131/5/505?sso-checked=true
Credit Line: Anemia at older age: Etiologies, clinical implications and management by Stauder, R., Valent, P., & Theurl, I., in Blood Journal, Vol. 131/Issue 5. Copyright 2019 by American Society of Hematology. Reprinted by permission of American Society of Hematology via the Copyright Clearance Center.

Document: NURS 6501 Final Exam Review (PDF document)

Note: Use this document to help you as you review for your Final Exam in Week 11.

Required Media (click to expand/reduce)

Module 7 Overview with Dr. Tara Harris
Dr. Tara Harris reviews the structure of Module 7 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Assignment. (3m)
Accessible player

Khan Academy. (2019a). Chronic disease vs iron deficiency anemia[LK1] . Retrieved from https://www.khanacademy.org/science/health-and-medicine/hematologic-system-diseases-2/iron-deficiency-anemia-and-anemia-of-chronic-disease/v/chronic-disease-vs-iron-deficiency-anemia
Note: The approximate length of the media program is 5 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 24, 26, 28, and 30 that relate to the reproductive and hematological systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

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RUBRIC:

Rubric Detail

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Name: NURS_6501_Module7_Case Study_Assignment_Rubric

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Excellent Good Fair Poor
Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following as it relates to the case you were assigned (omit section that does not pertain to your case, faculty will give full points for that section):

Explain the factors that affect fertility (STDs) 23 (23%) – 25 (25%)
The response accurately and thoroughly describes the patient symptoms.

The response includes accurate, clear, and detailed explanations of the processes related to women’s and men’s health, infections, and hematologic disorders and is supported by evidence and/or research, as appropriate, to support the explanation. 20 (20%) – 22 (22%)
The response describes the patient symptoms.

The response includes accurate, explanations of the processes related to women’s and men’s health, infections, and hematologic disorders and is supported by evidence and/or research, as appropriate, to support the explanation. 18 (18%) – 19 (19%)
The response describes the patient symptoms in a manner that is vague or inaccurate.

The response includes explanations of the processes related to women’s and men’s health, infections, and hematologic disorders, with explanations that are vague or based on inappropriate evidence/research. 0 (0%) – 17 (17%)
The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing.

The response does not include explanations of the processes related to women’s and men’s health, infections, and hematologic disorders, or the explanations are vague or based on inappropriate evidence/research.
Explain why inflammatory markers rise in STD/PID 18 (18%) – 20 (20%)
The response includes an accurate, complete, detailed, and specific analysis of the concepts and principles of pathophysiology across the life span and is supported by evidence and/or research, as appropriate, to support the explanation. 16 (16%) – 17 (17%)
The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 14 (14%) – 15 (15%)
The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research. 0 (0%) – 13 (13%)
The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.
Explain why prostatitis and infection happen. Also explain the causes of systemic reaction. 18 (18%) – 20 (20%)
The response includes an accurate, complete, detailed, and specific explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 16 (16%) – 17 (17%)
The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 14 (14%) – 15 (15%)
The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research. 0 (0%) – 13 (13%)
The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.
Explain why a patient would need a splenectomy after a diagnosis of ITP. 5 (5%) – 10 (10%)
The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 4 (4%) – 4 (4%)
The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 3 (3%) – 3 (3%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations are based on inappropriate evidence/research. 0 (0%) – 2 (2%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
Explain anemia and the different kinds of anemia (i.e., micro and macrocytic). 5 (5%) – 10 (10%)
The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 4 (4%) – 4 (4%)
The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 3 (3%) – 3 (3%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations are based on inappropriate evidence/research. 0 (0%) – 2 (2%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance.

A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

The purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3 (3%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.

The purpose, introduction, and conclusion of the assignment are vague or off topic. 0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English Writing Standards:

Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 (0%) – 2 (2%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors. 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors. 0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors.