NURS 6501 WEEK 10 Case Study Analysis
The case study concerns a 32-year-old woman presenting with a three-day history of fever, chills, nausea, vomiting, and vaginal discharge. She also reports LLQ discomfort and lower back pain bilaterally. Positive physical exam findings include LLQ pain on palpation, copious foul-smelling green drainage, erythematous cervix, bilateral adnexal tenderness, and positive chandelier sign. The purpose of this assignment is to discuss the factors affecting fertility, inflammatory markers in STD, and anemia in relation to the patient’s case.
The Factors That Affect Fertility
Tubal factor infertility (TFI) is a common cause of infertility in women and accounts for approximately 30% of infertility cases in females. The major cause of TFI is pelvic inflammatory disease (PID). PID is a sexually transmitted disease caused by STIs like Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium (Smolarczyk et al., 2021). They ascend from the lower genital tract to cause inflammation in the cervix, endometrium, and fallopian tubes resulting in cervicitis, endometritis, salpingitis, and PID. N. gonorrhoeae and Chlamydia mainly cause salpingitis and tubal infertility. The more the recurrence of PID, the higher the risk of infertility (Safrai et al., 2020). The patient has symptoms suggesting PID, meaning that she is at risk of infertility secondary to TFI.
Why Inflammatory Markers Rise In STD/PID
STDs and PID are characterized by a rise in inflammatory markers like C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), and cytokines. The rise is caused by the inflammation that occurs in STDs and PID. STIs and other pathogens cause inflammation in the genital tract (Mwatelah et al., 2019). In PID there is inflammation of the organs in the upper reproductive system cervix, fallopian tubes, and endometrium contributing to elevated levels of CRP, ESR, and cytokines (McCance & Huether, 2019). The patient in the case study has elevated ESR and CPR levels, likely caused by infection and inflammation in the upper reproductive system.
Anemia and the Different Kinds of Anemia
Anemia is a condition in which the hemoglobin concentration is lower than normal. It reflects the presence of fewer than the normal number of erythrocytes within the circulation. As a result, the amount of oxygen delivered to body tissues diminishes. Anemia is grouped into macrocytic and microcytic anemia based on the size and shape of RBCs (Chaparro & Suchdev, 2019). Macrocytic anemia is characterized by large-nucleated and misshaped RBCs. It occurs in Folic acid and Vitamin B-12 deficiency anemia. On the other hand, microcytic anemia is characterized by small and hypochromic RBCs and is primarily caused by Iron deficiency (Busaleh et al., 2021). The patient has hemoglobin of 16 and Hct of 44, which are within the normal range ruling out anemia in the patient.
Conclusion
Infertility occurs in PID due to Tubal factor infertility and inflammation of the cervix, fallopian tubes, and endometrium. The inflammatory process leads to elevated inflammatory markers like ESR, CRP, and cytokines. Macrocytic anemia has large-nucleated and misshaped RBCs, while microcytic anemia has small and hypochromic RBCs.
References
Busaleh, F., Alasmakh, O. A., Almohammedsaleh, F., Almutairi, M. F., Al Najjar, J. S., & Alabdulatif, A. (2021). Microcytic Anemia Hiding Vitamin B12 Deficiency Anemia. Cureus, 13(12), e20741. https://doi.org/10.7759/cureus.20741
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), 15–31. https://doi.org/10.1111/nyas.14092
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Mwatelah, R., McKinnon, L. R., Baxter, C., Abdool Karim, Q., & Abdool Karim, S. S. (2019). Mechanisms of sexually transmitted infection-induced inflammation in women: implications for HIV risk. Journal of the International AIDS Society, 22 Suppl 6(Suppl Suppl 6), e25346. https://doi.org/10.1002/jia2.25346
Safrai, M., Rottenstreich, A., Shushan, A., Gilad, R., Benshushan, A., & Levin, G. (2020). Risk factors for recurrent pelvic inflammatory disease. European Journal of Obstetrics & Gynecology and Reproductive Biology, 244, 40-44. https://doi.org/10.1016/j.ejogrb.2019.11.004
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
ASSIGNMENT INSTRUCTIONS
Welcome to module seven which is a one-week unit and week ten of the course. Most of you have done well and we must now finish strong. Please do not forget to attend the final exam review meeting as have been previously posted twice. In this module, you will examine fundamental concepts of diseases and disorders that impact women’s and men’s health, including infections and hematologic disorders. You will also evaluate the impact of patient characteristics, including racial and ethnic variables, on physiological functioning within these populations. Be sure to complete all assigned readings, the KC, and the case study and I am available to answer your questions. Here is the case study for this week. Please Note that some of the prompts may not relate to the case. Please answer or address only what pertains to the case.
Scenario 1: A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.
Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl
Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2
99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with reddened cervix and + bilateral adenexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram negative diplococci.
Please try to complete your KC 48 hours before the final exam
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.
learning resources
Required Readings
- 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
- Retrieved from https://emedicine.medscape.com/article/202158-overview
- Nagalia, S. (2019). Pernicious anemia
- Retrieved from https://emedicine.medscape.com/article/204930-overview#a3
- Stauder, R., Valent, P., & Theurl, I. (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=trueCredit 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)
- Download 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
- Module 7 Overview with Dr. Tara HarrisDr. 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)
- Khan Academy. (2019a). Chronic disease vs iron deficiency anemia
Note: The approximate length of the media program is 5 minutes.
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 “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
- 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).