What was the cause of this patient’s iron-deficiency anemia?

case 1 Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition Iron-Deficiency Anemia Case Study A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on stopping his activity. He has no history of heart or lung disease. His physical examination was normal except for notable pallor. Studies Result Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads Chest x-ray study, p. 956 No active disease Complete blood count (CBC), p. 156 Red blood cell (RBC) count, p. 396 2.1 million/mm (normal: 4.7–6.1 million/mm) RBC indices, p. 399 Mean corpuscular volume (MCV) 72 mm3 (normal: 80–95 mm3 ) Mean corpuscular hemoglobin (MCH) 22 pg (normal: 27–31 pg) Mean corpuscular hemoglobin concentration (MCHC) 21 pg (normal: 27–31 pg) Red blood cell distribution width (RDW) 9% (normal: 11%–14.5%) Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL) Hematocrit (Hct), p. 248 18% (normal: 42%–52%) White blood cell (WBC) count, p. 466 7800/mm3 (normal: 4,500–10,000/mcL) WBC differential count, p. 466 Normal differential Platelet count (thrombocyte count), p. 362 Within normal limits (WNL) (normal: 150,000– 400,000/mm3 ) Half-life of RBC 26–30 days (normal) Liver/spleen ratio, p. 750 1:1 (normal) Spleen/pericardium ratio <2:1 (normal) Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%) Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL) Blood typing, p. 114 O+ Iron level studies, p. 287 Iron 42 (normal: 65–175 mcg/dL) Total iron-binding capacity (TIBC) 500 (normal: 250–420 mcg/dL) Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL) Transferrin saturation 15% (normal: 20%–50%) Case Studies Copyright © 2018 by Elsevier Inc. All rights reserved. 2 Ferritin, p. 211 8 ng/mL (normal: 12–300 ng/mL) Vitamin B12, p. 460 140 pg/mL (normal: 100–700 pg/mL) Folic acid, p. 218 12 mg/mL (normal: 5–20 mg/mL or 14–34 mmol/L) Diagnostic Analysis The patient was found to be significantly anemic. His angina was related to his anemia. His normal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis.. His RBCs were small and hypochromic. His iron studies were compatible with iron deficiency. His marrow was inadequate for the degree of anemia because his iron level was reduced. On transfusion of O-positive blood, his angina disappeared. While receiving his third unit of packed RBCs, he developed an elevated temperature to 38.5°C, muscle aches, and back pain. The transfusion was stopped, and the following studies were performed: Studies Results Hgb, p. 251 7.6 g/dL Hct, p. 248 24% Direct Coombs test, p. 157 Positive; agglutination (normal: negative) Platelet count, p. 362 85,000/mm3 Platelet antibody, p. 360 Positive (normal: negative) Haptoglobin, p. 245 78 mg/dL Diagnostic Analysis The patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs test and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count dropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the RBC reaction. He was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal examination indicated that his stool was positive for occult blood. Colonoscopy indicated a rightside colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the surgery well. Critical Thinking Questions 1. What was the cause of this patient’s iron-deficiency anemia?2. Explain the relationship between anemia and angina. 3. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for the answer 4. What other questions would you ask to this patient and what would be your rationale for them Case 2 Studies The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed right-sided pneumonitis. The following studies were performed: Studies Results Complete blood cell count (CBC), p. 156 Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL) Hematocrit (Hct), p. 248 36% (normal: 42%–52%) Chest x-ray, p. 956 Right-sided consolidation affecting the posterior lower lung Bronchoscopy, p. 526 No tumor seen Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP) Stool culture, p. 797 Cryptosporidium muris Acquired immunodeficiency syndrome (AIDS) serology, p. 265 p24 antigen Positive Enzyme-linked immunosorbent assay (ELISA) Positive Western blot Positive Lymphocyte immunophenotyping, p. 274 Total CD4 280 (normal: 600–1500 cells/L) CD4% 18% (normal: 60%–75%) CD4/CD8 ratio 0.58 (normal: >1.0) Human immune deficiency virus (HIV) viral load, p. 265 75,000 copies/mL Diagnostic Analysis The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is an opportunistic infection occurring only in immunocompromised patients and is the most common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his prognosis is poor. The patient was hospitalized for a short time for treatment of PCP. Several months after he was discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually and died 18 months after the AIDS diagnosis. Case Studies Copyright © 2018 by Elsevier Inc. All rights reserved. Critical Thinking Questions 1. What is the relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS? 2. Why does the United States Public Health Service recommend monitoring CD4 counts every 3–6 months in patients infected with HIV? 3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you approach to your patient to inform about his diagnosis? 4. Is this a reportable disease in Florida? If yes. What is your responsibility a provider Students must review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.Case Study 1 & 2 topics change every semester. Topic TBDThe answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students’ work as all files submitted in this course are registered and saved in turn it in the program.Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted. Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.All answers to case studies must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) per case Study

What would you do first prior to prescribing any medication?

Howard is a 24 year-old male who presents to the clinic with his wife for what he states is severe lower back pain. He states the pain is so bad that he rates it as a “50 out of 10.” He also tells you that due to a past medical history of an ulcer, he cannot take any medications “like Motrin.” He states that the pain is from a car accident in 2012, and that it flairs up and he needs pain medications. He also tells you that he has a high pain tolerance, and that when he gets pain meds he requires the higher doses.Discussion 1What would you do first prior to prescribing any medication?What are the various schedules of medications for controlled substances?Would you prescribe a long or short acting narcotic? Why or why not?Discussion 2What other non narcotic medication options can you offer to this patient?What patient education is needed with them?What would you do if the patient and his wife tell you that none of them work for him?

Develop a drawing/network topology of your home network that includes computers, switches, routers, Internet Service Provider, and any security or firewall protection.

Using Appendix M in your textbook on page 275. Develop an interconnection agreement based on utilizing your home computer system as your home business system. The movement, protection, and reliability of your interconnection is important to your business so provide sufficient depth and scope of your interconnection agreement to ensure your business is protected and remains available. Develop a drawing/network topology of your home network that includes computers, switches, routers, Internet Service Provider, and any security or firewall protection.

Provide a discussion here which briefly describes the key points of the article and why they are useful to you in your own research and thinking.

Find an article which discusses the key components of Frederick/Finer Debate(the article has been uploaded) from a perspective that works with your own research. The article should address some aspect of public administration or public service which helps you with your ethics case development or the area in which you are interested(the proposal of my interest is uploaded). “Hint”: in order to do this you will need to familiarize yourself with the debate and its key components. Then focus in on the components which are in line with your case or research focus.Please share the article you found by attaching it to your discussion. Provide a discussion here which briefly describes the key points of the article and why they are useful to you in your own research and thinking.1-1.5 Pages total. Double space, 12 font size, times new roman, page numbers at thebottom center (excluding references and a title page).

Describe how the words we use to discuss gender and sexuality shape our perception of what is considered normal or abnormal. Provide an example within your response.

OverviewIn this journal activity, you will explore the ways in which use of language influences perceptions of human behavior.ScenarioTo better understand the elements that shape our view of human abnormality, Jamal has begun to reflect on his own lived experiences. During Jamal’s adolescence, no element seemed more powerful to him than language. Jamal clearly recalls boys taunting him as he prepared for gym class, “Hey freak, you’re in the wrong locker room!” Likewise, when boys and girls would disperse into gender-specific groups, Jamal often found himself gravitating toward the girls because they didn’t appear to be as mean as the boys; however, his female peers felt that he was too “weird” to be included in their clique. For Jamal, these emotionally painful events caused him to experience feelings of confusion, ostracism, isolation, and despair.For as long as he can recall, Jamal has had difficulty identifying with society’s views of gender and sexuality. He has never felt as though he is singularly male or female; these categories have simply never aligned with his idealized self-concept. Likewise, Jamal has never felt as though he was exclusively gay. On the contrary, he has always felt as though he could fluidly move between sexual orientations, depending on the situation and context, as though human sexuality existed on a spectrum from heterosexual to homosexual. For these reasons, Jamal has recently begun to identify as bisexual and gender non-binary and, for the first time in his life, feels normal.The word abnormal carries a lot of humanistic weight. Like a practitioner who is bound by ethical codes of conduct to ensure that no harm is done within the scope of clinical practice, each of us has a moral obligation to ensure that we don’t inflict psychological harm on others—intentionally or unintentionally—with the language we use when discussing gender and sexuality. As we learn to value our individual differences, one idea resonates: It’s our implicit responsibility to embrace all people with compassion, empathy, and acceptance as they attempt to be what comes most naturally: themselves.PromptThe following resources support your work on this activity:For this journal activity, you will focus on the influence of language on shaping perceptions of human behavior. Specifically, consider how the words we use can have a dramatic positive or negative influence on how we view the biological, psychological, and social orientations of others. Respond to the following prompts with a minimum of 3 to 5 sentences. Address the rubric criteria listed below and support your answers with a credible source when necessary.Describe how the words we use to discuss gender and sexuality shape our perception of what is considered normal or abnormal. Provide an example within your response.Imagine engaging in conversation with family, friends, or colleagues and eventually realizing that they were inadvertently promoting stereotypes about gender or sexuality. Describe the thoughts and feelings that you might experience during such a conversation.Describe the language used within your own culture (e.g., family members, friends, colleagues) when discussing gender and sexuality.Guidelines for SubmissionSubmit your completed Module Six Activity Template. Sources should be cited according to APA style.

Report, respond, relate, reason and reconstruct your perception of Aboriginal and Torres Strait Islander health and well-being

(500 words) In accordance with the 5Rs of Reflection Framework, reflect on your reactions (feeling and thoughts) to the learning materials (required and recommended readings, videos, lectures and tutorial material). Report, respond, relate, reason and reconstruct your perception of: a) Aboriginal and Torres Strait Islander health and well-being; (250 words). b) your role in ensuring cultural safe nursing care for Aboriginal and Torres Strait Islander peoples (250 words). Need 6 references – APA 6th edition References must be related to Aboriginal and Torres Strait Islander peoplesAs this is reflection so must be followed 5R’s framework …

Should you be skeptical about the scientific merit of this claim after browsing the Internet? Why?

The Research ProcessImagine you are in a fast-food restaurant where a lady tells you that she had heard there was a gene for liking or hating the taste of cilantro. You looked on the Internet to investigate this statement, and although you found similar comments on reputable websites, you are yet to find any scientific studies supporting this claim.Should you be skeptical about the scientific merit of this claim after browsing the Internet? Why?Do you think there are times when scientifically-sound research is not accepted for publication? Why?What should you do to continue this investigation?Using the South University Online Library, find two peer-reviewed articles discussing genetics and food preference. Using the skills you learned from this week’s lectures, summarize each of them.What is a primary source for any research study? Why is it important to read the primary source?Why do most students settle for reading secondhand or thirdhand accounts of research studies instead of reading the primary source?When might you have to depend on a secondary source of information? Are thirdhand accounts of research studies reliable? Why?

Evaluate hypothesis tests for population parameters from one population.

CompetencyEvaluate hypothesis tests for population parameters from one population.InstructionsScenario (information repeated for deliverable 01, 03, and 04)A major client of your company is interested in the salary distributions of jobs in the state of Minnesota that range from $30,000 to $200,000 per year. As a Business Analyst, your boss asks you to research and analyze the salary distributions. You are given a spreadsheet that contains the following information:A listing of the jobs by titleThe salary (in dollars) for each jobDeliverable 4 – Hypothesis Tests.xlsxIn prior engagements, you have already explained to your client about the basic statistics and discussed the importance of constructing confidence intervals for the population mean. Your client says that he remembers a little bit about hypothesis testing, but he is a little fuzzy. He asks you to give him the full explanation of all steps in hypothesis testing and wants your conclusion about two claims concerning the average salary for all jobs in the state of Minnesota.Background information on the DataThe data set in the spreadsheet consists of 364 records that you will be analyzing from the Bureau of Labor Statistics. The data set contains a listing of several jobs titles with yearly salaries ranging from approximately $30,000 to $200,000 for the state of Minnesota.What to SubmitYour boss wants you to submit the spreadsheet with the completed calculations, answers, and analysis.

How do you explain the change in the segment margin ratio?

Raner, Harris, & Chan is a consulting firm that specializes in information systems for medical and dental clinics, The firm has two offices—one in Chicago and one in Minneapolis. The firm classifies the direct costs of consulting jobs as variable costs. A contribution format segmented income statement for the company’s most recent year is given below:Required:1. By how much would the company’s net operating income increase if Minneapolis increased its sales by $75,000 per year? Assume no change in cost behavior patterns.2. Refer to the original data. Assume that sales in Chicago increase by $50,000 next year and that sale in Minneapolis remain unchanged. Assume no change in fixed costs.(a)Prepare a new segmented income statement for the company using the above format. Show both amounts and percentages.(b) Observe from the income statement you have prepared that the contribution margin ratio for Chicago has remained unchanged at 70% (the same as in the above data) but that the segment margin ratio has changed. How do you explain the change in the segment marginratio?

What value might there be in thinking about the, admittedly uncomfortable, subject of the end of all mankind? What comes to your mind when you consider this topic?

****NEED THIS ASSIGNMENT COMPLETE BY 11PM EASTERN TONIGHT!!!!*******Check attachment to see CHARTS!!!***Topic – Causes of Death in 1980 and 2014According to the 1980 Census, the United States population was approximately 226,540,000 in 1980, and according to US Census Bureau estimates, approximately 317,300,000 at the beginning of 2014. Using Census data for 1980 and estimates derived from mortality data and census estimates for 2014, we arrive at the population estimates given in the table below: YearTotal PopulationAges 15–24Ages 25–44Ages 45–64 1980226,540,00042,475,00062,707,00044,497,000 2014317,300,00046,000,00087,000,00080,000,000The National Center for Health Statistics published a document entitled “Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities” that includes a table listing the leading causes of death in both 1980 and 2014 for various categories of Americans. Under the Project Instructions link in Blackboard, you’ll find Discussion Board Forum 2: Data; this is a spreadsheet showing the leading causes of death in both 1980 and 2014 for these 3 age categories. Each of the first 3 questions has both a computational part and a discussion part. To get full credit for each of the discussion parts please support the reason you provide by citing a reference. This should not be an excessively difficult task: you can easily find information online for most of the illnesses or other causes listed in the report. All you need to do is provide the website you used (though other resources are also permitted if you prefer to use one of those). 1. Assuming that the population numbers in the above table are relatively accurate, use the Discussion Board Forum 2: Data spreadsheet to compute the deaths per 1000 people for each age group in both 1980 and 2014. Do not round your answer to the nearest whole number, provide at least 2 decimal places. Give these 6 values (e.g. deaths per 1000 people for ages 15–24 in 1980) and then cite a reference to discuss what might account for the changes between the deaths per 1000 in 1 of these 3 age categories between 1980 and 2014. Your discussion should be at least 40 words. 2. Besides the changes in the overall death rate in the past 3 decades, the leading causes of death vary somewhat between 1980 and 2014. Choose 1 of the 3 age ranges and select 1 cause of death from the Discussion Board Forum 2: Data spreadsheet that strikes you as noteworthy and that appears in both the 1980 and 2014 lists. For the cause of death that you selected, compute the number of deaths per 1000 in both 1980 and 2014 for your chosen age group. Do not round your answer to the nearest whole number, provide at least 2 decimal places. Cite a reference to discuss the possible reasons for any changes in the rates over this period. Your discussion should be at least 40 words. 3. Not only do the leading causes of death vary across time, they vary significantly for different age ranges. Looking only at the 2014 data, choose a cause of death that appears in both the 25–44 and 45–64 age categories and compute the number of deaths per 1000 people for both age categories. Do not round your answer to the nearest whole number, provide at least 2 decimal places. Cite a reference to discuss a possible reason for any differences in these values as people advance in age. Your discussion should be at least 40 words. 4. Contemplating causes of death might strike some people as unpleasant or even morbid. However, the Bible encourages us to give some thought to the fact of our own mortality. Ecclesiastes 7:2–4 says: “It is better to go to the house of mourning than to go to the house of feasting, for this is the end of all mankind, and the living will lay it to heart. Sorrow is better than laughter, for by sadness of face the heart is made glad. The heart of the wise is in the house of mourning, but the heart of fools is in the house of mirth.” It is interesting to consider why the author of Ecclesiastes encourages the wise to go to the house of mourning and the living to lay the end of all mankind to heart. What value might there be in thinking about the, admittedly uncomfortable, subject of the end of all mankind? What comes to your mind when you consider this topic? Please respond with at least 80 words.

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