Module 7 Assignment: Case Study Analysis

Module 7 Assignment: Case Study Analysis

Module 7 Assignment Case Study Analysis

Case Study Analysis

The case study focuses on a 14 –year –old female who required urgent care. The patient was in the company of her mother. The mother stated that the girl was facing an abnormal number of funny-looking red spotless and had an abnormal number of bruises on her legs. However, the mother objected that the trauma was related to the bruises noted after two weeks. She also noted that the girl had been experiencing a bad rest at home for the past three weeks, led by a bad case of mono. The girl was identified to have bleeding gums when brushing her teeth in the morning. The lab report identified that the girl had a normal WBC differential and hgb and hct.

However, platelet abnormal lab results are based on the platelet count of 100,000/mm3. Bleeding in her gums was also noticed when she brushed her teeth in the morning. A complete workup on the peripheral blood smear immune thrombocytopenic purpura was recommended at the ED. The paper focuses on factors that interfere with fertility and gives the reason for the rise of STD/PID due to the inflammatory markers.

Pathophysiology of Immune Thrombocytopenia Purpose (ITP)

According to Chen et al. (2022), immune thrombocytopenia purpura (ITP) pathophysiology is complex since it consists of T-cell and B-cell abnormalities. There are four causes of thrombocytopenia mechanism, which are consumption, hyperproliferation, destruction, and sequestration. In addition, the mechanism involves a significant proportion of cases and increases platelet destruction, which is an impaired platelet production. Therefore, the megakaryopoiesis and thrombopoiesis defect is experienced due to increased platelet destruction (Grodzielski et al., 2019).

The phagocytosis process helps remove the sanitized platelet, which occurs in the sequestration of the anti-platelet IgG antibodies (Carter, 2018). The sanitized platelet happens a few hours compared to the normal platelet half-life of 8 to 9 days. The drug-induced ITP absorption happens in the platelet cell membrane (McCance & Huether, 2019). Therefore, the autoantibodies react against the platelet glycoproteins. Platelet destruction can also occur when abnormal apoptosis occurs in the bone marrow (McCance & Huether, 2019).

Clinical Manifestation of Immune Thrombocytopenia Purpose (ITP)

Initially, ITP was perceived as a minor injury. However, the purpura and petechiae development

occurred every several days, leading to an increase in bleeding from the mucosal site (McCance & Huether, 2019). Patients with ITP show signs like blood in the urine, bleeding gums, and increased bleeding. The main cause of accelerated platelet consumption is increased splenic sequestration or decreased bone marrow production (McCance & Huether, 2019). The lab test helps predict the diagnosis, evaluating the anti-glycoprotein erythrocyte and leukocyte count.

Genetic/Ethnic Considerations of Immune Thrombocytopenia Purpose (ITP)

ITP highly occurs in women (Kjaer et al., 2020). In comparison to acute, the chronic ITP is progressively worse. Acute ITP lasts for approximately one to two months and is common in children (Kjaer et al., 2020). It is not common for a patient to present the intracranial bleeding for the organs or any other sites.ITP is also likely to occur in the newborn as thrombocytopenia.

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Conclusion

The patient presents ITP, which is associated with the previous diagnosis of Mononucleosis. It is important to review a patient platelet, which helps determine the anti-platelet antibodies when performing a diagnostic test. ITP highly occurs in women between 20 to 40 years.

References

Carter, C. M. (2018). Alterations in blood components. Comprehensive Toxicology, 249. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7152208/

Chen, D. P., Lin, W. T., Wen, Y. H., & Wang, W. T. (2022). Investigation of the correlation between immune thrombocytopenia and T cell activity-regulated gene polymorphism using functional study. Scientific Reports, 12(1), 1-8. https://www.nature.com/articles/s41598-022-10631-z

Grodzielski, M., Goette, N. P., Glembotsky, A. C., Constanza Baroni Pietto, M., Méndez-Huergo, S. P., Pierdominici, M. S., … & Marta, R. F. (2019). Multiple concomitant mechanisms contribute to low platelet count in patients with immune thrombocytopenia. Scientific Reports, 9(1), 1-10. https://www.nature.com/articles/s41598-018-38086-1

Kjær, M., Geisen, C., Akkök, Ç. A., Wikman, A., Sachs, U., Bussel, J. B., … & Skogen, B. (2020). Strategies to develop a prophylaxis for the prevention of HPA-1a immunization and fetal and neonatal alloimmune thrombocytopenia. Transfusion and Apheresis Science, 59(1), 102712. https://www.sciencedirect.com/science/article/pii/S147305021930285X

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier

Women and men’s health problems have considerable impact on their health, wellbeing, and quality of life (Chhetri et al., 2018; Khalafalla et al., 2019). Nurses and other healthcare providers assess patients to determine the most effective treatments to address their needs. Therefore, this paper examines health needs of a female patient that came to the emergency department with complaints related to sexually transmitted infection.

Factors that Affect Fertility (STDs)

Female fertility depends largely on several factors. One of them as seen in this case study is sexually transmitted infections. Untreated STDs often lead to the development of other complications such as pelvic inflammatory disease, which cause infertility. STDs such as chlamydia and gonorrhea contribute to the highest cases of infertility in the population. Pelvic inflammatory disease can cause scarring of the reproductive tissues, leading to infertility and complications such as ectopic pregnancies (Chhetri et al., 2018; Khalafalla et al., 2019). The additional factors that may affect fertility include weight, alcoholism, vitamin deficiencies, and thyroid disease.

Patient Symptoms

The patient’s complaints during the visit to the hospital include vaginal discharge, vomiting, chills, nausea, and fever. She notes that the symptom onset was three days ago. They started as LLW pain as well as bilateral lower back pain. The patient is married, and notes that she engages in sexual intercourse with her husband. Physical assessment findings showed elevated white blood cells, normal hemoglobin, hematocrit, and platelet levels. She has fever with normal cardio-respiratory exam and tachycardia. There is foul smelling green drainage and reddened cervices with bilateral adnexal tenderness. As a result, she is likely to be suffering from a sexually transmitted infection.

Why Inflammatory Markers Rise in STD/PID

Inflammatory markets rise significantly in STD and pelvic inflammatory disease. The rise is largely due to the presence of a bacterial infection in one’s system. The bacterial infection stimulates respiratory response, which includes an elevated release of white blood cells and neutrophils to fight the infection. This phenomenon can be seen in the patient’s lab values such as white blood cells and C-reactive proteins that are elevated. Inflammation also occurs due to the massive release of neutrophils and cytokines in response to the infections (Ravel et al., 2021). The presence of adnexal tenderness shows an elevated inflammatory response to the bacterial infection. CRP levels in the body rise whenever there is an inflammation in the body.

Conclusion

Female problems such as STDs and PID affects fertility status. Lifestyle factors such as obesity also play a role. Inflammatory biomarkers rise significantly with STDs and PIID. Patients are increasingly at risk of prostatitis and need for spleen removal due to these infections. Therefore, interventions to prevent and timely treatment of STDs are important.

 

 

References

Chhetri, A., Biswas, S. C., & Gupta, K. (2018). Infection and infertility. Practical Guide in Infertility; Jaypee Brothers Medical Publishers: Delhi, India, 107.

Khalafalla, K., Elbardisi, H., & Arafa, M. (2019). Sexually transmitted infection and male infertility. In Male Infertility in Reproductive Medicine (pp. 69–77). CRC Press.

Ravel, J., Moreno, I., & Simón, C. (2021). Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. American Journal of Obstetrics and Gynecology, 224(3), 251–257.

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