Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example
Introduction
The operationalization of the Affordable Care Act of 2010 has placed multiple demands on healthcare professionals while simultaneously presenting them with opportunities to develop a system that is more patient-focused. In the IOM report Key Message #, one patient in all settings requires care that focuses on their specific needs as individuals rather than most convenient for the professional involved in the patient’s care(Schnur, 2020). The US healthcare system is progressively shifting from acute and specialty care to one that effectively addresses primary care, transitional care, and care coordination in ways that promote health and wellness. The system should also ensure the prevention of diseases and adverse events and treat and manage chronic conditions like immune thrombocytopenic purpura (ITP), among other conditions. Consequently, this essay proposes developing a case study analysis that examines the patient’s system in the selected case study.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
Case Overview
The selected case study involves a 14-year-old female presented to the urgent care by her mother. In the last reports, the girl has experienced an abnormal number of bruises with her legs exhibiting funny-looking red blotches. The informant states the non-trauma bruises first emerged about 14 days, with the rest of the patient’s PMH being unremarkable who is currently on no medications. The further reports that the daughter is convalescing from a bad case of mono which was on bed rest for the past 21 days. The girl noticed that when brushing her teeth in the morning, her gums were bleeding. At the urgent care, lab tests indicated normal hemoglobin and hematocrit with average white blood cells differential but a below normal platelet count of 100 000 /mm3 instead of the 150 000/mm3. The physician at the urgent care noticed that upon pressure release, the venipuncture site continued to ooze, prompting this doctor to refer the patient and her mother to the ED to have a complete workup of the low platelet count, including a peripheral blood smear for suspected ITP. The subsections that follow explain the case study questions within the context of the patient scenario presented.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
Why Infection Happens and an Explanation of the Causes of Systemic Reaction
From the outset, it is essential to acknowledge that infection means a microbe has entered the body and has begun to multiply, but this does not necessarily disease. On the other hand, disease occurs when an individual’s body cells are destroyed either due to an infection or autoimmune response, triggering the signs and symptoms of that disease to appear. Contemporary studies indicate microbes are present in all our body surfaces ranging from the skin to the gut and mucous membranes. Major categories of microbes are viruses, bacteria, fungi, protozoa, and helminths that enter the human host through the mouth, nose, eyes, wounds, or urinal genital openings. In the present case scenario, ITP manifests through the destruction of circulating platelets and antiplatelet IgG antibodies presence that opsonize splenic clearance of platelets. The clearance causes low levels of circulating platelets. Since the ITP severity cannot be predicted by titer or antibody isotype, other factors are also believed to play a role. Once the body is ill, the immune system acts with the white blood cells, antibodies, and associated mechanisms acting to rid the body of the foreign invader and, in the process, cause systemic reactions spreading to other organs. This spreading of the reactions makes the 14-year-old girl have funny-looking red splotches on her legs and bleeding of gums when she brushes her teeth.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
Why a Patient Would Need a Splenectomy after a Diagnosis of ITP
ITP occurs as a primary disorder or secondary to an existing infection, autoimmune disease, or infection. According to Chatuverdi et al. (2018), the spleen plays a significant role in ITP pathogenesis as it is the primary site of platelet clearance. Subsequently, a splenectomy procedure, usually through the keyhole or laparoscopic surgery, involves spleen removal. It may be indicated as a second-line treatment of choice due to its cost-effectiveness (Matzardof et al., 2018). However, emerging pharmacological interventions are preferable as this surgery is associated with complications, infection, and thrombotic risks.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
Anemia and the Different Kinds of Anemia (i.e., micro and macrocytic)
Untreated or poorly controlled ITP puts the patient at a higher risk of anemia due to excessive bleeding and subsequent loss of red blood cells. Additionally, blood can seep into the skin and deeper tissues triggering purpura, deep tissue bruises, hematoma, or superficial bruises. Hematocrit describes the measure of the total volume percentage of red blood cells in the blood whose average value in men is 45% and 40% in women (Soundarya & Suganthi, 2017).(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
. Percentages below or above average are called anemias categorized as either microcytic if the mean corpuscular volume is below 80 um3, usually caused by iron deficiency and anemia of chronic disease, amongst others. Normocytic anemia is where the MCV range from 80-100 um3. Under normocytic anemias, the MCV falls less than 3% or exceeds by 3% or less. It is often caused by blood loss of less than a week or malignancy, among other causes. Intrinsic RBC defect or extrinsic RBC defect can also cause normocytic anemia. The third and last type of anemia is macrocytic anemia, where the MCV is more than 100um3. It can either be megaloblastic or nonmegablastic anemia. (Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
Conclusion
In conclusion, this essay has established that ITP is a significant disease that consumes a substantial healthcare budget. APRNs should keep themselves updated with current medical therapies for ITP to broaden the complicated treatment approaches. Among these is splenectomy that may be indicated to avoid complications like anemia.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
References
Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, 131(11), 1172-1182.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
Matzdorff, A., Meyer, O., Ostermann, H., Kiefel, V., Eberl, W., Kühne, T., … & Rummel, M. (2018). Immune thrombocytopenia-current diagnostics and therapy: recommendations of a joint working group of DGHO, ÖGHO, SGH, GPOH, and DGTI. Oncology research and treatment, 41(Suppl. 5), 1-30.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
Pan, J. Q., Wang, W., Wang, M. L., Li, X. Y., Wang, J. H., Zhao, W. W., … & Jiang, Y. F. (2017). Recognition of the human antibody-mediated platelet destruction in adult ITP patients by C-reactive protein. International journal of clinical and experimental pathology, 10(10), 10176.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
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Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American journal of obstetrics and gynecology, 216(1), 1-9.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
Zainal, A., Salama, A., & Alweis, R. (2019). Immune thrombocytopenic purpura. Journal of community hospital internal medicine perspectives, 9(1), 59-61.(Case Study Analysis on suspected immune thrombocytopenic purpura Comprehensive Nursing Essay Example)
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