J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month his-tory of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.
Past Medical History (PMH)
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about21⁄2years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause pep-tic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
Case Study Questions
1. The patient in this case study has seven potential contributing factors for the development of iron deficiency anemia. What are they?
2. Why did the gynecologist question the patient about constipation?
3. Why would you check on serum vitamin B12 and folic acid concentrations tested?
4. Symptoms are subjective clinical manifestations of an illness that can only be reported by the patient. Identify seven clinical symptoms in this case study that are consistent with a diagnosis of iron deficiency anemia.
5. Signs are objective clinical manifestations of an illness that can be observed by someone other than the patient. Identify a minimum of twenty clinical signs in this case study that are consistent with a diagnosis of iron deficiency anemia.
6. Provide five different treatment modalities that will help resolve iron deficiency anemia in this patient.