A nurse is caring for an 18-year-old woman in an outpatient clinic who is compla
ID: 3472133 • Letter: A
Question
A nurse is caring for an 18-year-old woman in an outpatient clinic who is complaining of increasing fatigue for 3 months. She denies other signs or symptoms. She is generally healthy with no pertinent past medical history. She takes no medications daily. A CBC was ordered by the physician and the following results came back the next day. Evaluate each of the above results. What does each result tell you about this patient's red blood cell function? What are common signs and symptoms of anemia the nurse should monitor for in this patient? What is the physiological reason for each? What are the two most common causes of anemia in this age female? Compare and contrast the pathophysiology of each.Explanation / Answer
1. Here the result of complete blood count (CBC) shows the level of heamoglobin (Hgb) 10.6 which is less than normal (reference value). The heamoglobin present in RBC binds with oxygen and carry to the different tissue for respiration purpose. If there is low Hgb, then the sufficient amount of oxygen will not carried to the tissue and hence patient will feel fatigue.
The level of Hct (hematocrit) is also low. The hematocrit value indicates the percentage of red blood cells in blood. Again if the hematocrit value is low it means the level of rbc is low in blood which causes insufficient oxygen transport.
MCV indicates the average size of RBC. If the MCV is low it means the size of RBC is not suitable for carry the sufficient amount of oxygen.
MCH indicates the average amount of heamoglobin in each RBC. Again the Low MCH affects the oxygen carraying capacity of RBC.
2. Common symptoms of anemia include:
- Easy fatigue: Because insufficient amount of oxygen causes anaerobic respiration which produces lactic acid accumulation in muscles and thus fatigueness.
- Rapid heart beat: Heart beat is increased to meet the demand of oxygen via pumping more oxygenated blood
- Insomnia: Rapid heart beat and fatigueness causes insomnia (sleep disturbance)
- Pale skin: Due to reduction of RBC in blood.
3. The two most common reason for anemia in the female with this age are:
- Loss of blood through menstrual cycle. Menstrual cycle is the phase of uterine cycle. During uterine cycle the endomatrium is formed in uterus to support the implantation after fertilization. If fertilization does not occur then the level of hormones (estrogen and progesterone) becomes very low which causes shading of this endomatrium layer through the process of menstrual cycle.
- Iron deficiency due to poor nutrition (iron is highly required in this age for proper growth and development and also to fulfill the blood loss during menstrual cycle).
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