NR 283 Week 4 Discussion Pathophysiology
Introduction
Part-1
Mr. X, a 57-year-old individual, visited his physician with several concerning symptoms. He reported experiencing marked fatigue, along with nausea and occasional diarrhea. He also complained of a sore, swollen tongue. Lately, he had been noticing a tingling sensation in his toes and a feeling of clumsiness. Upon microscopic examination of a blood sample, it was discovered that he had a reduced number of erythrocytes, many of which were mega oblasts, and a decreased number of leukocytes, including numerous large, hyper-segmented cells. Additionally, his hemoglobin and serum levels of vitamin B12 were below average. Subsequent tests confirmed a diagnosis of pernicious anemia.
The manifestations observed in Mr. X can be linked to the pathophysiology of pernicious anemia. This type of anemia is classified as megaloblastic anemia. It occurs due to the impaired absorption of vitamin B12 caused by a deficiency of intrinsic factor (IF), a protein produced in the gastric mucosa glands (Hubert et al., 2018, p. 197). In Mr. X’s case, his hemoglobin and vitamin B12 levels were low, indicating the presence of pernicious anemia.
NR 283 Week 4 Discussion Pathophysiology
Gastric abnormalities play a significant role in contributing to both vitamin B12 and iron deficiencies. Intrinsic factor is essential for the absorption of vitamin B12 in the stomach. In individuals with pernicious anemia, an autoimmune response leads to a lack of inherent characteristics, resulting in the inability to absorb adequate vitamin B12 from dietary sources (NHLBI). This deficiency of intrinsic factors causes vitamin B12 insufficiency. Complications associated with pernicious anemia arise from the lack of vitamin B12, such as nerve damage, unsteadiness, loss of balance, difficulty walking, weakened bones, hip fractures, confusion, dementia, depression, and memory loss.
Various tests can be performed to diagnose pernicious anemia. These include the Schilling test, which evaluates the absorption of vitamin B12; microscopic examination of blood samples to identify megaloblastic changes in red blood cells; complete blood count to assess the levels of red blood cells, white blood cells, and platelets; and bone marrow tests to evaluate the production and maturation of blood cells (Hubert et al., 2018, p. 199). However, vitamin B12 replacement therapy is necessary for individuals with pernicious anemia, typically administered through injections.
NR 283 Week 4 Discussion Pathophysiology
As a preventative measure, the treatment options for pernicious anemia include oral vitamin supplements, particularly for pregnant women and vegetarians. Diagnosing and treating pernicious anemia promptly is crucial to prevent complications such as cardiovascular stress and neurological damage (Hubert et al., 2018, p. 199). Risk factors for pernicious anemia include a family history of the condition, Northern European or Scandinavian heritage, and a history of autoimmune endocrine disorders.
Part-2
Ms. L, a 19-year-old woman with no previous medical history, was involved in a severe automobile accident that resulted in the death of her best friend. Initial examination by the EMT personnel at the accident scene revealed only minor scrapes and bruises with no signs of head trauma. However, during transportation to the hospital via ambulance, Ms. L started complaining of thirst and appeared restless. Further examination showed a rapid pulse and respiration, and her blood pressure dropped to 100/60 mm Hg. She also exhibited decreased responsiveness, indicating the onset of circulatory shock. The paramedics conducted additional checks to assess for internal injuries.
NR 283 Week 4 Discussion Pathophysiology
In this case, the contributing factors to shock is neurogenic shock. Neurogenic shock can occur when there is damage to the spinal cord or brain, leading to disruption of the autonomic system. This results in lower vascular resistance and alterations in vagal tone (Koya et al., 2021). In this situation, the major automobile accident suggests the possibility of spinal cord injuries contributing to neurogenic shock. The rapid pulse, increased respiration, and decreased blood pressure observed in Ms. L further support this diagnosis.
Specific signs and symptoms characterize shock, and in the early stage, these may include difficulty breathing, weak pulse, bradycardia, weakness, hypothermia, and lack of compensatory mechanisms. In the case of Ms. L, these signs and symptoms align with those seen in neurogenic shock. Neurogenic shock occurs in a percentage of cervical and thoracic spine injuries, and it can be caused by spinal anesthesia, Guillain-Barre syndrome, autonomic nervous system toxins, transverse myelitis, and other neuropathies (Dave et al., 2021). Emergency treatment for shock involves calling 911 and performing CPR if necessary. In the case of neurogenic shock, hemodynamic stabilization is the primary focus of treatment. Intravenous fluid resuscitation is the first-line approach for hypotension, followed by vasopressors and inotropes if hypotension persists despite adequate fluid volume.
Maintaining a mean arterial pressure (MAP) between 85 and 90 mmHg during the first seven days is essential to optimize spinal cord perfusion (Dave et al., 2021). Failure to promptly treat shock can lead to cardiopulmonary arrest, dysrhythmia, renal failure, multi-system organ failure, ventricular aneurysm, thromboembolic complications, stroke, and even death (Dave et al., 2021). Shock can be classified into different types based on their causes and manifestations. These include distributive, hypovolemic, cardiogenic, and obstructive shock.
Distributive shock is characterized by peripheral vasodilation and includes subtypes such as septic shock, Systemic Inflammatory Response Syndrome (SIRS), anaphylactic shock, neurogenic shock, and endocrine shock. Hypovolemic shock is characterized by reduced intravascular volume and increased systemic venous return. It can be further classified into hemorrhagic and non-hemorrhagic hypovolemic shock. Cardiogenic shock is characterized by reduced ventricular output and systemic hypoperfusion due to intracardiac causes. Various etiologies can lead to cardiogenic shock, including cardiomyopathies, arrhythmias, and mechanical factors. Obstructive shock is primarily caused by extracardiac factors that decrease left ventricular cardiac output. Subtypes of obstructive shock include pulmonary vascular and mechanical causes. Each type of shock presents distinct pathophysiologic changes and requires specific management approaches.
Work Cited
Hubert, R., & VanMeter, K. (2018). Gould’s pathophysiology for the health professions. (6th ed.). Elsevier. Pernicious Anemia. (n.d.). NHLBI, NIH.
https://www.nhlbi.nih.gov/health-topics/pessrnicious-anemia.
Koya, H. H., & Paul, M. (2021). Shock. StatPearls – NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK531492/.
Dave, S., & Cho, J. J. (2021). Neurogenic Shock. StatPearls – NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK459361/.
