Question

Scenario G.C. is a 78-year-old widow who relies on her late husband's Social Security income for all of her expenses. Over the past few years, G.C. has eaten less and less meat because of her financial situation and the trouble of preparing a meal "just for me." She struggles financially to buy medicines for the treatment of hypertension and arthritis. She goes to the outpatient clinic complaining that over the past 2 to 3 months she has felt increasingly tired, despite sleeping well at night. Her vital signs (VS) are 136/76, 16, 80. She denies any dyspnea or palpitations. The nurse practitioner orders blood work. G.C.'s chemistry panel findings are all within normal limits and a stool guaiac test result is negative. Her other results are shown in the chart.
Chart View Laboratory Test Results White blood cell (WBC) count 7600/mm3 Hematocrit (Hct) 27.3% Hemoglobin (Hgb) 8.3 mg/dL Platelets 151,000/mm3 Red Blood Cell (RBC) Indices Mean corpuscular volume (MCV) 65 mm3 Mean corpuscular hemoglobin (MCH) 31.6 pg MCH concentration (MCHC) 35.1% Red cell distribution width (RDW) 15.6% Iron (Fe) 30 mcg/dL Total iron-binding capacity (TIBC) 422 mcg/dL Ferritin 8 mg/dL Vitamin B12 414 pg/mL Folate 188 ng/mL
1. Which laboratory values are normal and which are abnormal?
2. Explain the significance of each abnormal result.
3. Based on these results and her history, what condition does G.C. have?
4. What individuals are at risk for this condition?
5. What other signs and symptoms of this condition do you assess for in G.C.?
6. Which question would best help you determine the impact of fatigue on her activities of daily living? a. "Are you upset about feeling more tired?" d. "Do you sleep more now than you used to? b. "How far can you walk until you get short of breathe?" c. "Have you been able to do what you would like to do?"
7. Discuss the treatment options for her condition.
8. The physician starts G.C. on ferrous sulfate (Feosol) 325 mg orally once per day. What teaching needs to be done regarding this medication?
9. As you are evaluating your teaching about ferrous sulfate, you determine that additional instruction is needed if G.C. says: a. "My stools will likely turn a tarry, black color soon." b. "I can take the iron and my calcium supplements at the same time." c. "I will increase my fluid and fiber intake as long as I am on the iron." d. "Taking the tablets when I eat my meals will help my stomach not be upset."
10. Discuss some ideas that might help her with her meal planning.
11. You teach G.C. about foods she should include in her diet. You determine that she understands your teaching if she states she will increase her intake of which of the following foods? a. Whole-wheat pastas and skim milk b. Lean cuts of poultry, pork, and fish c. Beans and dark green, leafy vegetables d. Cooked cereals, such as oats, and bananas
12. What evaluative parameters could you use to determine whether G.C.'s condition is improving?
13. Using SOAP, write a sample documentation entry for this encounter.


Thank you in advance!

Answer 1

1 The laboratory values which are normal and abnormal are

Normal values are for

• WBC
• Platelets
• MCV
• MCH
• MCHC
• RDW
• Vitamin B12
• Folate
• TIBC

The abnormal range are

• Low hemoglobin
• Low ferritin
• Low iron

2.The significance of abnormal valtes are

• Low level of iron in the blood has lead to poor absorption of the hemoglobin in the blood .Lie level of hemoglobin had lead to fatigue and tiredness besides good rest . Further ferritin is a protein which is needed for the absorption of iron when this is low it can not absorb enough iron in the blood .

3.GC has iron deficiency anemia

4.The people who are at risk for these type anemia are

• Women
• Poor dietary iron intake
• Inadequate food intake
• Malnutrition or deficiency of nutrients