- formatted and cited in current APA style with support from of academic sources. About 150 words each response
- You should respond to two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.
- All replies must be constructive and use literature.
example of a response
I found your post informative, and it helped me gain a more precise grasp of the diagnostic process, both from your explanation and the articles you referenced. Based on the information you provided, it appears that hospitalization is the most appropriate course of action for this 19-year-old patient suspected of having pelvic inflammatory disease. She is experiencing symptoms such as abdominal pain, nausea, and vomiting, indicating that she may have a systemic infection that requires immediate attention (Curry et al., 2019). CDC recommends that young women diagnosed with PID should receive treatment as soon as possible (STD facts – pelvic inflammatory disease – centers for disease control, n.d.). In addition, proper monitoring is crucial to manage her symptoms and prevent dehydration.
Given that the patient may have difficulty tolerating oral medications due to her nausea and vomiting, intravenous antibiotics should be administered. As stated in your post, hospitalization for monitoring becomes necessary if her body temperature exceeds 38 degrees Celsius (Curry et al., 2019). It is also crucial to check for pregnancy, and if present, hospitalization is required to manage infections while ensuring the fetus’s safety. You also mentioned that in case of any complicating factors like an abscess or tubo-ovarian complex, hospitalization and surgical intervention may become necessary. Therefore, keeping a close eye on the patient’s condition and ensuring she receives prompt and
appropriate treatment is essential.
Curry, A., Williams, T., & Penny, M. L. (2019). Pelvic inflammatory disease: diagnosis, management, and prevention. American family physician, 100(6), 357-364.
STD facts – pelvic inflammatory disease – centers for disease control … (n.d.-b). https://www.cdc.gov/std/pid/stdfact-pid.htmLinks to an external site.Links to an external site.
- The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
From the case provided, there are several ways in which Mr. J.R. may have injured his kidney. First, he may have pre-renal AKI, resulting from reduced kidney perfusion, which affects the kidneyâ€™s ability to clear toxins from the blood (Holland & Yetman, 2021). The patient presents with weakness, dizziness, pale appearance and sweating, indicating reduced blood flow and poor perfusion of tissues. He may also be dehydrated secondary to vomiting and diarrhea, a pre-renal cause for AKI.
Another possible type is intrinsic kidney failure, caused by direct damage to the renal structures, such as the glomeruli or the kidney tubules (Holland & Yetman, 2021). The patient presents with elevated temperatures, which may indicate infection and damage to kidney structures. The symptoms of nausea and vomiting may also be secondary to renal disease and injury. Finally, the patient had a metallic taste in the mouth associated with accumulating waste products in blood.
- Create a list of risk factors the patient might have and explain why
One of the major risk factors for AKI is the patientâ€™s advanced age. Mr. J.R. is a 73-year-old man, which makes him susceptible to comorbidities such as hypertension and diabetes that affect the kidney. With increasing age, there is a decreased renal mass and reduced renal blood flow, increasing the risk of kidney injury (Holland & Yetman, 2021). Another risk factor for the patient is dehydration due to prolonged vomiting, diarrhea, and limited fluid intake. Dehydration is a risk factor for pre-renal AKI since it reduces blood flow to the kidney. The patient also seems to have an infection from food poisoning; this is a risk factor since it may also affect blood flow to the kidneys.
- Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Anemia is one of the major complications in CKD patients causing fatigue, shortness of breath and headaches. With CKD, the kidneys produce less erythropoietin, an important component in the production of red blood cells (Rahman et al., 2022). This leads to low levels of hemoglobin in the body. CKD also results in inadequate iron uptake due to poor renal clearance and high hepcidin levels. Another complication is coagulopathy, which may manifest through easy bruising and gastrointestinal bleeding (Rahman et al., 2022). Coagulopathy is caused by platelet dysfunction, clotting factor deficiency and delayed clot formation, leading to prolonged bleeding time.
- According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
The most probable diagnosis for this patient would be gonorrhea. She presented with symptoms of lower abdominal pain and a malodorous vaginal discharge that she reports is greenish-yellow in color and smelly; these are clear presentations of gonorrheal infection (Springer & Salen, 2023). The disease is sexually transmitted; the patient reports being sexually active and failing to use a condom on multiple occasions. Although she denies oral or rectal intercourse, she cannot confirm that the partner has been committed to her. Furthermore, the microscopic examinations reveal positive findings on gram-negative intracellular diplococci, which confirms that Neisseria gonorrhea may be the causative agent (Springer & Salen, 2023). A raised WBC also reveals possible increased neutrophils, which also affirms the presence of bacterial infection.
- Based on the vaginal discharge described and the microscopic examination of the sample, could you suggest which would be the microorganism involved?
The vaginal discharge is described as thick, greenish-yellow and smelly, a clinical symptom of gonorrhea. Therefore, the microorganism involved would be Neisseria gonorrhea. A gram-negative intracellular diplococcus is reported based on the microscopic examination of the microorganism (Springer & Salen, 2023). This indicates that the bacterium is in pairs and contains gram-negative aspects during staining, which are components of Neisseria gonorrhea.
- Name the criteria you would use to recommend hospitalization for this patient
The initial aspect determining admission would be the intensity of the symptoms. This would include the severity of the pain, high fevers or if the patient develops pelvic inflammatory disease (PID) (Springer & Salen, 2023). Another criterion that would warrant hospitalization is if the patient is pregnant since it would require medical observation of the fetus and the mother. Additionally, I would recommend hospitalization if the patient were immunocompromised or harbored concomitant conditions.
Case Study 1
- Acute kidney injury occurs when there is a sudden reduction in kidney function. Acute kidney injuries generally have an onset that occurs over 48 hours and, with prompt treatment, is generally reversible. There are four phases of acute kidney injury: the initial phase, the oliguric phase, the diuretic phase, and the recovery phase. The individual typically does not start displaying symptoms until they are in the oliguric phase. Some of the common clinical manifestations in the oliguric phase are electrolyte imbalances typically increased, fluid volume overload, decreased urine output, metabolic acidosis, and azotemia (Dlugasch & Story, 2019). The next phase is the diuretic phase, and some of the common clinical manifestations are increased urine output, electrolyte imbalances typically decreased, dehydration, and hypotension.
- The main predictors and risk factors for an individual developing an AKI include sepsis, hypovolemia, chronic cardiovascular disease, age > 60 years, diabetes mellitus, hypertension, and renal replacement therapy (Magboul et al., 2020). Some of the risk factors for our patient in this case study include his age, gastroenteritis, fever, diarrhea, and vomiting. As an individual ages, the kidneys become more fragile and are more prone to injuries. Another risk factor that our patient has is gastroenteritis. This causes the individual to lose fluid within the body and makes less fluid available to the kidneys. This fluid imbalance begins to decrease an individual’s GFR, which leads to the potential for kidney injuries. Similar to gastroenteritis, vomiting, and diarrhea also lead to fluid loss within the body, which can lead to acute kidney injuries. The patient’s fever also puts him at risk for developing an AKI due to insensible water loss experienced in a fever. Patients with fevers tend to have sweating and perspiration due to the body becoming too warm, which can lead to an AKI.
- As the kidneys lose their function over time, complications can arise. Some of the complications these patients will experience are anemia and coagulation. Due to platelet dysfunction or uremic toxins, these individuals frequently develop coagulation problems. Due to reduced platelet aggregation and adhesion, decreased platelet count, and irregularities in clot formation, patients with CKD may have platelet dysfunction. Additionally, the kidney’s failure to filter uremic poisons can cause a buildup of these toxins in the circulation. The patient may be more susceptible to getting thrombosis as a result of these two conditions. The next complication the patient is at risk for is developing anemia. This can happen when the kidneys produce less erythropoietin, uremic toxins accumulate, and there are dietary shortages. Naturally, when the kidney’s ability to produce EPO declines, the production of red blood cells also declines, which results in the development of anemia (PortolÃ©s et al., 2021). The accumulation of uremic toxins, which are normally expelled by a healthy kidney, is another condition that might cause anemia to develop. However, CKD prevents the kidneys from filtering them, which causes a buildup of toxins that will impair red blood cell function. Nutritional deficiencies including those in iron, vitamin B12, and folic acid, which can result in the development of severe anemias, are the last cause causing CKD.
Case Study 2
- The most probable diagnosis for patient P.C. is a pelvic inflammatory disease related to gonorrhea. Pelvic inflammatory disease is typically brought on by the infections of gonorrhea and chlamydia which causes an infection of the female reproductive system. When PID arises, bacteria climb the reproductive system, which causes mucosal irritation, edema, and purulent discharge. Symptoms that patients may experience with pelvic inflammatory disease include fever, malaise, chills, and leukocytosis, are some of the common ways pelvic inflammatory disease manifests. The patient could also have pain or discomfort, especially in the lower back, pelvis, or lower abdomen (Dlugasch & Story, 2019). The patient may also have dysmenorrhea when a bacterial infection is more likely to occur after sexual intercourse. The patient may also have abnormal vaginal discharge, usually purulent, intermenstrual bleeding, heavy menses, urinary frequency, and dysuria. If we recall from this case study, patient P.C. currently has thick greenish-yellow vaginal discharge, which is purulent and a sign of an infection. The patient also states that she is currently having lower abdomen pain. Moreover, all these symptoms she is experiencing are presenting eight days after her last vaginal intercourse, where she reports not utilizing a condom. Therefore, from the symptoms she is stating that she is experiencing and from the listed clinical manifestations, it is fair to assume that she has pelvic inflammatory disease.
- Utilizing the information from the vaginal discharge and what was observed under the microscope, the microorganism that we can speculate that is currently causing Patient P.C.’s problems is Neisseria Gonorrhea. Neisseria Gonorrhea is a type of bacteria that, when viewed under a microscope, is a gram-negative intracellular diplococcus (Yeshanew & Geremew, 2018). This bacteria has a diplococci shape which appears round when viewed under a microscope. Also, when this type of bacteria is stained to determine whether it is gram-negative or gram-positive, it appears red or pink, which indicates it is gram-negative. The discharge the patient is experiencing can also indicate that the patient has the Neisseria gonorrhea bacteria. This type of bacteria generally causes a thick malodorous yellowish-green vaginal discharge which is exactly what our patient P.C. is experiencing.
- Most patients with pelvic inflammatory disease can be treated at home utilizing broad-spectrum antibiotics. However, in rare instances, the individual may need to be hospitalized to receive treatment as their symptoms worsen. Some symptoms requiring hospitalization would be if the patient starts to develop a fever and excruciating stomach pain; hospitalization would be advised based on the patient’s criteria. Additionally, people may have a pregnancy, tubo-ovarian cysts, difficulty taking oral medications, or noncompliance with therapy. Similar care will be provided if the patient is hospitalized as it would at home. IV broad-spectrum antibiotics will be administered to hospitalized patients, mainly ceftriaxone, doxycycline, or azithromycin. Additionally, the patient could get supportive treatment, such as IV fluids or pain relief, like NSAIDs (Yusuf & Trent, 2020). Follow-up will need to be evaluated after three days to ensure improvement in the patient’s symptoms.