Chapter 20 & 30 Active Learning

​Chapter 29 & 30 Active Learning

Ashley Bland & Anna Anderson​

​Chapter 29 Case Study

​Patient Profile

Randy is a 51-year-old man who comes to the emergency department (ED) with weakness and abdominal pain. He reports he is homeless. His medical history includes methicillin-resistant Staphylococcus aureus (MRSA) bacteria of the nares.

• Blood pressure 144/86, pulse 92, temperature 98.2°F, respirations 24

• Height 6’1”, weight 170 lb

• Heart rhythm irregular

• Oxygen saturation 89% on room air

• Alert, oriented to person and place

• Capillary refill sluggish in lower extremities; normal in upper extremities

• 2+ edema in lower extremities

​Objective Data

• Reports he does not drink or eat food consistently

• Says he has no family or any social support

• Had “a drink or two a little while ago”

​Subjective Data

​Patient Information

Open Ended

What health history information would you obtain from Randy?

Open Ended

Describe what Randy’s physical assessment should include

Open Ended

Based on the clinical manifestations that brought Randy to the ED, what diagnostic tests would you expect to be ordered and what would each test contribute?

Open Ended

What factors in Randy’s history place him at risk for anemia?

Open Ended

What resources might be available to this Randy after he is discharged from the hospital?

​Chapter 30 Case Study

​Patient Profile

​Dave, a 72-year-old man whose wife died 6 months ago, is brought to the health care provider by his daughter because he is not eating much and has been lethargic and sleeping a lot. He has a history of hyperlipidemia for which he takes niacin–lovastatin 500/20 mg PO daily at bedtime.

• Blood pressure 118/72, pulse 98, temperature 98.2°F, respirations 16

• Oxygen saturation 92% on room air

• Height 5’6”, weight 135 lb, BMI 21.7 kg/m²

• S1 and S2 auscultated and regular

• Bilateral radial pulses +3 and regular

• Lungs clear bilaterally

​Objective Data

• Has been unusually tired for the past couple of months

• Is frequently short of breath and sometimes feels like his “heart is pounding”

• Has lost weight because his wife always used to cook for him, and he doesn’t cook for himself

• Describes a typical daily meal as coffee and a donut for breakfast, a hot dog and lemonade for lunch, and a jelly sandwich on white bread and coffee for supper

​Subjective Data

​Patient Information

• Platelets             250,000/µL

• Iron                     28 mcg/dL

• Ferritin                14 ng/mL

• Cobalamin         600 pg/mL

• Folate                  10 ng/mL

• RBC            3,300,000/µL

• Hemoglobin       8.3 g/dL

• Hematocrit         24%

• MCV                    73 fL

• MCH                    23 pg

• WBC                    9100/µL

​Diagnostic Studies

​Patient Information Cont.

Open Ended

Interpret Dave’s laboratory results.

Open Ended

Based on the laboratory data and assessment findings, the HCP diagnoses Dave with iron-deficiency anemia.

What clinical manifestations of iron deficiency anemia does Dave have?

Open Ended

Explain iron-deficiency anemia and identify the probable cause of D.’s anemia.

Open Ended

How is iron-deficiency anemia treated?

Open Ended

Identify dietary iron sources to include in Dave’s teaching.

Open Ended

What are important points to include when teaching patients taking oral iron supplements?

Open Ended

What evaluative parameters could you use to determine whether Dave's anemia is resolving?

​Thank you!

Questions??​

Remember to check for pharm guides :)