Mrs. B is a 62-year-old white female who presents to your office with her daughter for follow-up after a recent Urgent Care visit.
- The daughter reports Mrs. B is demonstrating signs of dementia.
- Her daughter notes that the patient has not been eating much for the past few weeks reporting she has a gnawing pain in her stomach. If she does eat, she reports getting ‘full’ very quickly. She reports feeling mildly nauseous for the last few weeks.
- The patient sustained a fall injury about 9 months ago from a ladder. She shattered some teeth and developed an infection. She is under the care of an oral surgeon.
- The patient’s coworkers have mentioned to the daughter that ‘she is never in her office or available’ over the last few weeks and seems ‘off her game’.
- She was evaluated yesterday at Urgent Care and instructed to follow-up in your office today.
- Labs drawn at Urgent Care reveal a Hgb of 8 and HCT of 24.
Utilize the information provided in the scenario to create your discussion post.
Construct your response as an abbreviated SOAP note (SubjectiveObjectiveAssessmentPlan).
Structure your ‘P’ in the following format: [NOTE: if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]
Therapeutics:pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]
Educational: health information clients need to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit
Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making
Support the interventions outlined in your ‘P’ with scholarly resources.
NU636 Unit 5 PUD and Anemia
Mrs. B, a 62-year-old white female is brought to the facility by her daughter for urgent care. the daughter reports that she has been exhibiting symptoms such as decreased appetite, gnawing stomach pain, early satiety, mild nausea, and also signs of dementia in the past few weeks. It is also reported that Mrs. B had a fall injury about nine months ago and dental injuries with infection and she has been under oral surgeon care. Her condition has affected her and in the recent past, her coworkers noted that she has decreased work performance and has also been absent severally.
Labs: Hgb of 8 and HCT of 24.
Anemia: Anemia is a medical condition characterized by a deficiency of red blood cells or a decrease in the amount of hemoglobin in the blood, leading to symptoms such as fatigue, paleness, and reduced oxygen-carrying capacity. This is considered a primary issue because of the low Hgb of 8 and HCT of 24. This is considered low because, for adult women, the hemoglobin level should be approximately 12.0 to 15.5 grams per deciliter (g/dL) as shown by Cappellini et al. (2020) while Hematocrit should be approximately 36% to 48%. This low HB may also be the issue that is contributing to Mrs. B’s fatigue, pallor, as well as cognitive impairment including dementia as shown by Qiang et al. (2023).
Gastrointestinal issues: Mrs. B’s abdominal pain, early satiety, and nausea may be indicative of an underlying gastrointestinal issue, possibly an ulcer or gastritis.
- Peptic ulcers are open sores or lesions that develop on the inner lining of the stomach or the upper part of the small intestine (duodenal ulcers).
- Gastritis refers to inflammation of the stomach lining, which can be acute or chronic. It may be caused by various factors, including infections, irritants (such as alcohol or NSAIDs), or autoimmune diseases.
Both peptic ulcers and gastritis can present with abdominal pain, early satiety, as well as nausea. In addition, these symptoms can be non-specific and overlap with various other gastrointestinal conditions, and therefore, it is important to consider both of these possibilities and carry out further evaluation to rule them out.
Dementia: Dementia is a clinical syndrome characterized by a decline in cognitive function that interferes with daily activities. This is considered an issue of concern for this patient because according to Qiang et al. (2023), anemia is to a large extent associated with the development of dementia, and this patient has been diagnosed with dementia. Secondly, Mrs. B’s coworkers have noticed changes in her behavior and cognitive function, including decreased availability as well as a decline in work performance. Furthermore, Mrs. B is 62 years old, which falls within the age range where dementia is more common.
Anemia management using ferrous sulfate 325mg orally q24hr in addition to dietary changes to incorporate high iron and vitamin c diet. Iron supplementation is considered an important part of this management plan and it seeks to replenish the iron stores (Cappellini et al., 2020). Iron is a critical component of hemoglobin and because anemia occurs when there is inadequate hemoglobin in the blood, it is necessary to supplement it so as to replenish the depleted stores and allow for production of more hemoglobin. If supplementation is not tolerated, the plan would involve considering alternative oral preparations or parenteral iron and also blood transfusion. This plan also entails scheduling an endoscopy to assess the cause of abdominal symptoms and confirm either peptic ulcer disease and consequent management. this is because in some instances, PUD may lead to bleeding in the GI and hence anemia (Asiimwe et al., 2023). Another significant part of this plan entails ordering for additional testing, management, as well as neuropsychological assessments to confirm the status of cognition.
Educational plan would be to educate Mrs. B on anemia, its causes and complications, and also the importance of iron supplementation and dietary changes. Dietary consideration would involve the addition of vitamin-rich foods to the iron-rich ones to enhance the absorption of iron. This is because according to Skolmowska and Głąbska (2022), Vitamin C, also known as ascorbic acid enhances the absorption of non-heme iron by converting it into a more absorbable form in the digestive tract. This in turn makes the iron more beneficial to the body, and consequently, more production of hemoglobin. Education on adherence is also important as well as the need for review and follow-up.
Consultations and collaboration
It is important to refer the patient to a neurologist for evaluation on cognitive impairment. There is also a need to consider involving a social worker to assess her home environment and support her and her daughter. The social worker will offer a comprehensive and patient centered support including an assessment of her psychosocial, emotional and environmental issues that may impact her well-being. The main issue at this point is the cognitive impairments and the social worker would recommend home modifications that would make her environment sager and more conducive for recovery, while also offering supportive counselling to Mrs. B and her daughter.
Regular follow-up appointments will be necessary every month to monitor Mrs. B’s progress and adjust the treatment plan as needed.
Asiimwe, D., Bangi, I., Esanyu, J., Ojok, D., Okot, B., Olong, C., Wagubi, R., Kisembo, G., Sempijja, F., Muwanguzi, E., & Okongo, B. (2023). Association Between Helicobacter Pylori Infection and Anemia Among Adult Dyspeptic Patients Attending Kiryandongo General Hospital, Uganda. Journal of Blood Medicine, 14, 57–66. https://doi.org/10.2147/JBM.S392146
Cappellini, M. D., Musallam, K. M., & Taher, A. T. (2020). Iron deficiency anaemia revisited. Journal of Internal Medicine, 287(2), 153–170. https://doi.org/10.1111/joim.13004
Skolmowska, D., & Głąbska, D. (2022). Effectiveness of Dietary Intervention with Iron and Vitamin C Administered Separately in Improving Iron Status in Young Women. International Journal of Environmental Research and Public Health, 19(19), 11877. https://doi.org/10.3390/ijerph191911877
Qiang, Y. X., Deng, Y. T., Zhang, Y. R., Wang, H. F., Zhang, W., Dong, Q., Feng, J. F., Cheng, W., & Yu, J. T. (2023). Associations of blood cell indices and anemia with risk of incident dementia: A prospective cohort study of 313,448 participants. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 19(9), 3965–3976. https://doi.org/10.1002/alz.13088