Mr. Mason is a 78-year-old retired, widowed ironworker.  He has been estranged from his adult son, an only child, for many years.  He was recently diagnosed with advanced lung cancer.  He recognized that he needed to make some plans for his immediate future, so he contacted his son and allowed him power of attorney.  Mr. Mason is admitted to your unit in severe pain.  He is somewhat confused, and you are unable to elicit information from him about his wishes regarding life-sustaining measures.  You carefully begin discussing this difficult subject with his son, as it is your hospital’s policy that everyone admitted to your oncology unit be informed about advanced directives. 

Mr. Mason’s son begins to sob uncontrollably, saying, “I was never a good son.  I left home when I was barely 19 and didn’t even write or call for many years.  I am just getting to know my dad, and now this happens.  I want as much time with him as possible.  He told me a few days ago that he was ready to die and didn’t want to be kept alive on machines.  But I need some more time with him.  Please, do everything you can to keep him alive.  I need for him to forgive me.”

Post: Answer the following questions in your post:

1. What are the ethical principles involved in this scenario?  What ethical principles are at play when considering the view of the son, when considering the view of the patient?
   • Please respond using the ethical terms and principles reviewed in the textbook and interactive modules to support your points.
2. What is the best decision to make based on ethical principles?  In other words, what would you do and based on what ethical principles?
3. Does your answer change when you consider your legal duties and responsibilities?

Note: Be sure to discuss how the advanced directive does or does not fit into the healthcare 

Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
   In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

Submission Instructions:

• Include both case studies in your post.
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
• Checked for plagiarism and  AI

Respond to at least two of your peers’ initial posts that offer a different plan of action than yours for either issue. Include the following details in your response:

• Identify at least one different approach to increase the number of participants in your program that was shared by your peers that you did not mention in your post, and explain why considering this solution is useful.
• Identify at least one different plan of action shared by your peers to address the timeline-related issues that you did not mention in your initial post, and explain why considering this solution is useful.

Macrocytic Anemia

Selected Condition: Macrocytic Anemia

Macrocytic anemia is characterized by large red blood cells (macrocytic) and poor oxygen-carrying capacity. The term macrocytic is used to describe the size of red blood cells, and this can be ascertained from a blood test that computes the mean corpuscular volume (MCV). If the MCV exceeds 100 fL, the anemia is described as macrocytic. Low levels of vitamin B12 or folate, alcoholism, liver diseases, and some medications can cause this condition. Macrocytic anemia has general signs and symptoms and a detailed investigation is needed before diagnosing the cause.

Rationale for Selecting Macrocytic Anemia

I chose macrocytic anemia because it is a relevant and common problem in clinical practice. Anemia is prevalent among hospitalized patients, whereas macrocytic anemia is a subtype that may be associated with various diseases. Anemia can be a sign of a lack of necessary nutrients like vitamin B12 and folate or an indication of liver problems or medication that affects red blood cell formation (Moore, 2022). Knowledge of macrocytic anemia is crucial since it is at the core of patient care, including diagnosis, management, and patient counseling. Also, macrocytic anemia is another important differential in patients with chronic alcohol use or gastrointestinal pathology, which is significant to my practice as a nurse working in outpatient healthcare.

Prevalence and Incidence of Macrocytic Anemia in the United States

Macrocytic anemia is relatively high in the United States; it affects elderly patients and those with certain risk factors. A cross-sectional study by the National Center for Biotechnology Information (NCBI) reveals that macrocytosis, the major characteristic of macrocytic anemia, affects 2-4% of the population (Moore, 2022). The condition is more likely to be noticed in patients who are of advanced age. Specifically in elder care, the prevalence may increase to 10% due to factors like low nutritional intake, diseases, and medication hindering nutrient absorption (Moore, 2022).

The prevalence of macrocytic anemia also depends on the diseases that may lead to vitamin deficiency, including malabsorption disorders, autoimmune diseases, and chronic alcoholism. According to a survey by the American Society of Hematology, researchers found that vitamin B12 deficiency is the leading cause of macrocytic anemia in the United States, and the most affected group is the elderly (Soliman et al., 2024). Folate deficiency is another common cause, though it is less prevalent than the former. Furthermore, patients with alcohol use disorder require special consideration because alcohol interferes with folate metabolism and red blood cell formation, making patients with alcohol use disorder more prone to macrocytic anemia.

It is also important to note that macrocytic anemia is common in hospitalized patients and those with gastrointestinal or hematologic diseases. In a cross-sectional study that focused on adult inpatients, they identified that nearly 10% of the patients had macrocytic anemia, indicating this condition’s importance in the clinical setting (Rogers, 2023).

Summary of Scholarly Article on Macrocytic Anemias

The article “Macroytic Anemia” gives detailed information about the pathophysiologic mechanisms, etiologies, and clinical signs of macrocytic anemia (Koury & Hausrath, 2024). The article highlights that the underlying causes of macrocytic anemia include:

• Vitamin B12 deficiency: Vitamin B12 is very important for developing red blood cells in the human body. B12 deficiency causes a decrease in DNA replication in the bone marrow, which leads to the creation of oversized red blood cells.
• Folate deficiency: Folate is another vitamin required for DNA synthesis in the body, similar to vitamin B12. Folate deficiency fails to produce normal red blood cells in the bone marrow, which are instead more significant.
• Alcoholism: Alcohol affects folate metabolism and red blood cell formation, and when taken in the long run, it can lead to macrocytic anemia.
• Liver disease: Liver disease may also affect the metabolism of vitamin B12 and other nutrients, resulting in macrocytic anemia.
• Medications: Some drugs, like methotrexate or antiretroviral agents, interfere with the synthesis of red blood cells, leading to macrocytic anemia.

The article also describes the signs of macrocytic anemia; however, some patients may not show any signs or symptoms until the disease progresses to the more advanced stage, which may include fatigue, weakness, and pallor. The management of macrocytic anemia depends on the primary cause. If there is vitamin B12 or folate deficiency, these vitamins should be administered to treat the anemia. For patients with alcohol or liver issues, it is vital to treat the underlying condition in combination with the administration of micronutrients to enhance the patients’ status (Koury & Hausrath, 2024).

The article is directly related to my knowledge of macrocytic anemia as it presents a literature-based review of the causes and management of the condition. The article also pays much attention to early diagnosis; even if it is inconclusive, it is an essential aspect of nursing practice. This way, I will be able to recognize macrocytic anemia and its clinical manifestations and, hence, help manage patients and prevent complications arising from untreated anemia.

Conclusion

Macrocytic anemia is a frequent but severe problem that clinicians should not overlook. Understanding the pathophysiology, symptoms, and factors that can lead to it means that nurses are well-equipped to help diagnose and treat this condition. Macrocytic anemia can be managed with the correct approach to patient education, interprofessional collaboration, and proper medical management. Thus, knowledge of macrocytic anemia risk factors, diagnostic criteria, and possible complications is crucial for nurses to provide their patients with the highest level of care.

References

Koury, M. J., & Hausrath, D. J. (2024). Macrocytic anemias. Current Opinion in Hematology, 31(3), 82–88. https://doi.org/10.1097/moh.0000000000000804Links to an external site.

Moore, C. A. (2022, July 11). Macrocytic anemia. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK459295/#:~:text=Macrocytosis%20affects%202%25%20to%204,and%20vitamin%20B12%20and%20medicationsLinks to an external site..

Rogers, J. L. (2023). McCance & Huether’s pathophysiology: The biologic basis for disease in adults and children (9th ed.). Elsevier.

Soliman, M., Grayland-Leech, B., & Villines, Z. (2024). Macrocytic anemia: Causes, symptoms, treatment, and types. Medical News Today. https://www.medicalnewstoday.com/articles/321620Links to an external site..