For this assignment you will research the threats to your organiza

For this assignment you will research the threats to your
organization and provide a detailed paper on your findings.
Consider the factors listed below. Remember the given outline
from Module One is there for your use and will continue to be
very helpful as we finish up the SWOT. This outline is a great
tool for getting your different sections fully completed and
researched. Remember this paper on the threats to your
organization will become the fifth section of your overall
SWOT paper due at the end of Module 8.
Research and thoroughly explain at least TWO major threats to
the organization, discuss why these threats are present, and
what can be done to either remove or reduce them. Think about
some of the examples you see every day as you drive around.
For example, how many times do you see one gas station on the
corner and another gas station right next door or across the
street? This would be considered a threat, since they are
competing for customers in that area. What do you do when the
other gas station lowers the price of gas by a nickel or now
offers a hot food section? These are just a few of the things to
consider in this module as you work on the threats to your
organization. You should write a minimum of at least one full
paragraph for each of the threats presented. For each threat, you
need to ensure you use relevant business theories, concepts, and
practices that are aligned to support the statements and findings.
Note that bullet points are not acceptable.
Each of these threats must come from a force or forces
occurring within a dimension of the general environment within
the organization's external environment (keep in mind a threat
can stem from more than one dimension within the general
environment). Be sure to include in your analysis the relevant
dimension of the general environment from which each of these
forces is derived.
Factors to consider when you think about company threats:
· An increased number of new companies offering similar

products that shift the customer away from the company’s
brand.
· The physical environment (Is your building in a growing part
of town? Is the bus company cutting routes?).
· Changes in the law and government regulations that drive
costs of running the business to increase.
· Future trends in the economy and changes in the age, race,
gender, and culture of those you serve in your area.
Case Studies 3 & 4 (Combined in one)
76 y/o Hispanic female patient, who has been dealing with
financial constraints in last years,
has not been able to eat properly due to her economic situation,
comes to your practice c/o
that over the past 3 months she has felt increasingly tired. She
states sleeping well at night.
Her vital signs are B/P 135/74, R: 16; HR: 80, T 96.8. Pt denies
dyspnea or palpitations.
You order some blood work. Your patient’s chemistry panel
comes back all WNL, and the fecal occult
blood test negative. All the other results are shown below:
Answer the following questions:
a) Which lab values are normal, and which are abnormal?
· WBC: 7600/mm3-Normal Finding -5000-10000/mm3
o Mean corpuscular volume (MCV), is the average red blood
cell size.
o Normal MCV means that the red blood cells are normal in
size, but you can have a normal MCV and still be anemic if
there are too few red blood cells or if other RBC indices are
abnormal. Only 65% of patients with iron-deficiency anemia
will have a reduced MCV.
· Hematocrit: 27.3% Abnormal Finding -Female: 37%–47%
· Hemoglobin: 8.3 mg/dL Abnormal Findings- Female: 12–16

g/dL
· Platelets: 151,000 /mm3-Normal Finding - Adult/elderly:
150,000–400,000/mm3
· MCV 65mm3- Normal Finding - Adult/elderly/child: 80-95 fL
(femtoliter).
· MCH 31.6 pg- Abnormal Finding - Adult/elderly/child: 32–36
g/dL (or 32%–36%).
· MCHC 35.1%- Normal Finding- Adult/elderly/child: 32–36
g/dL (or 32%–36%
· RDW 15.6%- Abnormal Finding - Adult: variation of 11%–
14.5%.
· Fe 30 mcg/dL-Abnormal Finding - Female: 60–160
mcg/dL.
· TIBC 422 mcg/dL -Normal Finding - TIBC: 250–460 mcg/dL
or 45–82 μmol/L (SI units).
· Ferritin 8 mg/dl -Abnormal Findings- 10–150 mcg/L (SI
units).
· Vit B12 414 pg/mL-Normal Finding- 160–950 pg/mL
· Folate 188 ng/mL Abnormal Findings 5–25 ng/mL
b) Explain the significant of each abnormal value.
· Hematocrit: 27.3%Abnormal Finding -Female: 37%–47%
· Decreased levels indicate anemia (reduced number of RBCs).
· Anemia is a term given to the state associated with reduced
RBC numbers. Because the Hct is an indirect reflection of RBC
numbers, the Hct will also be reduced.
· Hemoglobin: 8.3 mg/dLAbnormal Findings- Female: 12–16
g/dL
· Decreased levels indicate anemia (reduced number of RBCs).
· Iron deficiency results in a decreased production of
hemoglobin, which in turn results in a small, pale (microcytic,
hypochromic) RBC.
· Dietary deficiency: With certain vitamin or mineral
deficiencies (eg, iron), the RBC number or size is decreased.

Therefore, the Hgb is decreased.
RED BLOOD CELL (RBC) indices
MCH 31.6 pg-Abnormal Finding - Adult/elderly/child: 32–36
g/dL (or 32%–36%).
· Mean corpuscular hemoglobin (MCH), is a measure of the
average amount of hemoglobin per red blood cell.IN this case is
slightly low.
RDW 15.6%- Abnormal Finding - Adult: variation of 11%–
14.5%.
· Red Blood Cell Distribution Width is essentially an indicator
of the degree of anisocytosis, a blood condition characterized
by RBCs of variable and abnormal size.
Clinical Significance of Increased RDW can be an indicator of:
Iron-deficiency anemia
Fe 30 mcg/dL-Abnormal Finding - Female: 60–160 mcg/dL.
Decreased Serum Iron Levels can be because of:
· Insufficient dietary iron: Because all body iron is from dietary
intake, a persistently reduced intake will lead to reduced serum
levels.
· Because all body iron is from dietary intake, a persistently
reduced intake will lead to reduced serum levels. Patient reports
poor intake, and not been able to eat properly.
· Iron-deficiency anemia: This anemia results when iron and
iron stores become depleted.
Iron deficiency results in a decreased production of hemoglobin,
which in turn results in a small, pale (microcytic, hypochromic)
RBC.
Ferritin 8 mg/dl -Abnormal Findings- 10–150 mcg/L (SI units)
· Decreases in ferritin levels indicate a decrease in iron storage
associated with iron-deficiency anemia.
· A ferritin level of below 10 mg/100 mL is diagnostic of iron-
deficiency anemia.

· A decrease in serum ferritin level often precedes other signs of
iron deficiency, such as decreased iron levels or changes in red
blood cell (RBC) size, color, and number.
· Only when protein depletion is severe can ferritin be
decreased by malnutrition.
Folate 188 ng/mL Abnormal Findings 5–25 ng/mL
· This test quantifies the folate level in the blood. It is used in
patients who have megaloblastic anemia. It is also used to
assess nutritional status, especially in alcoholics.
c) Based on these results and her history. What would be your
patient’s diagnosis?
Based on her results, clinical presentation, and physical
examination I can said the patient has Anemia.
Anemia is defined as a reduction in the number of red blood
cells (RBCs), hemoglobin concentration, or hematocrit. In
general, a hemoglobin concentration in adults below 13.6 g/dL
for men or below 12 g/dL for women suggests anemia. Although
certain signs and symptoms are sometimes associated with
anemia, the diagnosis is often based on laboratory data alone. In
this case, patient reports increasingly tired, apparently with
decrease in exercise tolerance, and not been able to eat properly
due economic situation which is an indication of nutritional
deficiencies. However, she slept well at night, and denies
dyspnea or palpitations, as well upon assessment vital signs
WNL. In addition, the fecal occult blood test to check for blood
in the stool which it would suggest bleeding in the GI tract was
negative, and not further testing was required.
Anemia is more common in individuals older than 65 years. The
most common cause of anemia in the elderly is anemia of
chronic disease (ACD), followed by nutritional deficiencies
(iron, B12, folate), and possibly, decreased marrow response to
erythropoietin.
A CBC with differential is the most important laboratory test.

IDA is commonly discovered incidentally during a routine CBC.
Once IDA is diagnosed, the history may reveal factors that
would cause iron deficiency, such as a recent hemorrhage, GI
bleeding, menorrhagia, multiple pregnancies, or inadequate
nutrition.
Iron Deficiency Anemia (IDA) is the most common type of
anemia in the world and the most common nutrient deficiency.
In the adult population, IDA predominantly affects women of
reproductive age and older adults. Dietary iron is absorbed in
the duodenum of the small intestine. The amount of iron
absorbed from the intestine is determined by several factors,
including the iron content of the meal, the form of iron being
ingested, the individual's iron status, and the presence or
absence of other substances that can enhance or inhibit iron
absorption.
When iron requirements increase or intake declines, the small
intestine increases absorption of iron to meet the increased
demand. If there is no additional supply of iron to meet this
increased demand, the body's iron stores begin to be depleted.
At this point, several hematologic parameters are affected. The
ferritin levels decline as body iron stores decrease. As body iron
stores are depleted, the transferrin saturation decreases, leading
to a reduced supply of iron to the RBC precursors, resulting in
impaired (iron-deficient) erythropoiesis. At this stage, however,
an overt microcytic anemia may not yet be present. Once the
iron stores are truly depleted and no iron is available for
erythropoiesis, an overt microcytic, hypochromic anemia is
present, which manifests in the CBC by a low hemoglobin
concentration.The RBC indices are the last to change (decreased
MCV, MCH, and MCHC). However, the RDW may be elevated
well before the MCV decreases as it reflects the newer, smaller
RBCs entering the circulation
d) Epidemiologically speaking, what individuals are at risk for
this condition?
You may be at increased risk for iron deficiency at certain ages:
· Infants between 6 and 12 months, especially if they are fed

only breast milk or are fed formula that is not fortified with
iron. The iron that full-term infants have stored in their bodies
is used up in the first 4 to 6 months of life. Babies who were
born prematurely may be at an even higher risk, as most of a
newborn’s iron stores are developed during the third trimester
of pregnancy.
· Children between ages 1 and 2, especially if they drink a lot of
cow’s milks. Cow’s milk is low in iron.
· Teens, who have increased need for iron during growth spurts.
· Older adults, especially those over age 65.
Certain lifestyle habits may increase your risk for iron-
deficiency anemia, including vegetarian or vegan eating
patterns. Not eating enough iron-rich foods, such as meat and
fish, may result in you getting less than the recommended daily
amount of iron.
e) What other signs and symptoms of this condition would you
assess for in this case?
The presentation of anemia can be variable, depending on the
acuteness of onset and the ability of the cardiopulmonary
system to compensate. If the patient is healthy and the onset of
anemia is gradual, there are few signs or symptoms until the
hemoglobin value falls below 7.5 g/dL. Patients may initially
experience fatigue, malaise, headache, dyspnea, irritability, and
a mild decrease in exercise tolerance. Further declines in
hemoglobin concentration may be associated with a markedly
reduced exercise capacity, resting tachycardia, and dyspnea
requiring supplemental oxygen. Other nonspecific findings that
can accompany long-term, moderate to severe anemia include
wide pulse pressure, midsystolic or pansystolic murmur,
confusion, lethargy, brittle nails, glossitis, angular cheilitis, and
spoon-shaped nails. Pallor of the mucous membranes, lips,
conjunctivae, nail beds, and palmar creases is a common sign of
anemia. Also, symptoms of increased bruising may be a clue to
a potential bleeding disorder contributing to blood loss and iron
deficiency.

f) 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?
b. Do you sleep more now that you used to?
c. How far can you walk until you get SOB?
d. Have you been able to do what you would like to do?
Fatigue is an overwhelming, sustained sense of exhaustion with
decreased capacity for physical
and mental work at a usual level. Therefore, the best means to
assess how fatigue is affecting
all areas of life are by determining whether the patient too tired
to take part in daily activities,
relationships, social events, and community activities.
g) Discuss the treatment option for her diagnosis
The most appropriate treatment protocols will depend upon the
underlying cause. In instances where the problem is precipitated
by a relatively simple explanation such as a nutritional
deficiency, ingesting iron or other appropriate supplements or
tailoring a diet rich in that nutrient might resolve the issue.
Iron replacement therapy with 60 to 120 mg of elemental iron
daily is indicated if hemoglobin is less than 11 g/dL, along with
an increase in iron-rich food intake.
The usual adult therapeutic dose is 150 to 200 mg of elemental
iron per day in divided doses until anemia is corrected. Lower
doses may still be effective and be better tolerated. If the
anemia is severe, the patient has an iron malabsorption problem,
or oral iron is not tolerated, replacement should be by parenteral
(intramuscular or intravenous) administration of iron. In this
case, the patient should be referred to a hematologist for
intravenous administration of iron because it has traditionally
been associated with adverse reactions. The intravenous iron
formulations, iron carboxymaltose and ferumoxytol, have a
much safer profile than older preparations.
Most patients with IDA are diagnosed and treated by their
primary health care providers. Patients who are referred to a

hematologist for consultation generally return to the primary
health care provider once the anemia has been corrected, or at
least once an accurate diagnosis has been made and the patient
is receiving stable iron replacement therapy.
Referral to a hematologist should be considered if there are not
adherence to treatment or exist an intolerance of oral iron
replacement, persistent IDA necessitating parenteral iron
therapy, and persistent microcytic anemia despite iron
replacement and the exclusion of other conditions.
Nonpharmacologic Management.
Dietary assessment, including types of foods and timing of
ingestion, is essential when treating nutritional causes of IDA.
Individuals with restrictive diets, such as vegetarian and vegan
diets, may need nutritional counseling to assist them in
choosing iron-rich foods that are in keeping with their belief
and practices. Other referrals may be required as evaluation for
the cause of the iron deficiency progresses, such as referral to
an internist or gastroenterologist to exclude any GI
malabsorption, however, in this case, may will need a referral to
social worker for financial assistant to help to provide de
financial aid to buy nutritional products.
h) What diet you would recommend her:
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.
I would recommend leafy greens, especially dark ones, are
among the best sources of nonheme iron. Meat and poultry. All
meat and poultry contain heme iron. Red meat, lamb, and
venison are the best sources. Poultry and chicken have lower
amounts. Beans are good sources of iron for vegetarians and
meat eaters alike. They’re also inexpensive and fortified foods.
Many foods are fortified with iron.
Iron from animal sources is absorbed better by the body.
However, you can help your body absorb plant-based iron by
eating a fruit or vegetable that is high in vitamin C (for

example, red bell peppers, kiwis, oranges).
i) What would be your initial supplement for this patient? (be
specific about the name,
dose, frequency, etc.)
The recommended dietary allowance (RDA) includes the iron
you get from both the food you eat and any supplements you
take for women after 51 years is 8mg/day.
Pharmacologic Management.
· Ferrous sulfate 325 mg TID by mouth
· Vitamin C 500 mg by mouth daily to improve iron absorption.
The usual adult therapeutic dose is 150 to 200 mg of elemental
iron per day in divided doses until anemia is corrected. Lower
doses may still be effective and be better tolerated. Although
the traditional dosage of ferrous sulfate is 325 mg (65 mg of
elemental iron) orally three times a day, lower doses (eg, 15-20
mg of elemental iron daily) may be as effective and cause fewer
side effects. To promote absorption, patients should avoid tea
and coffee and may take vitamin C (500 mg ) with the iron pill
once daily. If ferrous sulfate has unacceptable side effects,
ferrous gluconate, 325 mg daily (35 mg of elemental iron) is a
possible alternative for patients who cannot tolerate ferrous
sulfate.
Nonpharmacologic Management
Patients with mild to moderate anemia usually have mild
symptoms aspects to their care are safeguarding adequate rest,
hydration, and a well-balanced diet that provides adequate
vitamin and mineral intake.
j) What teaching you would you provide your patient about the
supplement you just prescribed above
Patients should receive education about the use of iron
supplements to ensure adequate treatment and an understanding
of the prescribed regimen. Iron absorption is optimum when
iron is taken 30 minutes before meals with ascorbic acid.
Absorption can be reduced by as much as 40% to 50% if it is
taken with meals; however, iron on an empty stomach can cause

more side effects, leading to noncompliance with medication.
Calcium can significantly inhibit iron absorption. Multivitamins
with calcium or dairy products should be taken 1 to 2 hours
after an iron supplement. Ascorbic acid enhances absorption of
iron; therefore, concurrent ingestion of foods rich in vitamin C,
such as orange juice, should be encouraged.
Discussion of side effects, such as constipation and nausea,
should be included in the treatment plan along with strategies
for management of these complaints (stool softeners, taking iron
at bedtime). Anticipatory guidance should also include notice
that stool may become a dark tar color. Patients who are
intolerant of one preparation may find another that produces
fewer or no side effects. As a health care provider will
encourage the patient to try various preparations before
recommending parenteral iron. For most people, a good diet
provides enough iron.
Taken at normal doses, iron supplements may cause upset
stomach, stool changes, and constipation.
Iron can interact with many different drugs and supplements.
Review the list of medication with your health care provider if
you have a chronic health condition or are taking out of counter
medications such as antacids, antibiotics, calcium, and others.
REF:
Buttaro, T. M., PolgarBailey, P., SandbergCook, J., Trybulski,
J. (022020). Primary Care, 6th Edition. [[VitalSource
Bookshelf version]]. Retrieved from vbk://9780323570152
Pagana, K. D., Pagana, T. J. (20171031). Mosby's Manual of
Diagnostic and Laboratory Tests - Elsevier eBook on
VitalSource, 6th Edition. [[VitalSource Bookshelf version]].
Retrieved from vbk://9780323446624
1. Chernecky CC, Berger BJ. Hemoglobin. Laboratory tests and
diagnostic procedures. 6th ed. Saunders: St Louis; 2013.

2. Cappellini MC, Motta I. Anemia in clinical practice—
definition and classification: Does hemoglobin change with
aging? Seminars in Hematology. 2015;52(4):261–269.
3. Hoffman R, Benz EJ, Siberstein LE, Heslop HE, et al.
Approach to anemia in the adult and child. Hematology: Basic
principles and practice. 6th ed. Saunders: St Louis; 2013.
4. Luzzatto L. Hemolytic anemias and anemia due to acute
blood loss. Kasper D, Fauci A, Hauser S, Longo D, Jameson J,
Loscalzo J. Harrison's principles of internal medicine. 19th ed.
McGraw-Hill: New York, NY; 2014
http://accessmedicine.mhmedical.com/content.aspx?bookid=113
0&sectionid=79731477.
5. Adamson JW, Longo DL. Anemia and polycythemia. Kasper
D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J.
Harrison's principles of internal medicine. 19th ed. McGraw -
Hill: New York, NY; 2014
http://accessmedicine.mhmedical.com/content.aspx?boo kid=113
6. Damon LE, Andreadis C. Blood disorders. Papadakis MA,
McPhee SJ, Rabow MW. Current medical diagnosis &
treatment. McGraw-Hill: New York, NY; 2018
7. Nicoll C, Mark Lu C. Appendix: Therapeutic drug monitoring
& laboratory reference intervals, & pharmacogenetic testing.
Papadakis MA, McPhee SJ, Rabow MW. Current medical
diagnosis & treatment. McGraw-Hill: New York, NY; 2018
8. Hoffman R, Benz EJ, Siberstein LE, Heslop HE, et al.
Disorders of hemostasis. Hematology: Basic principles and
practice. 6th ed. Saunders: St Louis; 2013.
9. Haider BA, Olofin I, Wang M, et al. Anaemia, prenatal iron
use, and risk of adverse pregnancy outcomes: Systematic review
and meta-analysis. British Medical Journal. 2013;346:f3443.
10. Beck KL, Conlon CA, Kruger R, et al. Dietary determinants

of and possible solutions to iron deficiency for young women
living in industrialized countries: A review. Nutrients.
2014;6:3747–3776.
1. Follow the rules
2. Answer all questions with a professional response using APA
format.
3. Include three (3) scholarly references.
4. All answers given to the case of study must have the
references cited "in the text" for each answer and a minimum of
3 (Three) Scholarly References (Journals, books) (No websites)
.
5. Start the document with an explanation about the disease
process and characteristics base on laboratory results and
characteristics/complaints, and information is given for the
patient. Answer all question on the same document.
6. The answers must be in your own words with reference to the
journal or book where you found the evidence to your answer.
7. Answers must be scholarly and be 5-6 sentences in length
with rationale and explanation. "No Straightforward / Simple
answer will be accepted".
8. Turn it in Score must be less than 15 %. Copy-paste from
websites or textbooks will not be accepted.
Case Studies 3 & 4 (Combined in one)
76 y/o Hispanic female patient, who has been dealing with
financial constraints in last years,
has not been able to eat properly due to her economic situation,

comes to your practice c/o
that over the past 3 months she has felt increasingly tired. She
states sleeping well at night. Her
vital signs are B/P 135/74, R: 16; HR: 80, T 96.8. Pt denies
dyspnea or palpitations. You order
some blood work. Your patient’s chemistry panel comes back
all WNL, and the fecal occult
blood test negative. All the other results are shown below:
WBC: 7600/mm3
Hematocrit: 27.3%
Hemoglobin: 8.3 mg/dL
Platelets: 151,000 /mm3
RED BLOOD CELL (RBC) indices
MCV 65mm3
MCH 31.6 pg
MCHC 35.1%
RDW 15.6%
Fe 30 mcg/dL
TIBC 422 mcg/dL
Ferritin 8 mg/dL
Vit B12 414 pg/mL
Folate 188 ng/mL
Answer the following questions:
a) Which lab values are normal, and which are abnormal?
b) Explain the significant of each abnormal value.
c) Based on these results and her history. What would be your
patient’s diagnosis?

d) Epidemiologically speaking, what individuals are at risk for
this condition?
e) What other signs and symptoms of this condition would you
assess for in this case?
f) 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?
b. Do you sleep more now that you used to?
c. How far can you walk until you get SOB?
d. Have you been able to do what you would like to do?
g) Discuss the treatment option for her diagnosis
h) What diet you would recommend her:
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.
i) What would be your initial supplement for this patient? (be
specific about the name,
dose, frequency, etc.)
j) What teaching you would you provide your patient about the
supplement you just
prescribed above.

For this assignment you will research the threats to your organiza

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