Case study A Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia. One of the major causes of anemia is the loss of blood. J.D experienced heavy menstrual flows for six days leading to a lot of blood loss. Assuming she does not eat iron-rich food, it could lead to iron deficiency anemia. Furthermore, J.D experienced intermenstrual bleeding for two months which is irregular and led to a lot of blood loss. Heavy blood loss in both cases was a major risk factor for developing anemia due to a lack of iron. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.   The major reason for dehydration is the severe loss of blood J.D was experiencing, while constipation might be due to hormonal changes especially progesterone and dysregulated estrogen. The two hormones build up in the body before and during the menstrual cycle and they are known to slow down the digestive system leading to constipation. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells? Erythropoiesis is the process by which red blood cells are formed. The formation of red blood cells requires cell proliferation from red cell precursors erythroblasts (Joseph et al., 2017). Cell differentiation in cell proliferation is aided by vitamin B12 and folic acid. A lack of vitamin B12 and folic acid means that there will be less or no cell differentiation which helps in increasing the red blood cells in the body. The body will experience anemia if there are insufficient red blood cells since they only have a 115-day lifespan. 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. Iron deficiency anemia has multiple symptoms. One of the signs is general body weakness. Lack of enough iron in the body leads to body inability to make the protein hemoglobin which carries oxygen all over the body. With less or no hemoglobin, the body tissues are unable to get the required oxygen, leading to less or no energy (Cappellini et al., 2020). Furthermore, pica is another symptom of iron deficiency anemia in which the body craves for non-food items such as clay and ice cream.  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.  Skin paleness- the hemoglobin in the blood gives it a red color. Iron deficiency leads to less hemoglobin in the blood, making it less red, resulting in skin losing color. Shortness of breath- decreased number of red blood cells makes the blood unable to carry the required amount of oxygen which is required for normal body processes. 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 colo.

1. Case study A
Name the contributing factors on J.D that might put her at risk
to develop iron deficiency anemia.
One of the major causes of anemia is the loss of blood. J.D
experienced heavy menstrual flows for six days leading to a lot
of blood loss. Assuming she does not eat iron-rich food, it could
lead to iron deficiency anemia. Furthermore, J.D experienced
intermenstrual bleeding for two months which is irregular and
led to a lot of blood loss. Heavy blood loss in both cases was a
major risk factor for developing anemia due to a lack of iron.
Within the case study, describe the reasons why J.D. might be
presenting constipation and or dehydration.
The major reason for dehydration is the severe loss of blood J.D
was experiencing, while constipation might be due to hormonal
changes especially progesterone and dysregulated estrogen. The
two hormones build up in the body before and during the
menstrual cycle and they are known to slow down the digestive
system leading to constipation.
Why Vitamin B12 and folic acid are important on the
erythropoiesis? What abnormalities their deficiency might cause
on the red blood cells?
Erythropoiesis is the process by which red blood cells are
formed. The formation of red blood cells requires cell
proliferation from red cell precursors erythroblasts (Joseph et
al., 2017). Cell differentiation in cell proliferation is aided by
vitamin B12 and folic acid. A lack of vitamin B12 and folic acid
means that there will be less or no cell differentiation which
helps in increasing the red blood cells in the body. The body
will experience anemia if there are insufficient red blood cells
since they only have a 115-day lifespan.
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

2. for Iron deficiency anemia.
Iron deficiency anemia has multiple symptoms. One of the signs
is general body weakness. Lack of enough iron in the body leads
to body inability to make the protein hemoglobin which carries
oxygen all over the body. With less or no hemoglobin, the body
tissues are unable to get the required oxygen, leading to less or
no energy (Cappellini et al., 2020). Furthermore, pica is another
symptom of iron deficiency anemia in which the body craves for
non-food items such as clay and ice cream.
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.
Skin paleness- the hemoglobin in the blood gives it a red color.
Iron deficiency leads to less hemoglobin in the blood, making it
less red, resulting in skin losing color.
Shortness of breath- decreased number of red blood cells makes
the blood unable to carry the required amount of oxygen which
is required for normal body processes.
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.
The first major recommendation is for J.D. to eat more food rich
in iron. It would help to increase the amount of iron in the
body. Additionally, the doctors could offer iron supplements to
ensure that JD has the required amount of iron in the body
(Elstrott et al., 2020). Besides, the doctors should consider
treating the menstrual problems causing J.D. to lose a lot of
blood eventually treating the underlying anemia deficiency
conditions.
Case study B
For patients at risk of developing coronary artery disease and
patients diagnosed with acute myocardial infarct, describe the
modifiable and non-modifiable risk factors.
The modifiable risks are factors that an individual can control.

3. They mostly consist of lifestyle diseases and choices. The risk
factors include smoking, being overweight, diabetes, lack of
physical activity, high blood pressure, and high blood
cholesterol (Joseph et al., 2017). The modifiable risks lead to
low density and triglycerides being deposited on the coronary
artery. The non-modifiable risks are those that cannot be
controlled. They include age in which older people above 65
years are at a high risk. Gender, where men are more at risk
than women, family history, and ethnic background are
additional non-modifiable hazards.
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?
Due to the myocardial infarction, a depression or ST-segment
elevation would be observed. Moreover, a T-wave inversion
would be seen as a result of increased myocardial inflation in
the heart. Findings compatible with the coronary event include;
chest pains and discomfort while playing and spreading of pain
from neck to the lower jaw.
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?
The best laboratory test to conduct is troponin T. The reasons
for using troponin T is that it increases in patients who have had
a recent cardiac problem and it indicates where the problem is
and its extent. Moreover, troponin T is very specific and
accurate in giving the cardiac abnormality that have just
happened and it measures a wide range of cardiac problems
making it among the recommended cardiac tests (Collinson,
2021).
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.
Inflammatory markers such as IL-6, IL1, and c-reactive protein

4. are released to the blood stream after myocardial infarct. The
inflammatory markers cause an increase in prostaglandin E2 in
hypothalamus resulting to increased temperatures. The
increased temperatures may be within 24 to 48 after the event.
In some instances, the temperatures may stay elevated for 4 to 5
days.
Explain to Mr. W.G. why he was experiencing pain during his
Myocardial Infarct. Elaborate and support your answer.
Mr. W.G pain was caused by the blockage of the blood supply
to the heart. Lack of blood supply led to the death of the heart
muscles. Furthermore, he experienced pain due production of
lactic acid which brought about nerve irritation. Lactic acid was
produced by anaerobic respiration since the cells could not get
enough oxygen due to the blockage which deprived them of
blood rich oxygen (Collinson, 2021).
References:
Cappellini, M. D., Musallam, K. M., & Taher, A. T. (2020).
Iron deficiency anaemia revisited.
Journal of Internal Medicine,
287(2), 153–170.
Collinson, P. (2021). High sensitivity troponin, analytical
advantages, clinical benefits and clinical challenges–An
update.
Clinical Biochemistry,
91, 1–8.
Elstrott, B., Khan, L., Olson, S., Raghunathan, V., DeLoughery,
T., & Shatzel, J. J. (2020). The role of iron repletion in adult
iron deficiency anemia and other diseases.
European Journal of Haematology,
104(3), 153–161. https://doi.org/10.1111/ejh.13345
Joseph, P., Leong, D., McKee, M., Anand, S. S., Schwalm, J.-

5. D., Teo, K., Mente, A., & Yusuf, S. (2017). Reducing the global
burden of cardiovascular disease, part 1: The epidemiology and
risk factors.
Circulation Research,
121(6), 677–694.
Iron deficiency Risk Factors
Iron deficiency anemia is the most common type of anemia
and is due to inadequate amount of iron necessary to produce
hemoglobin. (Dlugasch & Story, 2020) A study done in Jordan
showed that excessive menstruation in premenopausal women
was the most common etiology of iron deficiency anemia, as
seen with J.D. (Awidi et al., 2018) In the case of J.D, she is
experiencing intermenstrual bleeding between her periods along
with 6 days of heavy flow during her regular periods, leading to
increased blood loss and putting her at risk of developing iron
deficiency anemia.
Factors Leading to Dehydration and Constipation
As in the case above, the patient may be experiencing
constipation and dehydration for a number of reasons. One
reason for the dehydration would be the loss of blood during her
intermenstrual bleeding and 6 days of heavy bleeding during her
regular menstrual period. Another reason the patient may
possibly experience dehydration is due to the patient’s use of
diuretics to treat her hypertension. Diuretics lead to increased
urinary frequency, as seen with J.D, which leads to an increased
loss of fluids in the body, increasing her risks of becoming
dehydrated. (Puga et al., 2019) Dehydration often leads to
constipation as the body does not have enough fluid to move the
stool through the large intestine.
Vitamin B12 and Folic Acid
Vitamin B12 and folic acid are critical in the process of
erythropoiesis, the production of red blood cells, as they are
necessary for DNA synthesis. (Dlugasch & Story, 2020)

6. Deficiencies in vitamin B12 and folic acid will lead to impaired
DNA synthesis, and the body will produce abnormally large
cells known as megaloblasts that cannot function properly and
can lead to premature cell death through phagocytosis or
apoptosis. (Dlugasch & Story, 2020)
Clinical symptoms for Iron-Deficiency Anemia
J.D. is suspected of having iron-deficiency anemia, and this
diagnosis can be supported by her symptoms of extreme fatigue,
weakness and her heavy bleeding from her intermenstrual
bleeding and 6 days of heavy regular periods. Lack of iron in
the body due to excessive blood loss leads to a lack of healthy
red blood cells carrying oxygen to your tissues, leading to
increased feelings of fatigue and weakness. (Dlugasch & Story,
2020)
Signs of Iron Deficiency Anemia
In addition to feelings of fatigue and weakness, other
clinical manifestations of a patient diagnosed with iron
deficiency anemia might include tachycardia, dyspnea,
lightheadedness and dizziness that can lead to syncopal
episodes, and a pale appearance to the skin, known as pallor.
Brittle nails, decreased appetite, irritability and stomatitis are
other signs of iron deficiency anemia. (Dlugasch & Story, 2020)
When looking for diagnostic findings of iron deficiency anemia,
low levels of hemoglobin, hematocrit and serum iron levels
support a diagnosis. Also, low levels of ferritin are considered
to be the best indicator for iron deficiency anemia. (Bouri &
Martin, 2018)
Recommendations and Treatments for Iron Deficiency Anemia
When it comes to treating iron deficiency anemia, it is
important to determine why the patient is experiencing it. For
J.D., the gynecologist should further investigate what is leading
to her intermenstrual bleeding and excessively heavy blood flow
during her regular periods. Recommendations for increased iron
consumption through dietary sources should be given. Common
foods with high amounts of iron include liver, red meats, beans,
green leafy vegetables and fish. (Dlugasch & Story, 2020) In

7. addition to dietary sources, a patient may be given oral or IV
iron supplementation to increase iron levels. It is important to
also recommend increased vitamin C consumption, as this
supports absorption of iron in the body. (Dlugasch & Story,
2020)
Case Study #2
Risk factors for Coronary Artery Disease and Acute Myocardial
Infarction
Modifiable risk factors are behaviors and conditions that
can be controlled by a patient that can raise or lower a person’s
risk of developing a disease, and in the case of coronary artery
disease and acute myocardial infarctions, modifiable risk
factors include hypertension, hypercholesterol, diabetes,
obesity, stress, smoking and lack of exercise. Non-modifiable
risk factors are risk factors that cannot be controlled by a
patient and include a patient’s age, sex, ethnicity and family
history. (Hajar, 2017)
EKG Findings in Acute Coronary Event
Electrocardiograms can provide important information
about the presence, extent and severity of an acute myocardial
infarction. ST elevation could be seen on Mr. W.G.’s EKG and
would indicate a complete occlusion of a coronary artery, which
is an emergency. (Dlugasch & Story, 2020) Pathologic Q waves
could also be seen on the patient’s EKG and could reflect an
area of tissue in the heart that is electrically dead. (Dlugasch &
Story, 2020) Intense chest discomfort with a crushing sensation,
pain radiating to the neck and lower jaw, and pain not relieved
by 3 sublingual nitroglycerin tablets are all findings compatible
with an acute coronary event occurring.
Troponins
Troponins are cardiac specific biomarkers that are used to
confirm acute myocardial infarctions. Troponins are proteins
found in the muscles of the heart and when there is myocardial
damage, these proteins are released into the bloodstream. These
cardiac biomarkers are the best laboratory tests for indicating

8. acute myocardial infarctions and troponins are specific to the
heart and can only be found in the cardiac muscles. (Park et al.,
2017)
Increased Temperature after Myocardial Infarction
An increase in temperature is a common occurrence
following an acute myocardial infarction and can be observed as
early as 4-8 hours post MI event and can continue for up to 4-5
days. (Jang et al., 2017) This elevation in temperature is a
nonspecific inflammatory response to myocardial necrosis and
can be associated with elevated CRP and serum myocardial
enzyme levels. (Jang et al., 2017)
Chest pain during Myocardial Infarction
Chest pain associated with myocardial infarction is due to
the ischemia occurring in the cardiac muscle. Ischemia causes
the sensation of chest pain due to an accumulation of metabolic
waste products such as reactive oxygen species and adenosine,
and lactic acid. This accumulation stimulates nerve endings to
activate pain sensation. (Dlugasch & Story, 2020)
References
Awidi, M., Bawaneh, H., Zureigat, H., AlHusban, M., & Awidi,
A. (2018). Contributing factors to iron deficiency anemia
in women in Jordan: A single-center cross-sectional
study. PLOS ONE, 13(11).
https://doi.org/10.1371/journal.pone.0205868
Links to an external site.
Bouri, S., & Martin, J. (2018). Investigation of iron deficiency
anaemia . Clinical medicine (London, England), 18(3), 242–
244. https://doi.org/10.7861/clinmedicine.18-3-242
Delugash, L., Story, L. (2020). Applied pathophysiology for the
advanced practice
nurse. Jones and Bartlett Learning
Hajar, R. (2017). Risk factors for coronary artery disease:
Historical perspectives. Heart Views, 18(3), 109.
https://doi.org/10.4103/heartviews.heartviews_106_17

9. Links to an external site.
Jang, W. J., Yang, J. H., Song, Y. B., Chun, W. J., Oh, J. H.,
Park, Y. H., Lee, M. R., Hwang, J. K., Hwang, J., Hahn, J.,
Choi,
S., Lee, S., Choe, Y. H., & Gwon, H. (2017). Clinical
Significance of Postinfarct Fever in ST‐Segment Elevation
Myocardial Infarction: A Cardiac Magnetic Resonance
Imaging Study. Journal of the American Heart
Association, 6(4).
https://doi.org/10.1161/jaha.117.005687
Links to an external site.
Park, K. C., Gaze, D. C., Collinson, P. O., & Marber, M. S.
(2017). Cardiac troponins: from myocardial infarction to
chronic disease. Cardiovascular Research, 113(14), 1708-
1718. https://doi.org/10.1093/cvr/cvx183
Puga, A. M., Lopez-Oliva, S., Trives, C., Partearroyo, T., &
Varela-Moreiras, G. (2019). Effects of Drugs and Excipients on
Hydration Status. Nutrients, 11(3), 669.
https://doi.org/10.3390/nu11030669