The initial evaluation
QUESTION
A patient presents in the ER with a severely low hemoglobin and hematocrit count. Symptomatology includes listlessness, pale, pallor, and hypotensive. The initial assumption is blood loss via the gastrointestinal tract. As either an FNP or an AG-ACNP learner, provide an initial evaluation for either a pediatric or an adult patient. In addition, include the following in your presentation:
1. The presentation of the patient
2. A list of possible conditions that present similarly based on the patient’s symptoms
3. A list of treatment modalities
4. A rationale explaining the possible conditions
5. A rationale explaining the treatment
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
The initial evaluation
ANSWER
The initial evaluation
Check for the mouth dryness
Check the eyes of the patient for paleness and dryness.
Check skin dryness, pale spots on the skin, and skin turgor.
Check if the patient has edema on the lower limbs.
Patient’s presentation
The present symptoms include dizziness, pallor, headache, and paleness. During the laboratory assessment, it is noted that the patient has low hemoglobin and low blood cell count.
The conditions that present with similar symptoms/signs
Porphyria
Colon cancer
Thalassemia’s
Anemia (Sickle cell and pernicious)
Mode of treatment
The treatment of the ER entails fluids infusions and blood therapy (Self et al., 2018). The treatment focus on supplementing the patient with blood volume. This includes the administration of different blood products and blood transfusion. Lastly, other modes of treatment include vitamin B12, alpha-epoetin, and Fe-containing drugs to help form red blood cells.
The rationale for the different conditions’ porphyria’s arises because of issues in the biosynthesis of heme in the hemoglobin that aids in binding oxygen. This leads in low hematocrit and hemoglobin (Wiciński, 2020). The thalassemias occur because of malformation of the globulin chains, also referred alpha or beta of hemoglobin, thus poor tissues oxygenation and low hemoglobin levels. Severe blood loss also forms GIT tract in instances such as colon cancer, serious hookworm infection, and peptic ulcer disease lead to blood loss, thus lowering the blood volume, leading to hypotension.
The rationale for the treatment
It would be vital to consider blood transfusion to aid in replacing the blood that the patient has lost. Also, it is essential to use B12, epoetin, and Fe to facilitate the formation of red cells, which boosts the levels of hematocrit.