Blood transfusions are sometimes required in healthcare. Based on what you know about blood anatomy discuss why a patient would need a transfusion of PRBC (packed red blood cells), plasma, or platelets. A patient with anemia has a pulse oximetry reading in the high 80’s, would this be an expected finding, explain?
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Essay prompts: (at least 300 words per prompt)
- Blood transfusions are sometimes required in healthcare. Based on what you know about blood anatomy discuss why a patient would need a transfusion of PRBC (packed red blood cells), plasma, or platelets. A patient with anemia has a pulse oximetry reading in the high 80’s, would this be an expected finding, explain?
- Mike, 29 years old, was admitted to a community hospital three days ago with weakness and hypotension after sustaining a spider bite while hiking in the woods. Mike has a large hematoma on his left arm where he was bite. He has no prior medical history, no drug allergies, and does not take medication. Mike started to experience moderate respiratory distress, and started oozing blood from his IV sites, nose, and catheter. He is mildly jaundice and his skin is cool. His vital signs include a heart rate of 110 beats per minute and regular blood pressure of 92/44, slightly labored respiratory rate of 22 breaths per minute, and a pulse oximetry reading of 91 percent. What would your initial diagnosis be, explain? What diagnostic test would you order and why? What would you expect the diagnostic test to show? What is the treatment option for the diagnosis?
- During natural disasters like hurricanes, when the community is living in shelters, why would there be a concern about a tuberculosis outbreak? What circumstances have led to the spread of drug-resistant tuberculosis? Mary, a nurse, skin test was positive for tuberculosis. Does this mean she has tuberculosis? Explain.
- Each year many people go to their family physician with a common cold, but think they have the influenza. Based on symptoms how can you tell if you have a common cold or influenza? What are the causes and treatments for Pneumonia? What is the best way to prevent influenza and pneumonia?
Sample student answer
Blood Transfusion
Blood transfusion is often needed when a patient needs blood components. Blood transfusion is needed in bleeding disorders, hemophilia, sickle cell disease, cancer, especially leukemia, or anemia (Barriteau et al., 2020). Those involved in serious road accidents also need a blood transfusion. Apart from the highlighted diseases, patients with disseminated intravascular coagulation (DIC) also need a blood transfusion.
DIC caused bleeding by disrupting the clotting process. Physicians should conduct a proper diagnosis to identify whether a patient needs blood transfusion when the type of the blood component is needed. Diagnostic tests are also needed to screen a patient for other health problems. This essay discusses blood transfusion products, DIC, tuberculosis (TB), common cold, influenza, and pneumonia. The paper has also discussed the symptoms and diagnostic tests for DIC and TB.
Blood Transfusion Products
Blood transfusion is rarely done using whole blood. Different replacement products are available for blood transfusion based on the patients’ needs. Physicians recommend these products for different reasons. The first product is packed red blood cells (PRECs). PRECs is a kind of blood replacement product availed during a blood transfusion. Barriteau et al. (2020) note that PRECs are often recommended for patients with notable signs of anemia.
The authors also report that individuals who have lost a large amount of blood need PRECs transfusion. Plasma is another product of blood replacement. It is the part of blood made of liquid (Waters & Yazer, 2018). This part of the blood contains vital substances important to one’s overall health. Patients who need plasma transfusion have severe infections, liver failure, or serious burns. The last component of blood and product of transfusion is platelets.
Platelets are vital in the body because they prevent bleeding. Platelets transfusion is often needed if the patient’s body does not make enough platelets (Barriteau et al., 2020). Most cancer patients need platelets transfusion. Patients with sickle-cell anemia also need platelets transfusion. In other words, PRECs are needed only when the patient lacks red blood cells.
Pulse oximetry test is used to measure oxygen saturation of one’s blood. It measures the rate of oxygen sent to the body parts that are far from the heart, such as legs and arms (Osborn et al., 2019). Usually, a healthy individual has a pulse oximetry reading of 95% or higher.
Osborn et al. (2019) noted that a person with a pulse oximetry reading below 95% should seek medical attention. The authors noted that the pulse oximetry reading for anemia was 81.6%, making the reading of 80’s an expected finding. In other words, when a patient tests 80s on pulse oximetry, the individual has an oxygen problem and should seek medical attention.
Disseminated Intravascular Coagulation
My initial diagnosis for Mike’s case would be DIC. DIC is a serious and rare condition that prevents blood clotting by making the proteins responsible for blood clotting overactive (Kunwar et al., 2021). The condition is caused by an injury, another disease, or an infection that affects the blood clotting process.
This condition is the main diagnosis because it causes a spider bite. Kunwar et al. (2021) report that causes of DIC includes spider bites, liver diseases, trauma, severe burns, snake bites, acute hemolytic transfusion reaction, and many more. The patient also has DIC symptoms, including bleeding, low blood pressure, shortness of breath, weakness, and bruising, making the condition a primary diagnosis (Kunwar et al., 2021). DIC is the cause of the oozing of blood in the patient’s nose, catheter, and IV sites.
A diagnostic test should be ordered to confirm if the patient has DIC. I would recommend three tests. The first test is D-dimer. This test is used to screen for a blood clotting disorder. Gao et al. (2020) noted that D-dimer effectively diagnoses DIC. The second test is the fibrin degradation products (FDP) test. This test also checks for a blood clotting disorder. D-dimer and FDP tests are used for specific and faster diagnoses.
The last test is antithrombin. This test is necessary for checking the prognosis and severity of the condition (Gao et al., 2020). The D-dimer value of the patient would be the value of 21.7ug/mL showing that he has DIC. The FDP value would be 25µg fibrinogen equivalent unit (FEU)/ml. Antithrombin test would show low antithrombin elements in the patient’s blood. Kunwar et al. (2021) noted that physicians should correct the underlying cause of DIC to treat the condition.
In this case, the spider poison should be treated. Therefore, antivenom should be prescribed based on the spider that bit the patient. After treating spider bites, the patient airway should be restored using hemodynamic resuscitation (Kunwar et al., 2021). He should also undergo replacement therapy because he has lost many blood components through bleeding.
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Tuberculosis
Tuberculosis (TB) is a serious respiratory infection that affects mainly the lungs. Tuberculosis is spread through droplets released by a sick person into the air by sneezes and coughs. It spreads from one person to another (Murray et al., 2019). Tuberculosis is more prone during natural disasters, such as earthquakes and hurricanes, among homeless individuals. One of the risk factors for TB is a close-contact situation.
Most people seeking homage in shelters after a natural disaster are often in close contact. If a single person has TB, the population is likely affected because the disease is airborne. Murray et al. (2019) noted that low body weight and malnutrition is risk factor for TB. Populations displaced after hurricanes or other natural disasters often lack proper nutrition, putting them at risk of developing and spreading TB. In summary, close contact living status and poor nutrition among homeless people make them vulnerable to TB.
Drug-resistant TB develops when TB bacteria resist one or more first-line treatments for the disease. Various circumstances have led to the spread of drug-resistant TB. One of the circumstances is not taking medication as prescribed. People to do not take their drugs as directed by the physician are more likely to spread drug-resistant TB. Drug-resistant TB also spreads when drugs prescribed are not of good quality. Lastly, the disease also spreads when the physician has prescribed the wrong drug or dosage.
A skin TB test is used to screen for TB (Gualano et al., 2019). According to Gualano et al. (2019), a positive skin test for TB shows that TB bacteria have infected one. It does not mean that they have TB. Other tests should be conducted to determine whether the patient has TB disease or latent TB infection. Therefore, a positive skin test means that Mary has TB bacteria.
Influenza, Common Cold, Pneumonia
People find it hard to differentiate between the common cold and influenza because their symptoms are somewhat similar. However, to differentiate the two conditions, symptoms of influenza are often severe than those of the common cold (Nickbakhsh et al., 2019). For instance, fever is a symptom of both conditions. However, it is mild in the cold while higher in influenza. Fever caused by influenza can last for up to three days. Headache is common in influenza but occasionally occurs in the common cold. People with influenza usually feel severe body aches and pain.
However, in the common cold, the symptom is often slight. Fatigue and weakness are common in influenza and can last up to 2-3 days. However, patients with common cold sometimes feel mild weakness. Another difference is that sore throat, stuffy nose, and sneezing are common in the common cold but rare in influenza. The last difference is that people with influenza often experience extreme exhaustion while those with a common cold do not.
Many germs cause pneumonia. The disease is caused by viruses, such as Covid-19, fungi, bacteria-like organisms, such as mycoplasma pneumonia and bacteria. It also occurs when people inhale vomit, food, or drinks into their lungs. Pneumonia can be community-acquired, hospital-acquired, or healthcare-acquired.
Pneumonia caused by bacteria is treated using antibiotics, such as azithromycin (Wang et al., 2018). The authors noted that azithromycin is one of the effective antibiotics for bacterial pneumonia. Those caused by viruses or fungus are treated using antivirus or antifungal drugs, respectively. Though pneumonia and influenza can be suppressed using medication, prevention is the best way to deal with the two conditions. The best way to prevent the two diseases is through vaccination.
Vaccines used in the US to prevent pneumonia are pneumococcal conjugate vaccine or PCV13 and pneumococcal polysaccharide vaccine or PPSV23. Likewise, recombinant influenza vaccine (RIV4), quadrivalent inactivated influenza vaccine [IIV4], or live attenuated influenza vaccine (LAIV4) are vaccines used in the US to prevent flu.
Summary
Various components have been discussed in the essay. One of the issues is blood transfusion. Blood transfusion is rarely done using whole blood. Different replacement products are available for blood transfusion based on the patients’ needs. They include press, platelets, and plasma. The second component discussed is DIC. DIC is a serious and rare condition that prevents blood clotting. It is caused by an injury, another disease, or an infection that affects blood clotting.
The disease can be diagnosed using antithrombin, D-dimer, and FDP tests. The third component is TB. Populations displaced after hurricanes or other natural disasters often lack proper nutrition, putting them at risk of developing and spreading TB. People in shelters are also at risk of getting TB because they live so close to each other. Lastly, influenza, pneumonia, and the common cold have also been discussed in the essay.
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Conclusion
Blood transfusion should be done based on what a patient need. For instance, PRECs is recommended for patients with anemia with notable signs or who have lost a large amount of blood. Other blood components available for transfusion are platelets and plasma. DIC is a serious and rare condition that prevents blood clotting by making the proteins responsible for blood clotting overactive. The disease can be diagnosed using antithrombin, D-dimer, and FDP tests.
Tuberculosis is more prone during natural disasters, such as earthquakes and hurricanes, among individuals living in shelters because they lack proper nutrition and live close to each other. Common cold and influenza can be hard to diagnose. The common cold symptoms are less severe than those of influenza. Pneumonia is caused by many germs, including fungi, bacteria, and viruses.
References
Barriteau, C. M., Bochey, P., Lindholm, P. F., Hartman, K., Sumugod, R., & Ramsey, G. (2020). Blood transfusion utilization in hospitalized COVID‐19 patients. Transfusion, 60(9), 1919-1923. https://doi.org/10.1111/trf.15947
Gao, T. Y., Yang, W. C., Zhou, F. H., & Song, Q. (2020). Analysis of D-dimer cut-off values for overt DIC diagnosis in exertional heat illness. Medicine, 99(52), e23831. https://doi.org/10.1097/MD.0000000000023831
Gualano, G., Mencarini, P., Lauria, F. N., Palmieri, F., Mfinanga, S., Mwaba, P., … & Ippolito, G. (2019). Tuberculin skin test–Outdated or still useful for Latent TB infection screening?. International Journal of Infectious Diseases, 80, S20-S22. https://doi.org/10.1016/j.ijid.2019.01.048
Kunwar, S., Alam, M., Ezekwueme, F., Yasir, M., Lawrence, J. A., Shah, S., & Gordon, D. K. (2021). Diagnostic scores and treatment options for acute disseminated intravascular coagulation in children. Cureus, 13(9). DOI: 10.7759/cureus.17682
Murray, K. O., Castillo-Carandang, N. T., Mandalakas, A. M., Cruz, A. T., Leining, L. M., Gatchalian, S. R., & PEER Health Bohol Pediatric Study Team (2019). Prevalence of tuberculosis in children after natural disasters, Bohol, Philippines. Emerging Infectious Diseases, 25(10), 1884–1892. https://doi.org/10.3201/eid2510.190619
Nickbakhsh, S., Mair, C., Matthews, L., Reeve, R., Johnson, P. C., Thorburn, F., … & Murcia, P. R. (2019). Virus–virus interactions impact the population dynamics of influenza and the common cold. Proceedings of the National Academy of Sciences, 116(52), 27142-27150. https://doi.org/10.1073/pnas.1911083116
Osborn, Z. T., Villalba, N., Derickson, P. R., Sewatsky, T. P., Wager, A. P., & Freeman, K. (2019). Accuracy of point-of-care testing for anemia in the emergency department. Respiratory Care, 64(11), 1343-1350. https://doi.org/10.4187/respcare.06364
Wang, Q., Mi, G., Hickey, D., Li, Y., Tu, J., Webster, T. J., & Shen, Y. (2018). Azithromycin-loaded respirable microparticles for targeted pulmonary delivery for the treatment of pneumonia. Biomaterials, 160, 107-123. https://doi.org/10.1016/j.biomaterials.2018.01.022
Waters, J. H., & Yazer, M. H. (2018). The mythology of plasma transfusion. Anesthesia & Analgesia, 127(2), 338-339. https://www.spaar.org.pe/wp-content/uploads/2018/08/The-Mythology-of-Plasma-Transfusion.pdf