Question: .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, …

.D. is a 37 years old white woman who presents to hergynecologist complaining of a 2-month history of intermenstrualbleeding, menorrhagia, increased urinary frequency, mildincontinence, extreme fatigue, and weakness. Her menstrual periodoccurs every 28 days and lately there have been 6 days of heavyflow and cramping. She denies abdominal distension, back-ache, andconstipation. She has not had her usual energy levels since beforeher last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notesthat 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 deliverycomplications. All infants were born healthy. Patient history alsoreveals a 3-year history of osteoarthritis in the left knee,probably the result of sustaining significant trauma to her knee inan MVA when she was 9 years old. When asked what OTC medicationsshe is currently taking for her pain and for how long she has beentaking them, she reveals that she started taking ibuprofen, threetablets each day, about21⁄2years ago for her left knee. Due to aslowly progressive increase in pain and a loss of adequate reliefwith three tablets, she doubled the daily dose of ibuprofen. Uponthe recommendation from her nurse practitioner and becauselong-term ibuprofen use can cause pep-tic ulcers, she began takingOTC omeprazole on a regular basis to prevent gastrointestinalbleeding. Patient history also reveals a 3-year history of HTN forwhich she is now being treated with a diuretic and a centrallyacting antihypertensive drug. She has had no previoussurgeries.

Case Study Questions

1. Name the contributing factors on J.D that might put her at riskto develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might bepresenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on theerythropoiesis? What abnormalities their deficiency might cause onthe red blood cells?
4. The gynecologist is suspecting that J.D. might be experiencingiron deficiency anemia.
   In order to support the diagnosis, list and describe the clinicalsymptoms that J.D. might have positive for Iron deficiencyanemia.
5. If the patient is diagnosed with iron deficiency anemia, whatdo you expect to find as signs of this type of anemia? List anddescribe.
6. Labs results came back for the patient. Hb 10.2 g/dL; Hct30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler incolor than normal. Research list and describe for appropriaterecommendations and treatments for J.D.