In addition he is complaining of increasing

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In addition, he is complaining of increasing indigestion and that this is keeping him up at night. He has had to change his diet to avoid spicy foods and anything with chocolate. His wrists, knees and ankles are really hurting a lot especially since it has gotten colder. Kevin had his labs done just prior to his visit and the results are noted below: WBC 16.0 Segs 38 K+ 4.6 HgB 9.7 Gluc 104 Vit B 12 128 HCT 22 MCV 80
Plat 225k Ferritin 8.2 RBC 2.99 Creat 0.76 Folate 399 BUN 53 13. In relation to blood disorders, does Kevin have any sort of problem that can be noted from his lab work? ___________. If so what is the problem and how did you dx this problem from the lab results? _______________ _____________________________________________________________ _____________________________________________________________ 14.Based on your diagnosis, you suggest to Kevin that he decrease his dose of Nexium and change his diet. Why would you recommend this treatment plan? _______________________________________________________ _____________________________________________________________ _____________________________________________________________ 15. Kevin returns for repeat labs in 4 weeks and his Hgb is 9.0 and his HCT is 20. He states that he was unable to reduce his Nexium due to his severe indigestion and to be honest he really didn’t change his diet. Kevin is asking questions about how he became anemic and is concerned that he is bleeding somewhere. Explain how chronic bleeding can lead to iron deficiency anemia? _____________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ 16. In patient’s with GI Issues – what are the pros and cons to initiating Iron replacement therapy? __________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ The chart below is a helpful reference for 3 different types of anemias. Please review:
%2F499829258617609200%2F&psig=AOvVaw3LjGGPhpdUXZ74x0CSy1d8&ust=1543947866591426 17. Florence is a 72 y.o. female who presents to your office for a “check-up” after getting out of rehab 2 weeks ago. Her daughter is with her and states that her Mom is living with her at this time and she hasn’t had a drink in about 6 weeks. Florence states that she still has episodes of nausea, but her blood sugars are better – staying between 100-225 since getting out of rehab and that her appetite is better now, but her mouth is sore. Florence has been an alcoholic for at least 30 years and 6 months ago she was drinking a 5 th of Vodka a day and sometimes more. Her daughter is worried because she seems to be falling more in the past week or so and Florence keeps telling her that she’s catching her slippers on the carpet. During your exam, you note the following: watching Florence walk in the hall she seems to “go to the left” – grabbing for the wall so she doesn’t fall. She has a positive Romberg’s test, and pulls her feet away when you try to examine the soles. a. What is your differential diagnosis for Florence? List 3 - i. ____________________________ ii. ____________________________ iii. ____________________________ b. Explain why individuals with pernicious anemia have a low hemoglobin level? _______________________________________
________________________________________________________ ________________________________________________________ ________________________________________________________ c. Explain how pernicious anemia can cause a neurologic effect such as a tingling sensation in extremities or loss of coordination? _________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ d. Why is oral administration of vitamin B12 not effective as a treatment for pernicious anemia? ____________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ 18. Aplastic Anemia can result from impairment and or failure of bone marrow

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