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NUR09400 Management Of Chronic Disease

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NUR09400 Management Of Chronic Disease Question: Write a detailed report on diagnosis of a disease. Discuss the acute otitis media in children. Answer: Introduction The rationale of this report is to give the diagnosis of a disease of a seven year old boy, Mark, not his real name who had been referred with cough, fever, fatigue and other conditions multiple times in the hospital on different accounts. Before his admission, the client had received Ampicillin Sulbactam and Clarythromycine to treat his bacterial infections. During this time, he was diagnosed with pneumonia and inflammation of the ear, acute otitis media abbreviated as AOM. Although the patient was born normal with the normal birth weight of 3200grams, on physical examination that is seven years later, weakness and paleness of the skin were noticed. During this time, his weight was under a third percentile meaning that he had a failure to thrive but the vital signs all read normal. Upon his examination, two unusual things were noticed; bilateral pu-rulent ottorhea and fading breath sounds with rales, an indication of pulmonary edema, bronchitis or pneumonia. However, there was a great variation in results from the laboratory and the normal values of blood tests. Hence forth, the results obtained from the laboratory tests and the observations made from the patient will be used to provide diagnosis for the patient. Diagnoses Of The Disease Anemia From the information provided, there are a host of diseases that manifest in the patient but the main one is anemia. This is an illness characterized by low red blood cell count where the normal value vary from males to females and from one age group to the other (Coker et al. 2010). The disease can also be triggered by low levels of hemoglobin, a protein that transports oxygen to the rest of the body. Regardless of the cause, little oxygen in the body can lead to fatigue, dizziness as well as breathlessness. Once the underlying causes are identified the, the condition can be treated but when left untreated it can lead damage of the vital organs of the body like the heart leading to heart failure. The leading cause of anemia in the case provided can either be less /faulty production of RBCs or destruction of the RBCs. The illness can affect multiple systems of the body as well as produce a couple of signs and symptoms that affect the body such as fatigue, pallor, headache, cold feet/hands, numbness as well as low body temperature to mention just a few (Esayag et al. 2010). Moreover, in the presence of hypoxia, the heart needs to work extra harder to provide enough oxygen to the body, and this can lead to several heart related problems like breathlessness and arrhythmia. However, receiving proper treatment and on time can help lower the cardiac related problems. Chronic Disease/Infection Apart from factors like diet, chronic illness as well as infection can lead to anemia by lowering the levels of RBCs the body makes hence leading to a drop in the hemoglobin levels like as shown in laboratory data where hemoglobin level for the patient is 8.0g/dl yet they should range between 11.5 to 15.5g/dl/. Moreover, health factors such as kidney disease, rheumatoid arthritis and cancer are some of the diseases that may lead to the condition. During such events, what happens is that the inflammatory molecules alter the way through which iron is kept as well as used in the body thus making little to be available for the RBCs (Figueroa-Casas et al. 2013). Diagnoses Blood tests and normal RBC/WBC Ranges This is the primary test that had been used in the case study to test for anemia. Hemoglobin electrophoresis detects the various kinds of hemoglobin that are found in the blood. A reticulocyte count checks how well as well as how rapid red blood cells are manufactured (Coker et al. 2010) Iron, serum, total iron binding capacity as well as transferring levels are some of the test that can be used to measure the status of iron in the body/blood. From the laboratory data, it can also be noticed that the value of the white blood cells in the body (3850/ml) is less compared to the normal range of 4500-14500/ml. Since the WBCs are made in the bone marrow, it can be noted that a low white blood cell count can be as a result of viral infections that affect the work of the bone marrow, diseases or medication such as antibiotics that destroy the cells (Gazela et al.2012). From the case study, it is evident that the patient was suffering from different conditions and also prescribed various medications including Ampicillin Sulbactam, an antibiotic. The low WBC count can lead to lupus and anemia as well as tuberculosis that could have been suspected due to fever and coughing condition of the client (Goodhand et al. 2012). Blood Count The CBC is a key test that is used to identify illnesses. It measures the amount of hemoglobin in the RBC as well as hematocrit, the ratio of the volume of RBCs compared to the total blood volume (Herbst et al., 2011). Other factors measured include the platelets that help in blood clotting and the white blood cells that fights germs in the body. Unusual values of such can lead to diagnosis of anemia. However, the normal values may differ significantly with the laboratory data due to ethnic heritage. Needle Biopsy This is a modern technique that can be used for early diagnosis of anemia. What if does is that a needle is put into the back of the hipbone to extract a bone marrow for analysis. Although the method differs with other techniques like needle aspiration, where a large needle is used to extract a large sample from the tip, the test is also associated with pain as well as discomfort (Gavela et al. 2012). To make the procedure tolerable, a health professional will administer a sedative to ease the pain. Management And Treatment Of Anemia Supplements; mild to moderate deficiency can be treated with a couple of dietary changes as well as supplements. For instance, ferrous is easily absorbed in the body compared to ferric. It can be easily absorbed when taken with a meal as well as vitamin C (Janus &Moerschel 2010). Moreover, vitamin B12 plus folic acid are also key when it comes to manufacture of healthy red blood cells. What happens here in the case presented is that the doctor should recommend the patient to go on a diet rich in vitamin B12 as well as folate. Blockers; some components in the food may interfere with the ability to absorb iron in the body. For instance, calcium can hinder the absorption of mineral hence it would be good to get a recommendation from the doctor on the right amount of supplements to use. Treatment Of The Condition  Treat the underlying cause; proper treatment is all about identifying as well as treating the underlying cause of a disease. For example, if a bacterial infection is the main cause of anemia in the case study, antibiotics may help to resolve the problem. Corticosteroids can also be applied here to cover the immune system destruction of the RBCs.  However, it should be noted that every medication has potential risks as well as benefits that should be weighed when dealing with the case presented and other similar cases (Lieberthal et al. 2013.  As a health professional, it would be wise to inquire about the past medical history of the patient to find whether he might be allergic to certain medications. Chelation; This is another treatment procedure that can be used to treat anemia. A chelating agent is used to extract heavy metals such as mercury and lead from the body (Plurad et al. 2010). According to research the procedure is widely used among children and it can be best suited in the case presented in this report, but it should be noted that children with iron deficiency are at higher danger of lead poisoning. Bone marrow transplant; There are different types of cancer like the plastic anemia that interferes with the red blood cell production that can be treated with bone marrow transplant. According to Sabato et al. (2016), the procedure involves removing the allogeneic or autologous stem cells to replace the production of healthy blood. Hence, prior to infusion of a new tissue, the recipient must have chemotherapy, radiation and at times both to denature the existing tissues. Feeding on a healthy diet; A healthy balanced diet can help prevent deficiencies. As a doctor, I would recommend the patient in the case study, to give the body all the essential building blocks so as to give health blood as a result. Folic acid, vitamin B12, leafy greens, liver and dried fruits are some of the foods that would be recommended for the production of red blood cells. Other Conditions Diagnosed Pleural effusion This is a condition where unusual volumes of fluid are build up in the lungs. The condition can be caused by a number of things such as leakage from other organs, cancer, infections like pneumonia and tuberculosis like it was experienced in the first 15 months by the patient among other causes. The symptoms of the condition include fever, coughing and breathlessness (Tsampalieros et al. 2011).   Diagnosis A doctor talks to the patient about the symptoms of the condition and then gives a physical examination.  What follows is listening to the chest with a stethoscope as well as tapping on the chest. In the case provided, there is a bilateral diminished breath sounds from the client after listening to this his chest with a stethoscope. Although this condition can manifest during pneumonia, pulmonary edema, bronchitis or tuberculosis, the doctor confirms for pleural effusion using imaging tests. Chest X-ray; when using this technique the pleural effusion will appear white on the X-ray whilst the airspace will appear black as shown below. Computed topography; a CT scan takes many X rays at a go where a computer creates the imaginings of the whole chest inside as well as out.  Besides, computed topography scans are more preferred compared to X rays since they show more details (Venekamp et al. 2013).  Pleural Effusion Treatment Large or inflamed pleural effusions should be expelled to make a person feel healthier as well as avert any future problems (Yu et al. 2013). To achieve this, there are a couple of treatment options for the condition; Pleural drain; to prevent pleural effusion from coming back, one can use a long tern catheter put from end to end  of the skin into the pleural area. However, the doctor should inform you on when and how to remove the pleural effusion. Pleurodesis; in this treatment procedure, a doctor injects a very irritating material via the chest tube into a pleural cavity. The material inflames the pleura plus the chest wall, which then puts them together very tight as they heal. This method can avert pleural effusion from reappearing in different ways. Acute Otitis Media (AOM) It refers to the inflammation of the ear caused by bacteria. The inflammation occurs when the region behind the eardrum becomes inflamed as well as infected (Yu et al. 2013).  Infants and children like in the case study presented may experience one or the following symptoms fever, hearing loss, fluid drainage in the ear and irritability to mention just a few. Diagnosis Of AOM Otoscope; a doctor can use the otoscope machine to look into the patients ear as well as detect redness, swelling, fluid in the middle ear, or pus. Tympanometry; during this procedure, a doctor will use a small instrument to measure the pressure in the patients ear as well as check whether the eardrum is damaged.   Reflectometry; during this process, the doctor will use a small instrument that makes sound near the patients ear. The doctor will then check whether there is a fluid in the ear by listening to the sound reflected back (Coker et al. 2010) Treatment Of AOM Pain medications plus home care are preferred in treating AOM since antibiotics may increase the risk of side reaction from the antibiotics. Home medication; the doctor can choose a variety of home care treatments to relieve the clients pain whilst waiting for the acute otitis media  infection to fade away. Esayag et al (2010) holds that some of the home care remedies that can be used include applying warm, moist cloth over the infected or using over the counter ear drops to relieve the pain. Surgery; if the infections does not respond to home care remedy, the doctor can opt for a surgery especially when the conditions is worsening. The surgery options in this case can include adenoid removal or ear tubes. Brutons Disease This is a congenital disease that is characterized by a reduction of antibodies in the blood stream thus leading to low or weak immune system. The disease causes children to become ill because they are prone to contract infections in the sinuses, lungs as well as the middle ear. Some of the symptoms associated with this disease and are presented in the patient in the case study include lung infection or pneumonia, RBCs breakdown and blood stream infection to mention just a few. Diagnosis Of Bruton’s Disease Regular bacterial infections, absence of mature beta cells as well as low levels of immunoglobulin (IgG) lead to the diagnoses of Bruton’s disease.  A sample of blood serum of a child is analyzed for the presence of IgG using immuno electrophoresis technology. Also, the X chromosome is analyzed for defects as well as to find carriers for the defective gene. Treatment There are two key treatments for Bruton’s disease which include; Antibody replacement; this treatment provides patients with antibodies that they could not produce naturally hence help fight against infections. Abstinence from viral infections; it involves dealing away with vaccinations like mumps and rubella since a child can contract the disease through which the vaccine was introduced. Patient Education Although the bruton is common among boys, their families should know the nature of the condition as well as the need for early treatment. Genetic counselling is also recommended for parents and siblings who are affected. References Coker, T.R., Chan, L.S., Newberry, S.J., Limbos, M.A., Suttorp, M.J., Shekelle, P.G. and Takata, G.S., 2010. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in  children: a systematic review. Jama, 304(19), pp.2161-2169. Esayag, Y., Nikitin, I., Bar-Ziv, J., Cytter, R., Hadas-Halpern, I., Zalut, T. and Yinnon, A.M., 2010. Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia. The American journal of medicine, 123(1), pp.88-e1. Figueroa-Casas, J.B., Brunner, N., Dwivedi, A.K. and Ayyappan, A.P., 2013. Accuracy of the chest radiograph to identify bilateral pulmonary infiltrates consistent with the diagnosis of acute respiratory distress syndrome using computed tomography as reference standard. Journal of critical care, 28(4), pp.352-357. Gavela, T., Cabeza, B., Serrano, A. and Casado-Flores, J., 2012. C-reactive protein and procalcitonin are predictors of the severity of acute appendicitis in children. Pediatric emergency care, 28(5), pp.416-419. Goodhand, J.R., Kamperidis, N., Rao, A., Laskaratos, F., McDermott, A., Wahed, M., Naik, S., Croft, N.M., Lindsay, J.O., Sanderson, I.R. and Rampton, D.S., 2012. Prevalence and management of anemia in children, adolescents, and adults with inflammatory bowel disease. Inflammatory bowel diseases, 18(3), pp.513-519. Herbst, T., Sichelstiel, A., Schär, C., Yadava, K., Bürki, K., Cahenzli, J., McCoy, K., Marsland, B.J. and Harris, N.L., 2011. Dysregulation of allergic airway inflammation in the absence of microbial colonization. American journal of respiratory and critical care medicine, 184(2), pp.198-205. Janus, J. and Moerschel, S.K., 2010. Evaluation of anemia in children. American family physician, 81(12), pp.1462-1471. Lieberthal, A.S., Carroll, A.E., Chonmaitree, T., Ganiats, T.G., Hoberman, A., Jackson, M.A., Joffe, M.D., Miller, D.T., Rosenfeld, R.M., Sevilla, X.D. and Schwartz, R.H., 2013. The diagnosis and management of acute otitis media. Pediatrics, 131(3), pp.e964-e999. Plurad, D.S., Lustenberger, T., Kilday, P., Zhu, J., Green, D.J., Inaba, K., Talving, P., Belzberg, H. and Demetriades, D., 2010. The association of race and survival from sepsis after injury. The American surgeon, 76(1), pp.43-47. Sabato, R., Guido, P., Salerno, F.G., Resta, O., Spanevello, A. and Barbaro, M.F., 2016. Airway inflammation in patients affected by obstructive sleep apnea. Monaldi Archives for Chest Disease, 65(2). Tsampalieros, A., Griffiths, A.M., Barrowman, N. and Mack, D.R., 2011. Use of C-reactive protein in children with newly diagnosed inflammatory bowel disease. The Journal of pediatrics, 159(2), pp.340-342. Venekamp, R.P., Sanders, S., Glasziou, P.P., Del Mar, C.B. and Rovers, M.M., 2013. Antibiotics for acute otitis media in children. Yu, C.W., Juan, L.I., Wu, M.H., Shen, C.J., Wu, J.Y. and Lee, C.C., 2013. Systematic review and meta?analysis of the diagnostic accuracy of procalcitonin, C?reactive protein and white blood cell count for suspected acute appendicitis. British Journal of Surgery, 100(3), pp.322-329.

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