Case Studies 3 & 4 (Combined in one)
76 y/o Hispanic female patient, who has been dealing with financial constraints in last years,
has not been able to eat properly due to her economic situation, comes to your practice c/o
that over the past 3 months she has felt increasingly tired. She states sleeping well at night. Her
vital signs are B/P 135/74, R: 16; HR: 80, T 96.8. Pt denies dyspnea or palpitations. You order
some blood work. Your patient’s chemistry panel comes back all WNL, and the fecal occult
blood test negative. All the other results are shown below:
WBC: 7600/mm3
Hematocrit: 27.3%
Hemoglobin: 8.3 mg/dL
Platelets: 151,000 /mm3
RED BLOOD CELL (RBC) indices
MCV 65mm3
MCH 31.6 pg
MCHC 35.1%
RDW 15.6%
Fe 30 mcg/dL
TIBC 422 mcg/dL
Ferritin 8 mg/dL
Vit B12 414 pg/mL
Folate 188 ng/mL
Answer the following questions:
a) Which lab values are normal, and which are abnormal?
b) Explain the significant of each abnormal value.
c) Based on these results and her history. What would be your patient’s diagnosis?
d) Epidemiologically speaking, what individuals are at risk for this condition?
e) What other signs and symptoms of this condition would you assess for in this case?
f) Which question would best help you determine the impact of fatigue on her activities of
daily living?
a. Are you upset about feeling more tired?
b. Do you sleep more now that you used to?
c. How far can you walk until you get SOB?
d. Have you been able to do what you would like to do?
g) Discuss the treatment option for her diagnosis
h) What diet you would recommend her:
a. Whole-wheat pastas and skim milk
b. Lean cuts of poultry, pork and fish
c. Beans and dark green, leafy vegetables
d. Cooked cereals, such as oats and bananas.
i) What would be your initial supplement for this patient? (be specific about the name,
dose, frequency, etc.)
j) What teaching you would you provide your patient about the supplement you just
prescribed above.
the spread of diseases(vaccines.gov).Germs and especially vaccine preventable disease spread quickly, however when enough people get vaccinated the spread of diseases is limited.This means that the people unable to get vaccines will have partial protection(vacciens.gov). If someone happens to get the disease the chance of it spreading into a epidemic is decreased because it is harder for the disease to spread in a herd protected group. In order for herd immunity to work effectively, enough people need get vaccinated. In 2008, an outbreak of measles caused 48 infants to be quarantined because they were unable to get vaccinated. Theses infants were unable to rely on herd immunity because there was not enough vaccination in the community(NCBI). Vaccinations are important for herd immunity, in order to protect people who are not able to get vaccinated themselves. It is often argued that vaccines cause autism. Certainly if this was true it would be a valid concern. However, this argument has been debunked on multiple different accounts. The argument was started by a study published to the lancet in 1998 by , Andrew Wakefield, along with 12 co- authors. The study claimed “they found evidence, in many of the 12 cases they studied, of measles virus in the digestive systems of children who had exhibited autism symptoms after MMR vaccination.”(history of vaccines). Wakefield then went on to recommend replacing the combination MMR vaccine with single-antigen vaccinations given separately over time(history of vaccines). Now there was many problems with this study, the first being only 12 cases were studied. Anyone in the medical or science community knows that when accusations like this are released, it is supported by hundreds to thousands of case examples. The next problem with this case was Wakefield filed for a patent for a single antigen vaccine in 1997, like the one he recommended in place of the combination MMR vaccine (public health). More investigations were done on the study when it was found that Wakefield was paid money by attorney seeking to file lawsuits against vaccine manufacturers, he hid this information from the lancet(public health). While the skeletons of Wakefields motives were being discovered scientists all around were studding possible links between autism and vaccines. The paper was found to be fraudulent on many accounts. Firstly Wakefield was proven to be falsifying medical records and data regarding the data. Only two children showed autism like symptoms days after the vaccination while Wakefield recorded eight. Additionally at least two children in the case study had developmental delays noted in their records before the vaccines took place despite Wakefield claiming they were “normal” prior to the vaccination(history of vaccines). Additionally, numerous research has proven there to be no link was found between vaccinations, and autism. Furthermore ten out of the thirteen authors retracted their statements regarding the link. The editor of the lancet claimed that Wakefields studies were “fatally flawed” and the Lancet retracted the paper (independant). Finally, Britain’s medical council banned Wakefield from practicing medicine. On the accounts that the study was proven falsified, fraudulent, and ill-intentioned, it has been proven that vaccines do not cause autism. Vaccines have profoundly altered the everyday lives and health of the human race. The safety of vaccines is not questionable due to the constant regulation and research. The effectiveness of vaccines have been proven time and time again, and have even successfully eradicated a deathly and disastrous disease. Vaccines are not only still necessary but crucial for survival, without vaccines epidemics can occur quickly in a unvaccinated community, which unfortunately japan has experienced firsthand . Catching a vaccine preventable disease can be disastrous, if someone who catches the diseases is lucky enough to survive, they plausibly will be drowning in medical bills. Frankly choosing to not get a vaccine does not just affect oneself. People who are unable to get vaccines due to age, or medical reasons depend on everyone around them to get vaccinated in order to be partially protected. The ramifications of not getting vaccinated are sever, and ultimately lead to outbreaks, epidemics, and death. Although critics have argued vaccines cause Autism, the claims have been proven false. If valid research demonstrated, unknown information regarding vaccines, they would be taken into account and recommendations would be appropriately updated.